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Depressant Intoxication

Mood elevation, decreased anxiety, sedation, behavioral disinhibition, respiratory depression.

Depressant Withdrawal

Anxiety, tremor, seizures, insomnia

Alcohol Intoxication signs

Emotional lability, slurred speech, ataxia, coma, blackouts. GGT is a sensitive indicator of alcohol USE. AST 2x ALT

Mild alcohol withdrawal

Anxiety, tremor, seizures, insomnia

Severe alcohol withdrawal

DTs- Life threatening alcohol withdrawal syndrome that PEAKS 2-5 days after last drink. Autonomic system hyperactivity (tachycardia, tremors, anxiety, seizures) --> psychotic symptoms (hallucinations, delusions) --> confusion. Treat with benzos

Opioid Intoxication

CNS depression, nausea, vomiting, constipation, pinpoint pupils, seizures (OD life threatening). Treat: naloxone, naltrexone

Opioid Withdrawal

Sweating, dilated pupils, piloerection, fever, rhinorrhea, nausea, stomach cramps, diarrhea

Barbiturates Intoxication

LOW safety margin, marked respiratory DEPRESSION. Treat: symptoms management (assist respiration and increase BP)

Barbiturates withdrawal

Delirium, life-threatening CV collapse

Benzodiazepines Intoxication

Greater safety margin than barbiturates. Ataxia, minor respiratory depression. Treat with FLUMAZENIL (competitive GABA antagonist).

Stimulants intoxication

Mood elevation, psychomotor agitation, insomnia, cardiac arrhythmias, tachycardia, anxiety

Stimulants withdrawal

Post-use "crash," Depression, lethargy, weight gain, headache

Amphetamines intoxication

Impaired judgment, pupillary dilation, prolgoned wakefulness and attention, delusions, hallucinations, fever

Amphetamines withdrawal

Stomach cramps, hunger, hypersomnolence

Cocaine intoxication

Impaired judgment, pupillary dilation, hallucinations (tactile), paranoid ideations, angina, sudden cardiac death. Treat: BDZ

Cocaine withdrawal

Suicidality, hypersomnolence, malaise, severe psychological craving.

Caffeine intoxication

restlessness, increased diuresis, muscle twitching

Nicotine intoxication


Nicotine withdrawal

irritability, anxiety, craving. Treat: nicotine patch, gum, lozenges OR bupriopion or varenicline (chantix)

PCP intoxication

Belligerence, impulsiveness, fever, psychomotor agitation, vertical and horizontal nystagmus, tachycardia, homicidality, psychosis, delirium.

PCP withdrawal

Depression, anxiety, irritability, restlessness, anergia, disturbances of thought and sleep.

LSD intoxication

Marked anxiety or depression, delusions, visual hallucinations, FLASHBACKS, pupillary dilation

Marijuana intoxication

Euphoria, anxiety, paranoid delusions, perception of SLOWED time, impaired judgment, social withdrawal, increased appetite, dry mouth, conjuctival injection, hallucinations

Marijuana withdrawal

Irritability, depression, insomnia, nausea, anorexia. Most symptoms peak in 48 hours, last 5-7 days. Detected in urine up to ONE MONTH after use.

Heroin addiction increases risks for...

Hepatitis, abscesses, overdose, hemorrhoids, AIDS, right-sided endocarditis.


Long acting oral opiate, used for heroin detoxification or long-term maintenance.


Naloxone + Buprenorphine (partial agonist). Long acting with fewer withdrawal symptoms than methadone. Naloxone is NOT active when taken orally, so withdrawal ONLY if INJECTED.

Complications of alcoholism

Alcoholic cirrhosis, hepatitis, pancreatitis, peripheral neuropathy, testicular atrophy

Wernicke-Korsakoff syndrome

Deficiency of B1(thiamine). Confusion, opthalmoplegia, ataxia (Korsakoff's encephalopathy). Can progress to irrversible memory loss, confabulation, personality change (Korsakoff's psychosis). Associated with PERIVENTRICULAR hemorrhage and necrosis of mammillary bodies. Treat: IV B1

Mallory-Weiss syndrome

Longitudinal lacerations at the GE junction caused by excessive vomiting. Presents with hematemesis. Associated with PAIN unlike esophageal varices.

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