Alcohol use disorder
Presentation of alcohol intoxication
euphoria, heightened self esteem, tachycardia, dilated pupils, weight loss, psychomotor agitation, chills, sweating
Cocaine intoxication.
Deadly effects: vasoconstriction effect leading to MI, intracranial hemorrhage, or stroke
Withdrawal syndrome of hallucinogen
No withdrawal syndrome is produced but with long term LSD use, patients may experience flashbacks later in life.
Opioids stimulate what 3 receptors.
Mu, Kappa, and Delta
Scale used to monitor alcohol withdrawal
Clinical Institute Withdrawal Assessment (CIWA) scale
Presentation of alcohol withdrawal
insomnia, anxiety, hand tremor, irritability, anorexia, n/v, autonomic hyperactivity (diaphoresis, tachycardia, hypertension), psychomotor agitation, fever, seizures, hallucinations, and delirium.
Agitation, depersonalization, hallucinations, synesthesia, impaired judgement, nystagmus, ataxia, dysarthria, tachycardia, high tolerance to pain
PCP intoxication
Withdrawal from these are life threatening.
alcohol, benzodiazepines, barbiturates
Antagonizes NMDA glutamate receptors and activates dopaminergic neurons.
PCP
Medication used for benzodiazepine overdose.
FLumazenil
Benzodiazepines (chlordiazepoxide, diazepam, or lorazepam) used to keep patient calm and lightly sedated, then tapered down slowly.
Carbamazepine or Valproic acid can be used in mild withdrawal.
Antipsychotics for severe withdrawal (be careful of lowering seizure threshold)
Thiamine, folic acid, and multivitamin for nutritional deficiencies ("banana bag")
drowsiness, n/v, constipation, slurred speech, constricted pupils, seizures, and respiratory depression.
Opioid intoxication
Marijuana withdrawal.
Benzos and Barbs each do what to chloride channel opening.
Benzos increase the FREQUENCY of chloride channel opening.
Barbs increase the DURATION of chloride channel opening.
Mechanism of action of Varenicline and what is it used for.
a4b2 nicotinic cholinergic receptor partial agonist that mimics that action of nicotine, reducing the rewarding aspects and preventing withdrawal symptoms.
Naltrexone: opioid rec. blocker; decreased desire/craving.
Acamprosate: modulates glutamate transmission; should be started post detox for relapse prevention in pts who have stopped drinking. Can be used in pts with liver disease, contraindicated in severe renal disease.
euphoria, anxiety, sensation of slowed time, mild tachycardia, conjunctival injection, dry mouth, increased appetite.
marijuana intoxication
dysphoria, insomnia, lacrimation, rhinorrhea, yawning, weakness, sweating, piloerection, dilated pupils, abdominal cramps, HTN, tachycardia.
Opioid withdrawal
Mechanism of action of Amphetamines.
Eating large amounts of poppy seed bagels or muffins can result in a urine drug screen that is positive for this.
Opioids
Alcohol activates these receptors and inhibits these receptors.
Activates: GABA, dopamine, and serotonin
Inhibits: glutamate
Perceptual changes, labile affect, dilated pupils, tachycardia, HTN, hyperthermia, tremors, incoordination, sweating, palpitations.
Hallucinogen intoxication
Intense craving, dysphoria, anxiety, poor concentration, increase appetite, weight gain, irritability, restlessness, and insomnia
Nicotine withdrawal
Cannabinoid receptors in the brain inhibit this enzyme.
Adenylate cyclase
Second line treatments for alcohol use disorder and how they work.
Disulfiram: blocks enzyme aldehyde dehydrogenase and causes aversive reaction to alcohol (flushing, headache, n/v, palpitations, SOB). Contraindicated in severe cardiac disease, pregnancy, psychosis
Topiramate: anticonvulsant that potentiates GABA and inhibits glutamate rec. reduces cravings