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SUBSTANCE ABUSE / TOXINS (Drugs of Abuse (Cocaine (dropped image link,…
SUBSTANCE ABUSE / TOXINS
Drugs of Abuse
Cocaine
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Clinical Presentation
- anyosteolytic signs in the nasopharynx (thinned nasal septum, ulceration and perforation) or oropharynx (thinned, ulcerated and perforated palate)
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Lead Poisoning
Lead Poisoning example
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Notes
- note that children are especially susceptible to lead poisoning since theor blood BB is not fully developed = meaning the lead can access their brain easily
- they usually have normal development, then after exposure they have developmental delay and aggression or behavioural problems
- you need to rule this out for these symptoms especially if they come from a poor background and bad housing
- key spresenting sign is anemia
- lead poisoning halts heme synthesis in RBCs by stopping ALA dehydratase and ferrochelatase
--> portoporphorin cannot bind with ferrous iron to make heme
--> this is due to ferochelatase inhibiton by lead
--> thus portoporphorin actually binds Zinc instead of iron and this gives the anemia = improper heme, not with iron
- severe lead poisoning can even cause hemolytic anemia
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Types of *Withdrawal
- divide generally into stimulants and depressants
Depressant Withdrawal Symptoms
- withdrawal = opposite to Depressant
--> high energy physical movements (tremors, seizures)
--> not calm and cool --> anxiety and delerium
Benzo Withdrawal Symptoms
- BENZO withdrawal Bends you over and SPITS Anxiety
- S = sympathetic overdrive (sweating, papitations)
- P = palpitations
- I = insomia
- T = tremor
- S = Siezures
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Stimulants Withdrawal Symptoms
- cocaine, nicoteine, amphetamines
- withdrawal = opposite to stimulants
--> NO physical movements
--> feel down = depression + CRASH
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Common Drug Overdose and *Antidotes
- Benzos - FLU MAZ too high...
--> flumazenil
- you dont get SEROTONIN SHIVERS on CYPRUS ... but you may get the HEP if you DINE there
--> cyproheptadine
*Stimulant Drug Overdose / Withdrawal / Antidote
*Cocaine Intoxication
- can have hallucinations, psychosis very similar to spych disorder
- key differentiator is heart and sympathetic symptoms
- Cocaine makes you "WIDE EYED, DIAphoresis, and DIE with RESCUSS"
- Tx = treat the hypertensive crisis + calm down
--> Alpha blockers + Benzos
Cocaine makes you "WIDE EYED, DIAphoresis, and DIE with RESCUSS"
- WIDE EYED = mydriasis (pupils dilated)
- DIAphoresis = sweating
- DIE with RESCUSS = cardiac overdrive
--> tachy, palpitations, sudden cardiac death
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Cocaine MOA
- think of Cocaine like an extreme version of SNRIs
--> mainly affects NE and stops the reuptake
- high NE causes the systemic vasoconstriction and heart problems from cocaine
--> "WIDE EYED, DIAphoresis, and DIE with RESCUSS"
- SNORTING cocaine gives the same ISCHEMIA problems in the NASAL SEPTUM as ICHEMIA in the HEART
--> nasal perforation and Heart ischemia = sudden cardiac death
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Depressant Drug Overdose / Withdrawal / Antidote
- alcohol, barbituates, benzos, oppioids
Benzos Overdose
- Benzos = frequENZy of GABA receptors
- Benzos - FLU MAZ too high...
--> flumazenil
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Heroin Overdose and Detox
- methadone = 1st line + maintenance
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*Alcoholism and Quitting
- 1st line = naltrexone
--> oppioid antagonist
--> blocks cravings and reward from alcoholism
- alcoholics use Naloxone TRIX to stop
- nalaxone TRIX = naltrexone
- 2nd line = acamprosate
--> NMDA modulator
--> A camp PRO ain't no alcoholic
--> A camp PRO ain't = acamprosate
- 3rd line = disulfiram
--> aldehyde DHD antagonist
--> DIE and SUFFER with disufiram
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*Alcoholism Withdrawals
- Life-threatening, counterintuitive but need to stop Alcohol withdrawal seizures first, then DeTOX delerium tremins
--> use Benzos that act at GABA same as alcohol
--> counterintuitive that you have to give them their fix
- "2-4 day NO Bender DeTox for alcoholics"
- 1st line = Benzos
--> LORAZ and DIAZ
--> lorazapam, diazapam, chlordiazapoxide
"2-4 day NO Bender DeTox for alcoholics"
- 2-4 day DeTox = DT = delerium tremens happens 2-4 days after last drink
- after 12 hours seizures can set in before the DT
- No Bender = treat alcohol withdrawal with Benzos
DT = Delerium Tremens
- acoholic withdrawal symptrom that is LIFE-threatening
- "2-4 day NO Bender DeTox for alcoholics"
- 2-4 day DeTox = DT = delerium tremens happens 2-4 days after last drink
- No Bender = treat alcohol withdrawal with Benzos
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*Oppiods
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Oppioid Overdose
- respiratory depression is key for Oppioid overdose
- other signs = sedation and pinpoint pupils = miosis
- Naloxone = antidote for oppioid overdose
--> Mu specific oppioid receptors
--> also binds to kappa and delta (pain modulators), but less so
Clinical Cases
Clinical Case
- 3 more items...
*Respiratory Depression in Oppiods Toxicity / Overdose
- most common and life threatening in oppioid OD
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Oppioid Withdrawal
- Oppioid withdrawal is basically the same as the negative effects of cocaine intoxication
--> heart and sympathetic
--> Cocaine makes you "WIDE EYED, DIAphoresis, and DIE with RESCUSS"
- also nausea and vomiting
- Tx of oppioid withdrawal = methadone and buprenorphine
- methadone = full Mu antagonist
--> most commonly used
--> full agonist but no HIGH?
- buprenorphine = PARTIAL Mu antagonist
--> think "buprenorphine is LIKE MORPHINE, BUT not fully like morphine"
- UNIQUE symptoms for oppioid withdrawal:
--> lacrimation and yawning
--> Aunt Bern Cries and Yawns because she lost her job...
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Oppioid Addiction and recovery
- 1st line TX = methadone
- 2nd line TX = buprenorphine (+/- naloxone)
- methadone = full agonist
--> 2 properties makes methadone good for quitting oppioids
--> very long duration of action = supress cravings and withdrawal
--> very potent and strong (without the euphoric effects) = low cravings / keeps tolerance up so other oppioids don't work
- "METHA --- DONE"
"METHA --- DONE = METHA recovery is a LONG road , and it is PODENT"
- "METHA recovery is a LONG road , and it is PODENT"
--> methadone long duration of action
- "METHA --- DONE is PODENT"
--> methadone is high potent full agonist
- methadone = full agonist
--> 2 properties makes methadone good for quitting oppioids
--> very long duration of action = supress cravings and withdrawal
--> very potent and strong (without the euphoric effects) = low cravings / keeps tolerance up so other oppioids don't work
Notes:
- Precipitated opioid withdrawal
--> can occur when a patient who is physiologically dependent upon opioids and who has or recently had opioids in his/her system is administered an opioid antagonist (naloxone, naltrexone, or nalmefene) or an opioid partial agonist (buprenorphine)
Hallucinogens Drug Overdose / Withdrawal / Antidote
- PCP, LSD, canabinoids, MDMA = ecstasy
*PCP = Phencyclidine
- PCP main presentation:
--> hallucinations... then all of a sudden
--> "PCP" = look left right, left = Nystagmus
--> then "KARATE chop!!!" = agression / VIOLENCE
- NMDA glutamate antagonist
- has many different effects on other neurons, but mainly affects the modulation of dopamine release
- at low doses they are sedative, but at higher doses key is very AGGRESSIVE behaviour
--> violent even, can be fatal from trauma, etc.
PCP main presentation:
- HALLUCINATIONS ... then all of a sudden
- "PCP" = look left right, left = Nystagmus
--> key differentiation from cocaine, etc.
- then "KARATE chop!!!" = agression / VIOLENCE
--> PCP trips usually very violent
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*MDMA
- 3,4-Methylenedioxymethamphetamine,
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*Strategies for Addiction and Counselling
- when suspecting drug abuse of your prescribed meds, initially be
--> non-judgemental, talk about the reasons for misuse
--> being judgemental turns people off and shuts them down
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*Toxins
*Environmental Toxins
- muscarine = mushroom Ach Agonist
- organophosphates = ACh Esterase irreversible blockers
- fish toxins
--> all have to do with Na+ channels (either no depol/locked depol)
--> except for bad tuna and Mahi mahi histamine excess
*muscarine = mushroom toxin
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*Chemical Toxins
*Cyanide posioning
- cyanide binds to cytochrome int he mitochondria that is needed for TCA and ETC
- antidote for cyanide = methemeglobin
--> this can be made from normal HbA1 by giving
- tx = nitrites
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*Inhalents = Nitrous oxide N2O / glue
- very QUICK onset
- quick recovery also within 45 minutes
- sniffing glue
--> these are depressants
- Nitrous oxide N2O
--> laughing gas
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