Substance Abuse

Question 1

Define drug tolerance.

Answer 1

Drug tolerance is a condition in which the body’s tissues
become so adjusted to the presence of a drug that increased
doses of the drug are necessary to produce the desired effect.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 542.

Question 2

What is physical dependence to a drug?

Answer 2

Physical dependence to a drug is a state in which the drug must
be present in the body in order to prevent symptoms of
withdrawal so that normal physiologic activity can occur.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 542.

Question 3

What medical problems are associated with the

chronic abuse of opioids?

Answer 3

Malnutrition, aspiration pneumonitis, cellulitis, hepatitis,
endocarditis, tetanus, superficial skin abscesses, transverse
myelitis, acquired immunodeficiency syndrome, septic
thrombophlebitis, systemic septic emboli
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 546-548.

Question 4

What is the number one cause of unconsciousness

seen in individuals admitted to the emergency room?

Answer 4

Drug overdose
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 543

Question 5

What are some contraindications to gastric lavage?

Answer 5

Gastric lavage is not advised in patients in which laryngeal
reflexes are not intact, or when the substance ingested is
corrosive or a hydrocarbon.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 543.

Question 6

When are signs and symptoms of early alcohol

withdrawal syndrome typically seen?

Answer 6

6 to 8 hours after a drastic reduction in the blood alcohol
concentration. These signs and symptoms are most
pronounced at 24-36 hours.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 544.

Question 7

What are the two major risk factors associated with

alcoholism.

Answer 7

A family history of alcoholism, male gender
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 544

Question 8

What are the signs and symptoms of early

withdrawal syndrome?

Answer 8

Hyperactivity of the autonomic nervous system (cardiac
dysrhythmias, high blood pressure, tachycardia), generalized
tremors, perceptual disturbances such as hallucinations and
nightmares, mild confusion with associated agitation, insomnia,
nausea, and vomiting.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 544.

Question 9

What is delirium tremens?

Answer 9

A medical emergency that is life-threatening and is
characterized by combativeness, tachycardia, grand mal
seizures, hallucinations, and hypertension or hypotension.
Delirium tremens is seen 2-4 days once the ingestion of alcohol
has stopped.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 544.

Question 10

What is the mortality rate of delirium tremens? What

is the typical cause of death?

Answer 10

The mortality rate of delium tremens is 10% and is primarily
caused from seizures, hypotension, or cardiac dysrhythmias.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 544.

Question 11

How does cocaine stimulate the sympathetic

nervous system?

Answer 11

Cocaine blocks the presynaptic uptake of dopamine and
norepinephrine, resulting in increased postsynaptic
concentrations of the neurotransmitters.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 545.

Question 12

What are the characteristics of fetal alcohol

syndrome?

Answer 12

Mental retardation, growth retardation, and craniofacial
dysmorphology
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 545.

Question 13

How does an overdose of aspirin exert its pathologic

effects within the body?

Answer 13

Once in the body, aspirin is converted to its active metabolite,
salicylic acid. Salicylates are metabolic poisons at toxic levels,
affecting many organ systems by uncoupling oxidative
phosphorylation and interfering with the Krebs cycle. Ketoacids
and lactic acids accumulate within the body as a result of the
oxidative phosphorylation uncoupling.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 552-553.

Question 14

Describe the treatment of cocaine overdose.

Answer 14

The treatment for patients with an overdose to cocaine should
include the management of myocardial ischemia through the
administration of nitroglycerin. If cardiac vasospasm is present,
treatment with an alpha adrenergic blocker is suggested, as
beta adrenergic blockade can accentuate this condition.
Seizures should be managed through the administration of IV
benzodiazepines, and if hyperthermia is present, active cooling
measures are indicated.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 545.

Question 15

What is the primary manifestation of an overdose

associated with barbiturates?

Answer 15

Central nervous system depression
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 548.

Question 16

What is the most serious complication associated

with the withdrawal of barbiturates?

Answer 16

Grand mal seizures
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 548.

Question 17

List the symptoms of a barbiturate overdose.

Answer 17

Skeletal muscle tremors, diaphoresis, anxiety, tachycardia,
orthostatic hypotension, and hyperreflexia. There is also a
possibility of hyperthermia and complete cardiovascular
collapse. The most deleterious problem is the occurence of
grand mal seizures.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 548

Question 18

What are the medically approved uses for

amphetamines?

Answer 18

Amphetamines are used in the treatment of attention-deficit
disorders and hyperactivity in children, and for the treatment of
narcolepsy.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 549.

Question 19

What are the symptoms related to an overdose of

amphetamines?

Answer 19

A psychotic state, anxiety, hypertension, cardiac dysrhythmias,
tachycardia, diaphoresis, hyperthermia, hydriasis, and a
decrease in gastrointestinal motility. Progressive irritability of
the central nervous system occurs, which is characterized by
hyperreflexia, hyperactivity, and on rare occasion, seizures.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 549.

Question 20

What percentage of patients with alcohol withdrawal

syndrome suffer from delirium tremens?

Answer 20

Approximately 5%
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 544

Question 21

Describe the treatment of an overdose related to oral

amphetamine ingestion

Answer 21

An overdose from oral amphetamines should be treated with
gastric lavage or induced vomiting, followed by a cathartic and
the administration of activated charcoal.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 549

Question 22

Describe the withdrawal symptoms associated with

the acute cessation of amphetamine use.

Answer 22

Increased appetite, weight gain, extreme lethargy, and suicidal
depression.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 549.

Question 23

How should hypotension during anesthesia be
treated in a patient with a history of chronic
amphetamine abuse?

Answer 23

Hypotension should be treated with a direct-acting vasopressor
such as epinephrine or phenylephrine. Responses to indirectacting
vasopressors may be less effective due to the
catecholamine depletion caused by amphetamines.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 549.

Question 24

What are the symptoms related to salicylic acid

overdose?

Answer 24

Nausea, vomiting, tinnitus, low blood sugar, fever, seizures,
somnolence, coagulopathy, low CSF concentrations of glucose,
direct respiratory center stimulation, liver dysfunction, and
noncardiogenic pulmonary edema.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 552-553.