Drugs

Question 1

legal limit for intoxication in most states?
at what BAL do more than 50% of adults show obvious signs of intoxication?
coma in novice drinker?
respiratory depression?

Answer 1

legal limit: 0.08-0.1mg%,
obvious: 0.15mg%,
coma: 0.3mg%,
resp depression: 0.4mg%

Question 2

what can alcohol do to acid base?

Answer 2

methanol, ethanol, and ethylene glycol can cause metabolic acidosis with increase anion gap

Question 3

what should be given to patients with altered mental status from alcohol?

Answer 3

thiamine, glucose, naloxone

Question 4

should you do GI lavage for ETOH OD?

Answer 4

it has no role in ETOH OD but may be used in mixed ETOH OD

Question 5

4 things for alcohol dependence

Answer 5

1. AA
2. disulfiram
3. psychotherapy and SSRI
4. naltrexone- opioid antagonist, helps reduce cravings for ETPH

Question 6

3 parts of wernicke’s

Answer 6

1. ataxia
2. confusion
3. eye abnrmalities- nystagmus, gaze palsies

Question 7

3 parts of korsakoffs

Answer 7

1. impaired recent memory
2. anterograde amneisa
3. confabulation

Question 8

ddx of cocaine? how to test

Answer 8

ddx: methamphetamine and PCP
test: urine (3 days or more)

Question 9

how to treat cocaine intoxications

Answer 9

1. for severe agitation benzos
2. for severe agitation or psychosis: haloperidol
3. symptomatic support- HTN, arrythmias

Question 10

benzo vs. barbiturate mechanism. have together?

Answer 10

benzo increase the frequency of chloride channel opening while barb increase duration of chloride channel opening. together they are synergistic and can lead to respiratory depression

Question 11

gamma-hydroxy-butyrate

Answer 11

GHB- grevious bodily harm. dose specific CNS depressant-> memory loss, respiratory distress, and coma. commonly used as date rape drug.

Question 12

how to treat barbiturate OD? benzo OD?

Answer 12

barb OD: alkalinize urine with sodium bicarb to enhance renal excretion.
benzo: flumazanil.
both are supportive care- improve respiratory status and control hypotension

Question 13

merepidine + MAOI

Answer 13

even though merepidine is an opioid, can lead to serotonin syndrome

Question 14

.classic triad of opioid OD

Answer 14

respiratory depression, altered mental status, miosis. RAM

Question 15

withdrawal from opiates. deadly?

Answer 15

dysphoria, lacrimation, rhinorhea, sweating, weakness, piloerection, vomiting/nausea, dialted pupils, muscle ache. can treat with clonidine and/or bupernorphine. detox with methadone tapered over 7 days. NOT DEADLY but uncomfortable. opiate OD can be deadly from respiratory depression.

Question 16

caffeine withdrawal

Answer 16

resolve with 1 week. headache, nausea/drowsiness, anxiety, depression

Question 17

smoking during pregnancy->

Answer 17

low birth weight and persistent pulmonary HTN in newborn

Question 18

4 ways to treat nicotine withdrawal

Answer 18

1. couseling
2. nicotine replacement therapy
3. zyban- antidepressant that helps reduce cravings
4. clonidine

Question 19

MDMA sxs? can MDMA be detected in urine tox screens?

Answer 19

HTN, tachycardia, hyperthermia, serotonin syndrome, hyponatremia, death. not detected by routine tox screens.

Question 20

treatment for TCA OD

Answer 20

sodium bicarbonate

Question 21

acid-base of methanol, ethanol, ethylene glycol

Answer 21

all can cause metabolic acidosis with increased anion gap

Question 22

when do the earliest sxs of ETOH withdrawal appear after last drink

Answer 22

6-24 hours. irritable/insomnia. fever, disorientation, seizure, or hallucinations.

Question 23

what does cocaine intoxication do to BP and respiration.

Answer 23

can increase OR decrease BP. it can cause respiratory depression

Question 24

how can cocaine intox-> death

Answer 24

secondary to cardiac arrythmia, seizure, cerebrovascular accident, or respiratory depression

Question 25

how to treat cocaine intoxication

Answer 25

moderate agitation: benzos. for severe agitation or psychosis: haloperidol. symptomatic support: control HTN, arrythmias

Question 26

how to treat cocaine dependence

Answer 26

1. psychotherapy, group therapy 2. TCAs 3. dopamine agonists (amantidine, bromocriptine)

Question 27

can opiate + MAOI-> serotonin syndrome

Answer 27

yes- merepidine (demerol)

Question 28

what percent of demented pts have a treatable and reversible cause of dementia

Answer 28

15%

Question 29

which 2 opioids come up negative on a tox screen

Answer 29

methadone and oxycodone

Question 30

when do generalized tonic clonic seizure happen after last drink

Answer 30

between 6 and 48 hrs with peak at 13-24 hours

Question 31

acamprosate?

Answer 31

structurally similar to GAVA. thought to inhibit the glutamatergic system. should be start post detox for relapse prevention in pts who have stopped drinking.

Question 32

topiramate in alchol

Answer 32

anticonvulsant that potentiates GABA and inhibits glutamate receptors. reduced cravings for alachol

Question 33

how can MDMA cause death

Answer 33

OD an cause hyerthermia, deydration, rhabdo-> kidney failure

Question 34

which drug withdrawal has the highest mortality

Answer 34

barbiturate

Question 35

what is the most common cause of death from street heroin use

Answer 35

infection secondary to needle sharing

Question 36

how can opiate intoxication kill you? other sxs?

Answer 36

respiratory depression. can also cause nausea, vomiting, sedation, decreased pain perception, decreased GI motility, pupil constirction

Question 37

suboxone

Answer 37

buprenorphine+naloxone

Question 38

what is issue with naltrexone

Answer 38

compliance is an issue- it is a good choice for highly motivated pts

Question 39

can inhalants be deadly?

Answer 39

yes- secondary to respiratory depression or cardiac arrythmia