Term
EtOH complications of pancreatitis? |
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Definition
Pancreatitis – acute (abdominal pain, vomiting, pancreatic necrosis, pseudocyst formation). Dx – elevated serum amylase and lipase. chronic (chronic abdominal pain, malabsorption due to exocrine failure, hyperglycemia due to islet cell failure) |
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Term
What is most common cause of pancreatitis? |
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Definition
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Term
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Definition
Hepatic toxicity – proposed mechanisms: reactive oxygen species (ROS) -> reduced levels of antioxidants -> oxidative stress -> cell injury acetaldehyde and oxygen radicals -> interact with cellular proteins and macromolecules -> hybrid compounds (‘adducts’) -> impedes the function of the original proteins the adducts may also induce harmful immune responses Alcoholic hepatitis – acute inflammation of the liver, often after period of heavy EtOH use abdominal symptoms, sometimes fever lab -> incr hepatic transaminases AST(SGOT) > ALT(SGPT) (maybe by ~2x) increased bilirubin |
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Term
What is AST/ALT pattern seen wtih EtOH hepitisis? |
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Definition
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Term
EtOH and hepatic steatosis? |
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Definition
Hepatic steatosis deposition of fat within liver parenchyma. Vs. ‘NASH’ (non-alcoholic steatohepatitis). can cause hepatic inflammation, elevated liver-associated tests which then generate more testing, anxiety, etc. |
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Term
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Definition
Cirrhosis eventual fibrosis, portal hypertension, leading to numerous potential complications esophageal varices ascites coagulopathy due to diminished clotting factor synthesis hepatocellular carcinoma |
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Term
What is EtOH/Hep C synergy? |
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Definition
Alcohol use in the setting of hepatitis C virus (HCV) infection can accelerate the progression toward cirrhosis |
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Term
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Definition
Pregnancy Fetal Alcohol Syndrome broad range of physical, cognitive, and behavioral disabilities neuroimaging - reduced size of basal ganglia reduced size of the cerebellum impaired development or agenesis of the corpus callosum |
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Term
What are the effects of inhalents? |
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Definition
Nitrous oxide, nitrites – mechanism: vasodilation, increase in heart rate smooth muscle relaxation mainly used in context of sexual activity potential interaction with PDE-inhibitors (e.g. sildenafil) -> severe hypotension Nitrous oxide whipped cream canisters Amyl nitrite, isobutyl nitrite, butyl nitrite ‘poppers’ – implicated in AIDS circa 1983 |
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Term
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Definition
Withdrawal syndromes agitation delirium tremens (‘D.T.’s) Epidemiologic association with cancers of the mouth, throat, esophagus, liver, prostate, and in women, breast |
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Term
acute/chronic tox with huffing? |
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Definition
Acute toxicity: 129 inhalant abuse deaths were reported to a national data system in 1999 cardiac dysrhythmias ‘sudden sniffing death syndrome’ interference with oxygenation seizures Chronic toxicity: peripheral neuropathy hepatic injury (esp. hydrocarbons) behavioral and cognitive impairment |
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Term
Amphet and CV/Neurbehva complications? |
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Definition
CNS stimulants, includes (crystal) methamphetamine, methylphenidate Cardiovascular complications relate mainly to alpha- and beta-adrenergic agonist properties Neurobehavioral complications relate mainly to dopaminergic (over)release and nerve terminal injury at the synapse |
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Term
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Definition
Acute toxicity: systemic hyperthermia cardiovascular tachycardia (beta) hypertension (alpha and beta) myocardial infarction |
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Term
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Definition
Acute toxicity, contin. Neurologic seizures example: hemorrhagic stroke risk from OTC sympathomimetic amine - PPA “.. we estimate that 1 woman may have a stroke due to phenylpropanolamine for every 107,000 to 3,268,000 women who use products containing phenylpropanolamine as an appetite suppressant within a three-day window ..” NEJM 12/21/00 |
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Term
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Definition
Chronic toxicity: Cardiovascular dilated cardiomyopathy (reduced ventricular function) Neurobehavioral memory/learning impairment anxiety, paranoia, psychosis formication – sense of bugs crawling anorexia |
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Term
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Definition
Dermatologic burns from fires during home manufacturing Infectious ‘party and play’ (PnP) – behavioral disinhibition leading to transmission of HIV etc. |
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Term
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Definition
suggestion of increased rates of premature delivery placental abruption fetal growth retardation heart and brain abnormalities |
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Term
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Definition
Sedative-hypnotics, includes pentobarbital, secobarbital, phenobarbital, thiopental Complications relate to the inhibition of neuronal depolarization potentiating, prolonging, and mimicking GABA, the inhibitory neurotransmitter blocking glutamate receptors |
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Term
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Definition
Acute toxicity: narrow therapeutic index – small increment in dose can yield toxicity depression of the respiratory drive(s) - neurogenic and hypoxemic |
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Term
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Definition
Chronic toxicity: tolerance; withdrawal syndrome neonatal withdrawal |
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Term
what is main concern with barbs? |
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Definition
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Term
What happens with acute tox with benzos? |
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Definition
Acute toxicity: uncommon to require medical care for acute toxicity anterograde amnesia confusion (esp. elderly pts) |
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Term
what happens with chronic tox with benzos? |
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Definition
Chronic toxicity: rebound insomnia withdrawal syndrome |
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Term
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Definition
Blocks reuptake of norepi and norepi by the preganglionic neuron thus excess signal to the postganglionic neuron sympathomimetic alpha- and beta-adrenergic |
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Term
coke acute cardiac complications? |
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Definition
Acute cardiac complications: increased myocardial oxygen demand via increased heart rate, systemic arterial pressure, and LV contractility coronary artery vasoconstriction incr alpha-adrenergic stimulation incr endothelin production decr nitric oxide production incr platelet activation accelerated atherosclerosis, Acute cardiac complic, contin: cocaine-assoc chest pain In 2000, 175,000 U.S. E.R. visits myocardial ischemia tx: O2, aspirin, nitroglycerin, benzodiazepines avoid: beta-blockers myocardial infarction (MI) supposed 24-fold increase in MI risk within first hour after cocaine use, Acute cardiac complic., contin.: arrhythmia aortic dissection tx: beta-blockers avoid: aspirin Chronic cardiac complications accelerated atherosclerosis dilated or hypertrophic cardiomyopathy (from chronic sympathetic stimulation) |
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Term
what tx for aortic dissection? |
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Definition
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Term
what tx for myocardial ischemia? |
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Definition
oxygen, aspirin, nitroglyercin, bezos. NO beta blockers |
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Term
coke and respiratory tract? |
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Definition
Respiratory Tract: Nasal septal perforation ‘Crack lung’ Acute – hypersensitivity reaction with fever Chronic - unclear diagnosis tobacco use a possible confounder |
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Term
coke: acute neurological complications |
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Definition
Acute neurologic complications: seizures at high doses intracranial hemorrhage aneurysmal ( could -> subarachnoid bleed) hypertensive ( could -> intracerebral bleed) |
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Term
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Definition
Acute systemic complications: hyperthermia hypermetabolic state dopaminergic pathways ?involved impaired heat dissipation impaired sweating and vasodilation impaired behavioral response to heat mimics fever, creating need for eval rhabdomyolysis muscle ‘breakdown’ may be consequence of hyperthermia renal failure from ‘muscle pigment’ may develop |
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Term
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Definition
Pregnancy cocaine crosses placenta fetal plasma esterase activity low vs. adult maternal hypertension increased risk of fetal growth retardation, premature delivery reports of increased risk of congenital malformations neonatal irritability controversy re: longer-term neurobehavioral problems (‘crack babies’) decreased uterine blood flow spontaneous abortion placental abruption |
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Term
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Definition
MDMA (3,4-methylenedioxymethamphetamine) increased serotonin release and inhibition of reuptake Toxicities: hyperthermia, seizures, rhadomyolysis, fluid/electrolyte imbalance ‘rave’ setting hepatic injury cardiovascular effects incr HR, BP, myocard O2 consumption |
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Term
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Definition
Liquid ecstasy – GHB reported toxicity includes: confusion, hallucination coma, from which pt may rapidly awaken respiratory depression (esp with concurrent EtOH) fulminant hepatic failure requiring transplantation |
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Term
what are acute tox opiates? |
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Definition
Acute toxicity: mainly relates to overdose CNS depression to coma reduced rate of respiration reduced brainstem responsiveness to rising CO2 impaired pontine/medullary regulation of breathing rhythm |
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Term
what are key mech leading to death? |
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Definition
respiratory and CNS depression are key mech leading to death |
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Term
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Definition
Chronic toxicity: dependence risk of pneumonia prolonged Q-T interval on EKG high-dose methadone constipation risks related to IDU (injection drug use) Withdrawal Pregnancy neonatal abstinence syndrome potential confounding issues re: low birthweight, small head circumference etc. |
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Term
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Definition
Inert/particulate matter sugar, flour, quinine, starch example: talc (white powder) lodges in alveolar capillaries development of ‘talc granulomas’; appear as small nodules on CXR example: soil; shredded paper dyed with shoe polish (in black tar heroin) -> microbes |
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Term
what is major IDU related pathogen? |
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Definition
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Term
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Definition
HIV HBV – hepatitis B virus HCV – hepatitis C virus HDV - hepatitis D superimposed on HBV GBV-C – a flavivirus HTLV-I and II – human T-cell lymphotropic virus I and II |
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Term
what do you get HepC from? |
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Definition
HepC transmission is more closely linked to IDU than sexual contact |
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Term
why might the host be immunolgoicall supressessed? |
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Definition
May be malnourished or living in poor conditions Vitamin deficiencies may be present The humoral immune system may be polyclonally activated elevated IgM and IgG |
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Term
what are ways of drug admin? |
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Definition
Not limited to the well-known routes can inject cocaine, snort heroin Oral (p.o) Nasal insufflation (intranasal/snort) sinusitis epidemiologic association of HCV infection with sharing straws used for snorting cocaine; Smoking or inhalation ‘huffing’, ‘bagging’ etc. ‘hotboxing’ in a car transmission of M. tuberculosis Transrectal ‘keistering’, ‘booty bumping’ |
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Term
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Definition
IDU – ‘injection drug use’ development of injection equipment circa 1855 intravenous (IVDU) intramuscular (IM) subcutaneous (SC) a.k.a. ‘skin-popping’ ‘shooter’s patch’ |
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Term
what is edogenous endophthalmitis? |
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Definition
Eye/ear/nose/throat: endophthalmitis – infection of the ocular cavity (vitreous) endogenous endophthalmitis – seeded hematogenously (via IDU or other unrelated bacteremia) Staphylococcus aureus Candida species
differs from ‘exogenous’ endophthalmitis – stick/paperclip etc. into eye, or ocular surgery complication |
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Term
what are major problems with bloodstream? |
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Definition
Bloodstream: air embolism – injection/entry of air into the vascular system bacteremia/fungemia – transient or sustained circulation of bacteria or yeast (can be a hallmark of endocarditis as well - next slide) Staph. aureus Pseudomonas aeruginosa, others |
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Term
what are major cardiac problems? |
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Definition
Cardiac: endocarditis – organism in blood develops a nidus of infection on heart valve or other endocardial structure. usually a predisposing valvular abnormality (congenital or acquired) IDU (especially intravenous) can over time create damage to valves, especially TV, PV (but also MV, AoV) infective endocarditis (IE) – can categorize by presentation acute bacterial (ABE) subacute bacterial (SBE) by location R-sided (TV, PV) vs. L-sided (MV, AoV) native (NVE) vs. prosthetic (PVE) by organism bacterial vs. fungal ‘culture negative’; most common organism - Staph. aureus increasingly beta-lactam resistant (MRSA) Tx: prolonged antibiotic therapy (weeks), almost always IV valve-replacement surgery sometimes indicated quasi-ethical debate re: performing if ongoing IDU, since high risk of developing future PVE previous endocarditis is a risk factor for future episodes (if survives the first episode) |
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Term
what are peripheral vascular problems? |
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Definition
Peripheral vascular: arterial occlusion/vasospasm inadvertent intraarterial injection e.g. cocaine vasculitis rare - cocaine, amphetamines loss of medically-useful venous access due to overuse; septic thrombophlebitis infected vein wall/clot often accompanied by fever, bacteremia mycotic aneurysm seeding of vessel wall or vaso vasorum -> infection and weakening of arterial wall -> ‘mushroom-like’ (‘mycotic’) aneurysmal dilation |
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Term
what are pul infectious problems? |
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Definition
Cigarette use associated with ~four-fold increased risk of invasive pneumococcal disease (meningitis, bacteremia) (NEJM 3/9/00) Pneumothorax – air introduced from environment (or by lung puncture) during attempted injection into jugular vein |
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Term
what are renal complications? |
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Definition
Renal: sclerosing glomerulonephritis, a.k.a. ‘heroin nephropathy’ inflammatory process in glomeruli, presumably an immunologic reaction to circulating drug or contaminants |
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Term
what are major GI problems? |
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Definition
Gastrointestinal: splenic abscess complication of bacteremia hepatitis b, c, delta – acute liver failure cirrhosis hepatocellular carcinoma |
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Term
what are major derma problems? |
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Definition
Dermatologic: ‘Track marks’ carbon particles (?and hemosiderin), scarring Soft tissue infection cellulitis – infection of skin and subcutaneous tissues abscess – from skin-popping or IV use example: ‘speedball’ = cocaine + heroin local tissue ischemia from cocaine-induced vasoconstriction, plus microbes from unsterile agent/procedure -> risk for abscess
Dermatologic, contin.: Soft tissue infection, contin. fasciitis – infection of superficial or deep fascia soft-tissue pathogens: gram positives (staph/strept) rise in methicillin-resistant Staph. aureus (MRSA) among non-hospitalized persons aerobic gram negative rods from environment/water Pseudomonas, Serratia, Proteus, etc. Dermatologic, contin.: soft tissue pathogens anaerobes clostridial skin/subcut infectn skin-popping black tar heroin C. tetani - tetanus C. botulinum – wound botulism C. perfringens - gas gangrene C. sordellii - shock-like syndrome C. novyi – local infection and circulatory collapse |
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Term
musculoskeleton problems? |
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Definition
Hematogenous route more likely the cause than direct inoculation sternoclavicular joint involment after using jugular vein (Pyo)Myositis – focal infection within skeletal muscle usually Staph. aureus ; septic arthritis – infection of joint space Staph. aureus most common Pseudomonas Candida species osteomyelitis – infection of bone Staph. aureus most common |
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Term
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Definition
Neurologic: Vertebral osteomyelitis Spinal epidural abscess Staph. aureus most common in IDU may result in paraplegia or paralysis Brain abscess usu. subsequent to bacteremia/endocarditis Clostridial syndromes see dermatologic |
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