CH41: Alcohol, Drugs, Toxins and Chemical Agents

Question 1

Neurotransmitters and modulating agents attach to receptors at synapses are able to increase or decrease the permeability of ion channels and stimulate or inhibit second cytoplasmic messengers. Give examples. (p. 1210)

Answer 1

L dopa: dopamine
Tryptophan: serotonin
Choline: acetylcholine

Question 2

No particular aspect of alcohol metabolism has been found to account for the development of addiction with the possible exception of (p. 1211)

Answer 2

aldehyde dehydrogenase

Question 3

Energy liberated by oxidation of alcohol (p. 1211)

Answer 3

7cal/g

Question 4

Determine state of these alcohol levels (p. 1211)
30
50
100
200
300
400

Answer 4

30 mild euphoria
50 mild incoordination
100 obvious ataxia
200 confusion and reduced mental activity
300 stuporous
400 deep anesthesia

Question 5

Drugs that have eh effect of disulfiram but less potent (p. 1212)

Answer 5

sulfonyluroeas
metronidazole
furazolidone

Question 6

Refers to the period of severe intoxication for which the patient later has no memory– even though the state of consciousness was not grossly altered during that interval (p. 1213)

Answer 6

blackout

Question 7

Can be a therapeutic option for blood alcohol concentrations more than 500mg/dL (p. 1214)

Answer 7

hemodialysis

Question 8

Characteristic of methyl alcohol intoxication (p. 1214)

Answer 8

damage to retinal ganglion cells (scotomata)

bilateral degeneration of the putamen

Question 9

Major constituent of antifreeze (p. 1214)

Answer 9

Ethylene glycol

Question 10

Finding in ethylene glycol toxicity that may aid in the diagnosis (p. 1214)

Answer 10

Hippurate crystals (that can also be found in toluene ingestions)

Question 11

Treatment of alcohol intoxication (p. 1214)

Answer 11

Fomepizole (IV 4-methylpyrazole)

Question 12

Characteristic tremor of Alcohol Withdrawal (p. 1215)

Answer 12

fast frequency 6-8 Hz, slightly irregular, variable in severity, tending to diminish when the patient is in quiet surroundings and increase with motor activity or emotional stress

Question 13

Most common hallucinations of alcohol withdrawal (p. 1216)

Answer 13

Human voices

Question 14

Chronic auditory hallucinosis vs Paranoid schizophrenia (p. 1216)

Answer 14

the alcoholic illness develops in close relation to a drinking bout and the past history rarely reveals schizoid personality traits

Question 15

Withdrawal seizures from peak at around what time (p. 1216)

Answer 15

13 and 24 hours

Question 16

T/F During period of withdrawal, he patients are sensitive to stroboscopic stimulation; almost half of he patients respond with generalized myoclonus or convulsive seizure (p. 1216)

Answer 16

T

Question 17

Frequency of EEG findings is rum fits (p. 1217)

Answer 17

No greater than in normal persons in shapr conrast to the EEGs of nonalcoholic patients with recurrent seizures

Question 18

Treatment of Withdrawal seizures (p. 1218)

Answer 18

diazepam or sodium phenobarbital

Question 19

How many percent of cases of delirium tremens end fatally (p. 1217)

Answer 19

15%

Question 20

Early phase of alcohol withdrawal is associated with these metabolic abnormalities (p. 1218)

Answer 20

drop in serum magnesium
hypokalemia
rise in arterial pH
low pCO2

Question 21

These drugs should be avoided because it may decrease the threshold to seizures in patients with alcohol withdrawal (p. 1219)

Answer 21

phenothiazine

Question 22

T/F Alcoholic dementia lacks a distinctive, well- defined pathology (p. 1220)

Answer 22

TRUE

Question 23

Requisite for successful treatment of alcohol dependence (p. 1221)

Answer 23

Total abstinence from alcohol

Question 24

Drugs for alcohol dependence (p. 1221)

Answer 24

Disulfiram- dont give to patients with cardiac or advanced liver disease
Naltrexone
Acomprosate
Topiramate

Question 25

Acute opioid poisoning clinical findings (p. 1223)

Answer 25

``` Unresponsiveness Shallow respirations Slow respiratory rate or periodic breathing Pinpoint pupils Bradycardia Hypothermia ```

Question 26

Cause of death in opioid overdose (p. 1223)

Answer 26

Respiratory depression with asphyxiation

Question 27

Treatment of opioid overdose (p. 1223)

Answer 27

Naloxone 0.4 to 0.5mg repeated every 2 mins o a dose of 15mg IV

Question 28

The desensitization of opioid receptors mainly these accounts for tolerance through a mechanism of uncoupling of the receptor from the G protein complex (p. 1224)

Answer 28

mu type

Question 29

Treatment of Opioid Abstinence syndrome (p. 1225)

Answer 29

Methadone substitution- habituation Clonidine Naloxone/ Naltrexone

Question 30

Opioid complicaions (p. 1226)

Answer 30

occlusion of cerebral arteries amblyopia transverse myelopathy peripheral neuropathy

Question 31

MRI findings in opioid users (p. 1226)

Answer 31

Widespread white matter hyperintensity involving supra and infratentorial structures; predilection for CST and below the IC; with sparing of subcortical U fibers and grey matter structures

Question 32

Increases the potency of drugs (p. 1227)

Answer 32

higher lipid solubility | lower plasma PH

Question 33

MOA of Barbiturates (p. 1227)

Answer 33

suppress neuronal transmission, presumably by enhancing GABA inhibition at pre and post receptor sites to reduce excitatory potentials

Question 34

Fast acting barbiturates (p. 1227)

Answer 34

Pentobarbital, secobarbital

Question 35

Potential fatal dose of phenobarbital (p. 1227)

Answer 35

6 to 10g lethal overdose at 60mgdL for Pb 10mgdL for pentobarbital and amibarbital

Question 36

Treatment for barbiturates overdose (p. 1227)

Answer 36

Hemodialysis and hemofiltration with charcoal

Question 37

MOA of Benzodiazepines (p. 1228)

Answer 37

Act in concert with GABA to open chloride ion channels and hyperpolarize postsynaptic neurons and reduce their firing rate. Primary actions are on: cerebral cortex and limbic system

Question 38

MOA of Flumazenil (p. 1228)

Answer 38

binding o CNS diazepine receptors and thereby blocking the activation of GABAergic synapses

Question 39

Selective 5HT1A receptor serotenergic agonist (p. 1229)

Answer 39

Buspirone

Question 40

Of all the phenothiazines, this has the tendency to cause akathisia (p. 1230)

Answer 40

Molindone | Treatment: Propanolol

Question 41

Treatment for post-phenothiazine dyskinesia (p. 1230)

Answer 41

Amantadine

Question 42

Treatment for Neuroleptic Malignant Syndrome (p. 1231)

Answer 42

Bromocriptine | Dantrolene

Question 43

Most common adverse effect of all MAO inhibitors (p. 1231)

Answer 43

Postural hypotension

Question 44

Contraindicated when taking MAO inhibitors (p. 1232)

Answer 44

``` phenothiazines CNS stimulants TCA and serotonergic antidepressants sympathomimetic amines tyramine- containing foods ```

Question 45

Presently are the most effective drugs for the treatment of patients with depressive illness (p. 1232)

Answer 45

TCA | Serotonergic drugs

Question 46

Treatment of Serotonin Syndrome (p. 1233)

Answer 46

Discontinuation of medication | Cyroheptadine

Question 47

Neuro findings of Lithium intoxication (p. 1233)

Answer 47

``` fast frequency action tremor or asterixis Nausea Loose stools Fatigue Polydypsia and polyuria ```

Question 48

Cocaine withdrawal syndrome (p. 1234)

Answer 48

``` insomnia restlessness anorexia depression hyperprolactenemia dopaminergic sensitivity ```

Question 49

Marijuana activates this receptor, mainly on GABA-ergiv neurons in the hippocampus, amygdala and cortex (p. 1235)

Answer 49

CB1

Question 50

The source of recurrent inhibition of spinal and brainstem motor neurons preferentially affected by Tetanus Toxin (p. 1236)

Answer 50

Renshaw Cell

Question 51

Differentiate stiffman syndrome and tetanus (p. 1237)

Answer 51

In Tetanus, the physiologic silent period that occurs 50 to 100ms after reflex contraction is loss

Question 52

Treatment for Tetanus (p. 1237)

Answer 52

Antitoxin 10day course of Penicillin Metronidazole Tetracycline

Question 53

How to give tetanus immunity (p. 1238)

Answer 53

Toxoid every 10 years | If has a threat, one dose then 6 weeks after

Question 54

Most common clinical type of diphtheria (p. 1238)

Answer 54

faucial- pharyngeal form

Question 55

Characterized by early oropharyngeal symptoms, ciliary paralysis with retained pupillary response to light, subacute evolution of a delayed symmetrical sensorimotor peripheral neuropathy (p. 1238)

Answer 55

Diphtheria

Question 56

Has been useful in reversing the weakness of limn and extraoccular muscles in Botulism (p. 1239)

Answer 56

Guanidine hydrochloride

Question 57

Workup for lead poisoning (p. 1241)

Answer 57

Lead lines at the metaphysis of long bones Basophilic stippling in red cells Basophilic stippling of bone marrow erythroblasts

Question 58

Confirmation of Lead toxicity (p. 1241)

Answer 58

Lead excretion with calcium disodium edetate given in three doses (25mg/kg) 500mg in 24hrs means there is toxicity

Question 59

Treatment for Lead toxicity (p. 1242)

Answer 59

2,3 dimercaprol | oral penicillamine

Question 60

Transverse lines 1 to 2mm in width above the lunula of each fingernail (p. 1243)

Answer 60

Mees lines | found in arsenic

Question 61

Treatment for arsenic toxicity (p. 1243)

Answer 61

Dimercaprol

Question 62

Cock gait. Which element is in excess (p. 1244)

Answer 62

Manganese | Treatment: L dopa

Question 63

Pathologic findings in Mercury poisioning (p. 1244)

Answer 63

Striking degeneration of the granular layer of the cerebellar cortex with relative sparing of the Purkinje cells and neuronal loss and gliosis of the calcarine cortex

Question 64

Treatment for Mercury poisoning (p. 1245)

Answer 64

Penicillamine or Dimercaprol

Question 65

Symptoms reversing organophosphate poisoning (p. 1245)

Answer 65

Atropine and Pralidoxime

Question 66

Biopsies in patients who had Cisplatin (p. 1247)

Answer 66

Primary axonal degeneration

Question 67

MOA of neuropathy for patients taking Paclitaxel and Docetaxel (p. 1247)

Answer 67

Inhibitors of depolymerization of tubulin

Question 68

Most frequent side effect of Calcineurin inhibitors (p. 1249)

Answer 68

Tremor