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49 Cards in this Set

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