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T/F? There are more deaths, illnesses and disabilities from substance abuse than from any other preventable health condition?
True
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Addiction is characterized by the 5 C's, name them.
- chronicity
- impaired control over drug use
- compulsive use
- continued use despite harm
- craving
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How does abuse and dependence of BZDs affect the body?
- usually do not lead to life-threatening respiratory suppression
- switching between agents won't help alleviate the problem
- long term use can cause withdrawal if stopped abruptly
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Presentation of BZD intoxication
- memory impairment
- confusion
- drowsiness
- GI issues
- visual disturbances
- confusion
- slurred speech
- poor coordination
- swaying
- bloodshot eyes
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Lab tests for BZDs
tox screen. can be positive up to 6 weeks with chronic use
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How to treat a BZD overdose?
- do not induce emesis!!!!
- gastric lavage if patient presents within 1 hour
- administer activated charcoal
- supportive measures for hypotension and bradycardia
- Flumazenil rarely used anymore due to black box warning of seizures
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Presentation of BZD withdrawal
- anxiety
- agitaiton
- muscle cramps
- parasthesias, strange sensations
- sleep disturbances
- dizziness
- seizures
- delirium
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Use of Buspirone in BZD withdrawal
can be used in place of BZD if anxiety develops during or following taper
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Signs of GHB toxicities
- coma
- seizures
- respiratory depression
- vomitting
- bradycardia
- hypotension
- hypothermia
- anterograde amnesia
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Is there an antidote for GHB toxicity?
- No
- good supportive care and patients should recover in about 7 hours
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How do you know if GHB is present?
- patients presenting with unexplained or sudden coma with no evidence of head trauma or elevated ICP
- GHB does have an unpleasant salty taste
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Presentation of opiate intoxication and withdrawal
- acute phase: ranges from a few hours after stopping heroin to 3-5 days
- methadone ranges from 3-14 days
- development of delirium is a red flag!!!
- withdrawal: piloeretion
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Lab tests to detect opiates
- Tox screen
- 1-2 days: codeine, heroin, hydromorphone, morphine
- 2-3 days: methadone
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How to treat opiate overdose?
Naloxone 2 mg iv (can be put into a drip with D5W
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What should you monitor in cocaine intoxication?
- CBC
- electrolytes
- CPK
- EKG (continuously monitor)
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What are drugs you need to avoid in cocaine overdose?
- beta-blockers
- use bzds, aspirin, and nitroglycerin
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Lab tests for amphentamine intoxication
- urine screen for diagnostic purposes
- positive for 24-48 hours from ingestion
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How to treat amphetamine intoxication?
- induction of emesis is contraindicated (seizures)
- monitor electrolytes, renal function, CPK, and EKG
- treat agitaion with valium
- threat hypertension with nitroprusside or a beta blocker
- cooling blakets for hyperthermia
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How to treat NMDA (ecstasy)?
- monitor electrolytes, BUN, creatinine, LFTs, CBC, coagulation, CPK
- do not induce emesis
- IV line and hydrate
- bzds for agitation, seizures
- beta blockers for hypertension and tachycardia
- tx rhabdomyolysis
- cool patient with evaporated cooling
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Treatment for PCP?
- positive for 1 to 8 days
- valium or haldol for agitaiton
- diphenhydramine for dystonic reactions
- beta blocker or nitroprusside for hypertension
- cooling and hydration for hyperthermia
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Signs and Symptoms of ketamine
- derivative of PCP
- effects last about an 1 hr but can take 1-2 days to feel normal again
- presents "floating over ones body"
- colorless, odorless and tasteless
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Treatment for Ketamine intoxication
- no antidote exists
- spportive care focusing on cardiac and respiratory function
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Signs and symptoms of LSD intoxication
- colors are heard, sounds are seen
- not considered addictive
- mood changing
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Presentation of marijuana intoxication
- tchycardia and congestion
- THC can be positive for 4-5 weeks (up to 11 weeks with heavy use)
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What blood alcohol levels are death commonly seen?
greater than 400-500 mg/dL
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Cage questionaire
- cut down
- annoyed
- guilty
- eye opener
- a positive respone to 2 or more questions suggests an increased likelihood of alcohol abuse
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Treatment of alcohol withdrawal
- bzds
- are the standard to minimize symptoms and avoid progression to more severe stages
- thiamine (prevents wernicke-korsikoff syndrome)
- multivitamin (can be added to fluids)
- adjunct agents: beta blockers, clonidine
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Drugs to use for management of alcohol dependence
- disulfiram (Antabuse)
- natrexone (ReVia)
- acamprosate (Campral)
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