Mehl. Drug intoxication 04-27 (2)

Question 1

M. Glue? CP

Answer 1

Ataxia + cognitive decline in teenager.

Question 2

M. Glue. Will sound a bit like alcohol abuse but the effects of alcohol don’t occur so young.

Answer 2

.

Question 3

M. Paint. Decline of what?

Answer 3

Cognitive decline

Question 4

M. Paint. What CP is seen?

Answer 4

Q can say teenager is seen with gold or silver coloration around the nose/mouth.

Question 5

M. Butane (inhalant). Decline of what?

Answer 5

Cognitive decline.

Question 6

M. Butane (inhalant). classic inhalation of what? 2

Answer 6

Classically inhaling computer cleaner (dusters) or whipped cream bottles.

Question 7

M. Butane (inhalant).
Q will say high schooler found on floor in school bathroom + is brought into ED sluggish {vangus} + pupils and vitals all normal. Dx?

Answer 7

butane

Question 8

M. Most common drug addiction in the world.

Answer 8

Caffeine

Question 9

M. caffeine mechanism?

Answer 9

Adenosine accumulates in the brain throughout the day and causes sense of fatigue.
Caffeine blocks adenosine receptors, promoting sense of wakefulness.

Question 10

M. caffeine intoxication CP?

Answer 10

Intoxication can cause sense of over-stimulation, panic, and palpitations.

Question 11

M. caffeine withdrawal CP?

Answer 11

Withdrawal can cause headache, sense of depression, fatigue, anxiety (i.e., sense of worry/doom), and inability to concentrate

Question 12

M. smoking/vaping. cause what feeling?

Answer 12

Nicotine can promote sense of euphoria

Question 13

M. smoking/vaping. Withdrawal CP?

Answer 13

Withdrawal can cause many symptoms, including anxiety, depression, difficulty concentrating, and weight gain due to increased appetite.

Question 14

M. Marijuana. CP?

Answer 14

Injection (redness) of conjunctivae + dry mouth.

Question 15

M. Marijuana. incr. of what CP?

Answer 15

incr. risk of developing psychosis and schizophrenia.

Question 16

M. Cocaine. CP?

Answer 16

Mydriasis, tachycardia.

Question 17

M. Cocaine. can cause what cardiac pathology?

Answer 17

High BP causing aortic dissection; can cause chest pain (coronary vasospasm). gali dar MI sukelti

Question 18

M. Cocaine. in pregnant?

Answer 18

Abruptio placentae if pregnant teens

Question 19

M. Cocaine. Tx?

Answer 19

Give benzo if acutely intoxicated + observe in emergency

Question 20

M. Amphetamine. CP?

Answer 20

Mydriasis, agitation, INSOMNIA / staying up all night.
Can cause tactile hallucinations.

Question 21

M. Amphetamine. Tx?

Answer 21

Give benzo if acutely intoxicated + observe in emergency.

Question 22

M. PCP. CP?

Answer 22

Bellicosity / pugnacity (if you’re ESL, those mean wanting to fight + aggressive).

NYSTAGMUS +/- mydriasis.

Question 23

M. PCP.
One 2CK NBME Q gives mutism + constricted pupils for PCP + nothing about pugnacity, so just be aware this presentation is rare but possible.

Answer 23

.

Question 24

M. PCP. Tx?

Answer 24

Give benzo if acutely intoxicated + observe in emergency.

Question 25

M. MDMA (ectasy). CP

Answer 25

Euphoria, heightened sensory perception, low-grade fever, bruxism (teeth grinding).

Question 26

M. MDMA (ectasy). An NBME Q floating around gives increased creatine kinase, so this is also possible.

Answer 26

.

Question 27

M. MDMA (ectasy). Tx?

Answer 27

Give benzo if acutely intoxicated + observe in emergency.

Question 28

M. LSD (acid). CP?

Answer 28

Visual hallucinations.

Question 29

M. LSD (acid). Tx?

Answer 29

- Give benzo if acutely intoxicated + observe in emergency.

Question 30

M. MPTP. synthetic heroin. Causes what CP?

Answer 30

- Synthetic heroin. - Causes Parkinsonism. - Shows up on a 2CK form, so if you think it’s weird, take it up with NBME, not me.

Question 31

M. Heroin/opioids. E.g., oxycodone or dextromethorphan. CP?

Answer 31

Respiratory depression + constricted pupils + constipation.

Question 32

M. Heroin/opioids. Tx for ACUTE?

Answer 32

Naloxone (opioid receptor antagonist) for acute toxicity.

Question 33

M. Heroin/opioids. Tx TO DECREASE RELAPSE?

Answer 33

Methadone (opioid receptor agonist) to ̄ relapses.

Question 34

M. BZD. CP?

Answer 34

Respiratory depression.

Question 35

M. BZD. Antidote?

Answer 35

Flumazenil to treat acute toxicity (benzodiazepine receptor antagonist).

Question 36

M. Barbiturates. CP?

Answer 36

Respiratory depression

Question 37

M. Barbiturates. Q will say naloxone and flumazenil had no effect, so you eliminate to get to barbiturates.

Answer 37

.

Question 38

M. Acetaminophen. CP?

Answer 38

Fulminant liver failure.

Question 39

M. Acetaminophen. What about charcoal?

Answer 39

Give activated charcoal if ingested within 1-2 hours.

Question 40

M. Acetaminophen. Antidote?

Answer 40

N-acetylcysteine must be given after to regenerate reduced glutathione to prevent liver damage from NAPQI (acetaminophen metabolite).

Question 41

M. Aspirin. CP?

Answer 41

Tinnitus + mixed metabolic acidosis-respiratory alkalosis.

Question 42

M. Aspirin. Tx?

Answer 42

Give sodium bicarb to treat (­ excretion through urinary alkalinization).

Question 43

M. TCAs. CP?

Answer 43

CCCs (coma, convulsions, cardiotoxicity).

Question 44

M. TCAs. ECG changes?

Answer 44

ECG changes seen frequently in vignettes. For example, you’ll get a big vague paragraph about some drug overdose + they say in last line QT is prolonged. answer = the TCA. Then you remind student about cardiotoxicity and they’re like Oh yeah.

Question 45

M. TCAs. What additional effect?

Answer 45

Anti-cholinergic effects (i.e., delirium + hot, red, dry patient).

Question 46

M. Parkinsonism Cp?

Answer 46

diffuse stiffness + drooling;