Substance-Related Disorders Flashcards
A 19 yo man is brought to ER:
+dilated pupils +BP 175/105 +muscle twitching +yawning +runny nose
From which of the following drugs is this man most likely withdrawing?
a. Heroin
b. Alcohol
c. PCP
d. Benzo
e. Cocaine
a. Heroin
Untreated (heroin or morphine), sx resolve in 7-10 days. With longer-acting opiates (methadone), onset of symptoms is delayed for 1-3 days after last dose; peak sx do not occur until 3rd to 8th day, and sx may last for several weeks.
Although v distressing, opiate withdrawal is not life threatening.
50 yo man is brought to ER. His respirations are shallow and infrequent, pupils are constricted, and he is stuporous. He was noted to. have suffered a grand mal seizure in the ambulance. On which of the following drugs is this man most likely to have overdosed? What is the intervention?
a. Cocaine
b. LSD
c. Opiate
d. PCP
e. MDMA (Ecstasy)
c. Opiate
Severe opiate intoxication is associated with respiratory depression, stupor or coma, and sometimes pulmonary edema. Less severe intoxication is associated with slurred speech, drowsiness, and impaired memory or attention.
Early on, the pupils are constricted, but they dilate if the patient becomes anoxic because of the respiratory depression.
Intervention = IV naloxone
22 yo man used LSD 6 or 7 hours ago. He is agitated, confused, and hallucinating. How much longer will. intoxication with this substance last?
a. 1-6 hrs
b. 8-12 hrs
c. 14-18 hrs
d. 20-24 hrs
e. 26-30 hrs
a. 1-6 hrs
Most cases of intoxication with a hallucinogen are over within 8 to 12 hours, but prolonged drug-induced psychoses may occur, esp with phencyclidine (PCP), from which the psychosis may last several weeks.
How long do the following substances show + result on urine test:
Marijuana
PCP
Benzos
Marijuana = 3 days to 4 weeks depending on dose
PCP = 8 days
Benzos = 3 days
A 35 yo man stumbles into the ER. His pulse is 100 bpm, his BP is 170/95, and he is diaphoretic. He is tremulous and has difficulty relating a hx. He does admit to insomnia the past two nights and sees spiders walking on the walls. He has been a drinker since age 19, but has not had a drink in 3 days. Which of the following is the most likely dx? Initial tx?
Alcohol withdrawal delirium (DT)
When alcohol use has been heavy and prolonged, withdrawal phenomena start within 8 hrs of cessation of drinking.
Tx: Benzodiazepines
(diazepam and chloridiazepoxide = Librium)
Elderly pts or patients with severe liver damage may better tolerate intermediate acting benzos such as lorazepam and oxazepam.
A 26 yo woman presents with 1 mo hx of severe anxiety. She states that 1 month ago, she was a “normal, laid-back person.” Since that time, she rates her anxiety as an 8 on a scale of 1 to 10. She notes she is afraid to leave the house unless she checks that the door is locked at least 5 times. Which of the following would most likely cause these kinds of sx?
a. Alcohol intoxication
b. Amphetamine withdrawal
c. Caffeine withdrawal
d. Cocaine intoxication
e. Heroin intoxication
d. Cocaine intoxication
37 yo woman is admitted to inpatient tx program for withdrawal from heroin. 18 hours after her last injection of heroin, she becomes hypertensive, irritable, and restless. She also has nausea, vomiting, and diarrhea. Which. medication would be. best to treat some of the symptoms of opioid withdrawal?
a. Chlordiazepoxide
b. Haloperidol
c. Paroxetine
d. Phenobarbital
e. Clonidine
e. Clonidine
Clonidine, an alpha-2-adrenergic receptor agonist, is used to suppress some of the symptoms of mild opioid withdrawal. Clonidine is given orally, starting with doses of 0.1 to 0.3 mg three or four times a day.
Agitated and v combative young man at ER. Reacts with rage and tries to hit anyone who approaches him. When it is finally safe to approach him, resident notices very prominent vertical nystagmus. Shortly after, pt has a generalized seizure. Which substance abused?
a. Amphetamine
b. PCP
c. Cocaine
d. Meperidine
e. LSD
b. PCP
Intoxicated patients are often agitated, enraged, aggressive, and scared. B/c of their exaggerated and distorted sensory input, they may have. unpredictable and extreme rxns to environmental stimuli. Nystagmus and signs of neuronal hyper-excitability (from increased DTR to status epilepticus) and HTN are typical findings
65 yo man witnessed having a seizure on the sidewalk. Postictally, the pt was noted to be agitated and disoriented. Vital signs include: BP 165/105, pulse 120 bpm. Most likely dx?
a. Cocaine intoxication
b. Alcohol withdrawal
c. PCP withdrawal
d. Cocaine withdrawal
e. Alcohol intoxication
Treatment?
b. Alcohol withdrawal
Alcohol withdrawal delirum is a medical emergency, since untreated, as many as 20% of pts will die, usually as a result of a concurrent medical illness such as pneumonia, hepatic disease, or heart failure. Sx of this delirium include: autonomic hyperactivity, hallucinations, and fluctuating activity levels, ranging from acute agitation to lethargy.
Tx: chlordiazepoxide (oral) or lorazepam (IV or IM)
MOA of amphetamines vs cocaine
Amphetamines: Inc. release of dopamine and norepi in the synaptic cleft
Cocaine: inhibition of catecholamine reuptake
25 yo woman is dropped on doorstep of local emergency room by two men who immediately leave by car. She is agitated and anxious, and she keeps brushing her arms and legs “to get rid of the bugs.” She clutches at her chest, moaning in pain. Her pupils are wide, and her BP is elevated. Which of the following substances is she most likely. using?
a. Alcohol
b. Heroin
c. Alprazolam
d. LSD
e. Cocaine
e. Cocaine
Cocaine intoxication is characterized by euphoria but suspiciousness, agitation, anxiety, and hyperactivity are also typical presenting sx.
Among the most serious acute medical complications associated with high doses of cocaine are: coronary spasms, MIs, ICH, ischemic cerebral infarcts, and seizures.
- yo man comes for tx of his heroin addiction. He has been an addict for over 6 years, and has been injecting heroin for 5 of those 6 years. Three previous attempts at quitting have all been unsuccessful. Which of the following meds is the best option for him?
a. Methadone
b. Levomethadyl
c. Buprenorphine
d. Naloxone
e. Naltrexone
a. Methadone
This pt is likely to do better with methadone as he attempts to get rid of his heroin addiction. Methadone has the advantage that it frees addicts from needing to inject opioid substances, reducing the chance of HIV infection. It produces less drowsiness and less euphoria, so addicts can be functional and thus become employed
22 yo man is brought to ER after his friends noted he became agitated was “acting crazy” at a party. The pt was belligerent and agitated in the ER as well. On physical exam, vertical nystagmus, ataxia, and dysarthria were noted. THe pt has no previous mental or physical disorders. Which of the following is the best treatment option to give immediately?
a. Continuous NG suction
b. Minimization of sensory inputs
c. Urinary acidification
d. Naltrexone IM
b. Minimization of sensory inputs
16 yo man with long record of arrests for breaking and entering, assault and. battery, and drug possession is found dead in his room with a plastic bag on his head. For several months, he had been experiencing headaches, termors, muscle weakness, unsteady gait, and tingling sensations in. his hands and feet. These sx (and the manner in which the boy died) suggest that he was addicted to which of the following?
a. PCP
b. Cocaine
c. Meth
d. Inhalant
e. Heroin
d. Inhalant
Associated w: hearing loss, peripheral neuritis, paresthesias, cerebellar signs, motor impairment
muscle weakness is caused by rhabdomyolysis
A young female is brought to the ED after being found in a coma, next to an empty bottle of Vicodin, unresponsive. Administration of which substance would be most effective in the mgmt of this pt?
a. Naloxone
b. Flumazenil
c. Naltrexone
d. Phentolamine
e. Buprenorphine
A. Naloxone for emergency OD
Heroin and other opioid drug users
(Naltrexone and buprenorphine used primarily in mgmt of alcohol use disorder and opioid dependence).
