Depressant intoxication and withdrawal Flashcards
Depressant intoxication
Nonspecific: Mood elevation, Low anxiety Sedation Behavioral disinhibition, Respiratory depression
Depressant: Alcohol Opioid Barbiturate Benzo
Depressant withdrawal
Also non specific: Anxiety Tremor Seizures Insomnia
Depressant: Alcohol Opioid Barbiturate Benzo
Alcohol intoxication
Emotional lability Slurred speech Ataxia Coma Blackout GGT (sensitive indiactor of alcohol use) AST: ALT = 2:1
Alcohol withdrawal
Symptoms similar to other depressants
Severe alcohol can cause autonomic hyperactivity and DT
Tx for DT: benzo
Opioid intoxication
Euphoria Respiratory and CNS depression Low gag reflex Pupillary constriction (pinpoint) Seizure (overdose)
Tx: naloxone, naltrexone
Opioid withdrawal
Sweating, dilated pupils, piloerection (cold turkey) fever rhinorrhea, yawning, nausea, stomach cramp diarrhea
“Flu-like symptoms”
Tx: long term support, methadone, buprenorphine
Barbiturates intoxication
Low safety margin,
Marked respiratory depression
Tx: symptom management (assist respiration, increase BP)
Barbiturate withdrawal
Delirium,
Life-threatening CV collapse
Benzo intoxication
Greater safety margin,
ataxia,
minor respiratory depression,
Tx: flumazenil (competitive antagonist)
Benzo withdrawal
Sleep disturbance,
depression,
rebound anxiety
seizure (severe)
Heroin addition: increased risk and treatment
Hepatitis, abscesses, overdose, hemorrhoids, AIDS
R-sided endocarditis (staphy aureus)
Look for track marks
Methadone: long acting, for detox or long term maintenance
Naloxone and buprenorphine: partial agonist, long acting with fewer withdrawal symptoms than methadone.
Naloxone is active when taken orally, so withdrawal symptoms occur if injected (lower abuse potential)
Delirium tremens (DTs)
Alcohol withdrawal symptoms peaking at 2-5 days after last days.
Symptoms in order of appearance: autonomic system hyperactivity (tachycardia, tremors, anxiety, and seizures) psychotic symptoms (hallucinations, delusion), confusion.
Treatment: benzo
