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Alcohol
- Leading cause of mental retardation (fetal alcohol syndrome)
- serum gamma-glutamyltransferase- sensitive indicator of alcohol use
- AST value is twice ALT value
- Rx:
- Disulfiram: inhibits aldehyde dehydrogenase. produces symptoms of nausea, chest pain, hyperventilation, tachycardia, vomiting, effective for short term treatment only
- Acamprosate: helps prevent relapse; hypothesized to decrease glutamate receptor sensitivity
- Benzodiazepines: prevent alcohol-related seizures
- Naltrexone: opiate-receptor antagonist; reduces cravings; helps patient to stop after first drink
- Withdrawal: peaks 2-5 days after last drink
- autonomic system hyperactivity (tachycardia, tremors, anxiety, seizures), psychotic symptoms (hallucinations, delusions), confusion
- Rx: thiamine, sedative-hypnotics w/ gradual tapering, clonidine and propranolol, lorazepam for seizures
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CNS Stimulants
Cocaine, Amphetamines, Caffeine, Nicotine
- cocaine: blocks DA, NE, 5HT reuptake
- Amphetamines: releases DA, NE, 5HT, weak MAO inhibitor
- Caffeine: restlessness, inc diuresis, muscle twitching
- Nicotine: Restlessness
- Euphoria, hypervigilance, anxiety, grandiosity, tachycardia, pupillary dilation, dec appetite, hyperthermia (warm, sweaty skin)
- Toxicity: cardiac arrhythmias, MI, stroke, hallucination, paranoia, hyperthermia, seizures, death
- Rx: BZs, neuroleptics
- Withdrawal: craving, depression, fatigue, inc sleep time, inc appetite
- Nicotine Rx: bupropion/varenicline
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CNS depressants
Benzodiazepines, Barbiturates, EtOH
- Benzodiazepines: inc freq of GABA channel opening
- Barbiturates: inc duration of GABA channel opening
- = low safety margin (marked respiratory depression)
- impaired judgment, slurred speech, uncoordination, unsteady gait, stupor, respiratory depression, death
- Rx: flumazenil for BZ overdose
- Withdrawal: anxiety, delirium, insomnia, possible life-threatening seizures and CV collapse
- Rx: long-acting BZ to suppress acute symptoms, taper dose
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CNS depressant
Opioids
(heroin, morphine, oxycodone)
- stimulate mu, kappa, delta receptors; mu most imp in abuse
- Euphoria, analgesia, sedation, cough suppression, miosis, constipation,dec HR and BP
- Toxicity: respiratory depression, nausea/vomiting, miosis, coma, death
- Rx: naloxone, naltrexone
- Withdrawal (unpleasant but not life threatening): flu-like symptom: diarrhea, fever, rhinorrhea, lacrimation, sweating, yawning, muscle jerks, dilated pupils, piloerection
- Rx: methadone, LAAM, buprenorphine, clonidine
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Hallucinogens
PCP (angel dust), LSD
- Phencyclidine: PCP: belligerence (aggressive behavior), impulsiveness, agitated, vertical and horizontal nystagmus, dec response to pain, psychosis, homicidality, ataxia. Rx: Ketamine
- LSD: marked anxiety or depression, delusions, visual haallucinations, flashbacks, pupillary dilation
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Marijuana
Euphoria, anxiety, paranoid delusions, perception of slowed time, impaied judgement, social withdrawal, inc appetite, dry mouth, conjunctival injection, hallucinations
Withdrawal: irritability, depression, insomnia, nausea, anorexia. symptoms peak in 48 hrs and last for 5-7 days. can be detected in urine up to 1 month after last use.
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Inhalants (glue, solvents)
Belligerence, impaired judgement, uncoordination, causes multiple organ damage
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MDMA (methylenedioxymethamphetamine)
"ecstasy"
- 5HT releasers (amphetamine-like mechanism, except releases more 5HT than dopamine)
- cause damage to serotonergic neurons, causes hyperthermia
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