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40 Cards in this Set
- Front
- Back
MOA of antidote for Acetaminophen OD? |
MOA: glutathione precursor, helps inactivate the toxic acetaminophen metabolite (N-acetyl) |
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Bicarb urine alkalinization can be used for __________ OD |
aspirin OD |
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Ventral tegmental area neurons produce _________, responsible for the reward pathway |
dopamine (activated mesolimbic dopamine system & reward system = psychosis + euphoria) |
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Chronic drug abuse results in tolerance & dependence d/t _______________ |
enhanced metabolism (increased enzymes & elimination, need more to maintain effects) & down-regulation of receptors (NEVER stop drugs cold-turkey--> dangerous withdrawal) |
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If a patient comes in suffering from acute heroin withdrawal (dysphoria, nausea, diarrhea), what should you give them? what should you NEVER give them? |
tx: methadone (long-acting opioid replacement for long-term opioid withdrawal program, acute withdrawal is NOT safe) NEVER give them Naloxone alone--> will worsen withdrawal--> possible death!! (Naloxone is for OD only!) |
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Alcohol is metabolized to acetaldehyde by alcohol dehydrogenase (ADH) & microsomal ethanol oxidizing system, what drug inhibits the breakdown of acetaldehyde & causes headaches, N/V, etc w/ alcohol consumption? |
Disulfiram *causes "disulfiram reaction" by inhibiting acetaldehyde dehydrogenase & causes acetaldehyde to accumulate--> neg effects even w/ low alcohol consumption (used in alcoholic pts, not very good compliance) |
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MOA of alcohol |
facilitates GABA & inhibits NMDA glutamate receptors--> decr cog fxn depression of myocardial contractility vasodilation-->hypothermia relaxed uterine smooth muscle loss of liver fxn (hepatitis, cirrhosis, liver failure) inhibition of gluconeogenesis--> hypoglycemia |
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Chronic alcohol abuse can lead to what complications? |
irritation, inflammation, bleeding, & scarring of the gut wall--> pancreatitis peripheral neuropathies Wernicke-Korsakoff syndrome Gynecomastia, testicular atrophy, edema |
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Heavy alcohol consumption during the 1st trimester can lead to...... d/t accumulation of fatty acid ethyl esters (FAEEs), which are present in the newborn's meconium |
Fetal alcohol syndrome: mental retardation (MC) growth deficiency microcephaly midfacial underdevelopment |
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BAC > _______ can cause motor impairment >_________ can cause coma |
> 100 motor impairment > 300 coma (>500 death) |
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Alcohol abuse causes cross tolerance to sedative-hypnotic drugs, however ________ may be used to help prevent delirium or seizures during withdrawal, BUT only given In-hospital bc combining alcohol w/ this can cause DEATH!! |
Benzodiazepines (chlordiazepoxide, lorazepam) |
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________ can also be used for alcohol withdrawal to reduce tremors & HR & BP |
propranolol (beta-blocker) or clonidine (alpha2-agonist) |
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What are the 2 diff forms of cocaine? Which one has a much higher blood concentration when snorted? (cocaine is made from erythroxylon coca plant) |
1. hydrochloride salt = powder cocaine/coke, used IV (dissolved in water) or snorted 2. free base = crack, smoked or snorted, *much higher concentrations |
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MOA of cocaine What metabolite can be detected in urine up to 5 days after use? |
MOA: (amino ester) Blocks NE reuptake Blocks serotonin reuptake Blocks sodium channels in axonal membrane (anesthetic effects) *rapid metabolism by plasma pseudocholinesterase, lose high & crash w/i 3 hrs* metabolized to---> Benzoylecgonine |
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Cocaine short-term effects (cocaine is not commonly used as a topical local anesthetic d/t neg SEs) |
Increased energy Decreased appetite Mental alertness Vasoconstriction, Inc HR & BP (d/t inc NE, can lead to MI!!!) Inc temperature Dilated pupils IV site allergic rxn |
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Cocaine long-term effects |
Addiction Irritability & mood disturbance, restlessness Paranoia, auditory hallucinations Arrhythmias* MI* Respiratory failure*, chest pain Strokes* Seizures, HA Abdominal pain, Nausea, bowel gangrene Nosebleeds, runny nose |
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What should you NEVER give to a pt w/ cocaine OD? *suspect OD if pt comes in w/ chest pain, cardiac arrest or arrhythmia (v fib), DILATED pupils (ANS overdrive) |
beta-blocker |
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Pt presents w/ dysphoria, depression, sleepiness, fatigue, bradycardia (withdrawal sx) & has a damaged nasal septum* What drug is he likely withdrawing from? |
Cocaine (no tx for withdrawal, supportive care) |
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A newborn of a drug-addict displays tremulous, extreme irritability, suckling problems, vision problems, lack of coordination, & cognitive/neurobehavioral problems. What drug was the mother likely doing while pregnant? What other maternal complications can occur from this drug? |
Cocaine maternal malignant hypertension, cardiac ischemia, cerebral infarction, sudden death, spontaneous abortion, death in utero, high risk of premature membrane rupture, preterm delivery, IUGR, abruptio placentae |
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Cocaine mixed w/ _________ creates a very toxic metabolite that leads to lethal seizures & cardiac arrest |
alcohol |
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_______ may also be combined w cocaine in a brewed tea. What else is this drug commonly combined w/ in a hand-rolled cigarette form? |
Marijuana combined with ketamine in joint, causes hallucinations *various parts of the cannabis sativa plant are used, the top resin/hashy part is the most potent |
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Marijuana causes the release of ______ leading to the euphoric "high" What are the other effects? |
release of dopamine--> euphoric "high" other effects: Inc HR bronchodilation vasodilation--> red eyes (conjunctiva)* (d/t dilated vessels of the eye) Stinging/burning cough (d/t THC effects) cough & phlegm production (worsens COPD & asthma) |
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Marijuana impairs ability to focus attention, form memories, recal events, coordination, & balance. High doses may lead to what? |
acute toxic psychosis- hallucinations, delusions, depersonalization |
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__________ cause pts to see images, hear sounds, feel sensations (hallucinations), & rapid emotional swings |
Hallucinogens- LSD Mescaline, Psilocybin (anything in right combo can cause hallucinations, typically gas, shrooms, LSD, PCP, aerosols) |
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MOA of hallucinogens |
Stimulation of presynaptic & postsynaptic serotonin receptors |
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_______ is the MOST POTENT hallucinogen *rapidly absorbed, lasting 6-8 hrs, producing distortions (visual hallucinations- color & shape changes), mood changes (elation, paranoia & depression), & intense arousal (but decr performance) @ doses of 100 microg |
LSD (lysergic acid diethylamide) *clear, white, odorless water-soluble, sold as stamps, etc, similar to ergot alkaloids--> severe, prolonged vasoconstriction--> ischemia |
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What are the SEs of LSD? |
pupillary dilation Inc BP & HR flushing salivation lacrimation hyperreflexia |
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____________ cause hallucinations of sight, sound, & depersonalization (out-of-body experience) MOA? |
PCP (phenyclidine) & Ketamine *dextromethorphan (cough suppressant) can also cause similar effects at very high doses) MOA: blocks NMDA glutamate receptors in cortex & limbic structures--> GABA overdrive |
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If a pt comes in w/ vertical & horizontal nystagmus (blurred vision), ANS overdrive, & extreme aggitation & strength (req 5 ppl to hold them down), what do you suspect? *also likely have nausea, dizziness, decr pain perception, uncoordinated bizarre posture What can occur a year after cessation of chronic use? |
PCP (white powder, soluble in water or alcohol, snorted, smoked, or ingested) memory loss & depression may persist up to a year after stopping |
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__________ causes similar effects as cocaine (euphoria, increased alertness/ concentration, self-confidence, sexual excitation, decreased appetite & need to sleep) but is much LONGER lasting & effects are INSTANTaneous MOA? |
Methamphetamine (meth) MOA: Blocks reuptake AND increases release of dopamine--> massive amounts of dopamine stimulation of mesolimbic reward pathway Blocks NE (adrenergic) reuptake Inhibits MAO-a |
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Chronic use of methamphetamines leads to? (meth can be injected, snorted, ingested, smoked (ice)) |
addiction weight loss depression tooth decay "meth mouth" injection site necrosis neurotoxicity paranoia, hallucinations |
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Meth withdrawal is a very severe crash accompanied by ________ |
hypoglycemia, dehydration, disorientation |
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________ is the tablet form of meth, causes dry mouth, jaw clenching, muscle aches. May cause visual hallucinations, hyperthermia (inability to regulate temp--> may lead to liver, kidney, CV failure), & panic attacks at high doses. How does withdrawal present? |
MDMA (ecstasy, 3, 4 methylenedioxymethamphetamine) withdrawal- severe depression, anxiety, sleep problems, confusion, drug craving (meth withdrawal sxs) |
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Meth is synthesized from man-made products, often via ________________(using cold meds), which involved very volatile substances & often leads to explosions |
pseudoephedrine reductase method |
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_________ interact w/ mu receptors to cause euphoria, spinal analgesia, sedation, & eventually lead to tolerance & dependence. How does abstinent withdrawal present? (NEVER take pts off abruptly to prevent!!) |
Opiates (including heroin) withdrawal- ANS hyperexcitability, muscle spasm, lacrimation, tremor, diarrhea |
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Tx options for opiate withdrawal? |
Buprenorphine (partial agonist) - initial tx for withdrawal Buprenorphine + Naloxone (antagonist, prevents "high" effects) OR Methadone (long-lasting opioid substitute, no euphoric effects) for long-term withdrawal /opioid addiction |
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How does Opioid OD present? |
pinpoint pupils** histamine release reduced uterine contraction urinary retention/ constipation coma |
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___________ should also not be abrupty stopped d/t severe withdrawal sxs including hallucinations, anxiety, insomnia, irritability & seizures* How can withdrawal be tx? |
Benzodiazpenines withdrawal tx w/ chlordiazepoxide or larazepam, tapered dose 5-7 days |
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Benzo OD can present w/ bradycardia, hypotension, memory impairment, dizziness, CNS & respiratory depression. How can OD be tx? Which "date rape drug" is purposefully give to cause these effects, & exacerbate them w/ alcohol? |
OD tx w/ Flumazenil date rape drug = Flunitrazepam (flu's are opposite) |
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Benzodiazepines bind alternate site & increase GABA binding--> Cl influx--> hyperpolarization Which benzo is often used as a party drug bc it keeps abuser at a "zoned out level"? |
Alprazolam (Z-bars, zandy bars, football, zannies) *can decrease the desire for alcohol, but if taken w/ alcohol will cause OD--> CNS depression |