Medliorate

Improving medical students

Med Student’s Drug Guide – Part 1

Posted by medliorator on December 23, 2007

SDN’s Alison Hayward, M.D. and Sarah M. Lawrence present a concise guide to narcotics:

Alcohol
Alcohol is a CNS depressant that appears to act mainly as an agonist on GABA receptors and a blocker at NMDA receptors. It is more correctly referred to as ethanol or “EtOH” because there are other types of alcohols, including methanol (solvent alcohol), acetone (nail polish remover), and ethylene glycol (antifreeze). All these are part of the classic “MUDPILES” acronym for anion gap acidosis, because they are metabolized to ketoacids.

  • One drink = 1 shot = 1 glass of wine = 1 beer, each drink should elevate the blood ethanol level by approximately 20mg/dL, and coincidentally, this is about the amount that is metabolized by the average person in one hour.
  • You must be able to identify alcohol withdrawal, for two reasons: one, it often presents in hospitalized patients who have not revealed that they are dependent on alcohol, and two, it can kill. Therefore, when a patient on the wards (or in a board question) becomes tachycardic, agitated/tremulous, diaphoretic, and hypertensive, if you are the only one on the team to think of ethanol withdrawal, you’ll look like a superstar. Classically (in a board question) the patient will have been in the hospital for about 3 days, but in reality, onset can be as early as a few hours after the last drink. Another presentation that should raise your antennae is a patient with no history of seizure disorder who has a seizure after a day or two in the hospital. These seizures do usually have a brief post-ictal state, and are often accompanied by the other manifestations of ethanol withdrawal. Ethanol levels are likely to be negligible or zero, but should be drawn.
  • The big names to associate with alcohol are Wernicke and Korsakoff – a.k.a Wernicke-Korsakoff syndrome, which is a result of thiamine deficiency related to alcoholism. Wernicke’s encephalopathy is ataxia, altered mental status, and ophthalmoplegia. It can progress to Korsakoff psychosis, in which patients cannot recall events and so they create improbable stories to explain what has happened. This is called ‘confabulation’. Many a medical student has been fooled by a confabulator. Remember – if a wild tale starts sounding way too wild to be true, you might be dealing with a confabulator.
  • ethanol is the treatment for methanol poisoning, because it competitively inhibits methanol turning into formate.

Cocaine
Cocaine can be used in a number of ways. While chewing on a coca leaf can make a user feel mildly euphoric for a few hours, smoking crack cocaine gives the user a rush before they even have time to exhale. Cocaine use results in tachycardia, but also can cause dangerous arrhythmias, and can precipitate myocardial infarction through coronary vasospasm. The mainstay of treatment is benzodiazepines.

 

Ecstasy
[MDMA] came to prominence in the 1960s and 1970s when it was used as part of psychotherapy, for which it appeared useful to facilitate communication as part of relationship counseling. It is a synthetic drug that is used in pill form. The most common concern for side effects of ecstasy is during its use at dance parties, when users may go for many hours without drinking enough water to stay hydrated. The combination of increased temperature and dancing can cause significant dehydration. Common effects include euphoria and increased appreciation of tactile stimuli. Ecstasy is unlikely to kill users and usually only results in death if combined with other drugs. Treatment is symptomatic.

 

Methamphetamine
known on the street as “speed” or “crank” – or just “meth.” [Methamphetamine is a powerful stimulant that] increases levels of brain dopamine significantly, resulting in increased movement and enhanced mood. Although methamphetamine is classified in DEA Schedule II, it is not widely prescribed
Methamphetamine can be taken orally, by snorting, by injection, or by smoking. Tolerance and addiction are often rapid. Symptoms of methamphetamine use include wakefulness, increased physical activity, loss of appetite, rapid heart and respiratory rates, increased blood pressure and hyperthermia. Users may experience insomnia, anxiety, confusion, tremor, convulsions, aggression, hallucinations, memory loss and severe dental problems. Treatment for methamphetamine addiction is challenging and should include cognitive-behavioral therapy to help break deeply entrenched patterns of abuse.

 

Mushrooms
When you hear people referring to “shrooms” as a hallucinogen, they’re generally referring to Psilocybin mushrooms, also known as “magic mushrooms”. Mushrooms that contain the compounds psilocybin or psilocin cause users to have hallucinations and feelings of euphoria that last about 6-8 hours. Contrary to popular belief, the effects are not due to the “poisonous” nature of the mushrooms. In fact, the National Institute of Occupational Safety and Health’s Registry of Toxic Effects rates psilocybin’s toxicity at 641 (with 1 being most toxic), compared to aspirin at 199 and nicotine at 21. A person would reportedly have to consume his or her own body weight in psilocybin mushrooms to take a lethal dose. Not surprisingly, then, treatment is mainly observation and supportive care until the effects wear off. Psilocybin can be much more dangerous when used with alcohol or marijuana, due to increased amounts of risky behavior. Unpleasant side effects can include nausea and vomiting.

Raves, Rollin’, & Roofies: Your Guide to Club Drugs [Student Doctor Network]

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