Substance intoxication/withdrawal/treatment Flashcards
Alcohol intoxication
Disinhibition, emotional lability, slurred speech, ataxia, aggression, blackouts, hallucinations, memory impairment, impaired judgement, coma.
Alcohol withdrawal symptoms
Mild withdrawal: Tremor ( first symptom), tachycardia, hypertension, agitation (within 48 hrs).
Alcoholic hallucination: visual hallucinations without delirium (12 - 48 hrs).
Delirium tremens: visual hallucinations with severe autonomic instability, delirium, seizures, and possibly death ( 2 - 7 days).
Alcohol withdrawal Tx
Benzodiazepines (can require massive doses); thiamine, folate, and multivitamin replacement.
Opioids intoxication and management
Euphoria leading to apathy, CNS depression, constipation, pupillary constriction, and respiratory depression ( life-threatening in overdose).
Naloxone and naltrexone are opioid receptor antagonists and reverse the effects of opioids; may require redosing due to short half-life.
Opioids withdrawal
Not life-threatening
Anxiety, insomnia, flulike symptoms, piloerection, fever, rhinorrhea, lacrimation, yawning, nausea, stomach cramps, diarrhea, dilated pupils, hyperactive bowel sounds, muscle aches.
‘‘Hurts all over’’ and does not cause seizures.
Opioids withdrawal Tx
Mild: ondansetron, loperamide, benzodiazepines, and NSAIDs.
Severe: clonidine for autonomic symptoms, buprenorphine or methadone for craving.
Amphetamines intoxication and management
Psychomotor agitation, impaired judgement, HTN, pupillary dilation, tachycardia, fever, diaphoresis, anxiety, angina, euphoria, prolonged wakefulness/attention, arrythmias, delusions, seizures, hallucinations.
MDMA (methylenedioxy-methylamphetamine) ‘‘ecstasy’’ is an amphetamine with hallucinogenic properties; popular at dance parties or ‘‘raves’’ -> intoxications as above, plus hyperthermia, heat exhaustion, hyponatremia, may also precipitate serotonin syndrome.
Haloperidol can be given for severe agitation and symptom-targeted medications (antiemetics, NSAIDs…).
Amphetamines withdrawal
Not life threatening
Depression/ Dysphoria, hyperphagia, hyper somnolence, constricted pupils, post-use “crash” with anxiety, lethargy, headache, stomach cramps, fatigue, nightmares.
Amphetamines withdrawal Tx
IV Benzodiazepines and supportive tx.
Avoid pure B-blockers (lead to unopposed alpha activity, causing hypertensive crisis).
Cocaine intoxication and management
Psychomotor agitation, euphoria, impaired judgement, tachycardia, pupillary dilation, hypertension, paranoia, hallucinations, “cocaine bugs” ( the feeling of bugs crawling under one’s skin) sudden death.
Chronic use causes weight loss, erythema of the nasal turbinates and septum, and behavioral changes.
ECG changes from ischemia are often seen (“cocaine chest pain”).
TX haloperidol for severe agitation along with symptom specific medications (ex: to control HTN).
Cocaine withdrawal
Not life threatening
Depression, hyperphagia, constricted pupils, post-use “crash” with hypersomnolence, malaise, severe craving, angina, suicidality, nightmares.
Cocaine withdrawal Tx
IV Benzodiazepines and supportive tx.
Avoid pure B-blockers (lead to unopposed alpha activity, causing hypertensive crisis).
Barbiturates intoxication
Low safety margin; respiratory depression
Barbiturates withdrawal
Rebound anxiety, seizures, delirium/hallucination, life-threatening cardiovascular collapse, tremor, insomnia.
May mimic alcohol withdrawal, but HTN/tachycardia usually absent.
Barbiturates Tx
Benzodiazepines taper.
Benzodiazepines intoxication
Interaction with alcohol, amnesia, ataxia, somnolence, mild respiratory depression.
Avoid using for insomnia in elderly pts.
Can cause paradoxical agitation even in relatively low doses.
Benzodiazepines withdrawal
life threatening, Rebound anxiety, seizures, delirium/hallucination, tremor, insomnia, HTN, tachycardia, death.
May mimic alcohol withdrawal but HTN and tachycardia usually absent.
Benzodiazepines Tx
Benzodiazepines taper.
Nicotine Intoxication
Restlessness, insomnia, anxiety, arrythmias.
Nicotine withdrawal
Irritability, headache, anxiety, weight gain, craving, bradycardia, difficulty concentrating, insomnia.
Caffeine intoxication
Restlessness, insomnia, diuresis, muscle twitching, arrhythmias, tachycardia, flushed face, psychomotor agitation.
Caffeine withdrawal
Headache, lethargy, depression, weight gain, irritability, craving.
Synthetic opioids intoxication
Contains MPTP (1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine, synthetic heroin) leading to Parkinson-like disorder and loss of pigmented neurons in the substantia nigra.
Synthetic opioids withdrawal
None.
Bath salts (synthetic cathinones) intoxication
Stimulant drug that causes agitation, combativeness, delirium, and psychosis that may last for weeks.
Bath salts (synthetic cathinones) withdrawal
None.
Marijuana (cannabis) intoxication
Euphoria, laughter, slowed sense of time, impaired judgement, social withdrawal, increased appetite, dry mouth, conjunctival injection, hallucinations, anxiety, paranoia, decreased motivation.
Marijuana (cannabis) withdrawal
None.
LSD (lysergic acid diethylamide) intoxication and management
Marked anxiety or depression, delusions, visual hallucinations, flashbacks, pupillary dilation, impaired judgment, diaphoresis, tachycardia, HTN, heightened senses (ex: colors become more intense).
Tx: Supportive counselling; traditional antipsychotics for psychotic symptoms; Benzodiazepines for anxiety.
LSD (lysergic acid diethylamide) withdrawal
None.
Phencyclidine hydrochloride (PCP) intoxication and management
Assaultive/ combative, belligerence, psychosis, violence, impulsiveness, psychomotor agitation, fever, tachycardia, vertical/horizontal nystagmus, HTN, impaired judgment, ataxia, seizures, delirium.
Tx: Give benzodiazepines, or haloperidol for severe symptoms; otherwise reassure.
Gastric lavage can help eliminate the drug.
Phencyclidine hydrochloride (PCP) withdrawal
Recurrence of intoxication symptoms caused by reabsorption in the GI tract; sudden onset of severe, random violence.
