Psychiatry: Substance Abuse Flashcards by Tyler Rzucidlo

What are the key Physiologic Effects of Cocaine

Local anesthetic
-Na channel block

Inhibits Monoamine Uptake

Sympathetic Activation

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What are Monoamines

Dopamine
Serotonin
Norepinephrine

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What are Common features of cocaine intoxication

Increased energy
decreased need for sleep
alterness
Eupohoria
Hallucinations
Paranoia
Fever
Anxiety

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What type of hallucinations are most commonly seen in Cocaine Intoxication

Tactile
-bugs crawling on skin

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How do you treat cocaine intoxication

Benzodiazepines

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What are severe complications of cocaine intoxication

Rhabdomyolysis

Seizures

Myocardial Ischemia

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What is seen on physical exam in Cocaine intoxication

Dilated Pupils
Tachycardia
Hypertension

-SNS activation
-a/b receptor stimulation

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How does cocaine intoxication cause Myocardial Ischemia

Increase O2 demand
-Tachycardia, HTN

Decreased O2 supply
-coronary vasoconstriction

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Treatment options for Myocardial ischemia in Cocaine Intoxication

Benzodiazepines

Aspirin

Catheterization in severe cases

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How do Benzodiazepines aid in treatment of Myocardial Ischemia from Cocaine Intoxication

Sedating/calming

diminish stimulating effects of Cocaine

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What drug-class should be avoided in Myocardial Ischemia from Cocaine Intoxication

Beta-blockers
-increase alpha effects
-worsen HTN and chest pain

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What are the common symptoms of Cocaine Withdrawal

Depression
Anhedonia
Anxiety
Cravings
Increased Sleep

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What are the physiologic effects of Amphetamines

Stimulants that increase SNS activity and levels of DA/NE

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What are common features of Amphetamine Intoxication

Euphoria/Fever
Tachcyardia
HTN
Pupil dilation

Rhabdo/Seizures/ischeima

*Stimulate SNS

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How do you treat Amphetamine Intoxication

Benzodiazepines

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What Opioid is the common drug of abuse

Heroin

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What diseases are associated with dirty needles in heroin use

HIV
HBV
HCV

Bacteremia leading to tricuspid endocarditis

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What are the CNS effects of Opioids

Pain relief (Analgesia)
Euphoria
Sedation
Slurred Speech
Respiratory depression
Cough Suppression
Miosis (Small pupils)

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What are the PNS effects of Opioids

Constipation
N/V
Skin warmth and flushing

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What are common clinical uses of Opioids

Pain control
Acute Pulmonary Edema
Cough Suppression
Diarrhea
Shivering

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What is drug tolerance

Less effect of drug over time

Higher doses needed to achieve effects

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What is the most common cause of drug overdose death

Opioids

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What is seen on physical exam with Acute Opioid Intoxication

Euphoria to depresses mental status

Decreased RR
Decreased bowel sounds
Miotic (constricted) pupils

Seizures

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How do you treat opioid intoxication

Naloxone

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What is the mechanism of Naloxone

Short-acting opioid antagonist

What is a potential adverse effect of Naloxone

May overshoot dose and cause withdrawal

What scale is used to address Opioid Withdrawl

Clinically Oriented Withdrawal Scale (COWS)

What is naturally-occuring opioid withdrawl

starts 6-12 hours after last dose in opioid-dependent patients

What symptoms are seen in naturally-occuring opioid withdrawal

Restlessness Yawning Rhinorrhea and Lacrimation Piloerection N/V/D abdominal cramps

What are the medical treatment options for Opioid Withdrawal

Clonidine Opioid Agonists

What is the mechanism of Clonidine in Opioid withdrawal

Central alpha-agonist -blunts the SNS activation to provide sedating effect

What Opioid agonists are commonly used for opioid withdrawal

Buprenorphine Methadone

What are common treatment options for Opioid Use disorder

Buprenorphine Methadone Naltrexone

What is the mechanism of Buprenorphine for opioid use disorder

Partial Opioid agonist

What is commonly combined with Buprenorphine for Opioid Use Disorder

Naloxone

How is Buprenorphine administered

Sublingual tablet

What is the mechanism of Methadone for Opioid Use Disorder

Long-acting PO Opiate that acts to reduce cravings and maintenance

What is the mechanism of Naltrexone

Long-acting opioid antagonist used in detoxified patients to prevent relapse

What is a Schedule I Drug

No medial indication

What are some examples of Schedule I Drugs

Heroin LSD Ecstasy

What is a Schedule II Drug

High abuse potential

What are examples of Schedule II Drugs

Cocaine Methadone Fentanyl Ritalin

What are schedule III drugs

Moderate abuse potential

What are examples of Schedule III Drugs

Buprenorphine Ketamine Anabolic steroids

What are schedule IV drugs

low abuse potential

What are some examples of Schedule IV drugs

Benzodiazepines

What are Schedule V Drugs

very low abuse potential

What are some examples of Schedule V Drugs

Cough Medications with codeine

What are some examples of Barbiturates

Phenobarbital Pentobarbital

What is the MOA of Barbiturates

Anti-seizure drugs Activate GABA receptors

What is dangerous to combine with Barbiturates

Alcohol

How does Barbiturate Overdose present

Respiratory depression no antidote

How does Abrupt Barbiturate withdrawal present

Delirium Hallucinations Seizures CV collapse and death

What are some examples of Benzodiazepines

Diazepam Oxazepam Lorazepam

What is the MOA of Benzodiazepines

Increase GABA activity

How does a Benzodiazepines Overdose typically present

CNS depression with normal vitals AMS Slurred Speech Ataxia

What is the antidote for a Benzodiazepine overdose

Flumazenil

What is the MOA of Flumazenil

Benzodiazepine receptor antagonist

What is an associated adverse effect of Flumazenil

Withdrawl Seizures

What are common symptoms of Benzodiazepine withdrawl

Tremors Anxiety Depressed mood Hypersensitive to sensations Psychosis Seizures

How do you treat Benzodiazepine withdrawal

Benzodiazepines

What are common physical symptoms of Marijuana Intoxication

Euphoria Anxiety Impaired Coordination Conjunctival injection Dry mouth increased appetite tachycardia

What neurotransmitter does Ecstasy (MDMA) effect the most

Serotonin -increases release -decreased reuptake

What are common findings of Ecstasy Intoxication

Eupophoria/alertness Increased sociability/sexual desire Bruxism Tachycardia/HTN Hyperthermia Hyponatremia Hepatotoxicity

What are common findings in Ecstasy withdrawal

Depression/Anxiety fatigue and Lethargy Difficulty concentrating Loss of appetite Jaw soreness

What type of drug is LSD

hallucinogen

What are common symptoms of LSD

Trip Synesthesia Depersonalization Bad trip Flashbacks

How do you manage LSD intoxication

Supportive care

What is the Mechanism of Phencyclidine (PCP)

NMDA receptor antagonist in the CNS inhibits reuptake of DA, NE, 5HT

What are common symptoms of PCP intoxication

Stimulant AMS Psychosis Psychomotor Agitation Agitated, violent Tachycardia, HTN Nystagmus

What are most fatalities from in PCP use

Trauma -loss of pain/sensation -dissociate

How do you treat PCP intoxication

Benzodiazepines Haloperidol

Psychiatry: Substance Abuse Flashcards

(72 cards)