Test #2 Illicit Substances / Cocaine ARTICLES - Rude man Flashcards

Things I highlighted whilst reading.

1
Q

There was a study that testing driving performance with drugs. Does exposure to cannabis alone affect driving performance?

A

in that study, no it did not.

but if you add alcohol to it, i definitely will.

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2
Q

What is the elimination half-life of cannabis for the occasional user? How about the chronic (no pun intended) user?

A

occasional user: approx. 56 hours

chronic user: approx. 28 hours

(however, it can be sequestered in adipose tissue, extending its half-life to approx. a week)

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3
Q

Complete elimination of a single dose of cannabis may require how much time?

A

30 days, as THC can remain in the body a long time after being smoked.

the metabolism of cannabinoids creates more than 20 metabolites, most with psychoactive properties.

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4
Q

How does marijuana effect the cardiovascular system? (2)

A

myocardial depression and tachycardia

try to avoid drugs that can increase heart rate - ketamine, pancuronium, atropine, and epi

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5
Q

What is the half-life of cocaine?

A

0.5 - 1.5 hours

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6
Q

How is cocaine metabolized?

A

plasma and liver cholinesterases

the metabolites are water soluble and are excreted in the urine

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7
Q

Cocaine is extracted from the leaves of what plant?

A

Erythroxylon coca

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8
Q

What is cocaine’s mechanism of action?

A

it interferes with the presynaptic uptake of sympathomimetic neurotransmitters (eg. norepi, serotonin, and dopamine)

(a powerful euphoria is produced d/t free catecholamines stimulating the sympathoadrenal axix and prolongation of dopaminergic activity in the limbic system and adrenal cortex.

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9
Q

What happens to the blood flow in areas like the brain and heart when taking cocaine?

A

they are compromised as these vessels vasoconstrict or vasospasm temporarily.

this may lead to irreversible brain damage, stroke, and myocardial infarction or depression.

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10
Q

What can high doses of cocaine do to the heart?

A

depress ventricular function and slow electrical conduction

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11
Q

________-resistant hypotension may be encountered with cocaine use. However, it appears that low doses of _____________, titrated to effect, usually restore blood pressure

A

ephedrine-resistant

phenylephrine

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12
Q

Beta-blockers are contraindicated with cocaine use. Why?

A

because of the potential for unopposed alpha-adrenergic stimulation

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13
Q

How long should you recommend that a patient be cocaine-free prior to an elective surgery?

A

at least 1 week

if you could just hold off on the cocaine for a week or so… then you can resume your previous schedule

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14
Q

What medication has the potential to be an effective cocaine-abuse therapy?

A

ondansetron (0.2mg/kg, subcutaneous)

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15
Q

What are some of the effects of hallucinogen drugs, such as LSD, PCP, and mescaline?

A

they activate the sympathetic nervous system by causing hypertension and tachycardia

increase in body temp and dilation of pupils

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16
Q

The effects of hallucinogens can last how long after ingestion?

A

effects develop over 1-2 hours and last for approx. 12 hours

17
Q

With hallucinogen drugs, extreme caution should be used when administering medications that have a sympathomimetic stimulating effect, like ephedrine.

A

not a question, just good to know.

18
Q

What two medications are the optimum choice for management of hypertension and tachycardia related to the hyperadrenergic state of cocaine abuse?

A

titration of esmolol and nitroprusside.

esmolol is selective beta1 and is a better choice than a non-selective beta agonist like propranolol

19
Q

Do local anesthetics, such as tetracaine, procaine, and chloroprocaine, augment or attenuate the proconvulsive effects of cocaine?

A

they may actually augment the proconvulsive effects.

craziness….

20
Q

Which volatile agent would theoretically be the best choice to use with a cocaine abuser?

A

isoflurane, since it has less myocardial depressant effects and has a high threshold to induce cardiac arrhythmias.

21
Q

Chronic use of cocaine may cause catecholamine depletion. Would this cause an increased or decreased MAC requirement?

A

decreased MAC requirement