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Stage toxico > Substance-Related and Addictive Disorders > Flashcards

Substance-Related and Addictive Disorders Flashcards

1
Q

Describe: Substance-Related and Addictive Disorders (4)

A
  • neurobiological disorder involving compulsive drug seeking and drug taking, despite adverse consequences, with loss of control over drug use (think issues with the “3 Cs”: compulsive, consequences, control)
  • dependence is the hallmark of substance use disorders
  • these disorders are usually chronic with a relapsing and remitting course
  • there are 10 separate classes of substances identified in the DSM-5
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2
Q

Dependence is the hallmark of substance use disorders and comes in what forms? (3)

A
  • behavioural: substance-seeking activities and pathological use patterns
  • physical: physiologic withdrawal effects without use
  • cognitive: continuous or intermittent cravings for the substance to avoid dysphoria or attain drug state
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3
Q

There are 10 separate classes of substances identified in the DSM-5. Name them.

A
  • alcohol
  • caffeine
  • cannabis hallucinogens (phenylcyclidine [or similarly acting arylcyclohexlamines] and other hallucinogens)
  • inhalants
  • opioids
  • sedatives
  • hypnotics, and anxiolytics
  • stimulants (amphetamine-type substances, cocaine, and other stimulants)
  • tobacco
  • and other (or unknown) substances
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4
Q

Define: Drug abuse (1)

A
  • drug use that deviates from the approved social or medical pattern, usually causing impairment or disruption to function in self or others
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5
Q

Describe epidemiology: Substance-Related and Addictive Disorders (3)

A
  • 47% of those with substance abuse have mental health problems
  • 29% of those with a mental health disorder have a substance use disorder
  • 47% of those with schizophrenia and 25% of those with an anxiety disorder have a substance use disorder
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6
Q

Describe etiology: Substance-Related and Addictive Disorders (2)

A
  • almost all drugs (and activities) of abuse increase dopamine in the nucleus accumbens, an action that contributes to their euphoric properties and, with repeated use, to their ability to change signaling pathways in the brain’s reward system
  • substance use disorders arise from multifactorial interactions between genes (personality, neurobiology) and environment (low socioeconomic status, substance-using peers, abuse history, chronic stress)
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7
Q

Describe diagnosis: Substance-Related and Addictive Disorders (4)

A
  • substance use disorders are measured on a continuum from mild to severe based on the number of criteria met within 12 mo
    • mild: 2-3
    • moderate: 4-5
    • severe: 6 or more
  • each specific substance is addressed as a separate use disorder and diagnosed utilizing the same overarching criteria (i.e. a single patient may have moderate alcohol use disorder, and a mild stimulant use disorder)
  • testing for illicit drugs is most commonly done on urine or blood samples
    • serum toxicology screen is needed to assess alcohol level
    • toxicology may be helpful in differentiating withdrawal from other mental disorders
  • criteria for substance use disorders (PEC WITH MCAT)
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8
Q

Name criteria: Substance-Related and Addictive Disorders (11)

A
  • (PEC WITH MCAT)
    • use despite Physical or psychological problem (i.e. alcoholic liver disease or cocaine related nasal problems)
    • failures to fulfill External roles at work/school/home
    • Craving or a strong desire to use substance
    • Withdrawal
    • continued use despite Interpersonal problems
    • Tolerance, needing to use more substance to get same effect
    • use in physically Hazardous situations
    • More substance used or for longer period than intended
    • unsuccessful attempts to Cut down
    • Activities given up due to substance
    • excessive Time spent on using or finding substance
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9
Q

Name examples: Depressants (5)

A
  • Alcohol
  • opioids
  • barbiturates
  • benzodiazepines
  • GHB
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10
Q

Describe sx of intoxication: Depressants (6)

A
  • Euphoria
  • slurred speech
  • disinhibition
  • confusion
  • poor coordination
  • coma (severe)
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11
Q

Describe sx of withdrawal: Depressants (8)

A
  • Anxiety
  • anhedonia
  • tremor
  • seizures
  • insomnia
  • psychosis
  • delirium
  • death
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12
Q

Name examples: Stimulants (4)

A
  • Amphetamines
  • methylphenidate
  • MDMA
  • cocaine
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13
Q

Name sx of intoxication: Stimulants (8)

A
  • Euphoria
  • mania
  • psychomotor agitation
  • anxiety
  • psychosis (especially paranoia)
  • insomnia
  • cardiovascular complications (stroke, MI, arrhythmias)
  • seizure
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14
Q

Name sx of withdrawal: Stimulants (4)

A
  • ‘Crash’
  • craving
  • dysphoria
  • suicidality
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15
Q

Name examples: Hallucinogens (7)

A
  • LSD
  • mescaline
  • psilocybin
  • PCP
  • ketamine
  • ibogaine
  • salvia
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16
Q

Name sx of intoxication: Hallucinogens (5)

A
  • Distortion of sensory stimuli and enhancement of feelings
  • psychosis (++ visual hallucinations)
  • delirium
  • anxiety (panic)
  • poor coordination
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17
Q

Name sx of withdrawal: Hallucinogens (1)

A

Usually absent

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18
Q

Describe: General Approach to Assessment to Substance-Related and Addictive Disorders (2)

A
  • ask about more socially accepted substances (i.e. nicotine, alcohol) before asking about use of marijuana, misuse of prescription medicines, and about illicit drugs
  • obtaining history from family members may be helpful
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19
Q

Describe: General Approach to Treatment of Substance-Related and Addictive Disorders (7)

A
  • approach must be appropriate to the patient’s current state of change
  • patients will only change when the pain of change appears less than the pain of staying the same
  • provider can help by providing psychoeducation (emphasize neurobiologic model of addiction), motivation, and hope
  • principles of motivational interviewing
    • non-judgmental stance
    • space for patient to talk and reflect
    • offer accurate empathic reflections back to patient to help frame issue
  • encourage and offer referral to evidence based services
    • social: 12-step programs (alcoholics anonymous, narcotics anonymous), family education, and support
    • psychological therapy: addiction counselling, MET, CBT, contingency management, group therapy, family therapy, marital counselling
    • medical management (differs depending on substance): acute detoxification, pharmacologic agents to aid maintenance
  • harm reduction whenever possible: safe-sex practices, avoid driving while intoxicated, avoid substances with child care, safe needle practices/exchange, pill-testing kits, reducing tobacco use
  • comorbid psychiatric conditions: many will resolve with successful treatment of the substance use disorder but patients who meet full criteria for another disorder should be treated for that disorder with psychological and pharmacologic therapies
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20
Q

Name: Questions to Characterize Substance Use and Risk Assessment (8)

A
  • When was the last time you used?
  • How long can you go without using?
  • By what route (oral ingestion, inhalation (snorting), smoking, IV) do you usually use?
  • Are there any triggers that you know will cause you to use?
  • How has your substance use affected your work, school, relationships?
  • Substances can be very expensive, how do you support your drug use?
  • Have you experienced medical or legal consequences of your use?
  • Any previous attempts to cut down or quit, and did you experience any withdrawal symptoms?
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21
Q

Define: Confabulations (1)

A

the fabrication of imaginary experiences to compensate for memory loss

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22
Q

Describe: History of alcohol use (4)

A

Validated screening questionnaire for alcohol use disorders

  • C ever felt the need to Cut down on your drinking?
  • A ever felt Annoyed at criticism of your drinking?
  • G ever feel Guilty about your drinking?
  • E ever need a drink first thing in morning (Eye opener)?
    • for men, a score of ≥2 is a positive screen; for women, a score of ≥1 is a positive screen
    • if positive CAGE, then assess further to distinguish between problem drinking and alcohol use disorder
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23
Q

What’s considered moderate drinking?

  • Men
  • Women
  • Elderly
A
  • Men: 3 or less/d (≤15/wk)
  • Women: Women: 2 or less/d (≤10/wk)
  • Elderly: Elderly: 1 or less/d
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24
Q

Describe: Alcohol Intoxication (2)

A
  • legal limit for impaired driving is 17 mmol/L (50 mg/dL) reached by 2-3 drinks/h for men and 1-2 drinks/h for women
  • coma can occur with >60 mmol/L (non-tolerant drinkers) and 90-120 mmol/L (tolerant drinkers)
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25
Q

Describe: Alcohol Withdrawal (4)

A
  • medical emergency: occurs within 12-48 h after prolonged heavy drinking and can be life-threatening
  • ~50% of middle-class, functional individuals with EtOH use disorder have experienced alcohol withdrawal, 80% in hospitalized/homeless individuals
    • alcohol withdrawal can be described as having 4 stages, however not all stages may be experienced:
  • course: almost completely reversible in young; elderly often left with cognitive deficits
  • mortality rate 20% if untreated
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26
Q

Alcohol withdrawal can be described as having 4 stages, however not all stages may be experienced. Name and describe them.

A
  • stage 1 (onset 4-12 h after last drink): “the shakes” tremor, sweating, agitation, anorexia, cramps, diarrhea, sleep disturbance, anxiety, insomnia, headache
  • stage 2 (onset 12-24 h): alcoholic hallucinosis: visual, auditory, olfactory or tactile hallucinations
  • stage 3 (onset 24-48 h): alcohol withdrawal seizures, usually tonic-clonic, non-focal, and brief
  • stage 4 (onset 48-72 h): delirium tremens, confusion, delusions, hallucinations, agitation, tremors, autonomic hyperactivity (fever, tachycardia, HTN)
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27
Q

Name examples of A “Standard Drink” (8)

A
  • Spirit (40%): 1.5 oz. or 43 mL
  • Table Wine (12%): 5 oz. or 142 mL
  • Fortified Wine (18%): 3 oz. or 85 mL
  • Regular Beer (5%): 12 oz. or 341 mL

OR

  • 1 pint of beer = 1.5 SD 1 bottle of wine = 5 SD
  • 1 “mickey” = 8 SD (375 mL)
  • “26-er” = 17 SD (750 mL)
  • “40 oz.” = 27 SD
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28
Q

Name sx: Delirium Tremens (alcohol withdrawal delirium) (9)

A
  • Autonomic hyperactivity (diaphoresis, tachycardia, increased respiration)
  • Hand tremor
  • Insomnia
  • Psychomotor agitation
  • Anxiety
  • Nausea or vomiting
  • Tonic-clonic seizures
  • Visual/tactile/auditory hallucinations
  • Persecutory delusions
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29
Q

Describe: Management of Alcohol Withdrawal (4)

A
  • monitor using the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-A) scoring system
    • areas of assessment include:
      • physical (5): nausea and vomiting, tremor, agitation, paroxysmal sweats, headache/fullness in head
      • psychological/cognitive (2): anxiety, orientation/clouding of sensorium
      • perceptual (3): tactile disturbances, auditory disturbances, visual disturbances
      • all categories are scored from 0-7 (except: orientation/sensorium 0-4), maximum score of 67 mild <10, moderate 10-20, severe >20
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30
Q

Describe CIWA-A Scale Treatment Protocol for Alcohol Withdrawal: Basic Protocol (4)

A
  • Diazepam 20 mg PO q1-2h prn until CIWA-A <10 points
  • Observe 1-2 h after last dose and re-assess on CIWA-A scale
  • Thiamine 100 mg IM then 100 mg PO OD for 3 d
  • Supportive care (hydration and nutrition)
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31
Q

Describe CIWA-A Scale Treatment Protocol for Alcohol Withdrawal: History of Withdrawal Seizures (1)

A

Diazepam 20 mg PO q1h for minimum of three doses regardless of subsequent CIWA scores

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32
Q

Describe CIWA-A Scale Treatment Protocol for Alcohol Withdrawal: If age >65 or patient has severe liver disease, severe asthma or respiratory failure (2)

A
  • Use a short acting benzodiazepine
  • Lorazepam PO/SL/IM 1-4 mg q1-2h
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33
Q

Describe CIWA-A Scale Treatment Protocol for Alcohol Withdrawal: If Hallucinations are present (2)

A
  • Haloperidol 2-5 mg IM/PO q1-4h – max 5 doses/d or atypical antipsychotics (olanzapine, risperidone)
  • Diazepam 20 mg x 3 doses as seizure prophylaxis (haloperidol lowers seizure threshold)
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34
Q

When to admit to hospital according to CIWA-A Scale Treatment Protocol for Alcohol Withdrawal? (3)

A
  • Still in withdrawal after >80 mg of diazepam
  • Delirium tremens, recurrent arrhythmias, or multiple seizures
  • Medically ill or unsafe to discharge home
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35
Q

Describe: Wernicke-Korsakoff Syndrome (2)

A
  • alcohol-induced amnestic disorders due to thiamine deficiency (poor nutrition or malabsorption)
  • necrotic lesions: mammillary bodies, thalamus, brainstem
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36
Q

Describe: Wernicke’s encephalopathy (4)

A
  • acute and reversible
  • triad
    • oculomotor dysfunction such as nystagmus (CN VI palsy)
    • gait ataxia
    • confusion
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37
Q

Describe: Korsakoff’s syndrome (3)

A
  • chronic and only 20% reversible with treatment
  • anterograde amnesia and confabulation
  • cannot occur during an acute delirium or dementia and must persist beyond usual duration of intoxication/withdrawal
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38
Q

Describe management: Wernicke-Korsakoff Syndrome (4)

A
  • Wernicke’s preventative treatment (any patient in withdrawal): thiamine 100-250mg IM/IV x 1 dose
  • Wernicke’s acute treatment: thiamine 500 mg IV BID/TID x 72,h then reassess
  • Korsakoff’s: IV treatment as for Wernicke’s followed by thiamine 100 mg PO TID x 3-12 mo
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39
Q

Name pharmacological Treatment of Alcohol Use Disorder (4)

A
  • naltrexone (Revia®)
  • acamprosate (Campral®)
  • disulfiram (Antabuse®)
  • some evidence for the use of gabapentin, topiramate and ondansetron as anti-craving agents, but not Health Canada approved for this indication
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40
Q

In Treatment of Alcohol Use Disorder, describe: Naltrexone (Revia®) (3)

A
  • opioid antagonist
  • shown to be successful in reducing the “high” associated with alcohol, moderately effective in reducing cravings, frequency or intensity of alcohol binges
  • can be started if still consuming alcohol or abstinent
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41
Q

In Treatment of Alcohol Use Disorder, describe: Acamprosate (Campral®) (2)

A
  • NMDA glutamate receptor antagonist
  • useful in maintaining abstinence and decreasing cravings
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42
Q

In Treatment of Alcohol Use Disorder, describe: Disulfiram (Antabuse®) (4)

A
  • prevents oxidation of alcohol (blocks acetaldehyde dehydrogenase);
  • with alcohol consumption, acetaldehyde accumulates to cause a toxic reaction (vomiting, tachycardia, death)
  • if patient relapses, must wait 48 h before restarting Antabuse®; prescribed only when treatment goal is abstinence
  • RCT evidence is generally poor or negative
43
Q

Name types of opioids (6)

A
  • heroin
  • morphine
  • oxycodone
  • Tylenol #3® (codeine)
  • hydromorphone
  • fentanyl
44
Q

Name major risks associated with the use of contaminated needles (3)

A
  • increased risk of hepatitis B and C
  • bacterial endocarditis
  • HIV/AIDS
45
Q

Describe: Opioids Acute Intoxication (6)

A
  • direct effect on receptors in CNS resulting in
    • decreased pain perception
    • sedation
    • decreased sex drive
    • nausea/vomiting
    • decreased GI motility (constipation and anorexia)
    • respiratory depression
46
Q

Describe: Opioids Toxic Reaction (7)

A
  • medical emergency
  • typical syndrome includes
    • shallow respirations
    • miosis
    • bradycardia
    • hypothermia
    • decreased level of consciousness
  • caution: opioids have a longer half-life than naloxone; may need to observe for toxic reaction for at least 24 h
47
Q

Describe management: Opioids Toxic Reaction (4)

A
  • ABCs
  • IV glucose
  • naloxone hydrochloride (Narcan®): 0.4 mg up to 2 mg IV for diagnosis
  • treatment: intubation and mechanical ventilation, ± naloxone drip, until patient alert without naloxone (up to >48 h with long-acting opioids)
48
Q

Describe Opioid Antagonists: Naltrexone vs. Naloxone (7)

A

Naltrexone (Revia®)

  • Can be used for EtOH dependence (although not routinely used)
  • Long half life (h)

Naloxone (Narcan®)

  • Used for life-threatening CNS/respiratory depression in opioid overdose
  • Short half life (<1 h)
  • Very fast acting (min)
  • High affinity for opioid receptor
  • Induces opioid withdrawal symptoms
49
Q

Name street names: Cocaine (8)

A
  • blow
  • C
  • coke
  • crack
  • flake
  • freebase
  • rock
  • snow
50
Q

Describe: Cocaine (4)

A
  • alkaloid extracted from leaves of the coca plant
  • blocks presynaptic uptake of serotonin (causing euphoria), dopamine (linked to its addictive effect), norepinephrine and epinephrine (causing vasospasm, HTN)
  • sodium channel blockade: cocaine slows or blocks nerve conduction and acts as a local anesthetic by altering recovery of neuronal Na+ channels; it has a similar effect on cardiac Na+ channels and in overdose can manifest on ECG as prolongation of the QRS complex
  • self-administered by inhalation (90% bioavailability), insuffiation (i.e. intranasal; 80% bioavailability), or intravenous route
51
Q

Describe onset and duration of action of cocaine (2): inhaled vs insuffisated

A
  • inhaled: onset within seconds, lasting 15-30 min
  • insuffiated: onset in 3-5 min, blood levels peak at 10-20 min with effects beginning to fade after 45-60 min
52
Q

What’s the half-time of cocaine? (1)

A
  • biologic half-life of 1 h, thus repeated self-administration is common among users to maintain an effect
53
Q

Describe cocaine intoxication (6)

A
  • elation
  • euphoria
  • pressured speech
  • restlessness
  • sympathetic stimulation (i.e. tachycardia, mydriasis, sweating, pupillary dilatation, hypertension)
  • prolonged use may result in paranoia and psychosis
54
Q

Describe sx of cocaine overdose (5)

A

medical emergency

  • HTN
  • tachycardia
  • tonic-clonic seizures
  • dyspnea
  • ventricular arrhythmias
55
Q

Describe tx cocaine overdose (2)

A
  • treatment with IV diazepam to control seizures
  • beta-blockers (incl. labetalol or propranolol) are not recommended because of risk from unopposed alpha-adrenergic stimulation
56
Q

Describe cocaine withdrawal (4)

A
  • initial “crash” (1-48 h): increased sleep, increased appetite, dysphoria
  • withdrawal (1-10 wk): dysphoric mood plus fatigue, irritability, vivid unpleasant dreams, insomnia or hypersomnia, psychomotor agitation or retardation
  • complications: relapse, suicide (significant increase in suicide during withdrawal period)
  • management: supportive management
57
Q

Name: Common Presentations of Drug Use (19)

  • General
  • MSK
  • GI
  • Behavioral
  • Psychological
  • Social
A
  • General
    • ​Weight loss (especially cocaine, heroin)
    • Injected conjunctiva (cannabis)
    • Pinpoint pupils (opioids) Track marks (injection drugs)
  • MSK : Trauma
  • GI
    • ​Viral hepatitis (injection drugs)
    • Unexplained elevations in ALT (injection drugs)
  • Behavioural
    • ​Missed appointments
    • Non-compliance
    • Drug-seeking (especially benzodiazepines, opioids)
  • Psychological
    • ​Insomnia
    • Fatigue
    • Depression
    • Flat affect (benzodiazepines, barbiturates)
    • Paranoia (cocaine)
    • Psychosis (cocaine, cannabis, hallucinogens)
  • Social
    • ​Marital discord
    • Family violence
    • Work/school
    • Absenteeism and poor performance
58
Q

Describe: Treatment of Cocaine Use Disorder (2)

A
59
Q

Name complications of cocaine use (4)

A
  • cardiovascular: arrhythmias, MI, CVA, ruptured AAA, chest pain (accounts for 40% of all cocaine- related ED visits)
  • neurologic: seizures
  • psychiatric: psychosis, delirium, suicidal ideation
  • other: nasal septal deterioration, acute/chronic lung injury “crack lung”, possible increased risk of connective tissue disease
60
Q

Describe: Amphetamine intoxication (5)

A
  • euphoria
  • improved concentration
  • sympathetic and behavioural hyperactivity
  • and at high doses. can mimic symptoms of psychosis or mania
  • can eventually cause coma
61
Q

Describe: Chronic use Amphetamine (1)

A

chronic use can produce psychosis which can resemble schizophrenia with agitation, paranoia, delusions. and hallucinations

62
Q

Describe: Amphetamine withdrawal symptoms (3)

A
  • dysphoria
  • fatigue
  • restlessness
63
Q

Describe treatment of amphetamine induced psychosis (3)

A
  • antipsychotics for acute presentation
  • benzodiazepines for agitation
  • β-blockers for tachycardia, hypertension
64
Q

Name the most commonly used recreational drug

A

cannabis (marijuana)

65
Q

Describe: Cannabinoid Hyperemesis Syndrome (4)

A
  • An interesting and relatively new clinical phenomenon associated with chronic cannabis use characterized by cyclical, recurrent severe nausea, vomiting, and colicky pain.
  • Possibly due to increased potency of available THC products.
  • Patients often present to ED in acute distress with no evidence of specific GI pathology.
  • Many patients will successfully self-medicate with hot baths or showers
66
Q

Name: Medical Uses of Marijuana (5)

A
  • Anorexia-cachexia (AIDS, cancer)
  • Spasticity, muscle spasms (multiple sclerosis, spinal cord injury)
  • Levodopa-induced dyskinesia (Parkinson’s Disease)
  • Controlling tics and obsessive- compulsive behaviour (Tourette’s syndrome)
  • Reducing intra-ocular pressure (glaucoma)
67
Q

Name psychoactive substance in cannabis (1)

A

delta-9-tetrahydrocannabinol (O9-THC)

68
Q

Name general clinical manifestations of cannabis (6)

A

intoxication characterized by

  • tachycardia
  • conjunctival vascular engorgement
  • dry mouth
  • altered sensorium
  • increased appetite
  • muscle relaxation
69
Q

Name neuropsychiatric effects of cannabis (6)

A
  • altered mood, perception, and thought content:
    • increased sense of well-being
    • euphoria/laughter
  • impaired cognitive and psychomotor performance:
    • reduced reaction time
    • impaired attention, concentration, and short-term memory.
    • It may also impair motor coordination required to complete complex tasks requiring divided attention.
    • Notably, psychomotor impairments may interfere with one’s ability to operate heavy machinery such as automobiles
70
Q

Describe: Inhaled marijuana (3)

A
  • onset of psychoactive effects occurs rapidly with peak effects felt 15-30 min after intake
  • and lasting up to 4 h
  • acute exacerbation in patients with asthma may be a complication with inhalation
71
Q

Describe: Ingested marijuana (3)

A
  • following oral ingestion, psychotrophic effects set in with a delay of 30-90 min,
  • reach their maximum after 2-3 h
  • last for about 4-12 h depending on dose
72
Q

High doses of cannabis can cause what? (4)

A
  • depersonalization
  • paranoia
  • anxiety
  • and may trigger psychosis and schizophrenia if predisposed
73
Q

Chronic use of cannabis is associated with what? (1)

A

tolerance and an apathetic, amotivational state

74
Q

Describe assessment of cannabis (1)

A
  • standard urine drug screens
75
Q

Cessation of cannabis following heavy use produces what? (4)

A

a significant withdrawal syndrome:

  • irritability
  • anxiety
  • insomnia
  • decreased food intake
76
Q

Name types of hallucinogens: 5-HT2A agonists (4)

A
  • LSD
  • mescaline (peyote)
  • psilocybin mushrooms
  • DMT (ayahuasca)
77
Q

Name types of hallucinogens: NMDA antagonists (2)

A
  • PCP
  • Ketamine
78
Q

Name types of hallucinogens: κ-opioid agonists (2)

A
  • salvia divinorum
  • ibogaine
79
Q

Name effects of 5-HT2A agonists (6)

A

intoxication characterized by

  • tachycardia
  • HTN
  • mydriasis
  • tremor
  • hyperpyrexia
  • and a variety of perceptual, mood and cognitive changes (rarely, if ever, deadly; treat vitals symptomatically)
80
Q

Name psychological effects of high doses of hallucinogens (4)

A
  • depersonalization
  • derealization
  • paranoia
  • anxiety (panic with agoraphobia)
81
Q

Describe tolerance of hallucinogens (2)

A
  • tolerance develops rapidly (hours-days) to most hallucinogens so physical dependency is virtually impossible
  • although psychological dependency and problematic usage patterns can still occur
82
Q

Describe withdrawal syndrome of hallucinogens (1)

A
  • no specific withdrawal syndrome characterized
83
Q

Describe the management of acute intoxication of hallucinogens (5)

A
  • support
  • reassurance
  • diminished stimulation
  • benzodiazepines or high potency antipsychotics seldom required (if used, use small doses)
  • minimize use of restraints
84
Q

Describe long term adverse effects of hallucinogens (1)

A

controversial role in triggering psychiatric disorders, particularly mood or psychosis, thought to be chiefly in individuals with genetic or other risk factors

85
Q

Describe: Hallucinogen Persisting Perception Disorder (1)

A
  • DSM-5 diagnosis characterized by long lasting, spontaneous, intermittent recurrences of visual perceptual changes reminiscent of those experienced with hallucinogen exposure
86
Q

Name different names of MDMA (5)

A
  • “Ecstasy”
  • “X”
  • “E”
  • “M”
  • “Molly”
87
Q

Describe mechanism: MDMA (“Ecstasy”, “X”, “E”, “M”, “Molly”) (1)

A

Acts on serotonergic and dopaminergic pathways, properties of a hallucinogen and stimulant

88
Q

Describe effect: MDMA (“Ecstasy”, “X”, “E”, “M”, “Molly”) (3)

A
  • Enhanced sensorium
  • feelings of well-being
  • empathy
89
Q

Describe adverse effect: MDMA (“Ecstasy”, “X”, “E”, “M”, “Molly”) (12)

A
  • Diaphoresis
  • tachycardia
  • fatigue
  • muscle spasms (especially jaw clenching)
  • ataxia
  • hyperthermia
  • arrhythmias
  • DIC
  • rhabdomyolysis
  • renal failure
  • seizures
  • death
90
Q

Describe mechanism: Gamma Hydroxybutyrate (GHB, “G”, “Liquid Ectasy”) (1)

A

Biphasic dopamine response (inhibition then release) and releases opiate-like substance

91
Q

Describe effect: Gamma Hydroxybutyrate (GHB, “G”, “Liquid Ectasy”) (3)

A
  • Euphoric effects
  • increased aggression
  • impaired judgment
92
Q

Describe adverse effect: Gamma Hydroxybutyrate (GHB, “G”, “Liquid Ectasy”) (6)

A
  • Diaphoresis
  • tachycardia
  • fatigue
  • muscle spasms (especially jaw clenching)
  • ataxia
  • severe withdrawal from abrupt cessation of high doses: tremor, seizures, psychosis
93
Q

Describe mechanism: Flunitrazepam (Rohypnol®, “Roofies”, “Rope”, “The Forget Pill”) (2)

A
  • Potent benzodiazepine
  • rapid oral absorption
94
Q

Describe effect: Flunitrazepam (Rohypnol®, “Roofies”, “Rope”, “The Forget Pill”) (4)

A
  • Sedation
  • psychomotor impairment
  • amnestic effects
  • decreased sexual inhibition
95
Q

Describe adverse effects: Flunitrazepam (Rohypnol®, “Roofies”, “Rope”, “The Forget Pill”) (1)

A

CNS depression with EtOH

96
Q

Describe mechanism: Ketamine (“Special K”, “Kit-Kat”) (2)

A
  • NMDA receptor antagonist
  • rapid-acting general anesthetic used in pediatrics and by veterinarians
97
Q

Describe effect: Ketamine (“Special K”, “Kit-Kat”) (3)

A
  • “Dissociative” state, profound amnesia/ analgesia
  • hallucinations and
  • sympathomimetic effects
98
Q

Describe adverse effect: Ketamine (“Special K”, “Kit-Kat”) (3)

A
  • Psychological distress
  • accidents due to intensity of experience and lack of bodily control
  • In overdose: decreased LOC, respiratory depression, catatonia
99
Q

Describe mechanism: Methamphetamine (“speed”, “meth”, “chalk”, “ice”, “crystal”) (1)

A

Amphetamine stimulant, induces norepinephrine, dopamine, and serotonin release

100
Q

Describe effect: Methamphetamine (“speed”, “meth”, “chalk”, “ice”, “crystal”) (7)

A
  • Rush begins in min
  • effects last 6-8 h
  • increased activity
  • decreased appetite
  • general sense of well-being
  • tolerance occurs quickly
  • users often binge and crash
101
Q

Describe adverse effect: Methamphetamine (“speed”, “meth”, “chalk”, “ice”, “crystal”) (15)

A
  • Short-term use:
    • high agitation
    • rage
    • violent behaviour
    • occasionally hyperthermia and convulsions
  • Long-term use:
    • addiction
    • anxiety
    • confusion
    • insomnia
    • paranoia
    • auditory and tactile hallucinations (especially formication)
    • delusions
    • mood disturbance
    • suicidal and homicidal thoughts
    • stroke
  • May be contaminated with lead, and IV users may present with acute lead poisoning
102
Q

Describe mechanism: Phencyclidine (“PCP”, “angel dust”) (2)

A
  • Not understood
  • used by veterinarians to immobilize large animals
103
Q

Describe effects: Phencyclidine (“PCP”, “angel dust”) (3)

A
  • Amnestic
  • euphoric
  • hallucinatory state
104
Q

Describe adverse effects: Phencyclidine (“PCP”, “angel dust”) (8)

A
  • Horizontal/vertical nystagmus
  • myoclonus
  • ataxia
  • autonomic instability (treat with diazepam IV)
  • prolonged agitated psychosis (treat with haloperidol)
  • high risk for suicide
  • violence towards others
  • High dose can cause coma

Stage toxico (9 decks)

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