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Alcohol: Effects
- Incr GABA
- Decr glutamate
- CNS depression
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Alcohol: Withdrawal Sx
- Delirium tremens
- VS changes
- Diaphoresis
- GI & CNS AEs;
- WERNICKE'S syndrome: oculomotor, ataxia, confusion
- KORSAKOFF'S psychosis: amnesia, intell func spared
- confabulation
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Alcohol: Withdrawal Treatment
- Benzos: for tremor (can prevent if given early) and VS changes; long-acting like librium, valium, ativan preferred
- Long-acting CNS depressants: => sedation, decr anxiety
- Antipsych meds:
- B12 & Thiamine: may prevent Wernicke and Korsakoff
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Alcohol: Abstinence Drugs
- Naltrexone: opiate antagonists to diminish cravings
- Acamprosate: can decr EtOH desire
- Disulfiram: if combo w/ EtOH => REALLY SICK
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Opiates: Effects
- Pleasure
- Pain relief
- Physical dependence develops quickly
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Opiates: Withdrawal Sx
Rebound excitability
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Opiates: Addiction Treatment
- Methadone maintenance (AEs = constip, drowsy, sweating, decr libido)
- LAAM: q other day (methadone alternative)
- Naltrexone: opiate antags to decr cravings
- Buprenorphine: 3x/wk
-
Opiates: What to give in case of emergency opiate intox?
NALOXONE!!
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Benzos: Efects
- Enhance GABA
- Cause CNS depression
-
Benzos: Withdrawal Sx
- Can begin as long as 8 days after cessation
- Anxiety rebound
- Autonomic rebound
- Sensory excitement
- Motor excitation
- Cognitive excitation
-
Benzos: Addiction Treatment
Systematic switch to _____
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Cocaine: Effects
- Block reuptake and cause release of DA, NE, SA
- Sudden burst of mental alertness, incr confidence, sociability
- 10 to 20 minute rush, then let down
- **CNS stimulation followed by depression
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Cocaine: Withdrawal Sx
- NE => sleep 10-12 hrs
- Sleep disturb
- Suicidality
- Anhedonia
- Poor concentration
-
Cocaine: Fx of incr doses
- DEATH due to resp failure
- Restlessness, tremors/agitation
- Convulsions
- CNS depression
-
Ampetamine/Methamphetamine: Effects & Withdrawal
- A: blocks reup of NE & DA, little SA
- M: releases EXCESS DA (HIGHLY ADDICTIVE) => binge/crash pattern
- Higher & higher doses needed to get pleasure => higher the high, lower the low
- Withdrawal, possible Long-T fx on DA levels
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Nicotine: Effects
- Incr alertness, conc, attn
- Appetite suppression (mostly stimulant effect)
- Mood changes: anx, dep, irrit
- Physiologic changes: sleep dist, HA, GI, appetite
-
Nicotine: Withdrawal Treatments
- Replacements: 4-6wks
- Buproprion
- Clonidine (2nd line)
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Caffeine: Effects & Withdrawal
- Stim cortex => incr mental acuity
- Antag of adenosine receptors => prevent adeno from binding => enhance DA actions
- Withdrawal: HA, fatigue, impair psychomotor, diff conc, yawn, nausea
- W/ 300mg: tremors
- W/ 500mg: incr HR etc
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Marijuana: Effects
- THC: active ingredient
- Triggers DA release
- Impairs ability to form memories, recall events
- Long term use can => amotivational sx
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Hallucinogens: LSD & Designer Drugs (MDMA/Ecstasy, Foxy, PCP, etc) -- Effects
- Euporia, dysphoria
- Confusion, incoordination
- Impaired judgment, memory
- Often come to ED in ACUTE PSYCHOSIS (looks like paranoid schizophrenia)
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Hallucinogens: Specific Points about LSD, PCP & Amphetamine
- LSD: uses on bad trip can often be talked down
- PCP & Amp: more likely to strike out, panic, may harm selves but not feel pain
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Inhalants: Effects and Serious Intoxication
- = CNS depressants
- Euphoria, sedation, emotional lability, impaired judgment
- Intoxication: resp dep, stupor, coma, SUDDEN "SNIFFING DEATH", chronic neuro sx
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Steroids: Effects
- Risk of heart probs, sex AEs
- Incr in irrit & aggression
- Euphoria, incr energy, sex arousal, mood swings, distractability, forgetful, confusion
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PCP: Specifics
- Low doses: euphoria, floating, heightened emotionality, incoordination, distorted perceptions, feeling outside body
- High doses: PSYCHOSIS
- Pts may become violent towards self or others
- ***The drug is an anesthetic, so PCP-intox pts feel little or no pain
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