UW MED psych drugs cases (Nr 14 - 16) - inhalation, MDMA Flashcards
(14) A 15-year-old boy is brought to the emergency department by his father, who found the patient unconscious on his bedroom floor. It is unclear how long the patient had been unconscious, but his father saw him walking upstairs 5 minutes before finding him. The patient’s father was able to rouse him quickly, but the patient continued to feel drowsy and said he was dizzy. His speech was slurred, and he was unsteady on his feet. At the time of evaluation an hour later, the patient’s symptoms have resolved, and he denies any knowledge of why he lost consciousness. The father shares that the patient has come home drunk on several occasions. Medical history is noncontributory. Temperature is 36.7 C (98 F), blood pressure is 100/60 mm Hg, and pulse is 70/min. The patient is alert and fully oriented. On physical examination, heart and lung sounds are normal. Sensation is decreased in bilateral lower extremities. Liver function tests are slightly elevated. ECG is normal. Intoxication with which of the following is the most likely cause of this patient’s condition?
INHALANT ABUSE
(14) INHALANT ABUSE. Commonly abused inhalants include glue, toluene, nitrous oxide (“whip-its”), amyl nitrite (“poppers”), and spray paints. Inhalants may be abused by sniffing, huffing (ie, inhaled from a saturated cloth), or bagging (ie, inhaled from a bag over mouth or nose) to concentrate the inhaled substance.
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(14) INHALANT ABUSE. CP?
Signs of acute intoxication vary depending on the chemicals inhaled and may include transient euphoria and loss of consciousness. Inhalants are highly lipid soluble and produce immediate effects that typically last 15-45 minutes. They act as central nervous system depressants and may cause death.
Other symptoms of inhalant abuse include nose bleeds, headaches, and dermatitis (“glue sniffer’s rash”) around the mouth or nostrils due to chemical exposure. Liver function tests may be elevated with repeated use. Chronic abuse of nitrous oxide is associated with vitamin B12 deficiency and resultant polyneuropathy, as seen in this patient
(14) INHALANT ABUSE. Who has highest risk for abuse?
Boys age 14-17 are at highest risk for inhalant abuse. Abnormal odor on the breath or clothes and empty solvent bottles or gauze found in the trash are clues to use. However, when common household products are used, paraphernalia may not be found, making it difficult to detect.
(14) INHALANT ABUSE. vs opioid intoxication?
(Choice F) Opioid intoxication can cause loss of consciousness; however, such a loss of consciousness would likely last longer than a few minutes and would not be associated with a rapid recovery.
(14) INHALANT ABUSE. vs hallucinogens?
Hallucinogen intoxication is associated with impaired coordination, and some hallucinogens have a short duration of action. However, hallucinogens are not expected to cause loss of consciousness and are accompanied by perceptual changes (eg, depersonalization, hallucinations), tachycardia, diaphoresis, and tremors, which are not seen in this patient.
(14) INHALANT ABUSE. vs cocaine?
Cocaine is a central nervous system stimulant that typically produces increased arousal, psychomotor agitation, and increased heart rate and blood pressure, NOT the loss of consciousness, unsteadiness, and slurred speech seen in this patient.
(15) A 13-year-old girl is brought to the office by her mother due to abdominal pain. The mother says, “She’s had occasional stomach aches for the last few weeks. I thought it was just menstrual cramps, but she has started skipping meals and looks like she is losing weight.” Her mother also reports that the patient has become increasingly irritable, locking herself in her bedroom and coming out only to watch television. The patient says that her mother is “freaking out about nothing” and that she feels “fine.” She has no nausea, vomiting, or change in bowel habits. Medical history is significant for seasonal allergies treated with loratadine as needed. Vital signs are within normal limits. A 5-kg (11-lb) weight loss is noted since her last visit 6 months ago. Physical examination is significant for a flaky, eczematous rash around the mouth involving the nasolabial folds. The abdomen is soft and flat with no tenderness to palpation. A bilateral hand tremor is noted, and further neurological examination shows globally decreased reflexes. Which of the following is the most likely explanation for this patient’s presentation?
INHALANT USE
yra flaky, eczematous rash around the mouth involving the nasolabial folds.
(15) Inhalant abuse.
This patient’s irritability, abdominal cramps, and anorexia, in combination with perioral dermatitis and neurological signs, are concerning for inhalant use and intoxication.
Inhalants are easily accessible and found in everyday products (eg, glue, shoe polish, gasoline, spray paint). They readily cross the blood-brain barrier, resulting in euphoria and intoxication. Use typically begins in childhood or early adolescence via sniffing or inhaling (eg, placing a rag soaked with the substance on the mouth and/or nose).
(15) Inhalant abuse. what is characteristic?
The characteristic perioral dermatitis (ie, “glue-sniffer’s rash”) is due to the drying effect of hydrocarbons. It extends around the mouth and/or nose, classically involving the nasolabial folds (a highly characteristic feature). Other clues of inhalant abuse include the odor of chemicals on the breath or clothes or finding rags, gauze, or chemical containers in the trash
(15) Inhalant abuse.
Acute symptoms of inhalant use can include neurologic (eg, tremor, disorientation, headaches, slurred speech, hallucinations), gastrointestinal (eg, stomach cramps, nausea), cardiovascular (eg, arrhythmia), and respiratory (eg, wheezing, coughing) effects
Psychiatric manifestations include irritability, mood swings, aggression, and grandiosity. Chronic use results in weight loss and anorexia, neurocognitive impairment, cerebellar dysfunction, and peripheral neuropathy (eg, decreased reflexes).
(16) 21 y/o male + just returned from a party with friends and was “not acting like himself” prior to the seizure + seizures for 30 min. Hx - MDD, sertaline use.
Vitals: temp 40 + pulse 120, rhythmic + RR 16 + BP 179/96 + SpO2 98 proc. CP: flushed; diaphoretic; increased bowel sounds; soft and nontender; no hepatosplenomegaly Neurologic: deep tendon reflexes are 3+ and symmetric in all extremities; spontaneous myoclonus in the upper extremities; minimally responsive to painful stimuli.
Na 122; k 3,6, Cl 98; HCO3 20; Glu 90 mg/dl.
Ct scan normal.
CAUSE OF CONDITION?
Ecstasy intoxication (MDMA)
This patient’s presentation suggests MDMA intoxication complicated by serotonin syndrome.
Combining MDMA with other serotonergic drugs (eg, sertraline), as in this patient, further increases the risk of serotonin syndrome.
(16) Ecstasy intoxication.
MDMA, formulated as ecstasy or Molly, has mild hallucinogenic properties and is sometimes used by college students during parties to cause euphoria and increase sociability, alertness, empathy, and sexual desire.
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(16) Ecstasy intoxication.
MDMA is a synthetic amphetamine that exerts its effects by increasing what? 3
By increasing synaptic levels of norepinephrine, dopamine, and serotonin.
(16) Ecstasy intoxication. Severe intoxication may manifest with features of: 2?
sympathomimetic toxicity;
serotonin toxicity.
(16) Ecstasy intoxication. Severe intoxication may manifest with features of: sympathomimetic toxicity - CP?
hypertension, tachycardia, diaphoresis, and hyperthermia
(16) Ecstasy intoxication. Severe intoxication may manifest with features of: serotonin toxicity - CP?
serotonin syndrome (eg, altered mental status, hyperreflexia, myoclonus, seizures) and hyponatremia (due to drug-induced inappropriate antidiuretic hormone secretion as well as excessive water intake to reduce hyperthermia).
(16) Ecstasy intoxication. Recreational synthetic amphetamines and analogues (eg, MDMA, bath salts) may not show up as amphetamines in routine urine toxicology screens.
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(16) Intoxication table.
Violent behavior
Dissociation
Hallucinations
Amnesia
Nystagmus
Ataxia
DRUG?
NMDA antagonists (PCP = phencyclidine, ketamine)
Siaip visur sitas CP buvo prie PCP!!!
(16) Intoxication table. NMDA antagonists (PCP = phencyclidine, ketamine). CP?
Violent behavior
Dissociation
Hallucinations
Amnesia
Nystagmus
Ataxia
(16) Intoxication table.
Euphoria
Tachy/HTN
Hyperthermia
Serotonin syndrome
HYPONATREMIA
Seizures
Mydriasis
Drug?
MDMA (ecstasy)
(16) Intoxication table. MDMA (ecstasy). CP?
Euphoria
Tachy/HTN
Hyperthermia
Serotonin syndrome
HYPONATREMIA
Seizures
Mydriasis
(16) Intoxication table.
CNS depression
Normal vitals signs
Slurred speech
Ataxia
Coma
DRUG?
BENZODIAZEPINES
(16) Intoxication table. Benzodiazepines. CP?
CNS depression
Normal vitals signs
Slurred speech
Ataxia
Coma
(16) Intoxication table.
Euphoria
Depressed mental status
Respiratory depression
Miosis
Constipation
DRUG?
OPIOIDS
(16) Intoxication table. OPIOIDS. CP?
Euphoria
Depressed mental status
Respiratory depression
Miosis
Constipation
(16) Ecstasy intoxication. kiti ats. NO?
Nitrous oxide is an inhalant sometimes misused for its euphoric and calming properties. It can cause loss of consciousness and seizures (with significant overdoses), but elevated vital signs, myoclonus, hyperreflexia, and hyponatremia are not expected. In addition, its effects typically last only 15-45 minutes.
PCP = phencyclidine. GROUP?
Hallucinogen
LSD = group?
Hallucinogen
COCAINE = group?
Stimulant
Methamphetamine = group?
STIMULANT
MARIJUANA (THS = tetrahydrocanabinoid, cannabis) = group?
CANNABINOID
HEROIN = group?
OPIOID
Acute drug intox. other table.
Visual hallucinations
Euphoria
Dysphoria/panic
Tachy/HTN
DRUG?
LSD
Acute drug intox. other table. LSD. CP?
Visual hallucinations
Euphoria
Dysphoria/panic
Tachy/HTN
Acute drug intox. other table.
Euphoria
Agitation/psychosis
CHEST PAIN
SEIZURES
Tachy/HTN
MYDRIASIS
Drug?
Cocaine
Acute drug intox. other table. Cocaine. CP?
Euphoria
Agitation/psychosis
CHEST PAIN
SEIZURES
Tachy/HTN
MYDRIASIS
Acute drug intox. other table.
Violent behavior
Psychosis/diaphoresis
Tachy./HTN
Choreiform movements
Tooth decay
Drug?
Methamphetamine
Acute drug intox. other table. Methamphetamine. CP?
Violent behavior
Psychosis/diaphoresis
Tachy./HTN
Choreiform movements
Tooth decay
Acute drug intox. other table.
Increased appetite
Euphoria
Dysphoria/panic
Slow reflexes, impaired time perception
Dry mouth
Conjunctival injection
DRUG?
Marijuana (THC, cannabis)
Acute drug intox. other table. Marijuana (THC, cannabis). CP?
Increased appetite
Euphoria
Dysphoria/panic
Slow reflexes, impaired time perception
Dry mouth
Conjunctival injection
