Addiction and Overdose

Question 1

What are the effects of cocaine?

Answer 1

Stimulant and euphoriant

Increased alertness and energy

Increased confidence and impaired judgement

Lessens appetite and desire for sleep

Question 2

How long does cocaine stay in the body?

Answer 2

approx 30 minutes

Question 3

What are the side effects of cocaine use?

Answer 3

Palpitations

Psychosis

HTN

Both tachycardia and bradycardia

Mydriasis

Rhabdomylosis

Coronary artery spasm

Question 4

What are the withdrawl signs of cocaine?

Answer 4

Depression

Irritability

Agitation

Craving

Hyperphagia

Hypersomnia

Question 5

How is cocaine toxicity managed?

Answer 5

Benzodiazepines, first line

Benzodiazepine + GTN, if chest pain

Benzodiazepine + sodium nitroprusside, if HTN

B blockers are contraindicated due to risk of coronary vasospasm

Question 6

How long does amphetamine stay in the body?

Answer 6

Approx few hours

Question 7

What are side effects of amphetamine?

Answer 7

Amphetamine psychosis in heavy chronic use

Toxic confusion occasionally with convulsions and death

Question 8

Give examples of opiates

Answer 8

Opium

Morphine

Heroin (Diamorphine)

Methadone

Codeine

Dihydrocodein

Question 9

What are the effects of opiates?

Answer 9

Analgesia

Drowsiness and sleep

Euphoria/Intense pleasure

Respiratory depression

Cough reflex depression

Bradycardia and hypotension

Lowering body temperature

Pupillary constriction

Constipation

Question 10

What are the side effects of opiates?

Answer 10

N&V

Headache

Phlebitis

Anorexia

Constipation

Question 11

What are the withdrawl signs of opiates?

Answer 11

Craving

Insomnia

Yawning

Muscle pain and cramps

Increased salivary, nasal and lacrimal secretions

Dilated pupils

Piloerection

Question 12

What are the effects of ecstacy?

Answer 12

Relaxed euphoric state without hallucinations

Euphoria followed by a feeling of calm

Increased sociability

Inability to distinguish between what is and isn’t desirable

Question 13

How long do the effects of ecstacy last?

Answer 13

2-4 hours

Question 14

How quick do the effects of ecstacy come on?

Answer 14

20 minutes

Question 15

What are the side effects of ecstacy?

Answer 15

Nausea and dry mouth

Increased blood pressure and temperature

Dehydration risk

Large doses can cause anxiety and panic

Drug induced psychosis

Liver and brain cell damage

Question 16

What are the effects of cannabis?

Answer 16

Relaxing or stimulating

Euphoriant

Increases sociability and hilarity

Increases appetite

Changes in time perception,

Synaesthesia (merging of sense)

Question 17

What are the side effects of cannabis?

Answer 17

Respiratory problems

Toxic confusion

Exacerbation of major mental illness

Cannabis psychosis

Anxiety and panic

Hallucinatory activity

Question 18

What is the most toxic substance known to man?

Answer 18

Botulinium

Question 19

What is the general management principals in toxicology?

Answer 19

ABCDE

IV fluids for hypotension

IV lorazepam if fitting

Decomtamination with activated charcoal

• Within 1 hour of overdose
• 50g
• Mostly effective against drugs that are toxic in low doses, such as CCB or TCA
• Not safe to give if drowsy, due to aspiration risk

Targeted investigations

Specific antidotes

Question 20

What are the methods of active elimination?

Answer 20

Multiple doses of activated charcoal

Whole bowel irrigation to empty bowel quickly

Urinary alkalinization to enhance urinary excretion of weak acids by IV sodium bicarbonate

Haemodialysis

Question 21

How does apsirin overdose present?

Answer 21

Tinnitus

N&V

Confusion

Dehydration

Initial respiratory alkalosis and later metabolic acidosis

Question 22

How is aspirin overdose managed?

Answer 22

Gastric lavage

Activated charcoal if ingestion less than an hour ago

IV fluids

Alkaline diuresis with IV sodium bicarbonate

Dialysis may be needed if blood levels are high

Question 23

How does opioid overdose present?

Answer 23

CNS and respiratory depression

Miosis

Apnoea

(Urinary retention, constipation)

Question 24

How is opioid overdose managed?

Answer 24

Ventilation

Opioid antagonost/400mcg Naloxone

Opioid replacment therapy with methadone

Question 25

Give features of paracetamol overdose

Answer 25

N&V

Pallor

Sweating

ALT and AST in 10,000s

Question 26

Describe the process of paracetamol overdose

Answer 26

Less than 75mg/kg no risk of toxicity

More than 150mg/kg high risk of toxicity

Blood level at 4 hours dictates management

Hepato-toxicity occurs at 8 hours

Often asymptomatic in first 24 hours

If delayed presentation, uncertain timings or staggered overdose over an hour, start NAC before blood level

Question 27

How is paracetamol overdose managed?

Answer 27

Activated charcoal if ingested < 1 hour ago

N-Acetyl Cysteine (NAC) infusion

Liver transplant

Question 28

How is CCB overdose managed?

Answer 28

Calcium chloride

Question 29

How is benzodiazepine overdose managed?

Answer 29

Flumazenil

Question 30

Give features of b blocker overdose

Answer 30

Bradycardia

Hypotension

Heart failure

Syncope

Question 31

How is b blocker overdose managed?

Answer 31

If bradycardic, IV atropine

In resistant cases glucagon may be used

Haemodialysis is not useful

Question 32

Give features of tricyclic overdose

Answer 32

Early features

• Dry mouth
• Dilated pupils
• Agitation
• Tachycardia
• Blurred vision

Severe poisoning

• Seizures and QT prolongation and QRS widening
• Arrythmia
• Metabolic acidosis
• Coma

Question 33

How is tricyclic overdose managed?

Answer 33

IV bicarbonate, first line therapy for hypotension or arrhytmias