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Psychiatry > Substance Use disorders: Cocaine, Amphetamine, PCP, and Sedative Hypnotics > Flashcards

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

1
Q

Cocaine Mechanism of Action

A

inhibits DA reuptake from the synaptic cleft –> stimulant effect

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

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2
Q

Hallucination in cocaine intoxication are especially significant if

A

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.

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3
Q

Cocaine overdose can cause death secondary to

A

Cardiac arrhythmia
MI
Seizure
Respiratory Depression

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4
Q

What is the mechanism for cocaine causing MI?

A

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

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5
Q

Treatment of cocaine intoxication

A

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.

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6
Q

Pupils in cocaine intoxication

A

Dilated (mydriasis)

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7
Q

Pupils in cocaine withdrawal

A

Constricted (miosis)

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8
Q

Is abrupt withdrawal from cocaine life-threatening?

A

No, generally, withdrawal from stimulants is not dangerous.

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9
Q

Cocaine withdrawal symptoms

A

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

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10
Q

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

A

18 hours

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11
Q

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

A

may last for weeks, but usually peak in several days

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12
Q

Treatment for Cocaine withdrawal

A

supportive care, managing symptoms

Severe psychotic symptoms may warrant hospitalization

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13
Q

Mainstay of treatment for cocaine dependence

A

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

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14
Q

2 major categories of amphetamines

A 
Classic Amphetamines
Substituted Amphetamines ("designer"; "club drugs")
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15
Q

Examples of Classic Amphetamines

A

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

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16
Q

Classic Amphetamine mechanism of action

A

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

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17
Q

Classic Amphetamines used in treatment of…

A

Narcolepsy, ADHD, Depressive Disorders (usually severe)

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18
Q

Methamphetamines can be made by using….

A

over the counter medications, most commonly pseudoephedrine

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19
Q

Examples of substituted amphetamines

A

MDMA (ecstasy)
MDEA (eve)

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

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20
Q

Substituted amphetamines mechanism of action

A

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

Results in stimulant and hallucinogenic effects

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21
Q

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

A

Serotonin Syndrome

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22
Q

Symptoms of Amphetamine use

A 
Mydriasis
Increased libido
perspiration
respiratory depression
chest pain
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23
Q

Chronic Amphetamine use can lead to…

A

acne

accelerated tooth decay –> “meth mouth”

24
Q

Amphetamine Overdose

A

hyperthermia
dehydration
Rhabdomyolisis –>Renal failure

25
Q

Amphetamine withdrawal

A

Can lead to a prolonged depression

Complications of long half-life of amphetamines can cause psychosis, especially with heavy use

26
Q

Treatment for amphetamine intoxication/OD:

A

Rehydrate!!!!
Correct Electrolytes
Treatment of Hyperthermia

27
Q

Phencyclidine (PCP, “angel dust”) mechanism of action

A

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

28
Q

PCP smoked as “wet” means ___________, whereas smoked as a “joint” means ___________.

A 
Wet = sprinkled on cigarette
Joint = sprinkled on marijuana
29
Q

Ketamine (“Special K”) mechanism of action

A

Same as PCP, but less potent

Odorless and tasteless, so it is sometimes used as a date-rape drug

30
Q

Ketamine can cause these symptoms…

A

tachycardia
tachypnea
hallucinations
amnesia

31
Q

PCP intoxication symptoms:

A

Acronym RED DANES

Rage
Erythema
Dilated pupils
Delusions/hallucinations
Amnesia
Nystagmus
Excitation
Skin dryness
32
Q

PCP overdose can cause

A

Seizures, coma, death

33
Q

Rotatory nystagmus is pathognomonic for….

A

PCP intoxication

34
Q

Tactile and visual hallucinations are found in ….

A

both cocaine and PCP intoxication

35
Q

More than other drugs, this drug results in violence

A

PCP

36
Q

PCP intoxication treatment

A

Monitor vitals, temperature, and electrolytes
Minimize sensory stimulation

  • Benzo (lorazepam) for agitation, anxiety, spasms, and seizures
  • Antipsychotic (haloperidol) for severe agitation and psychotic symptoms
37
Q

Withdrawal from PCP

A

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

38
Q

Sedative-hypnotics include

A

Benzodiazepines and Barbiturates (the major ones)

Also: zolpidem, zaleplon, GHB, meprobamate

39
Q

Benzos are commonly used to treat…

A

anxiety disorders

40
Q

Benzo mechanism of action

A

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

41
Q

Barbiturates are commonly used for….

A

treatment of epilepsy and as anesthetics

42
Q

Barbiturate mechanism of action

A

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

43
Q

Sedative-hypnotic intoxication symptoms:

A 
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

44
Q

Sedative intoxication symptoms are synergistic when combined with….

A

other sedatives, alcohol, and opioids

45
Q

Long-term use of sedatives can lead to….

A

dependence and depressive symptoms

46
Q

General Treatment for sedative intoxication

A

Maintain Airway, breathing, and Circulation

Monitor Vital Signs

47
Q

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

A

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

48
Q

Additional Treatment applicable only to Barbiturate intoxication:

A

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

49
Q

Benzodiazepine OD can be treated with

A

Flumazenil

50
Q

Flumazenil mechanism

A

very short acting Benzodiazepine antagonist

*use with caution, may precipitate seizures

51
Q

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

A

Can be life-threatening

*Signs and symptoms of withdrawal are the same as those for alcohol withdrawal

52
Q

GHB (gamma-hydroxybutyrate) effects

A

Dose specific CNS depressant effects:
memory loss
respiratory depress
coma

*common use as date-rape drug

53
Q

Withdrawal from which drug carries the highest mortality rate?

A

Barbiturates

54
Q

Treatment of Choice for opiate withdrawal

A

Naloxone

55
Q

Treatment for Sedative withdrawal

A

Benzodiazepine taper

*Carbamezapine or valproate taper can be use to prevent seizures

Psychiatry (6 decks)

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