Substance-use Disorders

what are the only 2 substances that have life-threatening withdrawal

alcohol and benzos

triad for wernecke’s encephalopathy

1. ophthalmoplegia

2. confusion

3. ataxia

korsakoff’s psychosis

(caused by thiamine/B1 deficiency from alcohol)

1. anterograde amnesia

2. retrograde amnesia

3. confabulation

stages of alcohol withdrawal

1. minor withdrawal (6-12 hours) → tremors, irritability, anxiety, headache, tachycardia, insomnia

2. alcoholic hallucinations (12-24hours) → auditory & visual (sometimes tactile too)

3. withdrawal seizure (24-28 hours) → generalized tonic-clonic seizure

4. delirium tremens (48-96 hours) → delirium, severe autonomic instability, disorientation, hallucinations, agitation

1st line for alcoholic withdrawal

benzos

order of supportive management for alcohol withdrawal

thiamine BEFORE glucose

how to treat hallucinations in alcohol withdrawal

antipsychotic with taper (haloperidol 5 mg)

which protocol is used for alcohol use

CIWA

what medications can be given for delirium tremens that is refractory to benzos

1. phenobarbital

2. propofol

what are some meds that can help alcohol dependent pts ween off

1. disulfiram (antabuse)

2. naltrexone

disulfiram MOA

inhibits alcohol dehydrogenase → cant break down alcohol in body so causes very uncomfy symptoms when pt tries to drink

how to tx cannabis hyperemesis syndrome

1. hot bath/shower

2. ondansetron

3. metoclopramide

how to tx PCP

intoxication → sedate with benzos (or antipsychotics), low-stimulus env, restraints if needed

withdrawal → symptomatic

pupillary dilation in a opioid user may indicate

severe OD that is causing anoxia (bc opioids usuually cause constriction of pupils)