Case Intox
A 19-year-old college student is brought to the ED by friends after a party. She has slurred speech, an unsteady gait, and nystagmus, and she is laughing and flirting with staff. She has as positive romberg test.
List all 5 stages of change in order
What is Pre-Contemplation, Contemplation, Preparation, Action, Maintenance, Relapse?
This medication causes irreversible inhibition of the enzyme acetaldehyde dehydrogenase
Disulfariam (antabuse)
Alcohol increases the release of this major inhibitory neurotransmitter and strengthens its receptor action?
What is Gaba?
Withdrawal of these 3 substances can be lethal if left untreated
What is Barbiturates, Alcohol and Benzos
A 32-year-old man presents with paranoia. He hasn't slept in 3 days. BP 170/100, HR 122. He has dilated pupils, dry mouth, and severe tooth decay and gum disease. Which substance did he most likely use?
What is methamphetamine?
How many hours after stopping alcohol does withdrawal typically occur?
6-36 hours
Option for patients with poor compliance and alcohol cravings
What is Vivitrol
THC causes its high by binding this receptor. The receptor is plentiful in the hippocampus, which explains short-term memory loss.
What is CB1?
Yawning, Perspiration, Runny Nose, Muscle Twitching
What is Opioid Withdrawal
A 40-year old presents to the ER with flushing, sedation and confusion. His vitals are BP 80/55, RR 12/min and pulse 60/min irregular pupillary constriction and poor coordination. What substance has this patient likely been using.
What is Opioids?
Risk of Alcohol withdrawal seizures peaks at?
24 hours
Poorly absorbed, not metabolized by the liver and is excreted unchanged in urine. This makes it an effective choice for patients with hepatic insufficiency
What is Acamprosate - Campral
Excitotoxic damage during alcohol withdrawal comes from dysregulation of this excitatory neurotransmitter and stimulation of its NMDA receptors.
What is glutamate?
Headache can be a hallmark symptom of withdrawal from this substance
What is Caffeine
28 year old male presents with euphoria, Conjunctival injection, B/P 110/60, pulse 105. He is noted to appear slow and uncoordinated. He stated he was unsure how much time had passed since engaging in this substance use
MJ
What is the kindling effect?
more episodes of alcohol withdrawal, higher risk
Partial agonist of A4B2 and full agonist of A7 acetylcholine receptors
What is Chantix
Caffeine mechanism of action
nonselective antagonism at adenosine receptors
Increased appetite, anxiety, depressed mood, difficulty concentrating, insomnia, irritability, anger & restlessness
What is Tobacco Withdrawal
What is Cocaine?
How does the mechanism of action of cocaine differ from amphetamines
Cocaine- Increases synaptic levels of monoamines (dopamine, serotonin, and norepinephrine) by inhibiting uptake
Amphetamines- increasing synaptic release of the monoamines- dopamine, serotonin, and norepinephrine; also inhibit their reuptake leading to more in synaptic cleft
Tobacco smoke can result in lower serum concentration levels fluphenazine, haloperidol, olanzapine and clozapine due to metabolism of what
CYP1A2 activity
Mitragynine selective agonists of the opioid receptor type μ-opioid receptor.
What is Kratom
Irritability, Anxiety, Sleep disturbances, Depression. This substance stays in the system longer- so withdrawal may not be as intense.
What is Cannabis withdrawal