Illicit Drug use as seen in the ED

Question 1

Your pt has pinpoint pupils. What did they OD on?

Answer 1

Opioids

Question 2

Your pt has dilated pupils. What did they OD on?

Answer 2

Cocaine, amphetamines, LSD

Question 3

Nicotine causes miosis or myadriasis?

Answer 3

Miosis

Question 4

Your pt has nystagmus. What did they OD on?

Answer 4

EtOH, barbiturates, PCP

Also: carbamazepine, phenytoin, scorpion sting

Question 5

This drug causes flushing, increased gastric bloodflow, and CV and respiratory depression.
Also known to relax uterine smooth muscle.

Answer 5

EtOH

Question 6

Pt is withdrawing to EtOH in your ED. How do you tx?

Answer 6

Thiamine
correct electrolytes
Benzos

Question 7

Pt is intoxicated due to EtOH. How do you tx?

Answer 7

Thiamine + Glucose (if hypoglycemic)

correct electrolytes

Question 8

What drugs possess disulfram-like effects with taken w/ EtOH?

Answer 8

sulfonylureas, cefotetan, ketoconazole, procarbazine

Question 9

What is mecamylamine used for?

Contraindications?

Answer 9

Nicotine overdose (patches, vaping)
Contras: it is only available PO- not suitable for pts vomiting, convulsing, or w/ hypoTN

Question 10

Pt OD’d on benzos. Give:

Answer 10

Flumazenil

Question 11

Pt OD’d on opioids. Give:

Answer 11

Naloxone (Narcan)

Question 12

Although it is virtually impossible for a pt to OD on marijuana, you can give _____ to prevent injury and reassure those with panic reactions.

Answer 12

Benzos

B-blockers to reduce sinus tachycardia

Question 13

What drugs carry a risk of rhabdomyolysis?

How do you treat this to prevent renal damage?

Answer 13

Amphetamines
Cocaine
PCP
Clozapine and Olanzapine (atypical antipsychs)
Lithium
MAOIs

Vigorous hydration and urine alkalinization

Question 14

How does Cocaine work?

Answer 14

–I presynaptic DA reuptake via DAT –> ^ levels of DA in cleft

Question 15

How do amphetamines work?

Answer 15

They are substrates for the DAT –> competition for DA reuptake.
Also, once in the cell, they inhibit vesicular filling by VMAT –> increased intracellular concentrations of DAT –> decr. reuptake (presynaptic) and incr. non-vesicular release into cleft. –> incr. DA in cleft

Question 16

Your pt is ODing on cocaine and has severe tachycardia. Should you give a B-blocker? Why or why not?

Answer 16

NO! Unopposed a-effects, USE Labetalol (mixed a/B blocker)

Question 17

How do you tx HTN in cocaine or amphetamine overdose?

Answer 17

Nitroglycerine (vasodilation) or phentolamine (a1-blockade)

—> vasodilation

Question 18

How do you tx overdose of “club drugs” Ecstasy and Roofies?

Answer 18

Same as with cocaine and amphetamines. Tx symptoms individually.

Question 19

At low doses, ketamine and PCP cause these effects. How?

Answer 19

Sedation- NMDA antagonism
Analgesia, anesthesia, cognitive deficits, psychosis- Inhibition of Glu signaling
CV stimulation- MAOI effects
Lethargy/coma- sigma receptor (?)

Question 20

How do you tx hallucinations due to LSD, psilocybin, and mescaline?

Answer 20

Benzos for all 3

May need to add haldol (antipsychs) for LSD due to psychosis