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49 Cards in this Set
- Front
- Back
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Pyschologic dependence
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Compulsive drug-seeking behavior despite knowing the bad clinical effects that drug has on them.
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Physiological dependence
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Withdrawal of drugs has effects that are opposite of the effects the patient gets when takes drug.
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Addiction
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State of physiological and psychological addiction.
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What are risks of IV drugs?
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Hepatitis B
HIV Bacterial infection Tetanus |
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Most commonly abused opioids in America today:
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Heroine
Percocet (Oxycodone & Tylenol) |
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Signs and symptoms of acute opioid abuse:
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Respiratory depression
Mental status depression Miosis |
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Signs and symptoms of chronic withdrawal:
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Feel like they have the flu:
Lacrimation Mydriasis Yawn Crampy allover Sweat Insomnia Anxiety |
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Neonates born to heroin addicted mothers could die of:
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Neurotoxicity
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Treatment of opioid toxicity:
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1. ABC's - likely to die due to respiratory depression (supportive)
2. Narcan: Reverses respiratory and CNS depression. May give opioid withdrawal. |
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What's the half-life of Narcan?
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30-45 minutes
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Why do patients being treated for opioid toxicity need to be watched for 4-6hrs
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May have reversal of opioid toxicity due to the short half life of Narcan, treating an opioid with a longer half-life.
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Complications of Narcan:
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May induce opioid withdrawal.
Short half-life of Narcan, may wear out and if half life of opioid is longer, patient likely to go back into toxicity. |
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Pregnant woman abusing opioids should:
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Be admitted and placed on methadone
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List Sedative-hypnotics that may be used as drugs of abuse:
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ETOH
Barbiturates Benzodiezapines Chloral hydrate Gamma hydroxybutyrate - GHB; easily obtained on streets. |
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Which sedative used in pediatrics occasionally has a pear like odor and used to be given with alchohol and could potentiate effects of alchohol:
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Chloral hydrate
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What are the side effects of GHB?
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Agitation
Combativeness Seizures Bradycardia Rapid reawakening Amnesia Patients don't die, protect their airways |
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Street names of GHB
(Odorless, colorless, tasteless) |
Liquid Ecstasy
Liquid X Scoop Easy Lay - used in date rape (GHB is not Rohiepnol) |
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Clinical aspects of sedative drug abuse:
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CNS depression
Respiratory depression Lethargy Hypotension Coma Hypothermia |
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Chloral hydrate abuse can cause:
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Dysrhythmias
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Patients with sedative withdrawal are likely to die compared to heroin withdrawal.True of False
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True
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Symptoms of sedative hypnotic withdrawal:
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Insomnia
Nausea Vomiting Sweating Confusion Tachycardia Hypertension Hyperthermia Seizures |
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Treatment for sedative-hypnotic toxicity:
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Supportive care: respiratory depression, major problem.
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This drug works well to reverse acute BZD toxicity, to patient who is lethargic (from BZD prescribed by you).
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Flumazenil
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Why wouldn't you give Flumazenil to a patient with BZD OD or with unknown cause of lethargy?
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If chronic user of BZD, probably a BZD addict and could cause BZD withdrawal and likely to have Sz.
Unknown cause: Flumazenil, lowers Sz threshold and could cause Sz in these patients lethargic from other drugs. |
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Drug used to reverse chloral hydrate induced dysrhthmias:
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Beta-blockers
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How would you enhance phenobarbital elimination?
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Alkanize urine
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Treatment of sedative hypnotic withdrawal:
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Drug substitution
Reintroduction Referral |
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Alkaline form of cocaine:
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Crack cocaine: smoked
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Speed ball:
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Combination of cocaine and heroin. Cocain wears off fast and heroin allows them to relax (unresponsive).
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Name two stimulants that are drugs of abuse:
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Ecstasy (ingested as tablets)
Cocaine |
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What are the MOA's of cocain and Ecstasy:
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Block reuptake of DA, NE and serotonin.
cocaine - more deadly. |
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Clinical features of cocaine and methamphetamine:
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Tachycardia
Hypertension Coronary vasospasm with chest pain Cholesterol plaques & coronary artery disease (platelet aggregation). Euphoria Strokes Rhabdomyolysis hyperthermia Dehydration Diaphoresis |
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Clinical features of Ecstasy:
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Like cocaine but may kill
Same as cocaine AND Euphoria HYPONATREMIA - COULD CAUSE DEATH (esp. with dehydration) JAW EXTENSION HALLUCINATION Bruxism |
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Treatment for stimulant OD:
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SUPPORTIVE
Sz (or agitated) - calm them down, BZD or Barb Hyperthermia - cool, ice water, fans, sedation - BZD. Hypertension - Vasodilate - Sodium nitroprusside, phentolamine |
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Hallucinogens in abuse:
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LSD
Phencyclidine Marijuana - Clinical but no end orgna effects |
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MOA of LSD
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Interacts with serotonin receptors in brain.
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MOA of Phencyclidine (PCP, Angel dust)
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Dissociative anesthetic, related to ketamine
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Clinical aspects of LSD abuse:
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Euphoria, panic attack, pyschotic rxns.
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Clinical aspects of LSD abuse:
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Tachycardia, thn, diaphoresis, ataxia, agitation, combative
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Clinical aspects of marijuana abuse:
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Drowsiness, euphoria, paranoia, distortion of time and space.
Very wimpy drug, no end organi damage |
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What is the first thing you check with all drug abuse:
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Check blood sugar in any one with change in mental status, do not want to miss hypoglycemia
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Rx. of hallucinogen toxicity:
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Supportive
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Inhaled substances that are abused to get high:
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Volatile hydrocarbons - get rapid onset and offset of intoxicating effects.
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How are these inhalants delivered into the body?
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Sniff
Huff - on cloth Bagging - inhalations from bag Ballooning - put gas into balloon (mostly N2O). |
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Clinical features from hydrocarbon abuse:
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Euphoria,
Dysrhythmias (Vfib & Vtach) - due to hydrocarbon sensitization to catecholamines |
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Clinical features of chronic abuse of toluene (glue):
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Metabolic acidosis, hypokalemia, hypochloremia, hypophosphatemia (<2), and severe weakness and paralysis.
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Which drugs have been shown to reverse hydrocarbon reduced dysrhythmias?
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Beta-blockers.
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Clinical features of Nitrous oxide abuse:
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Transient Euphoria and CNS depression.
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Clinical features of chronically abused Nitrous oxide:
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Demyelinating polyneuropathy
Extremity weakness Megaloblastic anemia |
