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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
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