Drugs of abuse and toxicity

Question 1

What is abstinence syndrome?

Answer 1

signs and symptoms that occur on withdrawal of a drug in dependent person

Question 2

What is addiction?

Answer 2

compulsive drug-using behavior where the person uses the drug for personal satisfaction

Question 3

What is a controlled substance?

Answer 3

drug deemed to have abuse liability

Question 4

What is dependence?

Answer 4

signs and symptoms opposite of those caused when withdrawn from chronic use or abruptly lowered

Question 5

What is a designer drug?

Answer 5

synthetic derivative of a drug with slightly modified structure but no major change in action

Question 6

How does dopamine work in regard to addiction?

Answer 6

primary role in expression of reward – appears that most addictive drugs affect dopamine in the CNS

Question 7

What is drug class I and its drugs?

Answer 7

no medical use, high addiction potential – flunitrazepam, heroin, LSD, mescaline, PCP, MDA, MDMA, STP, marijuana

Question 8

What is drug class II and its drugs?

Answer 8

medical use and high addiction potential – amphetamines, cocaine, methylphenidate, short acting barbiturates, strong opiods

Question 9

What is drug class III and its drugs?

Answer 9

medical use and moderate abuse potential – anabolic steroids, barbiturates, dronabinol, ketamine, sodium oxybate

Question 10

What is drug class IV and its drugs?

Answer 10

medical use and low abuse potential, benzos, chloral hydrate, mild stimulants, most hypnotics, weak opiods

Question 11

What are sedative-hypnotics?

Answer 11

Benzos (pams and lams), barbiturates (barbitals) and sodium oxybate (GHB), alcohol

Question 12

What are the effects of sedative-hypnotics?

Answer 12

reduce inhibitions, suppress anxiety, produce relaxation – facilitation of GABA effects or enhance brain dopaminergic pathways

Question 13

What are overdose signs on sedative-hypnotics?

Answer 13

slurred speech, drunken behavior, dilated pupils, weak and rapid pulse, clammy skin, shallow respiration, coma, death

Question 14

What can potentiate the effect of the depressant of sedative-hypnotics?

Answer 14

opioid analgesics, antipsychotics, marijuana, drugs with sedatives

Question 15

How do acute overdoses occur in sedative-hypnotic drugs?

Answer 15

depression of medullary, respiratory, and cardiovascular centers

Question 16

How do you manage a sedative-hypnotic overdose?

Answer 16

maintenance of patient airway + ventilatory support
Flumazenil = benzodiazepine antidote but can cause seizures if too fast
not for barbiturates or alcohol

Question 17

What does withdrawal look like for sedative-hypnotics?

Answer 17

anxiety, tremor, n/v, delirium, hallucinations, seizures

long term can have weight loss, tingling/numbing, headache

Question 18

What is withdrawal treatment for sedative-hypnotics?

Answer 18

long activating sedative hypnotic followed by gradual dose reduction and prevent seizures
clonidine or propranolol may be used to suppress this

Question 19

What can you use to make a patient stop drinking alcohol?

Answer 19

naltrexone, acamprosate, disulfuram cause very sick reaction to alcohol

Question 20

What are the effects of opioids?

Answer 20

euphoria –> sedation, rapid tolerance dependence and addiction
po/smoking = milder effects

Question 21

What are examples of opioids?

Answer 21

heroin, morphine, codiene, oxycodone, meperidine, fetanyl

Question 22

What does an opioid overdose look like?

Answer 22

respiratory depression

Question 23

How do you treat an opioid overdose?

Answer 23

naloxone and ventilatory support (airway!)

Question 24

What are withdrawal symptoms for opioids?

Answer 24

lacrimation, rhinorrhea, yawning, sweating, weakness, goose flesh, n/v, tremors, hyperpnea (rarely fatal)

Question 25

How can you help treat withdrawal from opioids?

Answer 25

replacement with pharmacologically similar drug and slow dose reduction, buprenorphine, use of naloxone to make more intense neonates = special management

Question 26

What do amphetamines do?

Answer 26

stimulate, increasing release of dopamine, nore, serotonin

Question 27

What do stimulants cause?

Answer 27

euphoria and self-confidence

Question 28

What can chronic meth stimulant use cause?

Answer 28

psychotic state with delusions, paranoia, picking

Question 29

What are overdose signs for methamphetamine stimulants?

Answer 29

agitation, restlessness, tachycardia, hyperthemia, hyperreflexia, seizures no antidote

Question 30

What is chronic meth stimulant abuse associated with?

Answer 30

necrotizing arteritis

Question 31

What are stimulant withdrawal symptoms?

Answer 31

increased appetite, sleepiness, exhaustion, depression

Question 32

What do overdoses look like for cocaine?

Answer 32

stimulant too -- common fatalities from arrhythmias, seizures, respiratory depressions. No antidote available either

Question 33

What is associated with increased fetal morbidity and mortality?

Answer 33

cocaine use in pregnancy

Question 34

How do you handle a poisoning situation?

Answer 34

supportive care -- airway and blood pressure support, toxicology screenings

Question 35

What are three procedures wildly used to reduce absorption of poisons from GI tract?

Answer 35

inducing emesis w/in 1 hr of ingestion* gastric lavage w/in 1 hr of ingestion* activated charcoal absorbs poison throughout *Small intestine not cleared

Question 36

What is the major cause of hepatic failure in the US?

Answer 36

acetaminophen toxicity

Question 37

What is the metabolite of acetaminophen toxicity?

Answer 37

N-acetyl-p-benzoquinone imine (NAPQI) due to overload of pathway so forced into toxic metabolite

Question 38

What is the antidote for severe APAP toxicity?

Answer 38

n-acetylcysteine (NAC)

Question 39

What is methanol in that patients may ingest?

Answer 39

windshield and gas line antifreeze, fuel, rapid PO absorption

Question 40

What makes methanol toxic?

Answer 40

metabolites -- metabolized by alcohol dehydrogenase to form formaldehyde (problem)

Question 41

What happens with methanol and ethylene glycol toxicity?

Answer 41

metabolic acidosis, glycoaldehyde, renal injury

Question 42

What are two antidotes for methanol exposure?

Answer 42

ethanol and fomepizole, blocking the metabolism of alcohol dehydrogenase

Question 43

What does cyanide do?

Answer 43

complete blockade of oxidative phosphorylation critically with cytochrome a3, resulting in loss of ATP synthesis ----> everything ceases to function

Question 44

What are the antidotes for cyanide?

Answer 44

nithoidote: sodium nitrite IV and sodium thiosulfate IV may cause significant HYPOtension, monitor SpO2, give high dose O2 cyanokit -hydroxycobalamin ** very high affinity for cyanide, faster option

Question 45

What drug has a narrow therapeutic index?

Answer 45

Digoxin -- toxicity resulting from lower cardiac conduction and heightened automaticity

Question 46

What are overdose symptoms of digoxin?

Answer 46

unusual blind spots, color mismatch, irregular pulse, tachycardia

Question 47

What is the antidote for a digoxin overdose?

Answer 47

digibind, digitalis antidote, digifab

Question 48

What do you give to treat an arsenic exposure?

Answer 48

dimercaprol

Question 49

What do you give to treat an iron exposure?

Answer 49

deferoxamine

Question 50

What do you give to treat a lead exposure?

Answer 50

succimer, EDTA

Question 51

What do you give to treat a mercury exposure?

Answer 51

succimer, dimercaprol

Question 52

What is a chelator?

Answer 52

binding agent that suppresses chemical activity by forming cheleates -- metal toxicity treatment relies on this

Question 53

What is the antidote to warfarin?

Answer 53

phytonadione -- vitamin K (orally)

Question 54

How does warfarin work?

Answer 54

inhibits regeneration of Vitamin K through inhibiting reductase C1 and quinone reductase