Cocaine Intoxication - WORST CONSEQUENCES
Other side effects?
Cardiac arrhythmia, Stroke, MI
Rhabdomyolysis from constricture of muscle vasculature
also see increased DTR, Hyper-mydriasis, sweating, tics etc
Grandiose euphoria and can look manic
Can also see Tactile Hallucinations - Formication = bugs crawling on skin!
Treatmend for cocaine intoxication?
For seizures - diazepam or phenytoin
MI - TREAT THE MI
AGitation and angina - BZD and occasionally Nitroglycerin
What's Withdrawal from cocaine like? Life threatening or not?
Not life threatening but can last for several days
occasionaly increased risk of suicide
Psychological Depression!!! Cocaine blocks reuptake of catecholamine and so stop using and get refractory period where receptors upregulated but not releasing as much and so physiological depressoin
Same as cocaine but more psychotic symptoms and effects take longer to start and last longer
Same thing with withdrawal
Hallucinogen intoxication - effects? and treatment
Effects - not life threatening except ppl do stupid shit on them
Tachycardia, sweating, mydriasis, anticholinergic effects, hyperthermia, Depersonalization and derealziation, Illusion, synaesthesia
Treatment - supportive, Benzo, anitpsychotic if bad hallucinations
What is Hallucinogen Persisting PErception disorder?
Flashbacks that occur after you stop using hallucinogen and can continue for months to years
triggered by stress, fatugie, anxiety, dark environments, drug use
PCP - Onset/Duration, Side Effects
Quick onset and can last for several hours to DAYS!!! But can Wax and wane from wild to sedated - like Delirium
CAN DIE FROM EFFECTS
Often people commit Serious Self-Injuryious acts w/o realizing it bc it is a semi-anesthetic
- VERTICAL AND HORIZONTAL GAZE NYSTAGMUS!!!
HTN, Tachycardia, decreased pain, ataxia, slurred speech, muscle rigidity, hyperthermia, euphoria
Can cause Paralysis symptoms
Mechanism of Action of PCP? Treatment of Intoxication?
NMDA Glutamate Receptors!
Tx - supportive and quiet, safe environment
Agitation - can use BZD
No longer do acidification of urine
Like Alcohol intoxication - minimal respiratory effects when used alone but dangerous when used in combination
Treatment - supportive
Flumezanil - BZD receptor Antagonist but be careful bc can put into BZD withdrawal which is life threatening!
BZD Withdrawal - what's it like?
Can be Fatal!!!
Same as for EtOH but onset later after last use and course is longer
Seziures can be common
Treatment is same as for alchohol
Opioid intoxiction - What it's like? In infants? Treatment?
CAN BE FATAL FROM CENTRAL RESP DEPRESSION
see Miosis, drowsiness, constipation, itching, euphoira, psychomotor retardation
In Infants - see seizures
Treattment - Establish Oxygenation!!!
Naloxone - Mu Antagonist given IV, IM, or Rectal and can reverse respiratory depression
Caution w/ Methadone OD bc much longer so can RE-narcanize
Opidate Withdrawal - what's it like? Is it life threatening?
Withdrawal seen w/in 6-24 hrs or several days longer and subacute symptoms can last for months
NOT life-threatening Except in Noenates and Disabled!!!
Symptoms - goosebumps, dilation, sweating, runny nose, N/V, Diarrhea, Tachycardia, HTN, MUSCLE TWITCHING
Seizures in Neonates
1) Clonidine - Alpha blocker bc LC gets inhibited w/ chronic opioid use and then stop suddenly and get bad sympathetic rebound effects so this helps dampen those
3) Buprenorphine - Partial Mu Agonist
3 types of inhalants?
Volatile Organic Compounds - CNS depressants
Nitrites - Vasodilate and smooth muscle relaxation
Nitrous Oxide - CNS depressant and alters neuronal memnbranes and Da/Opiate system
Inhalant Withdrawal and Intoxication
Intoxication - short, nystagmus, unsteady gait, slurred speech, euphoria, collapse, light-heeaded
Only supportive Measures
DANGER - Nitrites and Vasodilation - Bottom Out BP
Inhalant Withdrawal - non-specific seen a few days after last use
STeroid Intoxication, Treatment, Withdrawal
Symptoms - Roid rage, HA, sweating, HTN, ab pain, increased appetite, aggression, insomnia
Treatment - Supportive, Psychosis can treat w/ neuroleptic if prolonged, Agitation treat w/ BZD
Withdrawal - non-specific and opposite effects of symptoms
DETOX w/ SLOW taper
Ketamine - what's so weird about ketamine intoxication
Dissociative Anesthetic - In the K hole
Hallucinations and disocation but realtively cal