OnlineMedEd: Psychiatry - Drugs of Abuse

Question 1

What demographics have a higher incidence of alcohol abuse?

Answer 1

• Males (3x more common than females)

* Native Americans and Alaskans

Question 2

These signs and symptoms suggest alcohol intoxication: __________________.

Answer 2

• AMS
• Slurred speech
• Cerebellar dysfunction
• Coma
• Disinhibition
• Nausea and vomiting

Question 3

Differentiate Wernicke encephalopathy and Korsakoff syndrome.

Answer 3

• Wernicke’s encephalopathy is caused by thiamine deficiency and presents with nystagmus and AMS; it is reversible.
• Korsakoff syndrome is an irreversible disorder caused by damage to the mammillary bodies that results in confabulation.

Question 4

Alcohol is eliminated via zero-order metabolism at _______ per hour.

Answer 4

0.03%

This is important in litigation. If you know someone’s BAC at one point and when they started drinking, then you can extrapolate how high their BAC was.

Question 5

How should alcohol intoxication be treated?

Answer 5

• Acute intoxication in a conscious person: wait it out (IV fluids and NSAIDs can be given for symptom management)
• Acute intoxication in an unconscious person: give thiamine and then D50
• Chronic abuse: Alcoholics Anonymous

Question 6

Why does alcohol withdrawal occur?

Answer 6

In response to chronic alcohol intake, the body downregulates GABA receptors (because there is too much GABA stimulation). When you remove alcohol, the sparser GABA population is not stimulated enough and the brain’s neurons are overactive.

Question 7

Early alcohol withdrawal presents with ____________ hypertension.

Answer 7

diastolic

Question 8

Why do you absolutely need to intervene in delirium tremens (with benzodiazepines)?

Answer 8

You need to give benzodiazepines because confusion and agitation (signs of delirium tremens) usually precede seizures, which can be life-threatening.

Question 9

Long-acting benzodiazepines like ______________ are given to treat DTs. Short-acting ones like __________ can be given to initially manage an acutely delirious person.

Answer 9

chlordiazepoxide and diazepam; lorazepam

Question 10

Opiate withdrawal presents with _________________.

Answer 10

• Cramping
• Diarrhea
• Irritability
• Yawning
• Lacrimation
• Dysphoria / pain

Question 11

How can you treat PCP intoxication?

Answer 11

Officially, acidification of urine can speed excretion and haloperidol can subdue a violent patient. In practice, however, those things are difficult to do to a violent patient and the patient may just need to be handcuffed and restrained until they sober.