Drug Intoxication and withdrawal Flashcards
(27 cards)
Depressants
Alcohol
Opioids
Barbs and Benzos
Depressants- general intox S&S
Mood elevation Decreased anxiety Sedation Behavioral disinhibition Respiratory depression
Depressants- withdrawal
Anxiety
Tremor
Seizure
Insomnia
Alcohol- intox
Emotional lability
Slurred speech
Coma
Blackouts
AST»_space; ALT (AST is 2X ALT)
GGT is a sensitive indicator of alcohol use
Alcohol- withdrawal
Mild: anxiety, tremor, seizures, insomnia
SEVERE: autonomic hyperactivity and delirium tremens (hallucinations) –> tx with benzos
Opioids- intox
Miosis
Respiratory depression (and CNS)
Constipation
Tx: Naloxone (acute reversal) and naltrexone (longer term management of opioid AND ALCOHOL overdose)
Opioid- withdrawal
Mydriasis
Tachycardia
Sweating
Piloerection
Fever
Rhinorrhea
Nausea, stomach cramps
Diarrhea ("flu-like symptoms")
LACRIMATION AND YAWNING- characteristic of heroin overdose
Less likely to have seizures with withdrawal (unlike alcohol and benzos)
Tx: long-term support, methadone, bupernorphine
NOT NALOXONE!!! This will make it worse
In neonates will see similar symptoms + hypertonia, irritability, and jittery movements
Barbs- intox and withdrawal
Intox: low safety margin, respiratory depression
Withdrawal: delirium, life-threatening cardiac complications
Benzos- intox and withdrawal
intox: bigger safety margin; respiratory depression
Tx: flumazenil –> but this can precipitate seizures
withdrawal: sleep disturbance, depression, rebound anxiety, and seizures
Stimulants
amphetamines
cocaine
caffeine
nicotine
Stimulants- general intox symptoms
Mood elevation Psychomotor agitation Insomnia Cardiac arrythmias Tachycardia Anxiety
Stimulants- general withdrawal symptoms
Overuse "crash" Depression Lethargy Increased appetite Sleep disturbance Nightmares
Amphetamines- intox
Mechanism: Increase RELEASE of catecholamines and reuptake inhibitor
Euphoria, grandiosity, PUPILARY DILATION (due to increased sympathetic response)
Tx: benzos (spec. for agitation and seizures)
Cocaine- intox
Prevents reuptake of catecholamines (like SSRIs, SNRIs, and TCADs)
Symp overstimulation: Sweating, tachy, high BP, hyperactivity
Impaired judgement
Pupillary dilation
Hallucinations (tactile- cocaine crawlies)
Angina
Sudden cardiac death
Atrophy of intranasal septum (with nasal abuse)
Tx: alpha blockers, benzos
DONT give beta blockers as this will make NE specifically go after the vasculature and unopposedly VASOCONSTRICT
Cocaine- withdrawal
Hypersomnolence
Irritability
Depression
Caffeine- intox
restlessness, increased diuresis, muscle twitching
Caffeine- withdrawal
Headache, difficulty concentrating, flu-like symptoms
Nicotine- intox
restlessness
Nicotine- withdrawal
irritability, anxiety, restlessness, difficulty concentrating
Tx: nicotine patch, gum, lozenges; buproprion/ varenicline
Hallucinogens
Phencyclidine
LSD
Marijuana
MDMA (ecstasy)
Phencyclidine
VIOLENCE Impulsivity Psychomotor agitation NYSTAGMUS Delirium Seizures Tachy
(like cocaine abuse + violence + hallucinations and seizures)
LSD
Hallucinations Anxiety or depression Delusions Depersonalization Paranoia Nausea Dilated pupils Euphoria
(different than cocaine abuse b/c these patients have NORMAL HR and BP) –> they also don’t have intense thirst as seen in folks who have anticholinergic symptoms
Marijuana
Euphoria, anxiety, paranoid delusions, perception of slowed time, impaired judgement, increased appetite, dry mouth, CONJUNCTIVAL INJECTION, hallucinations
Dronabinol- pharmaceutical form –> used in AIDS pts (to increase eating) and for patients taking chemo (anti-emetic)
Detectable in urine for up to 1 month
MDMA (ecstasy)- intox
Hallucinogenic stimulant
Euphoria, disinhibition, hyperactivity
Life threatening effects: HTN, tacky, hyperthermia, hyponatremia, serotonin syndrome
