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Drug misuse (Opiates (Clinical presentation (Acute use (Psychological …
Drug misuse
Opiates
Clinical
presentation
Acute use
Psychological
Euphoria
Sedation
Physical
Sweating
Dry mouth
Na+V
Withdrawal
Psychological
Agitation
Insomnia
Craving (can last wks)
Physical
General: sweats, gooseflesh
Cardio - palpitations
Abdo: abdo pain, N+V, diarrhoea
ENT: lacrimation, rhinorrhoea, sneeze
Musc: myalgia/arthralgia
Overdose
Physical
Unconcious/drowsy
Respiratory arrest
Diagnosis
History
Social - homeless, prostitution,
poor social support, crime
Examination
General - sweating, track marks
Cardio - tachy +HTN (withdrawal), brady+hypo (OD)
Neuro - pinpoint pupils (unreactive to light if OD)
Resp - low RR, reduced cough
Pathophysiology
Opium, heroin (diamorphine), morphine, methadone, pethidine, buprenorphine, tramadol, codeine
Snorting, smoking, SC, IV
Anti-sympathetic activity
Management
Initial ABCDE
CPR, resp support
Definitive
Overdose
Opiate antagonist
E.g. naloxone
MOA: inhibits opiate binding, reduces effect
NB: Short t1/2, may need multi doses
Withdrawal
Assisted
Conservative
Education and support
Medical
Taper amounts used over time
Symptomatic relief e.g. benzodiazepines, buscopan
Medicated
Community Drug
and Alcohol Team
Conservative
Education and support
Medical
A2 agonist
E.g. iofexidine
Full opiates
E.g. dihydrocodeine, methadone
Route: PO; no max dose
MOA: substitute heroin; slower onset
Method: cautious titration, gradually reduce
SEs: N+V, constipation, drowsy, hypotension,
respiratory depression
Partial opiates
E.g. buprenorphine
Route: PO
MOA: partial agonist, prevents
effects of heroin if taken
Complications IVDU
Psychological
Mood disorder
Depression, bipolar
Personality disorder
Self harm and suicide
Physical
Cardio
Arrhythmias
Endocarditis
Resp
Pneumothorax
Systemic
BBV (HIV, HBV, HCV, syphilis)
Neuro
Brain abscesses
Peripheral neuropathy
Musc
Skin abscesses
Osteomyelitis
Renal
Nephritic syndrome
Rhabdomyolysis
Social
Unemployment
Homelessness
Poor social support
Criminal activity
Cannabis
Pathophysiology
Smoked with tabacco or oral
Many carcinogens
Dependence
Clinical
presentation
Physical
Resp/cardio disease
Psychological
Sedation/relaxation
Psychosis (hallucinations)
Panic attacks
Paranoia
Depersonalisation
Epidemiology
3rd after alcohol and nicotine
Diagnosis
Examination
Cardio - tachycardia, HTN
Psych - psychosis, panic
History
Sedatives
Diagnosis
History
Examination
Cardio - arrhythmia, reduced RR
Neuro - tremor, twitches, dysarthria,
cerebellar signs
Psych - anxiety, psychosis, insomnia
Clinical
presentation
Acute use
Psychological
Reduced anxiety
Sedation/confusion
Physical
Cerebellar syndrome
Dysarthria
Respiratory depression
Death
Withdrawal
Psychological
Anxiety
Insomnia
Paranoia
Psychosis (rare)
Physical
Nausea
Sweating
Palpitations
Tremor
Muscle twitches
Pathophysiology
Prescribed meds or illegal
Benzodiazepines, barbituates
Tolerance, dependence and withdrawal
Management
Initial ABCDE
Definitive
Conservative
Support and education
Psychological
Psychoeducation
Interventions per alcohol
Medical
Long-acting benzo e.g.diazepam
Reduce dose over time
Stimulants
Amphetamines
Pathophysiology
Speed, wizz, ritalin
Increased sympathetic activity
PO, snorting, IV
Can get tolerance
Diagnosis
History
Examination
General - sweating
Cardio - tachy, HTN
Resp - irregular resp
Neuro - dilated pupils, ataxia
Clinical
presentation
Intoxication
Psychological
Euphoria
Increased energy
Decreased appetite
Anxiety, panic, paranoia
Psychosis
Physical
Dry mouth
Palpitations
Sweating
Overdose
Physcial
Cerebral haemorrhage
Arrhythmias
Death
Withdrawal
Psychological
Dysphoria
Irritability
Anxiety
Cravings
Hyperphagia
Management
Antidepressants
e.g. SSRI
Dopamine agonist
E.g. bromocripine
Cocaine
Pathophysiology
Snorted, smoked (crack)
Intoxication and withdrawal (not life threat)
Clinical presentation
Per amphetamines
Epidemiology
Commonest class A drug
Diagnosis
Per amphetamines
Ecstasy
Pathophysiology
Amphetamine (MNDA)
, Increased sympathetic activity
Pychoactive; also 5HT neurotoxicity
Clinical
presentation
Psychological
Energised
Sensuality
Insomnia
Decreased appetite
Anxiety, panic, paranoia
Hallucinations (auditory, visual)
Physical
Sweating
Epidemiology
Young adults, clubbing
Diagnosis
History
Examination
General - sweating, hyperthermia
Cardio - tachy, HTN
Complications
Death
Others
Ketamine
PCP
New psychoactive
substances
Types
Mephedrone (MCAT), naphyrone,
BZP, GBL, synthetic cannabinoids (spice)
Clinical
presentation
Psychological
Reduced inhibition
Excited/paranoid
Physical
Drowsy, coma
Seizures
Death
Definition
Substances used like illegal highs
but no covered by Misuse of Drugs Act
Complications
Death
Hallucinogens
Diagnosis
History
Examination
General - hyperthermia
Psych - anxiety, psychosis
Clinical
presentation
Psychological
Perceptual change (distortions/hallucinations)
Altered awareness
Synaesthesia
Anxiety/panic
Pathophysiology
LSD, magic mushrooms
Taken PO
Volatile
substances
Pathophysiology
Glue, solvents, lighter fluids, aerosols
Inhalation
Arrhythmias and cardiac arrest
Clinical
presentation
Psychological
Euphoria
Perceptual change
Hallucinations
Physical
Ataxia, other cerebellar signs
Confusion/coma
Diagnosis
History
Examination
Cardio - arrhythmias
Neuro - reduced GCS, ataxia, nystagmus,
cerebellar signs (chronic)
Abdo - liver disease (chronic)
Psych - psychosis
Epidemiology
Adolescents/YAs