Flashcards in Substance Abuse Deck (45):
If a patient presents to the ED with abdominal pain, agitation, sweating, dilated pupils, and fever, what might be the cause?
Current Use would be: Elevated Mood, Sedation, Pupil Constriction (suppresses neural output / miosis)
What is an immediate acting drug that can reverse heroin and other opioid effects?
What agent can be used to help immediate symptoms of Opioid withdraw / Heroin?
What are the common symptoms of stimulant agents such as "Speed" or Amphetamines?
- Increased mood and alertness
- Increased agitation
- Pupil Dilation
- Increased energy and less tired
- CV Effects
- Decreased Appetite
- Increase Pain Threshold
If after an injury a patient is admitted to the hospital, then about 2-3 days later he begins to have constant tachycardia and hypertension with delusional thinking and tremor. What the patient had been taking chronically before admission and is now withdrawing from?
Depressants / Sedatives
What is the typical scenerio for withdraw of stimulants?
- Significant Depressed Mood
- Strong Psychlogical craving and irritability
- Increased Hunger (Amphetamines)
- Pupil Constriction
A 32 year old presents to the ED who appears sedated, but elevated mood. He has history of HIV. What is most likely drug?
-- Heroin (IV drug use probably gave him HIV)
What is a physical exam finding that can contribute to diagnosing a patient with cocaine abuse?
Erythema within the nose
A 28 year old is hospitalized after trying to jump from one build to another and his friends state he was very angry when they refused to do it with him. What is the likely drug of choice?
PCP -- Methamphetamines
Where are the locations that addicting drugs most commonly work to reinforce future use?
- Ventral Tegmental Area (depressants / sedation)
- Nucleus Accumbens (Most stimulants and cannaboids)
- Prefrontal Cortex
What is a significant predictor of likelihood of addiction?
Tolerance to side effects
What are factors that contribute to addiction?
- Predisposition / Triggers -- started on pain pills w/ surgery and end up getting addicted
-- Impulse control deficits
-- Family Reinforces Behavior with Co-dependent
What is the best treatment for addiction?
No single treatment works for everyone, must have a designed treatment specific for each person
During Detox what should be taken for Opioid detoxification?
Clonidine and Loperamide
What should be used in an alcoholic who is detoxing?
What are the steps in Addiction treatment?
Active Treatment -- seperating from substance and lifestyle changes
Maintenance -- staying changed
Why is relapse especially dangerous?
Patient have been clean for a duration and their tolerance decreases and the patient go back to the dose they were at before they stopped, which is very high and can cause overdose if just jumping right to it.
What are the most common methods of treatment?
Motivational Enhancement Therapy -- create conditions to enhance the patient's efforts and encourage
12-Step Approach -- most residental centers use
Self-Help --complements efforts
What are only certain ethnic groups more susceptible to Codeine and Opiate abuse?
Codeine is converted to Morphine by CYP2D6 and different ethnic groups have different concentrations of it
How do Opioids affect respiration mechanisms?
- Reduce respiratory response to elevated CO2
- Eliminates response of respiratory drive to low O2
What are specific correlative signs of opiate intoxication?
- Pupillary Constriction
- Drowsiness / Slurred Speech / Attention Impaired
What are specific signs of opiate withdrawl several days after stoppage?
- Pupillary Dilation
- Yawning -- insomnia
How does Methodone treatment work for opioid abuse?
- Long Acting to prevent withdraw and doesn't give them the high
How does Buprenorphine / Suboxone work to treat opioid abuse?
Partial Agonist -- Has constant Opioid effect over log-scale with a very long half life
Thus, maintains a constant level without fluctuations in level, which contribute to patients increasing dose/abuse.
How can Buprenophine be prevented from being used?
- Adding Naloxone, which is an opioid receptor antagonist, except very short half-life.
-- If the patient tries to crush the drug and inject it there will be no effect, but if they take it PO will get the effect from the long acting opioid.
What are the side effects or risk of long term Buprenorphine?
- Similar effects of opioids with constipation/nausea
- No distruption of cognitive function or psychomotor performance
- No organ damage over time
How do you treat acute pain with patients chronically on Buprenorphine?
Use short acting opiods
-- will just add to the opioid effects to give them pain relief
if surgery, then stop buprenorphine temporarily
Who most commonly uses Marijuana?
-- Age dependent
-- M > F
-- Higher prevalence than cigarettes
What is the cellular mechanism of THC?
-- binds the CB1 Receptor in the cerebellum-hippocampus-basal ganglia
-- Inhibits adenylyl cyclase activity by Gi preventing neurotransmitter release
What are the endogenous cannabinoids?
What is the CB1 Antagonist?
-Used to be used to prevent hunger and weight loss, but ended up causing psych symptoms and suicide
What are the effects of THC most commonly?
- Memory impairment = difficult repeat subtractions and memory consolidation
- Diminished reaction time
- CV -- Tachy, Orthostatic Hypotension, worsens Angina
- Pulm -- decrease ciliary function and alveolar macrophages with irritating lungs
- GU -- Lowers T and sperm counts, decreases Prolactin Release (can make infertility worse)
What are the most common psychopathologic effects from THC?
- Acute Anxiety Reaction
- Transient Paranoid Feeling
- Exacerbation of Schizophrenia
What are therapeutic uses of THC in medicine?
Dronabinol -- AIDS to help appetite
Cannabidiol Mixture -- MS and Cancer Pain
Why is Spice and Special K especially dangerous?
- CB1 Agonist Activity with unknown concentrations due to not being regulated
What receptor does PCP (Phencyclidine) produce hallucinogenic effects at?
How are Ketamine and PCP similar and different?
Both are NMDA Antagonists
- Ketamine has a shorter half-life
What are the effects of PCP?
CNS: Anxiety, Aggression, Hallucinations, etc
Sympathomimetic -- Tachycardia and HTN Crisis (More NE in the clefts)
What commonality between Indoleamines (LSD) and Phenethylamines (Mescaline / MDMA)?
They are all cross reactive with one another.
-- Hallucinogens --
How are LSD effects different from PCP?
-- Sensory and Subjective Effects thought to be due to agonist of 5HT2
Both PCP/LSD Sympathomimetic
-- Less Aggression and Agitation than PCP
What are risks associated with LSD both acutely and long term?
Acutely -- Anxiety, panic, depersonalization
Chronic -- Flashbacks up to years later induced by LSD
-- Long term damage from 5HT
How is MDMA (Esctasy) different from LSD?
- Induces a feeling of "Well-being and connection with the world" and alters time perception
What is Gamma-Hydroxybutyrate?
Precursor to GABA found in CNS
- Primarily a depressant inducing a state of relaxation/tranquility and higher doses can cause temporary amnesia
What are the toxicities of Toluene from inhaling it from solvents?
- Bone Marrow Suppression
- Aplastic Anemia