Illicit drugs.

/10

Which of the following is INCORRECT about Methamphetamine?

Theoretically if you give B Blockers then you will get unopposed Alpha receptor stimulation causing worse vasoconstriction.

It causes sympathetic stimulation.

More than 14.7 million Americans have tried it.

Theoretically you should avoid giving B Blockers in Methamphetamine overdose.

It was not until 2006 that the Major League Baseball in the USA banned it.

It causes sympathetic and parasympathetic stimulation.

/10

One person dies of the overdose of this drug every 10 hours in San Francisco. What drug is it?

Fentanyl precusors are most often made in China---made into Fentanyl in Mexico---than carried over the border to the United States. It has become the narcotic of choice because of it's potency and price.

As yet it has not made a big impact on the illicit drug use in Australia---watch this space.

Heroin.

"Crack" Cocaine.

Fentanyl.

Ketamine.

/10

Which of the following would you NOT expect to possibly see in MDMA (Ecstasy) ingestions.

Patients can get hyperthermia not hypothermia. Structurally Ecstasy (MDMA) is similar to a combination of Methamphetame (Speed) and Mescaline (a hallucinogen).

A big problem is that people think they are buying Ecstasy but instead were getting other drugs like PMA (Paramethoxyamphetamine) which is a lot more potent than MDMA (Ecstasy). Pill testing at "Grooving the Moo" festival found that half of the tablets people thought were Ecstasy did not have any Ecstasy in them.

Hypothermia.

Water intoxication causing hyponatremia.

Serotonin syndrome.

Auditory or visual hallucinations.

/10

An 18yr old man presents after sniffing "Ivory wave" bath salts 3 times in 15 minutes. What could you expect to see?

So called "Bath salts" have in them synthetic cathinones. Natural cathinones are found in Khat---a stimulant chewed in Africa.

Effects are similar to amphetamines with the possibility of severe agitation and paranoia.

Treatment is generally supportive with benzodiazepines for agitation.

Agitation, paranoia and sympathomimetic effects.

Visual hallucinations and a far away stare.

Deep sedation with respiratory depression and small pupils.

Sweating, small pupils, vomiting and urinary incontinence.

/10

The price of Cocaine on the street in Australia is around A$300 per gram. Only 2 other countries in the world have more expensive cocaine. Which are they?

The UAE and Saudi Arabia have the death penalty for drug possession which pushes up the price. Colombia is only about 5-10% the price of Australia.

South Africa and Oman.

The United Arab Emirates and Saudi Arabia.

Switzerland and the United States of America.

Colombia and Bolivia.

/10

What would you expect if a young man presents following ingestion of GHB ( Gammahydroxybutyrate)?

GHB (also known as Grevious Bodily Harm---amongst others) is the precursor to GABA and is like the opposite to Amphetamines. The decrease in LOC tends to only last a few hours. To tube or not to tube---that is often the question.

Hypertension, agitation and hyperventilation.

Decreased level of consciousness and hyperventilation.

Decreased level of consciousness and respiratory depression.

Decreased level of consciousness, vomiting and diarrhoea.

/10

What do you see in patients with long term cannabis use who present to the ED?

Cannabinoid hyperemesis syndrome is not infrequently seen with cyclical vomiting, non specific abdominal pain and the characteristic showering.

In the short term antiemetics, occasionally Buscopan and low dose Droperidol IV can assist.

Definitive treatment is cessation of cannabis otherwise it is very likely to return.

Shortness of breath relating to early pulmonary fibrosis.

Shortness of breath related to early emphysema.

Florid psychosis.

Abdominal pain, vomiting and requirement for excessive hot showers.

/10

Which of the following statements about Ketamine is CORRECT?

It is a clear , colourless and odourless liquid.

Known by various names--Kitkat, Special K, Lady K----but not KKK.

There has been a surge in its abuse. The Federal Police doubled their haul of Ketamine in the last year.

It is a light blue colour

The K-Hole is a name for the dissociative state you enter.

Known on the street as KKK.

It's abuse is stable in NSW in the last 3 years.

/10

Which of the following is related to prolonged abuse of Nitrous Oxide (Laughing Gas)?

The spinal cord degeneration is meant to be due to a depletion of Vitamin B12.

Cyclical vomiting.

Subacute combined degeneration of the spinal cord.

The development of Multiple sclerosis.

"The giggles" where ordinary routine moments produce inappropriate laughter.

/10

What drug were these songs about? Captain Jack (Billy Joel), Brown Sugar (Rolling Stones), Comfortably Numb (Pink Floyd).

The head of Bayers research department synthesised Heroin in 1897, 11 days after he synthesised aspirin. He supposidly named it Heroin based on the German word "Heroish" which in German means heroic and strong.

Cocaine.

Fentanyl.

Alcohol.

Heroin.

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