Substance Intoxication and Withdrawal

Question 1

Depressants

Answer 1

opioids
barbiturates
benzodiazepines
alcohol

Question 2

stimulants

Answer 2

amphetamine
MDMA
cocaine
caffeine
nictoine

Question 3

hallucinogens

Answer 3

PCP
LSD
Marijuana

Question 4

General cxs of injection drug users

Answer 4

right sided endocarditis
hepatitis, abscesses
overdose
hemorrhoids
AIDS

Question 5

Opiods moa

Answer 5

mu receptor agonist

morphine, heroin, methadone

Question 6

Opioid Intoxication

Answer 6

constipation
respiratory depression 
pup constriction (pin point)
seizures
heroin look for track marks
TXT: naloxone, symptomatic treatment

Question 7

Opioid withdrawal

Answer 7

anxiety, insomnia, sweating, dilated pupils, piloerection (cold turkey)
fever, nausea, stomach cramps, diarrhea
yawning
txt: clonidine, methadone, buprenorphine + naloxone

Question 8

Barbitruates MOA

Answer 8

increased duration of GABA a channel

Question 9

Barbitruate intoxication

Answer 9

respiratory/ CNS depression

txt: symptom management, support BP, assist respiration

Question 10

Barbiturate withdrawal

Answer 10

anxiety, seizures, delirium
similar to alcohol
life-threatening cardiovascular collapse
txt: long acting benzo’s with taper

Question 11

Benzo’s MOA

Answer 11

increased frequency of GABA a opening

Question 12

Benzo’s intoxication

Answer 12

amnesia, ataxia, somnolence, minor respiratory depression

txt: flumazenil but not generally used b/c can sleep it off and can precipitate seizures

Question 13

Benzo’s withdrawal

Answer 13

rebound anxiety, seizures, tremor, insomnia

txt: long-acting benzo’s, symptomatic treatment

Question 14

Amphetamines MOA

Answer 14

simulates biogenic amine (DA, NE, 5HT) release + decrease reuptake

Question 15

Amphetamines intoxication

Answer 15

mental status changes: euphoria, impaired judgement, delusions, hallucinations, prolonged wakefulness/attention
sympathetic activation: psychomotor agitation, pupillary dilation, hypertension, tachycardia, fever

TXT: haloperidol, vitamin C, antihypertensives

Question 16

MDMA (ecstasy) MOA

Answer 16

similar to amphetamines

effects 5-HT more than dopamine

Question 17

MDMA (ecstasy) intoxication

Answer 17

hyperthermia, club drug
hyponatremia (increased fluid intake or ADH secretion)
symptomatic treatment

Question 18

MDMA (ecstasy) withdrawal

Answer 18

mood offset for several weeks

symptomatic treatment

Question 19

Cocaine MOA

Answer 19

block biogenic amine

Question 20

Cocaine intoxication

Answer 20

euphoria, hallucinations, paranoid
sympathetic activation: decreased appetite, tachycardia, pupillary dilation, hypertension, angina
can cause severe vasospasm
BB contraindicated!
txt: halperiodal, benzo’s, labetalol, vitamin c

Question 21

cocaine withdrawal

Answer 21

severe depression, suicidality
hyperphagia, hypersomnolence, fatigue
txt: bupropion, bromocriptine, SSRI’s for depression

Question 22

PCP moa

Answer 22

NMDA receptor antagonist

ketamine similar drug

Question 23

PCP intoxication

Answer 23

belligerence, impulsiveness, fear, homicadility, psychosis, seizures, agitation, tachycardia, ataxia
txt: benzo’s, haloperiodal

Question 24

PCP withdrawal

Answer 24

depression, anxiety, irritability, restlessness, disturbance of thought and sleep
TXT: symptomatic

Question 25

LSD moa

Answer 25

action at 5-HT receptor

Question 26

LSD intoxication

Answer 26

visual hallucination, anxiety or depression, delusions, pupillary dilation bad trip panic txt: antipsychotics, benzo's, talking down

Question 27

Marijana MOA

Answer 27

binds to cannabinoid receptor

Question 28

Marijuana intoxication

Answer 28

euphoria, anxiety, disinhibition, paranoid delusions, perception of slowed time, conjunctival injection, impaired judgment, social withdrawal, ↑ appetite, dry mouth, hallucinations largely psychological effects amotivational syndrome hyperemesis syndrome

Question 29

marijuana withdrawal

Answer 29

mild symptoms irritability, depression, insomnia, nausea, anorexia most symptoms peak in 48 hours and last for 5 - 7 days can be detected in urine up to 1 month after last use

Question 30

Inhalants intoxication

Answer 30

``` presentation belligerence, assaultiveness apathy, impaired judgement blurred vision, coma treatment no specific treatment antipsychotics (haloperidol) if severe aggression ```

Question 31

Alcohol minor withdrawal

Answer 31

``` 6 hrs Trembling Irritability Anxiety Headache Tachycardia Insomnia txt: Thiamine Folate Multivitamin Dextrose IV Fluids ```

Question 32

Alcoholic Hallucinosis

Answer 32

12-24 hrs Visual, auditory, and in some cases tactile hallucinations txt: benzo's and barbiturates

Question 33

Withdrawal seizure

Answer 33

48 hrs tonic clonic seizure benzo taper head ct

Question 34

Delirium trements

Answer 34

``` 48-96 hrs Autonomic instability Disorientation Hallucinations Agitation ``` Suspect in patient with unknown history follwed by DT symptoms 2 days later Benzodiazepine taper