Substance-related disorders Flashcards
Withdrawal
The development of a substance-specific syndrome due to cessation of substance use that has been heavy or prolonged
Tolerance
The need for increased amounts of the substance to achieve the desired affect or diminished effect if using the same amount of the substance
Withdrawal symptoms of a drug are usually __________ its intoxication effects.
For example, alcohol is sedating, but alcohol withdrawal can lead to _________ and __________
Opposite to
excitation, seizures
____________ is the most commonly abused substance in the US
Alcohol
Most adults will show some signs of intoxication with a BAL > ____ and obvious signs with BAL > ____mg/dL
100
150
Ethanol, along with methanol and ethylene glycol, can be a cause of metabolic acidosis with increased anion gap
What are the effects of alcohol in the CNS?
Alcohol activates GABA and serotonin receptors, and inhibits glutamate receptors and voltage-gated Ca channels.
GABA receptors are inhibitory and glutamate receptors are excitatory, so alcohol is a potent CNS depressant.
Delirium tremens has a _____% mortality rate, but only occurs in ____% of patients that are hospitalized for EtOH withdrawal
15-20%
5%
What are confabulations?
Memories of events that never occurred, sometimes referred to as false memories.
Associated with Korsakoff psychosis
Patients are unaware that they are “making these up”
In a person with alcohol withdrawal syndrome, how would you treat someone with seizures?
Treat with benzodiazepines
(These stimulate GABA receptors and are an anticonvulsant and muscle relaxant)
If a patient in alcohol withdrawal experiences Delirium Tremens, how long after the last drink does this usually occur?
Usually begins 48-72 hours after the last drink; 90% of cases begin within 7 days.
What biomarkers are useful in detecting recent prolonged drinking or monitoring for relapse?
BAL
LFTs (AST and ALT)
CDT (carbohydrate-deficient transferrin)
GGT (gamma-glutamyl transpeptidase)
MCV (mean corpuscular volume)
AST:ALT ratio >/= 2 and elevated GGT suggest excessive alcohol use
What are the symptoms of Delirium Tremens?
seizures (usually generalized tonic clonic)
visual and tactile hallucinations
increased RR, HR and BP
How do you treat Delirium Tremens?
treatment includes anticonvulsants such as phenytoin (Dilantin) and sedatives such as benzodiazepines.
What is the effect of cocaine on the CNS?
Cocaine blocks dopamine reuptake from the synaptic cleft, causing a stimulant effect.
(dopamine plays a role in behavioral reinforcement; the “reward” system of the brain)
What affect does cocaine have on a person’s pupils?
Dilates them
Cocaine overdose can cause death secondary to what effects?
cardiac arrhythmias
respiratory depression
seizures
MI
stroke
What is the treatment for cocaine dependence?
There is no FDA-approved pharmacotherapy for cocaine dependence.
Psychological interventions (contingency management, group therapy, etc) are efficacious and are mainstay treatment
What are the symptoms of amphetamine abuse?
dilated pupils
increased libido
perspiration
respiratory depression
chest pain
Heavy use of amphetamines may cause amphetamine psychosis, a psychotic state that may mimic schozophrenia
What symptoms result from amphetamine overdose?
hyperthermia
dehydration
rhabdomyolysis, which –> renal failure
What is the treatment for amphetamine overdose?
Rehydrate
correct electrolyte imbalance
treat hyperthermia
Symptoms of amphetamine withdrawal
prolonged depression
occasionally, complications of their long half-life can cause psychosis
What are the symptoms of ketamine ingestion?
tachycardia
tachypnea
hallucinations
amnesia
What symptoms is pathognomonic for PCP intoxication?
rotary nystagmus
Tactile and visual hallucinations are found in both cocaine and PCP abuse
More than with other drugs, intoxication with PCP results in violence
What is a significant complication of barbituate withdrawal?
Death.
Off all the kinds of drug withdrawals, withdrawal from barbituates has the highest rate of mortality.
Symptoms of sedative intoxication are synergystic when combined with alcohol or opioids/narcotics.
Long-term sedative use may –> dependence and may cause depressive symptoms
Treatment of barbituate overdose
Activated charcoal and gastric lavage to prevent further gastrointestinal absorption (if drug was ingested in the prior 4-6 hours).
Alkalinize urine with sodium bicarbonate to promote renal excretion.
Treatment for benzodiazepine overdose.
Activated charcoal and gastric lavage to prevent further gastrointestinal absorption (if ingestion was in the prior 4-6 hours)
Flumazenil
Flumazenil.
(use, mechanism)
Very short-acting benzodiazepine (BDZ) antagonist.
used for treating BDZ overdose.
**Use with caution when treating overdose, as it may precipitate seizures
In general, withdrawal from drugs that are sedating is life-threatening, while withdrawal from drugs that are stimulating is not.
The signs and symptoms of withdrawal from sedatives/hypnotics are similar to what other drug?
What symptom can occur that is life-threatening?
EtOH
Tonic-clonic seizures can occur and can be life-threatening
What is the treatment of choice for opiate overdose?
Naloxone
What is the treatment for sedatives/hypnotics?
Benzodiazepine taper
Carbamazepine or valproic acid taper may be used for seizure prevention
Name 9 examples of opioids
heroin
methadone
oxycodone (OxyContin)
Percocet (oxycodone/acetaminophen)
Vicodin (hydrocodone/acetaminophen)
codeine
dextromethorphan (in cough syrup)
morphine
meperidine (Demerol)
Which are the opioid receptors?
mu, kappa, delta
What is the most common cause of death from street heroin usage?
Infection secondary to needle sharing
What are the symptoms of opioid intoxication?
drowsiness/sedation
nausea
vomiting
decreased gastric motility/constipation
decreased pain perception
constricted pupils
respiratory depression (which can kill you)
What is the classic triad of opioid overdose?
Respiratory depression
Altered mental status
Miosis
How do you treat an opioid overdose?
Administration of naloxone or naltrexone (opioid antagonists) will improve respiratory depression, but may precipitate severe withdrawal in an opioid-dependent person
Ensure adequate airway, breathing, and circulation. Ventilatory support may be required.
What is another name for Meperidine? How does it differ from other opioids regarding symptoms?
Demerol
Meperidine dilates pupils, whereas other opioids cause pupils to constrict (miosis)
Is opioid withdrawal life threatening?
No, but it does cause severe symptoms:
dysphoria/anxiety
insomnia
lacrimation
rhinorrhea
yawning
weakness
sweating
piloerection
nausea/vomiting
fever
dilated pupils
abdominal cramps
HTN
tachycardia
Treatment of opioid withdrawal
Symptom-targeted:
- clonidine (for autonomic symptoms, alpha2 agonist)
- NSAIDS for pain
- dicyclomine for abdominal cramps
Severe symptoms: Detox with buprenorphine or methadone
**Monitor degree of withdrawal with COWS (clinical opioid withdrawal scale)
**Use objective measures to assess withdrawal severity (pupil size, tremors, pulse)
What is Suboxone?
Pertial opioid agonist used to treat opioid dependence.
Contains buprenorphine and naloxone.
Rapid recovery of consciousness following the administration of IV naloxone is consistent with opioid overdose.
Treatment for hallucinogen intoxication
Hallucinogens do not cause physiological dependence or withdrawal (though they may cause psychological dependence)
Tx consists of monitoring for dangerous behavior and rassuring pt.
Use benzodiazepines or antipsychotics if necessary for agitated pts.
What is an LSD flashback?
a recurrence of symptoms mimicking a prior LSD trip that occurs spontaneously and lasts for minutes to hours.
What is Dronabinol?
a pill form of THC (tetrahydrocannabinol) that is FDA-approved for certain indications
How do inhalants affect the CNS
They act as CNS depressants
Can you overdose on inhalants?
Yes. May be be fatal secondary to respiratory depression or cardiac arrythmias.
Long-term use can cause permanent damage to CNS (eg, dementia, impaired memory, epilepsy, reduced IQ), PNS, liver, kidney, heart and muscle.
How do you treat inhalant overdose?
Monitor airway, breathing and circulation.
Identify solvent used; may require chelation therapy (ie, leaded gasoline)
Describe overdose with caffeine
>1g: may tinnitus, severe agitation, visual light flashes, cardiac arrythmias
>10g: death may occur secondary to seizures and respiratory failure
Tx: supportive and symptomatic
