abused substances

• 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

• 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

• 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

• 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

• 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

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.

Belligerence, impaired judgement, uncoordination, causes multiple organ damage

• 5HT releasers (amphetamine-like mechanism, except releases more 5HT than dopamine)
• cause damage to serotonergic neurons, causes hyperthermia