Substance misuse Flashcards
(20 cards)
slurred speech, ataxia, aggression, blackouts, hallucinations, memory impairment, impaired judgment, coma
Dx?
Alcohol intoxication
Tremor, tachycardia, hypertension, malaise,
nausea, seizures, delirium tremens (DTs), agitation
Dx?
Alcohol withdrawal
Treatments of alcohol?
((↓ Cravings)):
Naltrexone (μ-opioid receptor blocker).
Can start while patient is still drinking.
((Aversion منفّر)):
Disulfiram (acetaldehyde dehydrogenase inhibitor): Produces an unpleasant response (eg, flushing, nausea, vertigo, palpitations) when EtOH is consumed!!
((Withdrawal)):
■ Stabilize vital signs; correct electrolyte abnormalities.
■ Thiamine (administer before: glucose, to prevent Wernicke encephalopathy), glucose, and folic acid.
■ Start medium-length benzodiazepine taper (e.g. lorazepam, diazepam, chlordiazepoxide).
■ Add haloperidol for hallucinations and psychotic symptoms.
Interactions with alcohol, amnesia, ataxia, somnolence, mild respiratory depression
Dx?
Benzodiazepines Intoxication
Avoid using for insomnia in the elderly; can cause paradoxical agitation even in relatively low doses
Rebound anxiety, seizures, tremor, insomnia,
hypertension, tachycardia, death
Dx?
Benzodiazepine withdrawal
Euphoria
Hypervigilance
Grandiosity
Paranoia
Tachycardia
Pupillary dilation
Dx?
cocaine/amphetamine intoxication
Depression Fatigue Excess Sleep Increased appetite Unpleasant dreams (nightmares)
Dx?
Amphetamines/Cocaine Withdrawal
Treatment of Amphetamines/Cocaine?
((Antipsychotics))
Benzodiazepines
Desipramine (tricyclic)
Bromocriptine
Amantadine
Amphetamine and cocaine addicts suffer from what schizophrenics suffer chronically; hyperactive dopamine. That’s why they are given as a treatment antipsychotics.
Why do we give Bromocriptine and Amantadine for Amphetamines/Cocaine?
These are anti-parkinsonian agents
which increase dopamine.
These drugs are used for two reasons:
(a) To help people through withdrawal reactions.
(b) Low levels of Bromocriptine are prophylactic in helping people not
going back to drugs again.
Restlessness
Insomnia
Excitement
Agitation
Diuresis
GI disturbances
Dx?
Caffeine Intoxication
Headache
Fatigue
Drowsiness
Nausea
Repeated vomiting
usually it lasts 1-4 days
Dx?
Caffeine Withdrawal
Impaired motor coordination
Anxiety
Slow reaction time
Impaired judgement
Conjunctival injection (red eyes)
Increased apetite
Dx?
Cannabis Intoxication
(Marijuana, hashish, THC, pot, reefer)
[Note that cannabis has no withdrawal effects, but they can affect respiratory system, associated with Amotivational syndrome!]
What is the treatment of Cannabis intoxication?
- Support
2. Foster Abstinence
Pupillary constriction
Constipation
Drowsiness
Slurred speech
Respiratory depression
Bradycardia
Comma Death
Dx?
Opiates Intoxication
Heroin, morphine, codeine, oxycodone, percoset , meperidine, horse, smack, H, Junk, china, white, sag
Pupillary dilation Yawning Flu like symptoms Runny Nose Fever
Muscle aches
Nausea and vomiting
Insomnia
Dx?
Opiate withdrawal
It lasts usually anything between 7 and 10 days
What is treatment of opiate addiction?
Naloxine (90 min half life)
Naltrexone (24 half life)
Naloxone and naltrexone are opioid receptor antagonists and reverse the effects of opioids; may require redosing because of short half-life
Clonidine (palliative)
Methadone (also LAMM) More addicting than heroin Substitutes addiction (withdrawal 7 to 10 weeks)
Buprenorphine
- Opioid partial agonist
- Sufficient agonism to all stopping use of heroin or methadone
- Taken sublingually
- Half life 1-3 days
- Use in combination with naloxone
Irritability
“Depressed Mood”
Depressed Heart Rate
Increased Appetite
Insomnia
Anxiety
Dx?
Nicotine Withdrawal
Treatment of Nicotine addiction?
Extremely difficult to quit smoking.
1 trial success, less than 10%.
Usually multiple attempts to quit.
Aids: Nicotine Patch; nicotine gum; behavioural techniques.
Medications:
- Bupropion (Antidepressant)
- Verenicline (binds to Nic receptors)
- Bromocriptine (DA on the NAC)
Nystagmus
Unsteady gait
Crushing around nose and mouth
Lack of coordination (due to cerebellar interference
Belligerence/slight confrontational
Impaired judgement
Lethargy
Dx?
Inhalants intoxication
Glue, paint thinner, shoe polish, turpentine, cleaners, market pens
They are not considered addictive and has no withdrawal effects
Treatment:
Counselling
Psychoeducation
Hallucinations
Illusions
Lack of coordination (perceptual distort the world around you
Tremors
Anxiety
Ideas of Reference
Depersonalisation
Pupillary dilation
Synesthesias (perceptual confusions: hearing something that is seen; tasting something that is heard)
Dx?
Hallucinogens Intoxication
[LSD, mescaline, peyote, mushrooms]
Treatment:
Supportive Counselling “talking down”
Antipsychotics
Benzodiazepines
