abused substances

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Author:
manjinder
ID:
146731
Filename:
abused substances
Updated:
2012-04-10 15:52:08
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abused
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abused substances
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  1. 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
  2. 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
  3. 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
  4. 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
  5. 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
  6. 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.
  7. Inhalants (glue, solvents)
    Belligerence, impaired judgement, uncoordination, causes multiple organ damage
  8. 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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