SUD 14% Flashcards
tx of alcohol intoxication
Thiamine, magnesium, multivitamin, dextrose (particularly if chronic alcoholism)
Benzodiazepines (if withdrawal)
define at-risk drinking (men vs women)
Continuous use of alcohol
- men: 4 drinks/day or 14 drinks/week
- women: 3 drinks/day or 7 drinks/week
define alcohol tolerance
need for increased amounts of alcohol; diminished effect with continued use of same amount
define 2 complications of alcohol intoxication
Wernicke’s TRIAD:
- confusion
- ataxia, ophthalmalgia
- thiamine deficiency ^^
Korsakoff: IRREVERSIBLE
anterograde and retrograde amnesia, aphasia, apraxia (difficulty with skilled movement), agnosia
si/sx of alcohol withdrawl
- sweating
- tachycardia
- increased hand tremor
- insomnia
- N/V
- hallucinations
- agitation
- anxiety
- seizure
list steps of alcohol withdrawal
uncomplicated
withdrawl sz
alcohol hallucinosis
DT
- uncomplicated (6-24h): increased CNS activity (tremors, anxiety, diaphoresis, palpitations, insomnia)
- withdrawal seizure (12-24h): MC tonic-clonic
- alcoholic hallucinosis (48h): hallucinations with normal vital signs
- delirium tremens (2-5d): delirium, hallucinations, agitations, abnormal vitals
differentiate b/w
- alcoholic hallucinosis
- delirium tremens
- alcoholic hallucinosis (48h): hallucinations with normal vital signs
- delirium tremens (2-5d): delirium, hallucinations, agitations, abnormal vitals
tx of acute alc withdrawal
- Benzos, Clonidine, Barbiturates, Anticonvulsants
- •IV fluids
- •Thiamine & Magnesium
- •Glucose
tx of chronic alc withdrawal
- Naltrexone
- Acamprosate
- Thiamine
Antabuse (punishes you for drinking)
lsit alc withdrawal meds
Disulfiram (Antabuse) - inhibits acetaldehyde dehydrogenase, aversive conditioning
Naltrexone - dec desire
Acamprosate - changes brain chemistry in a way that reduces anxiety, irritability, and restlessness associated with early sobriety
Topiramate
Gabapentin - dec desire
alc withdrawl sx & mgt
Time since last drink:
6 hrs
12-24 hrs
48 hrs
48-96 hrs
si/sx of Marijuana intox & withdrawal
Moderate dose:
- •euphoria, giddiness
- •dry mouth (cotton mouth)
- •conjunctival erythema
- •tachycardia, hypotension
High Dose: hallucinations, paranoia, delusions
Withdrawal:
- •irritable
- •insomnia & restless
- •diaphoresis
- •diarrhea
- •twitching
testing and tx of marijuana intoxication
Urine drug test can detect for 4-6 days and up to 50d in chronic users
Treatment: Symptomatic
tx of tobacco dependence
Nicotine Replacement
- Bupropion
- Varenicline (Chantix)
Urine drug test: can detect cannabis for ___-___days in occasional users and up to____ days in chronic users.
Urine drug test: can detect cannabis for 4-6 days in occasional users and up to 50 days in chronic users.
si/sx of marijuana
intox
withdrawal
Intoxication: Euphoria, anxiety, disinhibition, paranoid delusions, a perception of slowed time,
conjunctival injection, impaired judgment, social withdrawal, ↑ appetite, dry mouth, hallucinations
Withdrawal: Irritability, depression, insomnia, nausea, and anorexia.
- Most symptoms peak at 48 hours and last for 5-7 days.
tx of marijuanan OD
No specific treatment is required. Symptomatic treatment only
si/sx of PCP intoxication
Patient that is extremely aggressive and becomes enraged when sudden movements or loud sounds are made.
Belligerence, impulsiveness, fear, homicidality, psychosis, delirium, seizures, psychomotor agitation, vertical and horizontal nystagmus, tachycardia, ataxia
physical detachment, unusual strength, dilated pupils, body distortion
si/sx of LSD intox
Patient wants to hurt himself. They say that he has “been freaking out” and seeing things that are not there.
- visual hallucinations and synesthesias (seeing sound as color)
- marked anxiety or depression, delusions, pupillary dilation
- “bad trip” panic
- abnormal gait
- tremors
tx og LSD/PCP
antipsychotics (e.g., haloperidol)
benzodiazepines
LSD: talking down, supportive counseling
PCP: low stimulus environment
23-year-old male is brought into the ED by his friends at 1 a.m. They are afraid that he is going to hurt himself. They say that he has “been freaking out” and seeing things that are not there. At one point, he tried to ride a bike off the roof of a house. On exam, you see a young man who appears to be in a panic. His gait is abnormal, he has diffuse tremors and his pupils are dilated.
dx/tx
LSD intox
antipsychotics (e.g., haloperidol)
benzodiazepines
talking down, supportive counseling
24-year-old who was brought into the ED and has attempted to assault a nurse several times. He is extremely aggressive and becomes enraged when sudden movements or loud sounds are made. The patient is escorted to a dimly lit, quiet exam room where he becomes much calmer. On physical exam, the patient is agitated and has nystagmus. His blood pressure in the ED is 180/100 mmHg
dx/tx
PCP
antipsychotics (haloperidol)
benzodiazepines
low stimulus environemnt
si/sx of opioid intoxication / withdrawl
Constipation - no tolerance to this side effect
Respiratory depression - life-threatening
Pupillary constriction (pinpoint pupils)
Seizures (overdose is life-threatening)
withdrawal
- Anxiety, insomnia, anorexia, sweating, dilated pupils, piloerection (“cold turkey”),
- Fever, rhinorrhea, nausea, stomach cramps, diarrhea (“flulike” symptoms)
- Yawning
tx of opioid intox / withdrawl
naloxone
Symptomatic treatment
withdrawl:
- Clonidine: α2 agonist that decreases NE and sympathetic output making autonomic symptoms less intense
- Methadone (long-acting)
- Buprenorphine + naloxone (Suboxone): can precipitate withdrawal if given too soon (partial mu agonist)
- Zofran for nausea/vomiting
tx BZD intoxication / withdrawal
intoxication with flumazenil which is a competitive GABA antagonist.
withdrawal with long-acting benzo such as clonazepam w/ taper
si/sx od BZD intox / withdrawal
Intoxication: respiratory depression, hypotension, amnesia, ataxia, stupor/somnolence, coma, death.
Withdrawal: _rebound anxiety, seizures (life-_threatening) and tremor-most commonly found in short-acting benzos such as alprazolam.
35-year-old female who arrives at the ED with impaired memory, poor concentration, and extreme drowsiness. Pupils are not dilated on the exam and the patient is minimally responsive. Of greatest concern is the patient’s respiratory rate of 5/min
barbituate OD
Tx:
Intoxication: symptom management, support BP, assist respiration, intubation, and bemegride,
Withdrawal: long-acting benzodiazepines with taper
21-year-old male is brought into the ED by the police for an altercation. Last night, the patient was at a party and seemed much more active than usual according to his girlfriend. He punched another male at the party in the face claiming that he was hitting on his girlfriend. On exam, you see an agitated young male with dilated pupils, and his pulse is 128/min.
Dx//Tx
cocaine intox
Antipsychotics (haloperidol)
- Benzodiazepines
- Antihypertensives (labetalol - need alpha-1 blockade)
- Vitamin C - promotes excretion
Do not restrain patients - may result in rhabdomyolysis
tx of cocaine withdrawal
bupropion
bromocriptine
SSRIs for depression
si/sx of cocaine intox
↓ appetite
tachycardia
pupillary dilation
hypertension, angina
23-year-old female is brought into the ED by her friends as they are concerned about her behavior. She seems more energetic than usual and this has gone on well past the end of the rave. On exam, you see a young female in neon clothing, consumed with the colors of her outfit, and very affectionate towards you.
si/sx of intox
MDMA
Intoxication: hyperthermia and social closeness, “club drug,” hyponatremia
A young child from low socioeconomic background arrives in the ED with a headache, loss of appetite, rhinorrhea, injected sclera, dizziness, photophobia, or a cough
dx///tx
dx: inhalanat related disorders
tx: Antipsychotics (haloperidol) if severe aggression
si/sx of inhalant tox
Mild/moderate: euphoria, slurring speech, confused, hallucinations, watery eyes, impaired vision, rash
High dose: cardiopulm failure, liver, kidney, bone marrow suppression *all organ failure
PCP vs LSD??
Patient that is extremely aggressive and becomes enraged when sudden movements or loud sounds are made.
Patient wants to hurt himself. They say that he has “been freaking out” and seeing things that are not there.
1 - PCP
2- LSD
which SUD ODs present w/
mydriasis
miosis
mydriasis (dilation) - stimulant / hallucingins (PCP, LSD)
miosis (constriction) - opiod
A young child from low socioeconomic background arrives in the ED with a headache, loss of appetite, rhinorrhea, injected sclera, dizziness, photophobia, or a cough
inhalant related disorder
Antipsychotics (haloperidol) if severe aggression
watery eyes, impaired vision and cough makes you think??
inhalant
Wrenekies encephalopathy is caused by??
thiamine deficency (vit B1)
when tx AUD you must give IV ____ & ___ before glucose
thiamine & Mg
differentiated b/w opiod intoxication vs withdrawal
INTOX
- euphora
- •sedation & impaired memory
- •slurred speech
- •impaired social function
- •pupil constriction
- •respiratory depression
- •bradycardia & hypotension
- •N/V, flushing
WITHDRAWL
- lacrimation
- •HTN, tachycardia
- •pruritic
- •piloerections (goose bumps)
- •pupil dilation
- •flu-like symptoms
- •yawning
tx of OUD intox vs withdrawl
Intoxication:
- Naltrexone (1st line)
- Methadone,
- Buprenorphine
OD: Naloxone
Withdrawal:
- Methadone
- Clonidine
- LofexidineSuboxone
do not restrain due to rhabdo risk
stimulants
dilayed pupils and sniffles / nasal congestion
cocaine
tx withdrawal of cocaine
Bromocriptine
Bupropion
sympathomimetic toxodrone - how to tx HR??
NO BB - use CCB!
differentiate b/w amphetamine vs cocaine intox
cocaine - “sniffles”, perf septum, duration of high <2 hrs
Amplet - duration of high 4-6 hrs
excoration b/w toes is unique to what stimulate disorder?
amphetamines
methadone MOI
CI??
synthetic opioid acting on Mu - prvents euphjoria
QTc Prolongation
MOI of buprenorphine
partial Mu agonist
K antagonist
MOI of disulfram
accumlated acetylaldehydr in blood – produce adverse side effects of drinking
