Medical Substance-Related Disorders – Psychiatry | Lecturio


[Music] next let’s move on to amphetamines or stimulants so classic amphetamines include things like dexedrine and Ritalin these release dopamine from nerve endings causing a stimulating effect this is a highly abused substance especially in teenagers and young adults designer amphetamines are also newer on the markets and include things like MDMA and ecstasy these release dopamine and serotonin from nerve endings and these have both stimulant and also hallucinogenic properties clinical uses for amphetamines would include ADHD narcolepsy and depression when somebody hasn’t thought I mean intoxication some of the symptoms are going to be euphoria changes to their blood pressure and heart rate nausea dilated pupils weight loss and psychomotor changes they may also have chills respiratory problems sweating seizures arrhythmia and hallucinations how long does the urine drug screen stay positive for amphetamines well you’ll want to know it’s one to two days so you can always test for this in a patient’s urine when they come to the hospital and in terms of amphetamine withdrawal symptoms they can’t experience a crash which is going to look like irritability and also hyper somnolence PCP is another substance that you’ll want to know a little bit about for your boards it’s also called angel dust and it’s a hallucinogen and it antagonizes NMDA glutamate receptors and activates dopamine neurons PCP and ketamine which is a similar agent were both developed originally as anesthetics and now they can be actually abused in culture so PCP intoxication will look like restlessness also reckless behavior and impulsivity impaired judgment assaultive ‘no sand very important to know if your boards PCP intoxication can actually cause a rotatory nystagmus which is really a cardinal feature of this you may see a taxi ax in your patient hypertension tachycardia and muscle rigidity along with a high pain threshold how long does the urine drug screen stay positive for PCP do you know well the answer is one week so actually for quite a while and because of muscle rigidity associated with PCP because remember these patients are going to be restless reckless agitated so they may get muscle rigidity and it’s important to check their CPK and also their liver function because these two things are often very elevated in PCP users the treatment for PCP is of course to manage the ABCs airway breathing and circulation stabilized the patient’s vital signs and electrolytes acidify their urine and treat them medically with benzodiazepines or possibly neuroleptics or low dose antipsychotics to help with the agitation and hallucinatory effects that they’re experiencing now let’s talk about opiates opiates include things like heroin codeine dextromethorphan morphine methadone and meperidine there’s worldwide a pretty huge opiate crisis right now so all those that these medications were originally formed to help people control pain they’re actually highly highly abused so there is this current opioid epidemic and there is now because of that a push for doctors to prescribe non opiate medications to alleviate pain and even to help patients practice mindfulness which is actually being studied and researched and being shown to be very effective for pain management well how do opiates actually work so they stimulate opiate receptors such as mu Kappa and Delta and these are involved in the sedation analgesia and dependency opiate intoxication looks as follows drowsiness nausea and vomiting constipation slurred speech constricted pupils this is very important to note because I’ve talked about other medications or substances earlier which can cause dilated pupils however opiates cause pinpoint or constricted pupils it can cause seizures and respiratory depression you want to treat the intoxication phase with ABC’s managing airway breathing and circulation because opiates can cause respiratory depression it’s extremely important to make sure your patient is breathing in an overdose you’re gonna give IV naloxone or naltrexone to reverse the effects of opioids you also will ventilate and intubate independency when patients have had chronic use of opioids over a long period of time you might consider an outpatient management plan with methadone or suboxone you’ll offer them psychotherapy and also Narcotics Anonymous through that they can get peer support to help them with their dependency and addiction the withdrawal symptoms of opiates include dysphoria insomnia lacrimation or development of Tears rhinorrhea yawning and weakness they may sweat or get pilo erection they can be vomiting have a fever they’ll actually have dilated pupils during the withdrawal syndrome and they’ll complain of profuse and very intolerable muscle aches it’s extremely important to note that as much as it is uncomfortable to experience opiate withdrawal it is not deadly nor life-threatening so what are the four types of opiate receptors we talked about these before but they’re very important to know for your exam so again there Mew Kappa lambda and Delta and something else that you may encounter in clinical practice is a patient who presents with something called skin popping so you want to know what this looks like for clinical practice in your exam if you encounter a case scenario of a patient who has circular depressed scars often in their toes the back of their thighs and this is what’s called skin popping it occurs from injection site use often of opioids and it can be deadly because patients can develop abscesses here and so it’s very important when you’re evaluating your patient to do a head-to-toe physical exam and actually be very attuned to looking for any abscesses checking their vital signs because they may have a fever and you really want to treat this very aggressively and because this is so important to note and often comes up on exams opioid intoxication is going to cause pinpoint pupils to the eyes so here’s a case example that I want you to consider a teenage boy is brought to the emergency room by his parents you smell an odd odor on his breath what do you make of it well you should consider in this teenager inhalant abuse or huffing and what you want to do clinically is look for a rash near his nose or mouth to help confirm your suspicions common problems caused by inhalants use include brain atrophy this is caused by heavy metal exposure such as to copper and zinc also encephalopathy seizures epilepsy decreased IQ ataxia myoclonus Korea other things that can happen are tremor optic neuropathy motor and sensory neuropathy death by respiratory depression cardiac arrhythmias aspiration hepatic and renal failure and rhabdomyolysis you want to treat inhalant with supportive measures and by maintaining the ABCs their airway breathing and circulation this concludes our talk of other substances you now know about some of the most commonly abused substances a little bit about what it looks like when a patient intoxicated and also withdrawing and you know the importance of first and foremost for every patient managing their airway breathing and circulation you also have a little bit more background on how to offer further treatment options and even long-term substance use options [Music]

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