Street drug

Question 1

Crack cocaine clinical manifestations

Answer 1

decreased gastric motility, euphoria, chest pain, shortness of breath, occasional vasculitis of skin

Question 2

first line treatment option for alcohol use disorder

Answer 2

naltrexone, a mu opioid receptor antagonist

acamprosate - glutamate modulator

Question 3

Benefit of using naltrexone

Answer 3

can start while patient is still drinking and helps to decrease ETOH cravings and reduce heavy drinking, and increased days of abstinence

Question 4

what is considered heavy drinking by gender?

Answer 4

ETOH >5 drinks for men

>4 for women

Question 5

In whom is naltrexone contraindicated?

Answer 5

Those on opioids, those with acute hepatitis flare up and acute liver failure

Can use acamprosate

Question 6

When do we use bupropion?

Answer 6

smoking cessation and depression

not used in helping people quit drinking

Question 7

When do we use benzos?

Answer 7

only for acute severe ETOH withdrawal. It has high risk for abuse and dependence and doesn’t help with treatment of ETOH use disorder

Question 8

Who can use aldehyde dehydrogenase inhibitor disulfram?

Answer 8

highly motivated individuals; doesn’t reduce ETOH cravings.

Second line

Question 9

Role of SSRI in ETOH use disorder

Answer 9

None, doesn’t help with quitting ETOH use.

Question 10

MDMA is also known as

Answer 10

ecstasy or Molly; most common stimulant used in dance clubs or raves

Question 11

what happens when pts ingest MDMA?

Answer 11

it releases serotonin, dopamine, and NE from presynaptic neruosn and prevents metabolism by inhibiting the monoaminse oxidase.

causes for euphoria and sense of profound insight, intimacy and well being but also can get agitation and combativeness

Question 12

When do patients start to get affected by MDMA?

Answer 12

start within 30-60 minutes and last up to 8 hours.

Question 13

adverse effects of MDMA or ecstasy?

Answer 13

see delirium, hyperthermia, autonomic instability, neuromuscular irritability and see end organ damage like rhabdomyolysis, acute renal failure, hepatic failure and ARDS and DIC.

Can see heat from exertion and MDMA induced hyperthermia can lead to excessive water intake and cause severe hyponatremia - which can cause confusion, agitation, and seizures (From MDMA and hyponatremia)

Question 14

treatment for MDMA is

Answer 14

supportive care, benzosdiazepines (for hypertension, seizures, and agitation) and fluids for hyponatremia, and ice baths for hyperthermia

Question 15

diphenhydramine overdose

Answer 15

anticholinergic overdose symptoms such as flushing (red as a beet) very dry skin without diaphoresis (dry as abone) and mydriasis (blind as a bat), and agitation (mad as a hatter) and fever (hot as a hare). Can see sedation as a antihistamine effect

Question 16

PCP ingestion presentation

Answer 16

see bizarre or violent behavior
psychomotor agitation, hallucinations, incoordination
see nystagmus (horizontal or vertical)

Question 17

psilocybin is also known as

Answer 17

shrooms or hallucinogen in mushrooms

Question 18

psilocybin ingestion causes

Answer 18

serotonergic effects that are mild and rarely see seizures

Question 19

risperidone overdose

Answer 19

Would see muscle stiffness and or oversedation. NMS can occur with antipsychotic overdose see AMS, severe hyperthermia >104C and generalized lead pipe rigidity rather than hyperreflexia.

Question 20

tardive dyskinesia is

Answer 20

sterotyped movements (lip smacking, grimacing, tongue movements and eye blinking) and sometimnes with limbs torso and fingers and they cannot use the limbs involved. Caused from increased activation of dopamine D2 receptors seen with antipsychotic medications.

Question 21

treatment of tardive dyskinesia?

Answer 21

no treatment

use the lowest dose of antipyschotics for the shortest amount of time

Seen more with haloperidol over atypical antipyschotics.

Question 22

tachycardia, hypertension, hyperthermia and poor dentition are all presentation of

Answer 22

methamphetamine intoxication

“see meth mouth”

Question 23

methamphetamine is a

Answer 23

white powder that is easily dissolved into water and acts as stimulant to release catecholamines and cause a sympathomimetic toxidrome.

Can be snorted, injected, ingested and smoked.

Question 24

when do you start to see methamphetamine intoxication

Answer 24

within minutes of ingestion and can last to >24 hrs.

Question 25

what do you check for someone with methamphetamine intoxication?

Answer 25

serum glucose, EKG for conduction abnormalities, electrolytes and Cr and CK to rule out rhabdomyolysis. Get a UDS

Question 26

treatment of methamphetamine intoxication

Answer 26

benzos and antipyschotics

the benzos helps to decrease CNS catecholamine release and IM is ok

Try to avoid physical restraints due to isometric muscle contract can cause cardiac collapse and lactic acidosis and worsen hypothermia.

Second generation antipyschotics like ziprasidone are second line agents and preferred over haloperidol.

Question 27

Symptoms of amphetamine intoxication

Answer 27

increased alertness, euphoria, HTN tachycardia hyperthermia and hyponatremia (from increased ADH release and water consumption)

Question 28

which is best way to screen adults for unhealthy alcohol use?

Answer 28

NOT CAGE

single item screening test or AUDIT -C screen

Question 29

what is the single item ETOH screen?

Answer 29

asks how many times in the past year you have had 5 (4 for women) or more drinks in one day?

Question 30

what does the AUDIT C ask?

Answer 30

how often do you drink alcohol?
many drinks do you have on a typical day when you are drinking?
how often do you have 6 (4 for woman) or more drinks on one occasion?

Question 31

why is CAGE no longer the recommended questionnaire?

Answer 31

because it emphasizes complications of heavy use and fails to identify full spectrum of heavy unhealthy use.

Question 32

Complications of cocaine use?

Answer 32

acute coronary syndrome (MI, ischemia)
Aortic dissection
myocarditis, cardiomyopathy
coronary artery aneurysms
vasculitis
stroke

Question 33

management of cocaine induced chest pain:

Answer 33

aspirin
nitroglycerin and calcium channel blockers for pain
NO beta blockers
benzodiazepines for BP and anxiety
fibrinolytics not preferred due to increased risk for hemorrhagic risk
immediate cardiac catherization with reperfusion when indicated

Question 34

what is cocaine?

how to does it work to increase ACS?

Answer 34

potent sympathomimetic (tachycardia, hypertension, increased cardiac output) and vasconstrictor due to synaptic accumulation of catecholamines.

Promotes clot formation byincreasing platelet activation and decreasing anticoagulant factors.

These effects happen regardless route of ingestion (intranasal, inhalational, IV)

Question 35

treatment of cocaine induced chest pain with

Answer 35

aspirin and nitroglycerin and calcium channel blockers.

betablockers are contraindicated and can worsen pain with unopposed alpha.

Question 36

when does alcohol withdrawal start?

Answer 36

within hours of last drink; can have positive or negative alcohol levels.

Question 37

which benzo is preferred for pts who are in ETOH withdrawal and may be at risk for delirium tremens

Answer 37

lorazepam because of short half life and no metabolites

Question 38

late onset alcoholism is seen in

Answer 38

> 65 yrs or older and alcoholism in aging population is undiagnosed in >50% of cases.

see frequent recent accidents, disproportionately increased AST to ALT. Se high MCV. See insomnia, and decreased care about appearance and poor self care and poor oral intake.

Question 39

why do people like K2 or synthetic marijuana?

Answer 39

also called spice

like it because gives the high of marijuana but can’t be detected on drug screen.

Question 40

who should not get naltrexone?

Answer 40

ETOH dependent drinkers with hepatic impairment

naltrexone can cause hepatoxicity

Question 41

who should not get acamprosate

Answer 41

severe CKD (GFR<30)

approved for maintenance of abstinence in ETOH disorder

not first line therapy

Question 42

why do we like naltrexone for alcohol use disorder?

Answer 42

reduces alcohol consumption compared to placebo