Addiction Management - FLIPPED

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Questions and Answers

What is a possible consequence of abruptly stopping alcohol in a patient with chronic use?

  • Decreased heart rate
  • Increased GABA receptor sensitivity
  • Neuronal hyperexcitability (correct)
  • Improved mental clarity

Which statement correctly describes the patient's alcohol use risk?

  • Risk primarily due to illicit drug use, not alcohol
  • Low risk due to moderate consumption
  • Increased risk of withdrawal syndrome due to high consumption (correct)
  • No risk associated with intermittent binge drinking

What physiologic effect does chronic alcohol consumption have on GABA receptors?

  • No effect on GABA receptors
  • Upregulation of GABA receptors
  • Downregulation of GABA receptors (correct)
  • Increased GABA receptor activity

Which symptoms indicate possible alcohol withdrawal syndrome?

<p>Sympathetic overstimulation and visual hallucinations (A)</p> Signup and view all the answers

What could enhance the CNS depressant effects in someone consuming alcohol and certain sedatives?

<p>Combination of alcohol with barbiturates (D)</p> Signup and view all the answers

What might the patient's bloodshot and congested eyes indicate?

<p>Intoxication, possibly from cannabis (C)</p> Signup and view all the answers

What is the significance of the patient's slow speech and delayed responses?

<p>Effects of a psychoactive substance (A)</p> Signup and view all the answers

What does the patient's excessive hunger after a lack of food throughout the day suggest?

<p>Cannabis-induced appetite stimulation (B)</p> Signup and view all the answers

Which receptor's agonism is responsible for the psychoactive effects seen in this patient?

<p>CBI receptor (A)</p> Signup and view all the answers

What is the most likely cause of the patient's confusion and disorientation?

<p>Intoxication, likely from cannabis (D)</p> Signup and view all the answers

What effect does cannabis intoxication have on a person's judgment?

<p>Leads to impaired judgment (D)</p> Signup and view all the answers

Which of the following symptoms is least likely to be associated with cannabis intoxication?

<p>Visual distortions (A)</p> Signup and view all the answers

What could the patient's avoidant behavior when questioned by the relative indicate?

<p>Denial of substance use (D)</p> Signup and view all the answers

What is the main mechanism of action of amphetamines?

<p>Induction of neurotransmitter release (B)</p> Signup and view all the answers

What symptom is indicative of methamphetamine intoxication?

<p>Skin excoriations (C)</p> Signup and view all the answers

What type of clinical manifestation is seen in benzodiazepine intoxication?

<p>Ataxia (D)</p> Signup and view all the answers

What symptom is associated with cannabis withdrawal?

<p>Insomnia (B)</p> Signup and view all the answers

During which intoxication might a patient experience auditory hallucinations?

<p>LSD intoxication (A)</p> Signup and view all the answers

What is a potential severe complication from methamphetamine use?

<p>Seizures (C)</p> Signup and view all the answers

Symptoms such as agitation, hypersensitivity to stimuli, and suicidal thoughts are most associated with withdrawal from what substance?

<p>Amphetamines (C)</p> Signup and view all the answers

What would indicate possible LSD intoxication in a patient?

<p>Perceptual distortion and paranoia (D)</p> Signup and view all the answers

Which of the following withdrawal symptoms is common with benzodiazepine cessation?

<p>Diaphoresis (C)</p> Signup and view all the answers

What treatment approach is recommended for amphetamine intoxication?

<p>Supportive therapy and fluid management (D)</p> Signup and view all the answers

In the context of drug withdrawal, which symptom is most likely linked to nicotine cessation?

<p>Increased appetite/weight (A)</p> Signup and view all the answers

What does the term 'physiologic crash' imply in the context of amphetamine use?

<p>Initial high energy followed by sudden fatigue (B)</p> Signup and view all the answers

What is a common side effect of avoiding amphetamines and facing withdrawal?

<p>Anhedonia and anxiety (C)</p> Signup and view all the answers

What phenomenon is associated with chronic use of hallucinogens like LSD?

<p>Flashbacks (B)</p> Signup and view all the answers

Flashcards

Cannabis Intoxication Mechanism

Cannabis intoxication occurs via activation of the Cannabinoid Receptor 1 (CBI receptor).

CBI Receptor Agonist

A substance that activates the CBI receptor, producing cannabis-like effects.

Symptoms of Cannabis Intoxication

Effects include euphoria, anxiety, paranoid delusions, slowed time perception, impaired judgment, social withdrawal, increased appetite, dry mouth, bloodshot eyes, and hallucinations.

Nicotine Intoxication Mechanism

Nicotine intoxication involves stimulation of the central nicotinic acetylcholine receptor.

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Patient Presentation - Cannabis

Patient exhibits altered alertness, confusion, disorientation, poor coordination, difficulty with balance, dry mouth, increased appetite, and bloodshot eyes. A history of smoking cigarettes for 20 years is present.

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Lysergic Acid Diethylamide (LSD) Intoxication

LSD causes perceptual distortions, anxiety, paranoia, psychosis, and flashbacks. Mydriasis (pupil dilation) can occur.

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General Feedback Mechanism

General feedback reviews the specific neurotransmitter mechanisms associated with various types of intoxication and describes their consequences.

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Alcohol Withdrawal Syndrome

A set of symptoms that occur when a person abruptly stops or significantly reduces alcohol consumption after a period of heavy drinking.

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Delirium Tremens

Severe form of alcohol withdrawal that includes altered mental status, agitation, and potentially life-threatening symptoms like seizures.

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GABAergic agent

A substance that affects GABA, a neurotransmitter that inhibits nerve activity; e.g., alcohol.

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Downregulation of GABA receptors

Chronic alcohol abuse causes a reduction in the number or responsiveness of GABA receptors.

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Hyperexcitability

Increased neuronal excitability.

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Sympathetic Overstimulation

Excessive activity of the sympathetic nervous system causing symptoms like anxiety, increased heart rate, elevated blood pressure, and sweating.

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Alcohol Withdrawal Symptoms

Symptoms include anxiety, tachycardia, hypertension, diaphoresis, tremors, altered mental status, and visual hallucinations, occurring a few days after stopping alcohol.

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Chronic Alcohol Use

Regular heavy alcohol use over an extended period.

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Amphetamine Intoxication

Characterized by euphoria, grandiosity, dilated pupils, prolonged wakefulness, hyperalertness, high blood pressure, paranoia, fever, and possible skin sores. Severe cases may lead to cardiac arrest or seizures.

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Benzodiazepine Intoxication

Causes ataxia (loss of coordination) and mild respiratory depression. Has a wide safety margin.

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LSD Intoxication

Causes perceptual distortions (seeing or hearing things that aren't there), anxiety, paranoia, psychosis, and dilated pupils.

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Nicotine Withdrawal

Symptoms include irritability, anxiety, restlessness, difficulty concentrating, increased appetite, and weight gain.

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Amphetamine Withdrawal

Characterized by a crash after use, leading to dysphoria, anhedonia (loss of pleasure), anxiety, low energy, depression, increased appetite, sleep problems, and agitation.

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Benzodiazepine Withdrawal

Causes significant autonomic nervous system symptoms (sweating, nausea, vomiting, fast heart rate, high blood pressure), neurological symptoms (seizures, tremors), and potentially memory problems, and withdrawal psychosis.

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Treatment for Amphetamine Intoxication

Symptomatic treatment, including fluid therapy, managing fever, blood pressure, and heart rhythm issues, along with benzodiazepines (for seizures).

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Treatment for Benzodiazepine Intoxication

Flumazenil and supportive care based on the overdose severity.

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Intoxication Treatment General

Symptomatic treatment for the intoxication itself and psychosocial support for withdrawal

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Study Notes

Intoxication Mechanisms and Treatment

  • Cannabis intoxication: CBI receptor agonist; causes euphoria, anxiety, paranoid delusions, slowed time perception, impaired judgment, social withdrawal, increased appetite, dry mouth, and conjunctival injection.

Patient Presentation and Diagnosis

  • 48-year-old female: Brought to ED by son at 9:00 AM, extremely happy but confused and disoriented; slow speech, delayed responses, poor coordination, difficulty balancing; dry mouth, extreme hunger, minimal breakfast; bloodshot, congested eyes; good hydration, adequate respiratory and cardiac function.

  • Patient's relative: Nervous and avoidant.

Diagnostic Considerations

  • Mechanism of Action: The clinical presentation suggests cannabis intoxication.

Appropriate Management

  • Treatment: Symptomatic treatment for intoxication.
  • Withdrawal: Psychosocial support, and interventions for potential withdrawal.

Additional Patient Examples

  • 22-year-old female: Brought to ER by friends; confused, disoriented, unusual sensory perceptions (sounds, colors); talks to self, moves anxiously, erratic mood changes, reports being chased. Dilated pupils, sweating

    • Possible diagnosis: LSD intoxication. (visual hallucinations, auditory hallucinations, depersonalization, paranoia, anxiety)
  • 24-year-old male: Wound to index finger; history of intravenous drug use, heavy alcohol consumption.

    • Possible diagnosis: Alcohol withdrawal with delirium tremens. (Possible delirium, sympathetic overstimulation, and altered mental state).
  • Important Considerations:

  • Individual history and presentation matter in diagnosis: Specific symptoms help pinpoint cause.

  • Withdrawal symptoms, and their severity are tied to substance use: Assess for both current intoxication and the potential for withdrawal.

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