Drugs Of Abuse Updated

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Intoxication

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is the reversible effects of using a drug including psychological or physiological

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Withdraw

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Is the psychological or physiological change from cessation or reduction of substance use

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Abuse

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Is the social, dangerous situations and failed obligations at work school, or home, and legal ramification that are due to substance use. Substance is used despite consequences over a period of a year.

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Dependence

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Maladaptive use that leads to tolerance and withdraw and a significant time spent trying to purcure substance. Supercedes a diagnosis of substance abuse.

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Alcohol Withdraw

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Most serios form is delerium trements that begins with in 72 hours of cessaion that include tremors and seizures. Also hallucination, autonomic instability and fluctuating psychomotor activity.

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Treatment of Alcohol Withdraw

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Benzodiazepines. Thiamine. Folate

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Amphetamines/cocain withdraw

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Bromocriptine. Buproprion

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Opiate Withdraw Treatment

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Methadone. Clondidine. Buprenophine

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Anabolic Steroid Withdraw Treatment

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SSRI

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Symptoms of Alcohol Withdraw

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Tremors. Hallucinations. Seizures. Delirium termens.

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Amphetamines/cocaine withdraw Symptoms

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Anxiety, tremors. Headaches. Depression. Increased appetitie. Suicide

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Opaties Withdraw Symptoms

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Fever, chills, lacrimation, abdominal cramps. Muscle spasms

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Anabolic Steroid Withdraw Symptoms

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Depression, headaches, anxiety, increased concern over apperance.

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Treatment of Overdose of Cocain

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Antipsychotics, BZs, antihypertensives

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Treatment of Hallucinogens Intox

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Antipyschotics. Bz. Talking down.

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Inhalant Intox treatment

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Antipsychotics

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Treatment of Opiate Overdose

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Nalaxone

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Anabolic Steroids Intox

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Antipsychotics

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Positive Test for CAGE

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2 Answere questions

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Detoxification

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5 to 10 days in hospital to see they are safetly detoxed

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Rehabilitation

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28 days to prevent relapse.

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Most Common Abuse Substances

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Caffiene. Alcohol. Nicotene.

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MOA of Alcohol

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Activates GABA and serotonin. GABA is inhibitory.

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Metabolization of Alcohol

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Alcohol via alcohol dehydragenase to acetylaldehyde. Acetylaldhyde dehydrogenase to acetate.

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Differential to Alcohol Intoxication

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Hypoglycemia. Hypoxia. Ethylene glycol. Et-OH drug overdose. Methanol poisoning. Pyschosis. Psychomotor Seizures. Hepatic Encephalopathy.

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Acid/Base Chemistry and Alcohol

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Causes Anion Gap Metabolic acidosis. Methanol. Ethanol and Ethylene glycol.

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Treatment of Alcohol Inoxication

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Obtain finger stick glucose to exclude hypoglycemia. Thiamine and Folate, and naloxone for the effects of opiod usage.

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Long Term Effects of Alcohol Use

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Wernicke's encephalopaty (ataxia, confusion). Karsakoffs (imparied recent memory, anterograde amensia)

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Coaine MOA

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Blocks dopamine reuptake form the synaptic cleft.

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Cocaine Intox

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Patient presents with euphoria with high or low blood pressure, tachy or bradychardia, psychomotor agitation. May lead to MI due to cocaine's vasoconstrictive properties.

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Differential Diagnosis to Cocaine Intox

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PCP. Amphetamine. Sedative Withdraw.

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Coaine Intox Treament

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For mild use benzodiazapine. For severe halaperidol. Symptomatic support

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Cocaine Dependence Treatment

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TCA. Dopamine agonists. Psychotherapy.

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Amphetamine Types

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Methamphetamine. Methylphenadate. Dextroamphetamine. Substituded amphetamines is MDMA and MDEA.

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Classic vs. Designer Amphetamines

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Classic release dopamine form the nerve endings. Designer release serotonin and dopamine.

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Differential Diagnosis to Amphetamine

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PCP. Cocaine. High doses cause psychotic episode similar to schizphrenia.

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Treatment of Amphetamines

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Mild intox give BZ. Severe give Halaperidol.

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PCP MOA

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Works by being an NMDA antagonist and releasing dopamine.

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PCP Intox

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Rotary nystagmus. Out of control behavior. HTN. Tachycardia. Muscle rigidity.

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Treatment of PCP

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Monitor vitals and electrolytes. Acidify urine with ammonium Cl-. Diazepam for muscle spasms. Haloperiodal for severe agitation.

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Differential Diagnosis for PCP Intox

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Psychotic states. Cocaine Intox. Schizophrenia.

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Treatment of Sedative Hypntoics

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For barbituates alkalinize the urine with sodium bicarbonate. For BZ flumanizil, as long as not dependent. For both improve respiratory status and control hypotension.

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Opiate Intoxication

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Respiratory depression. Constricted pupils. Constipation. Nausea and vomitting.

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Opiate and MAOI

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Merpidine given with MAOI can cause seritonin syndrome.

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Differential Diagnosis of Opiate Intox

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Sedative hypnotics. Alcohol.

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Treatment of Opiate Overdose

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Nalaxone may cause withdraw.

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Merpidine and Pupils

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Only opiate that dilates pupils

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Opiate Withdraw

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Dysphoria. Insomnia. Lacrimation. Rhinorrhea. Yawning. Piloecrection. Nausea vomiting.