Rec Drugs

Drugs #

Alcohol (EtOH) #

Veisalgia: medical word for hangover

Withdrawl #

EtOH hits the GABA receptors (same as benzos and barbituates, all hit different spots on GABA receptor). When tolerance is developed, this induces a compensatory increase in NMDA (excitatory) receptors (EtOH binds there too). If patient stops drinking, then you’re left with unchecked excitatory pathway that opens up when you remove the inhibitory (i.e. EtOH) stimulus on the NMDA receptors which results in autonomic overexcitation (i.e. withdrawl).

Treatment #

  • Treat early with phenobarb (hits both GABA and NMDA, benzos only really hit GABA)
    • 10mg/kg ideal body weight, can go up to 30mg/kg (still way safe from toxicity standpoint)
    • Limit to 10mg/kg in ESLD
    • Phenobarb toxicity/somnolence
      • Ammonium chloride alkalinization of urine
      • Phenobarb Half life in Adults: ≈79 hours (range: 53 to 118 hours).
  • Benzos can cause delirium which can be confused for withdrawal, meaning need for more benzos (vicious cycle); look for on later days (day 5ish on)
  • Lorazepam can be used in ESLD (different metabolism)
  • Diazepam preferred
    • Faster onset and longer lasting
  • Librium (Chlordiazepoxide) tapers really only useful outpatient with motivated patients that want to quit drinking but want to avoid withdrawal
    • No evidence for inpatient help, likely prolongs hospital stay

High Dose Thiamine #

  • 500mg IV TID x 2 days
  • 300mg IV qday x 5 days
  • 100mg PO thereafter

Hallucinations #

x Alcoholic Hallucinosis (AH) Delirium Tremens (DT)
Onset 12-48 hrs 48-96 hrs
Duration 1-2 days 1-5 days
Symptoms Hallucinations, usually visual, pt usually knows they’re not real and thus they’re disturbing to pt Later onset, pt usually not disturbed by visual hallucinations + autonomic issues as well

Marijuana #

Hyperemesis #

  • Chronic smokers
  • Hot shower makes it better
  • Must abstain to totally fix it.

Recreational Drugs #

Meth #

CO predominance

  • Heavy psychotic component => hallucinations
  • Can cause psych problems
  • Redirectable
  • Shoot or smoke
  • Causes puffy hands

Treatment #

  • Benzos
  • Halidol
  • Dark room


  • Rage, aggressive
  • Not as rediretable as amphetamines

Heroine/Fentanyl/Opiates #

  • Somnolent, dissociated
  • Look for apnea

Treatment #

  • Naloxone
    • 0.4mg in 10mL saline
    • Repeat every 30 sec
    • Titrate to better breath and more wakefull

Cocaine/Crack #

  • ↑HR, ↑RR
  • Vasculopaths
  • Hypercoaguable
  • MI

Treatment #

  • Benzos


Extacy => pill
Molly => powder

  • Euphoric
  • ↑ water intake
  • ↓ Na
  • Hyperthermic

Treatment #


Pearls #

  • Oxycodone metabolites should be present in urine for up to 3 days.