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Rx2013
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Symptoms of BAL 50mg/dl
- euphoria
- talkativeness
- relaxation
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Symptoms of 100mg/dl BAL
- CNS depression
- impaired motor & sensory function
- impaired cognition
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symptoms of >140mg/dl BAL
decreased blood flow to the brain
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Legal BAL in MO
0.08% or 80 mg/dl
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Ethanol toxicities of the liver
- Fatty Liver
- Alcoholic hepatitis
- Cirrhosis
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Characteristics of cirrhosis
- non-reversible
- mallory bodies
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Alcohol metabolism
- mostly takes place in the liver
- some in the brain
- free radicles are released creating oxidative stress
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Ethanol effects on the cardiovascular system
- cardiomyopathy (both atrial and ventricular hypertrophy) and heart failure
- arrhythmias
- hypertension
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There is a direct correlation to > 3 per day
hypertension
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Alcohol can prevent
coronary heart disease
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Common fetal alcohol syndrome abnormalities
- growth retardation
- microcephaly
- poor coordination
- abnormal facial development
- minor joint abnormalities
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Incidence of FAS births in the US
0.2-1.5/1000 live births
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Wernicke-Korsakoff syndrome
- vision changes, ataxia, impaired memory
- Thiamine (B1) deficiency
- indirect effect of alcohol
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Nicotine LD50
0.5-1 mg/kg (40-60 mg)
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Toxic effects of nicotine
- standalone carcinogenicity is unknown
- teratogenicity is little
- blood pressure increases because nicotine is a vasoconstrictor
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dose of nicotine that causes N/V
2-5 mg
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Common ADEs with opiates
- constipation
- dry mouth
- n/v
- sedation
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Uncommon ADEs with Opiates
- bad dreams/hallucinations
- dysphoria/delirium
- pruritus/urticaria
- respiratory depression
- urinary retention
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Drugs to treat n/v secondary to opiates
- prochlorperazine
- haloperidol
- metocloperamide
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Drugs to treat pruritus/urticaria secondary to opiates
- fexofenadine
- diphenhydramine
- loratadine
- doxepin
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Drugs to treat respiratory depression secondary to opiates
naloxone
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Cocaine CNS Toxicity
- euphoria, anxiety, agitation, hyperactivity
- muscle rigidity
- paranoid psychosis
- weight loss
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Cocaine cardiovascular toxicity
- HTN
- increased platelet aggregation
- coronary artery spasm => MI
- shock
- hyperthermia
- tachyarrhythmia, Vtach or Vfib
- Renal failure
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Amphetamine CNS toxicity
- Addiction
- Psychosis
- memory loss
- aggression
- mood disturbance
- dental problems
- wt loss
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Amphentamine abuse during pregnancy
- Premature delivery
- fetal growth retardation
- heart and brain abnormalities
- placental abruption
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Amphetamine cardiovascular toxicity
- dysrhythmias
- HTN
- heart failure
- rhabdomyolysis
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LSD effects
- most potent mood changing chemical
- dilated pupils
- increased body temp
- increased HR and BP
- Profuse sweating
- loss of appetite
- sleeplessness, dry mouth, tremors
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Antidote for LSD
no specific antidote
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Acute marijuana toxicity
- impairs short term memory, attention & judgement
- impaired coordination and balance
- increased HR
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Persistent marijuana toxicity
impaired memory and learning skills
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Long term toxicity with marijuana use
- addiction (lower than most drugs)
- increased risk of bronchitis, cough or emphysema
- increased risk for cancer of head, neck and lungs
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Inhalants and aerosols
- volatile gases
- solvents
- aerosols
- anesthetic gases
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Volatile gases
- butane
- propane
- aerosol propellants
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Solvents
- model glue
- gasoline
- toluene
- acetone
- amul nitrite
- cleaning solvent
- printing fluids
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Aerosols
- deodorants
- hair spray
- freon
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Toxic effects of inhalants and aerosols
- loss of consciousness/convulsion
- cardiac arrhythmias
- death
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CNS effects of aerosols & inhalants
ataxia and peripheral neuropathy
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Cardiac effects of aerosols & inhalants
- MI
- more so with halogenated solvents
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Nephrotoxicity with aerosols and inhalants
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Hepatotoxicity with aerosols and inhalants
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Hematological toxicity with aerosols and inhalants
- bone marrow suppression
- N2O or benzene
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Hypertension and tachycardia are associated with
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Hypotension associated with
sedative hypnotics
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Hypothermia associated with
CNS depressants
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pupil constriction associated with
opioids
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Pupil dilation associated with
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Nystagmus (involuntary eye movement) associated with
- sedatives
- phencyclidine
- ketamine
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Nystagmus, dysarthria & ataxia
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Twitching and muscular hyperactivity
cocaine
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Coma
- opioids
- sedative hypnotics
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Mecamylamine
- Nicotine antidote
- nAChR antagonist
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Flumazenil
Benzodiazepine antidote
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alcohol antidotes
- naltrexone
- acamprosate
- disulfiram
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Rimonabant
- Marijauna antidote
- CB1 receptor antagonist
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