Drug Abuse
General:
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Substance use: is the use of drug that induces physiological, psychological and\or behavioral changes.
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Substance abuse: when the usage cause maladaptive changes to patient’s life or causes a risk for patient well-being.
Examples:
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Alcohol:
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Most common abused drug is alcohol.
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Alcohol is depressant.
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First thing to do for a patient presented to ER with Alcohol intoxication, give thiamine B1
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To prevent the onset or progression of Wernicke Korsakoff syndrome.
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Scheduled Cholrdiazepoxide (benzodiazepine) in alcohol intoxication to prevent delirium.
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Amphetamines & their derivatives:
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Methyl amphetamine (crystal meth) high potential for abuse.
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Amphetamine sulphate (fast acting).
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Ectasy (white burger, white dove, dance drug) MDMA has a brief duration of effect.
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Effect:
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Short-term: Euphoriant, myardiasis, decreased appetite followed by fatigue and depression.
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Long-term: Manic-like presentation and/or paranoid psychosis.
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Withdrawal symptoms: anxiety, depression, tremor, increase appetite
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Treat with SSRIs.
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Death is caused by malignant hyperpyrexia and dehydration.
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Cocaine:
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Water-soluble hydrochloride salt (snorting) -> White powder.
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Insoluble (crack) → smoked →rapid and fast effect.
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Effect:
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Irritability, restlessness, paranoid ideation, and convulsions.
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Persistent sniffing can cause nasal septal perforation.
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Death is caused through MI, stokes, hyperthermia, and arrhythmias (even in people with normal coronary arteries).
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Cannabis:
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Other names (grass, pot, skunk, spliff, marijuana).
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Effect:
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Onset is within 10-30 min when smoked.
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Exaggerate the pre-existing mood (depression, euphoria, or anxiety)
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followed by increased appetite.
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Red eye, increase the appetite, disturb the perception of time and place.
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Amotivations syndrome (apathy and memory dysfunctions) with daily
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usage.
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Long-term use increases the risk of developing schizophrenia.
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Opiates & Narcotics:
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Cross-tolerance:
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Using any of the other drugs in this class reduces withdrawal effects of one.
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Effect:
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Calming, slight euphoria, decrease physical discomfort, and flattening of emotional response.
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Withdrawal effects usually subside after 7 days of abstinence.
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Patients who cannot obtain opiate abstinence they may be on oral methadone for maintenance and withdrawal symptoms.
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Patients have high mortality rate due to accidental overdose or blood-born
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infections through sharing needles.
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Overdose should be promptly managed with administering an opioid antagonist (Naloxone).
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Amphetamines/ Cocaine withdrawal symptoms: depression, hyperphagaia,
and hypersomolence.
Consider cocaine toxicity in young patients with ischemic chest pain.
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Benzodiazepine:
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Effect:
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Behavioral disinhibiting, somnolence, sever sedation, respiratory depression.
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Treat overdose with Flumazenil.
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Intubate in case of respiratory depression.
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Withdrawal symptoms:
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Anxiety, insomnia, hyperactivity, seizure, and decreased appetite.
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Treat with long-acting benzodiazepine: Clonazepam.
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Drug-induced Psychosis:
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Reported with amphetamines, cocaine, and hallucinogens (cannabis).
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ICD-10 criteria for diagnosis of drug-induced psychosis requires:
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These symptoms occur within 2 weeks and often within 2 days (48 hours) of the drug use
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And symptoms should persist for more than 2 days but not more than 6 months.
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Character:
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Hallucinations (auditory or sensory)
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Delusions
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Psychomotor disturbances
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Misidentification
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Refrences:
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Kumar, Parveen J, and Michael L Clark. Kumar & Clark's Clinical Medicine. Print.
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Who.int,. 'WHO | Community Management Of Opioid Overdose'. N.p., 2015. Web. 18 Sept. 2015.
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Gloucestershire.gov.uk,. 'Reduce Alcohol - Mobile Subsite'. N.p., 2015. Web. 1 Oct. 2015.
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YouTube,. 'Substance Use Disorders - CRASH! USMLE Step 2 And 3'. N.p., 2015. Web. 11 Oct. 2015.
Written by: Roaa Amer
Reviewed by: Abdulrahman AlNasser
Rawan Al-Tuwaijri
Format Editor: Adel Yasky