Substance Use disorders: Cocaine, Amphetamine, PCP, and Sedative Hypnotics

Question 1

Cocaine Mechanism of Action

Answer 1

inhibits DA reuptake from the synaptic cleft –> stimulant effect

*plays a role in behavioral reinforcement (via reward system)

Question 2

Hallucination in cocaine intoxication are especially significant if

Answer 2

tactile hallucinations

these types of hallucinations are rare in other substance intoxications and other psychiatric disorders, but are more common in cocaine and amphetamine intoxication.

Question 3

Cocaine overdose can cause death secondary to

Answer 3

Cardiac arrhythmia
MI
Seizure
Respiratory Depression

Question 4

What is the mechanism for cocaine causing MI?

Answer 4

strong vasoconstrictive effect on the coronary arteries can lead to ischemia that progresses to MI

Question 5

Treatment of cocaine intoxication

Answer 5

For mild to moderate agitation/anxiety: Benzodiazepines
For severe agitation or psychosis: Antipsychotic (haloperidol)
Symptomatic support: control HTN/arrhythmia
Temperature >102F is a MEDICAL EMERGENCY: ice bath, cooling blankets, etc.

Question 6

Pupils in cocaine intoxication

Answer 6

Dilated (mydriasis)

Question 7

Pupils in cocaine withdrawal

Answer 7

Constricted (miosis)

Question 8

Is abrupt withdrawal from cocaine life-threatening?

Answer 8

No, generally, withdrawal from stimulants is not dangerous.

Question 9

Cocaine withdrawal symptoms

Answer 9

Post-intoxication depression, hypersomnolence, vivid dreams, constricted pupils, psychomotor disturbance

Question 10

Mild to moderate cocaine use will have withdrawal symptoms that resolve within

Answer 10

18 hours

Question 11

Heavy, chronic cocaine use will have withdrawal symptoms that may last

Answer 11

may last for weeks, but usually peak in several days

Question 12

Treatment for Cocaine withdrawal

Answer 12

supportive care, managing symptoms

Severe psychotic symptoms may warrant hospitalization

Question 13

Mainstay of treatment for cocaine dependence

Answer 13

psychological interventions: contingency management, group therapy, other psychotherapies as needed

Question 14

2 major categories of amphetamines

Answer 14

Classic Amphetamines
Substituted Amphetamines ("designer"; "club drugs")

Question 15

Examples of Classic Amphetamines

Answer 15

Dextroamphetamine
Methylphenidate (ritalin)
Methamphetamine (ice, speed, crystal meth, crank)

Question 16

Classic Amphetamine mechanism of action

Answer 16

inhibits reuptake and promotes release of DA and NE from nerve endings —> stimulant effects

Question 17

Classic Amphetamines used in treatment of…

Answer 17

Narcolepsy, ADHD, Depressive Disorders (usually severe)

Question 18

Methamphetamines can be made by using….

Answer 18

over the counter medications, most commonly pseudoephedrine

Question 19

Examples of substituted amphetamines

Answer 19

MDMA (ecstasy)
MDEA (eve)

*Think dance clubs and raves (likely will have these in an exam question on these drugs)

Question 20

Substituted amphetamines mechanism of action

Answer 20

Release DA, NE, and Serotonin (5HT) from nerve endings

Results in stimulant and hallucinogenic effects

Question 21

What should you be worried about if a substituted amphetamine is taken with an SSRI?

Answer 21

Serotonin Syndrome

Question 22

Symptoms of Amphetamine use

Answer 22

Mydriasis
Increased libido
perspiration
respiratory depression
chest pain

Question 23

Chronic Amphetamine use can lead to…

Answer 23

acne

accelerated tooth decay –> “meth mouth”

Question 24

Amphetamine Overdose

Answer 24

hyperthermia
dehydration
Rhabdomyolisis –>Renal failure

Question 25

Amphetamine withdrawal

Answer 25

Can lead to a prolonged depression Complications of long half-life of amphetamines can cause psychosis, especially with heavy use

Question 26

Treatment for amphetamine intoxication/OD:

Answer 26

Rehydrate!!!! Correct Electrolytes Treatment of Hyperthermia

Question 27

Phencyclidine (PCP, "angel dust") mechanism of action

Answer 27

antagonizes NMDA glutamate receptors and activates dopaminergic neurons--> can cause stimulant or depressive effects (varies with dose and from person to person)---> can cause dissociative and hallucinogenic effects

Question 28

PCP smoked as "wet" means ___________, whereas smoked as a "joint" means ___________.

Answer 28

``` Wet = sprinkled on cigarette Joint = sprinkled on marijuana ```

Question 29

Ketamine ("Special K") mechanism of action

Answer 29

Same as PCP, but less potent Odorless and tasteless, so it is sometimes used as a date-rape drug

Question 30

Ketamine can cause these symptoms...

Answer 30

tachycardia tachypnea hallucinations amnesia

Question 31

PCP intoxication symptoms:

Answer 31

Acronym RED DANES ``` Rage Erythema Dilated pupils Delusions/hallucinations Amnesia Nystagmus Excitation Skin dryness ```

Question 32

PCP overdose can cause

Answer 32

Seizures, coma, death

Question 33

Rotatory nystagmus is pathognomonic for....

Answer 33

PCP intoxication

Question 34

Tactile and visual hallucinations are found in ....

Answer 34

both cocaine and PCP intoxication

Question 35

More than other drugs, this drug results in violence

Answer 35

PCP

Question 36

PCP intoxication treatment

Answer 36

Monitor vitals, temperature, and electrolytes Minimize sensory stimulation * Benzo (lorazepam) for agitation, anxiety, spasms, and seizures * Antipsychotic (haloperidol) for severe agitation and psychotic symptoms

Question 37

Withdrawal from PCP

Answer 37

HAHA GOT YOU!!!, ok maybe I didn't There is no withdrawal syndrome for PCP HOWEVER, "flashbacks" of intoxication symptoms can happen due to release of the drug from lipid stores

Question 38

Sedative-hypnotics include

Answer 38

Benzodiazepines and Barbiturates (the major ones) | Also: zolpidem, zaleplon, GHB, meprobamate

Question 39

Benzos are commonly used to treat...

Answer 39

anxiety disorders

Question 40

Benzo mechanism of action

Answer 40

potentiate the effects of GABA by increasing the FREQUENCY of Chloride Channel opening

Question 41

Barbiturates are commonly used for....

Answer 41

treatment of epilepsy and as anesthetics

Question 42

Barbiturate mechanism of action

Answer 42

potentiate the effects of GABA by increasing the DURATION of Chloride Channel opening **At high dose act as a direct GABA agonists and have lower margin of safety relative to Benzos

Question 43

Sedative-hypnotic intoxication symptoms:

Answer 43

``` Drowsiness and Confusion Hypotension slurred speech incoordination and ataxia mood lability impaired judgement nystagmus respiratory depression ``` OD can result in respiratory depression, coma, and death

Question 44

Sedative intoxication symptoms are synergistic when combined with....

Answer 44

other sedatives, alcohol, and opioids

Question 45

Long-term use of sedatives can lead to....

Answer 45

dependence and depressive symptoms

Question 46

General Treatment for sedative intoxication

Answer 46

Maintain Airway, breathing, and Circulation | Monitor Vital Signs

Question 47

If sedative drug was ingested within the last 4-6 hours you can consider....

Answer 47

Activate charcoal and gastric lavage to prevent further GI absorption of the drug

Question 48

Additional Treatment applicable only to Barbiturate intoxication:

Answer 48

sodium-bicarbonate to alkalinize the urine in order to increase renal excretion

Question 49

Benzodiazepine OD can be treated with

Answer 49

Flumazenil

Question 50

Flumazenil mechanism

Answer 50

very short acting Benzodiazepine antagonist *use with caution, may precipitate seizures

Question 51

Abrupt abstinence from sedatives, especially from benzos and bariturates, after chronic use can....

Answer 51

Can be life-threatening *Signs and symptoms of withdrawal are the same as those for alcohol withdrawal

Question 52

GHB (gamma-hydroxybutyrate) effects

Answer 52

Dose specific CNS depressant effects: memory loss respiratory depress coma *common use as date-rape drug

Question 53

Withdrawal from which drug carries the highest mortality rate?

Answer 53

Barbiturates

Question 54

Treatment of Choice for opiate withdrawal

Answer 54

Naloxone

Question 55

Treatment for Sedative withdrawal

Answer 55

Benzodiazepine taper *Carbamezapine or valproate taper can be use to prevent seizures