Alcohol
Describe the primary MOA of alcohol
Increases GABAa channel opening
dopamine reuptake inhibitor
Describe the MOA of barbituates
Increases DURATION of GABAa channel opening
(Benzos increase FREQUENCY of GABAa channel opening)
What is a classic ocular symptom seen in opioid overdose?
miosis
Describe the MOA of caffeine
adenosine antagonist
What drug class(es) are used to manage alcohol withdrawal?
Benzodiazepines (and barbituates)
Hyponatremia is caused by which drug and why?
MDMA, due to increased hypotonic fluid intake and ADH secretion
What is the usual mechanism of death in benzodiazepine overdose?
respiratory depression
What is a classic dermal symptom seen in opioid withdrawal?
piloerection
What is a classic ocular symptom of PCP intoxication?
nystagmus
Long term use of alcohol has what affect on brain receptor populations?
Upregulate NDMA receptor, downregulate GABA receptor
What are the FDA approved medications to treat amphetamine abuse?
none
What is a potential adverse affect of flumazenil?
seizures
Why is naloxone added to buprenorphine in formulations approved to treat opioid abuse?
Naloxone is not active when taken orally, so withdrawal symptoms occur only if injected. Intended to prevent overdose when suboxone is injected.
Which substance is known to cause flashbacks years after intoxication?
LSD
How long after last drink is a patient at greatest risk of having a seizure?
48hours
Restraining patients who are intoxicated with stimulants can precipitate what physiological process?
rhabdomyolysis
What are the symptoms of benzodiazepine withdrawal?
Insomnia
Seizures
Rebound anxiety
Tremor
What is an opiate?
Naturally occurring opioid such as morphine or codeine.
Heroin, oxycodone, hydrocodone, etc are semisynthetic opioids and fentanyl, methadone, meperidine, etc are synthetic opioids. NONE are considered opiates.
Cannabis withdrawal can cause what GI syndrome?
Cannabinoid Hyperemesis Syndrome
What are the FDA approved medications to treat alcohol abuse?
Disulfiram
Acamprosate
Naltrexone (PO/IM)
Why are betablockers contraindicated in cocaine induced MI?
beta-blockade leads to unopposed alpha-agonism. may cause hypertensive crisis.
Benzodiazepine overdose is especially dangerous when combined with which other substances? Name at least 5.
Alcohol
Barbituates
Certain Muscle Relaxants (Soma, Miltown, etc)
Opioids
GHB or sodium oxybate
Methaqualone (Quaalude)
Chloral hydrate
Gabapentin, Pregabalin
Describe the MOA of buprenorphine and why it can precipitate withdrawal in an opioid dependent patients.
mu opioid receptor partial agonist. In opioid dependent persons, can cause withdrawal due to high receptor affinity (lower Ki) that causes it to displace opioid agonists of lower receptor affinity (heroin, methadone, etc) from the receptors. Since it is a partial agonist, it does not fully activate the receptor, leading to a precipitated opioid withdrawal.
How is cocaine classified under the Controlled Substances Act?
Schedule II. Can be found as a 4% topical or nasal solution and is used as a local anesthetic.