Substance misuse Flashcards
1st line treatment in alcohol withdrawal ?
benzodiazepine e.g. chlordiazepoxide
lorazepam preferred if liver disease
peak incidence of seizures in alcohol withdrawal ?
36 hours
peak incidence of delirium tremens in alcohol withdrawal ?
48-72 hours
features of delirium tremens ?
coarse tremor delirium auditory and visual hallucinations confusion fever tachycardia
definition of substance misuse ?
3 or more of the following present together;
- compulsion
- difficulty controlling use
- tolerence
- priority
- persistent use despite harmful consequences
mechanisms of alcohol withdrawal ?
chronic alcohol consumption enhances GABA mediated inhibition in the CNS (similar to benzodiazepines) and inhibits NMDA type glutamate receptors
withdrawal does the opposite (decreased GABA inhibition and increased NMDA glutamate transmission)
features of opiate overdose ?
respiratory arrest with a pulse
fixed unreactive pinpoint pupils
snoring with reduced respiratory rate
reduced consciousness/coma
withdrawal symptoms of heroin ?
muscle pain/ cramps diarrhoea craving insomnia increased lacrimal, nasal and salivary secretions dilated pupils pilo-erection
treatment of opiate overdose ?
naloxone
1st line treatment of cocaine overdose ?
1st line benzodiazepine
if
treatment of cocaine overdose if patient is hypertensive ?
benzodiazepine + sodium nitroprusside
what are complications associated with cocaine overdose ?
CV;
- QRS widening
- PR prolongation
- tachycardia or bradycardia
- aortic dissection
- stroke
seizure
psychosis
hallucinations
rhabdomyolysis
hyperthermia
metabolic acidosis
what are presenting features of cocaine overdose ?
diaphoresis mydriasis hypertension hyperthermia agitation tachycardia
mechanism of barbiturates ?
increase inhibitory GABAG neurotransmitters to increase duration of chloride channel opening
mechanism of benzodiazepines ?
increase inhibitory GABA neurotransmitters to increase frequency of chloride channel opening
