Drugs of Abuse Management High-Yield PDF

Drugs of Abuse Management High-Yield WE MAKE DOCTORS Psychoactive drug intoxication and withdrawal Hallucinogens Lysergic acid diethylamide Mechanism...

Drugs of Abuse Management High-Yield WE MAKE DOCTORS Psychoactive drug intoxication and withdrawal Hallucinogens Lysergic acid diethylamide Mechanism Intoxication 5-HT 2A -serotonin-receptor Perceptual distortion (visual, Agonist (increased serotonin auditory) concentrations in the synaptic Depersonalization cleft → hallucinations) Anxiety Paranoia Psychosis Treatment of intoxication Flashbacks (usually nondisturbing) Supportive care, reassurance Mydriasis Psychotic symptoms: first-generation antipsychotics Anxiety: benzodiazepines Psychoactive drug intoxication and withdrawal Hallucinogens Cannabis/Cannabinoids Mechanism Intoxication Withdrawal Irritability Tetrahydrocannabinol Euphoria, Anxiety, Paranoid delusions Anxiety interacts with Perception of slowed time Depression cannabinoid receptors Impaired judgment Insomnia CB1 and CB2 → Social withdrawal Restlessness inhibition of adenylate ↑appetite, Dry mouth ↓ appetite cyclase Conjunctival injection Hallucinations. CBI receptor Agonist Treatment Intoxication: symptomatic treatment Withdrawal: psychosocial support and interventions  Medical Marijuana Dronabinol A synthetic cannabinoid Mechanism Clinical Use Adverse effects CBI receptor Agonist Used to increase appetite and treat Neuropsychiatric Adverse nausea/vomiting in terminally ill patients Effects: exacerbation of mania, (e.g., those undergoing chemotherapy) and depression, or schizophrenia. in patients with AIDS Hemodynamic Instability: Relieves pain in cancer patients Occasional hypotension, Reduces intraocular pressure in hypertension, syncope, or individuals with glaucoma tachycardia may occur. Seizures, abuse of dronabinol, Paradoxical Nausea, Vomiting, Interaction with Disulfiram and Metronidazole: disulfiram-like reactions or Abdominal Pain (e.g., abdominal cramps, nausea, vomiting, headaches, flushing) can occur in patients concurrently receiving disulfiram, metronidazole, or other drugs.  Psychoactive drug intoxication and withdrawal Hallucinogens MDMA Mechanism Withdrawal Intoxication 5HT2A-serotonin-receptor and Depression D2-receptor agonists and Also called ecstasy. Fatigue serotonin and dopamine Euphoria, hallucinations, disinhibition, Change in apetite reuptake inhibitors: ↑serotonin hyperactivity Difficulty concentrating and dopamine concentrations ↑thirst, bruxism, distorted sensory and Anxiety in the synaptic cleft → time perception, mydriasis. hallucinations Lifethreatening effects include hypertension, tachycardia, hyperthermia, hyponatremia, serotonin syndrome.  Psychoactive drug intoxication and withdrawal Hallucinogens Phencyclidine Mechanism Intoxication Treatment ↓ of environmental stimuli Violence, Nystagmus, Impulsivity Inhibits dopamine, serotonin, and Gastric lavage to ↑ drug Psychomotor agitation, Tachycardia norepinephrine reuptake elimination Hypertension, Analgesia, Psychosis Antagonizes NMDA receptors → Supportive care Delirium, seizures. stimulant or depressive Sedation with benzodiazepines neurological effects (dose (for severe agitation) or dependent) haloperidol (if psychotic symptoms are present)  Psychoactive drug intoxication and withdrawal Amphetamines Methamphetamines Mechanis Pharmacological Intoxication symptoms m effect Triggers a cascading Users experience an increase in focus, Restlessness, tremors, hyperreflexia, release of increased mental alertness, and the rapid respiration, confusion, norepinephrine, elimination of fatigue, as well as a assaultiveness, hallucinations, panic dopamine, and decrease in appetite. states, hyperpyrexia, and rhabdomyolysis. serotonin. The drug induces dramatical changes in Fatigue and depression usually follow the Acts as a dopaminergic heart rate, body temperature, blood central stimulation. Cardiovascular effects and adrenergic pressure, appetite, attention, mood, and include arrhythmias (tachycardia), reuptake inhibitor. responses associated with alertness or hypertension or hypotension, and In high concentrations alarm condition (resemble the circulatory collapse. Gastrointestinal acts as a monoamine physiological and psychological effects symptoms include nausea, vomiting, oxidase inhibitor of an epinephrine-provoked fight-or- diarrhea, and abdominal cramps. Fatal flight response) poisoning usually terminates in convulsions  Psychoactive drug intoxication and withdrawal Amphetamines Methamphetamines intoxication treatment Agitation Critical hypertension Hyperthermia (hyperpyrexia) First-line therapy Benzodiazepines: First-line therapy 1.- Lorazepam IV Sedation with First-line therapy Benzodiazepines: 2.- Diazepam IV Benzodiazepines: 1.- Lorazepam IV If no IV access Midazolam IM 1.- Lorazepam IV 2.- Diazepam IV 3.- Nitropusside 2.- Diazepam IV If no IV access Midazolam IM 4.- Phentolamine If no IV access Midazolam IM Avoid pure beta-blockers 3.- Evaporative cooling measures 4.- Cooling Blankets 5.- Neuromuscular paralysis Paralysis and tracheal intubation may be necessary; succinylcholine should not Do NOT GIVE antipyretics be used for rapid sequence intubation. Tachycardia above 180bpm: First-line benzodiazepines, if necessary additional rate control calcium channel blocking drug (diltiazem). Beta-blockers should Psychoactive drug intoxication and withdrawal CNS Depressants Alcohol Mechanism Intoxication Treatment GABA-A receptor Emotional lability, slurred speech, ataxia, Agitation, anxiety, withdrawal positive coma, blackouts. AST value is 2× ALT value seizures, tremors, diaphoresis, allosteric (“ToAST 2 ALcohol”). Severe CNS GI symptoms, modulator. depression, respiratory depression, and delusions/hallucinations, death. delirium tremens Treatment: supportive (eg, fluids, Treatment: longer-acting antiemetics) benzodiazepines.