substance abuse Flashcards
delirium tremens tx
benzodiazepines (chlordiazepoxide, lorazepam)
alc intox tx
tapering doses of bento
thiamine, folic acid, multivitamin
mgSO4 to prevent post withdrawal seizures
long term complication of alc intake
wernicke encephalopathy - bc of poor diet of alcoholics –> thiamine def. ataxia, confusion, ocular abn
can cause korsakoff’s syndrome: impaired recent memory, anterograde amnesia, confabulation
Cocaine pthway
blocks dopamine repute from synaptic cleft - stimulant effect. indirect sympathomimetic. mimic fight or flight response
cocaine clinical presentation
euphoria, incr or decr BP, tachy or brachy, nausea, dilated pupil, wt loss, psychomotor agitation or depression, chills, sweating. can cause respiratory depression, seizures, arrhythmias, hallucination (tactile).
vasoconstrictive- MI, CVA
cocaine overdose
can kill secondary to cardiac arrhythmia, seizures or respiratory depression
cocaine DD
amphetamine, phencyclidine (PCP) intox, sedative w/d
cocaine dx
urine drug test, pos for 3d
cocaine tx
intox:
1) mild-mod: benzo
2) severe/psychosis: haloperidol
3) symptomatic support
dependence
1) psychotx, group
2) TCA
3) dop agonist (amantadine, bromocriptine)
cocaine w/d
not life threatening. cause dysphoric (crash)= malaise, fatigue, depression, hunger, constricted pupil, vivid dreams, psychomotor agitation or retardation
tx: supportive
amphetamine types
classic and
substituted
classic amphetamine
dextroamphetamine (dexedrine), methylphenidate (ritalin), methampheamine (ice, speed, crystal meth, crack)
release dopamine from nerve endings –> stimulant effect. used to tx narcolepsy, ADHD, depressive D
substituted amphetamine
aka designer. - MDMA (ecstasy)m MDEA (eve)
release dopamine and 5HT from nerve endings- stimulant and hallucinogenic properties
amphetamine intox presentation, dd, dx, tx, w/d
same as cocaine. urine drug screen pos for 1-2d. neg screen doesn’t rule it out bc many aren’t sensitive enough.
PCP pthwy
hallucinogen that antagonize n-methyl-d-aspartate (NMDA) glutamate R and activate dopaminergic neurons. similar to ketamine. aka angel dust
PCP intox sx and signs
recklessness, impulsivness, impaired judgment, assaultiveness, rotatory nystagmus (pathognomonic), ataxia, HTN, tachym M rigidity, high tolerance to pain. overdose-seizure, coma.cause more violence than any other drug.
pcp intox tx
monitor BP, T, electrolytes
acidify urine with NH4Cl and ascorbic acid,
benzo or dopamine antagonist- ctrl agitation and anxiety
diazepam - M spasm and seizures
haloperidol- ctrl severe agitation and psychotic sx
PCP dx
urine drug screen pos for >1wk. CPK and AST often elvated
dd acute psychotic states, schizophrenia
w/d - none but may have flashbacks
sedative hypnotics
benzos, barbiturates (tx epilepsy and as anesthetic). the two are synergistic. can cause respiratory depression
benzodiazepam pthwy
potentiate effects of GABA by incr freq of cl ch opening
barbituate ptwy
potentiate GABA by incr duration of Cl ch opening
at high dose, direct GABA agonist and lower margin of safety compared to BDZs.
sedative hypnotic intox
sedative= drowsy, slurred speech, incoordination, ataxia, mood lability, impaired judgment, nystagmus, respiratory depression, comma or death in overdose (especially barbiturates)
sx aug by ethos.
dd: alc intoxx, generalized cerebral dysfunc- delirium
dd: urine or serum drug test pos for 1wk. electrolyte, ecg
sedative hypnotic tx
maintain airway, breathing, circulation
activate charcoal to prevent GI absorption
barbituates- alkalize urine with NaCO3 to promote renal excretion
benzo- flumazenil in overdose
supportive care
flumazenil
short acting BDZ antagonist. can precipitate seizure
sedative hypnotic w/d
life threatening (w/d from stimulants/hallu is not) autonomic hyperactivity, insomnia, anxiety, tremor, n/v, delirium, hallu, seizure tx: long acting bend- chloroiasepoxide or diazepam - then taper dose. tegretol or valproic acid for seizure ctrl.
opiates
ex heroin, morphine. stimulate opiate R (mu, kappa, delta) affect dopaminergic system.
opiate intox
drowsiness, n/v, constipation, slurred speech, constricted pupil, seizure, respiratory depression –> coma –> death.
meperidine + MAOi –> serotonin syndrome (hyperthermia, confusion, hyper/potnesion, M rigidity
opioid dd
sedative-hypnotic intox. severe etoh intox
dd- rapid recovery of consciousness after admin of IV naloxone. urine/blood test pos for 12-36hr.
opioid tx
intox- ABC
overdose- naloxone or naltrexone. may need ventilatory support.
dependence: oral methadone daily taper over mo/y. psychotx
triad of opiod overdose
rebels admire morphine
respiratoyr depression, altered mental status, miosis
opiate w/d
not life threatening. w/d syndrome- dysphasia, insomnia, lacrimation, rhinorrhea, yawning, weakness, sweating, piloerection, n/v, fever, dilated pupils, muscle ache
tx: moderate sx- clonidine or buprenorphine. severe- detox with methadone over 7d
hallucinogens intox, w.d
psilocybin (mushrooms)
lsd
pharm effect vary.
tolerance dev quickly but reverses rapidly
no dependence or w/d
perceptual changes, papillary dilation, tachy, tremors, incoordination, sweating, palpitations
tx- guidance and reassurance. severe- antipsychotics or benzo
marijuana
cannabis is a THC cannabinoid R in brain inhibit adenylate cyclase. effects augmented by EtOH.
can tx nausea in cancer pt and incr appetite in AIDS pt. no sep or w/d
marijuana intox
euphoria, impaired coordination, mild tachycardia, conjunctival injection, dry mouth, incr appetite
urine test pos for 4 wks
supportive and sx treatment
inhalants
CNS depressants. user usually adolescent male
intox- impaired judgment, belligerance, everything
overdose may be fatal secondary to respiratory depression or arthymia.
long term use- permanent damage to CNS, PNS, liver kidney, M
tx: ABC, sx, psychotx
dx- serum drug pos for 4-10hr
no w/d
caffeine
adenosine antagonist. incr cAMP and stimulate effect via dopaminergic system
nicotine pthwy
stimulate nicotinic R on autonomic ganglia of sympathetic and PSNS. –> CNS stimulant–> restlessness, insomnia, anxiety, incr GI motility. incr attention, mood, decr tension
nicotine w/d
craving, dysphoria, anxiety, incr appetite, irritability, insomnia
smoking cessation
behavioral counseling, nicotine replacement therapy (gum, patch), zyban (antidepressant decr craving), clonidine
