Drug Abuse

Examples:

• Alcohol:

  • Most common abused drug is alcohol.

  • Alcohol is depressant.

  • First thing to do for a patient presented to ER with Alcohol intoxication, give thiamine B1

    • To prevent the onset or progression of Wernicke Korsakoff syndrome.

  • Scheduled Cholrdiazepoxide (benzodiazepine) in alcohol intoxication to prevent delirium.

 

• Amphetamines & their derivatives:

  • Methyl amphetamine (crystal meth) high potential for abuse.

  • Amphetamine sulphate (fast acting).

  • Ectasy (white burger, white dove, dance drug) MDMA has a brief duration of effect.

  • Effect:

    • Short-term: Euphoriant, myardiasis, decreased appetite followed by fatigue and depression.

    • Long-term: Manic-like presentation and/or paranoid psychosis.

  • Withdrawal symptoms: anxiety, depression, tremor, increase appetite

    • Treat with SSRIs.

  • Death is caused by malignant hyperpyrexia and dehydration.

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• Cocaine:

  • Water-soluble hydrochloride salt (snorting) -> White powder.

  • Insoluble (crack) → smoked →rapid and fast effect.

  • Effect:

    • Irritability, restlessness, paranoid ideation, and convulsions.

    • Persistent sniffing can cause nasal septal perforation.

  • Death is caused through MI, stokes, hyperthermia, and arrhythmias (even in people with normal coronary arteries).

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• Cannabis:

  • Other names (grass, pot, skunk, spliff, marijuana).

  • Effect:

    • Onset is within 10-30 min when smoked.

    • Exaggerate the pre-existing mood (depression, euphoria, or anxiety)

    • followed by increased appetite.

    • Red eye, increase the appetite, disturb the perception of time and place.

    • Amotivations syndrome (apathy and memory dysfunctions) with daily

    • usage.

    • Long-term use increases the risk of developing schizophrenia.

 

• Opiates & Narcotics:

  • Cross-tolerance:

    • Using any of the other drugs in this class reduces withdrawal effects of one. ​

    • Effect:

      • Calming, slight euphoria, decrease physical discomfort, and flattening of emotional response.

    • Withdrawal effects usually subside after 7 days of abstinence.

    • Patients who cannot obtain opiate abstinence they may be on oral methadone for maintenance and withdrawal symptoms.

    • Patients have high mortality rate due to accidental overdose or blood-born

    • infections through sharing needles.

    • Overdose should be promptly managed with administering an opioid antagonist (Naloxone).

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