substance abuse

Question 1

delirium tremens tx

Answer 1

benzodiazepines (chlordiazepoxide, lorazepam)

Question 2

alc intox tx

Answer 2

tapering doses of bento
thiamine, folic acid, multivitamin
mgSO4 to prevent post withdrawal seizures

Question 3

long term complication of alc intake

Answer 3

wernicke encephalopathy - bc of poor diet of alcoholics –> thiamine def. ataxia, confusion, ocular abn
can cause korsakoff’s syndrome: impaired recent memory, anterograde amnesia, confabulation

Question 4

Cocaine pthway

Answer 4

blocks dopamine repute from synaptic cleft - stimulant effect. indirect sympathomimetic. mimic fight or flight response

Question 5

cocaine clinical presentation

Answer 5

euphoria, incr or decr BP, tachy or brachy, nausea, dilated pupil, wt loss, psychomotor agitation or depression, chills, sweating. can cause respiratory depression, seizures, arrhythmias, hallucination (tactile).
vasoconstrictive- MI, CVA

Question 6

cocaine overdose

Answer 6

can kill secondary to cardiac arrhythmia, seizures or respiratory depression

Question 7

cocaine DD

Answer 7

amphetamine, phencyclidine (PCP) intox, sedative w/d

Question 8

cocaine dx

Answer 8

urine drug test, pos for 3d

Question 9

cocaine tx

Answer 9

intox:
1) mild-mod: benzo
2) severe/psychosis: haloperidol
3) symptomatic support
dependence
1) psychotx, group
2) TCA
3) dop agonist (amantadine, bromocriptine)

Question 10

cocaine w/d

Answer 10

not life threatening. cause dysphoric (crash)= malaise, fatigue, depression, hunger, constricted pupil, vivid dreams, psychomotor agitation or retardation
tx: supportive

Question 11

amphetamine types

Answer 11

classic and

substituted

Question 12

classic amphetamine

Answer 12

dextroamphetamine (dexedrine), methylphenidate (ritalin), methampheamine (ice, speed, crystal meth, crack)
release dopamine from nerve endings –> stimulant effect. used to tx narcolepsy, ADHD, depressive D

Question 13

substituted amphetamine

Answer 13

aka designer. - MDMA (ecstasy)m MDEA (eve)

release dopamine and 5HT from nerve endings- stimulant and hallucinogenic properties

Question 14

amphetamine intox presentation, dd, dx, tx, w/d

Answer 14

same as cocaine. urine drug screen pos for 1-2d. neg screen doesn’t rule it out bc many aren’t sensitive enough.

Question 15

PCP pthwy

Answer 15

hallucinogen that antagonize n-methyl-d-aspartate (NMDA) glutamate R and activate dopaminergic neurons. similar to ketamine. aka angel dust

Question 16

PCP intox sx and signs

Answer 16

recklessness, impulsivness, impaired judgment, assaultiveness, rotatory nystagmus (pathognomonic), ataxia, HTN, tachym M rigidity, high tolerance to pain. overdose-seizure, coma.cause more violence than any other drug.

Question 17

pcp intox tx

Answer 17

monitor BP, T, electrolytes
acidify urine with NH4Cl and ascorbic acid,
benzo or dopamine antagonist- ctrl agitation and anxiety
diazepam - M spasm and seizures
haloperidol- ctrl severe agitation and psychotic sx

Question 18

PCP dx

Answer 18

urine drug screen pos for >1wk. CPK and AST often elvated
dd acute psychotic states, schizophrenia
w/d - none but may have flashbacks

Question 19

sedative hypnotics

Answer 19

benzos, barbiturates (tx epilepsy and as anesthetic). the two are synergistic. can cause respiratory depression

Question 20

benzodiazepam pthwy

Answer 20

potentiate effects of GABA by incr freq of cl ch opening

Question 21

barbituate ptwy

Answer 21

potentiate GABA by incr duration of Cl ch opening

at high dose, direct GABA agonist and lower margin of safety compared to BDZs.

Question 22

sedative hypnotic intox

Answer 22

sedative= drowsy, slurred speech, incoordination, ataxia, mood lability, impaired judgment, nystagmus, respiratory depression, comma or death in overdose (especially barbiturates)
sx aug by ethos.
dd: alc intoxx, generalized cerebral dysfunc- delirium
dd: urine or serum drug test pos for 1wk. electrolyte, ecg

Question 23

sedative hypnotic tx

Answer 23

maintain airway, breathing, circulation
activate charcoal to prevent GI absorption
barbituates- alkalize urine with NaCO3 to promote renal excretion
benzo- flumazenil in overdose
supportive care

Question 24

flumazenil

Answer 24

short acting BDZ antagonist. can precipitate seizure

Question 25

sedative hypnotic w/d

Answer 25

``` life threatening (w/d from stimulants/hallu is not) autonomic hyperactivity, insomnia, anxiety, tremor, n/v, delirium, hallu, seizure tx: long acting bend- chloroiasepoxide or diazepam - then taper dose. tegretol or valproic acid for seizure ctrl. ```

Question 26

opiates

Answer 26

ex heroin, morphine. stimulate opiate R (mu, kappa, delta) affect dopaminergic system.

Question 27

opiate intox

Answer 27

drowsiness, n/v, constipation, slurred speech, constricted pupil, seizure, respiratory depression --> coma --> death. meperidine + MAOi --> serotonin syndrome (hyperthermia, confusion, hyper/potnesion, M rigidity

Question 28

opioid dd

Answer 28

sedative-hypnotic intox. severe etoh intox | dd- rapid recovery of consciousness after admin of IV naloxone. urine/blood test pos for 12-36hr.

Question 29

opioid tx

Answer 29

intox- ABC overdose- naloxone or naltrexone. may need ventilatory support. dependence: oral methadone daily taper over mo/y. psychotx

Question 30

triad of opiod overdose

Answer 30

rebels admire morphine | respiratoyr depression, altered mental status, miosis

Question 31

opiate w/d

Answer 31

not life threatening. w/d syndrome- dysphasia, insomnia, lacrimation, rhinorrhea, yawning, weakness, sweating, piloerection, n/v, fever, dilated pupils, muscle ache tx: moderate sx- clonidine or buprenorphine. severe- detox with methadone over 7d

Question 32

hallucinogens intox, w.d

Answer 32

psilocybin (mushrooms) lsd pharm effect vary. tolerance dev quickly but reverses rapidly no dependence or w/d perceptual changes, papillary dilation, tachy, tremors, incoordination, sweating, palpitations tx- guidance and reassurance. severe- antipsychotics or benzo

Question 33

marijuana

Answer 33

cannabis is a THC cannabinoid R in brain inhibit adenylate cyclase. effects augmented by EtOH. can tx nausea in cancer pt and incr appetite in AIDS pt. no sep or w/d

Question 34

marijuana intox

Answer 34

euphoria, impaired coordination, mild tachycardia, conjunctival injection, dry mouth, incr appetite urine test pos for 4 wks supportive and sx treatment

Question 35

inhalants

Answer 35

CNS depressants. user usually adolescent male intox- impaired judgment, belligerance, everything overdose may be fatal secondary to respiratory depression or arthymia. long term use- permanent damage to CNS, PNS, liver kidney, M tx: ABC, sx, psychotx dx- serum drug pos for 4-10hr no w/d

Question 36

caffeine

Answer 36

adenosine antagonist. incr cAMP and stimulate effect via dopaminergic system

Question 37

nicotine pthwy

Answer 37

stimulate nicotinic R on autonomic ganglia of sympathetic and PSNS. --> CNS stimulant--> restlessness, insomnia, anxiety, incr GI motility. incr attention, mood, decr tension

Question 38

nicotine w/d

Answer 38

craving, dysphoria, anxiety, incr appetite, irritability, insomnia

Question 39

smoking cessation

Answer 39

behavioral counseling, nicotine replacement therapy (gum, patch), zyban (antidepressant decr craving), clonidine