Adolescent medicine
Download
1 / 83

Adolescent Medicine - PowerPoint PPT Presentation


  • 145 Views
  • Uploaded on

Adolescent Medicine. 16 May 2006. 0900 Routine Appt. Case 1. TC a 16 y/o male CC: Allergies per mother. HPI. His mother comes back to the room and says his eyes have been red for the last 4 months She thinks he has allergies. He doesn’t think there is any problem. Symptoms FH

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Adolescent Medicine' - leda


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Adolescent medicine l.jpg

Adolescent Medicine

16 May 2006



Case 1 l.jpg

Case 1

TC a 16 y/o male

CC: Allergies per mother


Slide4 l.jpg
HPI

His mother comes back to the room and says his eyes have been red for the last 4 months

She thinks he has allergies.

He doesn’t think there is any problem.


What do you want to know l.jpg

Symptoms

FH

Medications

HEADSS

LABS

Physical

What do you want to know?


Headss l.jpg
HEADSS

  • Parents recently divorced

  • Failing independent studies.

  • Hanging out with friends

  • Smokes

  • Has had 1 LTP

  • Not suicidal


Slide7 l.jpg
PE

  • Alert normal vital signs

  • Presence of gynecomastia

  • Otherwise normal exam





New marijuana l.jpg
“New” Marijuana

  • Marijuana of the 60’s had a THC concentration of 0.5% to 1%

  • Marijuana of today has been engineered to have a THC concentration of 6% to 15%


Effects l.jpg
Effects

  • Elation

  • Euphoria

  • Impaired short-term memory

  • Divided attention tasks difficult

    • (e.g. driving)

  • Loss of critical judgment

  • Distortion of time perception


Bad effects l.jpg
Bad effects

  • Visual hallucinations

  • Perceived body distortions

  • Panic attacks

  • Paranoia

  • Amotivational syndrome


Clinical manifestations l.jpg

Lowered temperature

Tachycardia

Hypertension

Tachypnea

(experienced user)

Plasma testosterone suppression

Lowers sperm count

Gynecomastia

Questionable physiologic dependency

Clinical manifestations


Back to tc l.jpg
Back to TC

  • His mom said she wants a drug test


Marijuana drug screen l.jpg
Marijuana drug screen

  • Detection window 7 to 30 days

  • Screen

    • RIA/EIA

  • Confirmation

    • GC / MS

  • Interpretation

    • Second-hand exposure

    • foods



Case 2 l.jpg
Case 2

  • CC a 17 year old boy

  • Stat consult to ER for strange behavior


Slide19 l.jpg
HPI

  • 17 Y/O male being restrained in the E.D. Says the terrorists are after him.


What do you do l.jpg

ABCDE

PE

LABS

Meds

What do you do?


Slide21 l.jpg
PE

  • Pulse 160

  • BP 180/100

  • Temp 101

  • Agitated

  • His pupils are dilated.


Slide22 l.jpg
UDS

AMPHETAMINES……………….PENDING

BENZODIAZEPINES……………PENDING

COCAINE…………………………PENDING

OPIATES………………………….PENDING

THC(CANNABINOIDS)………… PENDING

BARBITUATES………………….. PENDING

PCP(PHENCYCLIDINE)……….. PENDING

METHADONE…………………….PENDING

TCAs(DeWitt)


Cocaine l.jpg
Cocaine

  • Epidemiology

    • Use dropped from 1985 – 1990

    • 5.8 million to 1.6 million users

      • (use in prior 30 days)

    • High school seniors (Ever used)

      • 17.3% (1985)

      • 5.9% (1994)

      • 8.7% (1997)

      • 4.7% (2003)

        • Crack is about ½ of total cocaine use





Cocaine27 l.jpg
Cocaine

  • Clinical manifestations

    • Euphoria

    • Increased motor activity

    • Decreased fatigability

    • Paranoid ideation (occasionally)


Cocaine28 l.jpg
Cocaine

  • Clinical manifestations

    • Pupillary dilatation

    • Tachycardia

    • Hypertension

    • Hyperthermia

  • Death

    • “Speedball”

      • Cocaine injected with heroin


Cocaine drug screen l.jpg
Cocaine Drug Screen

  • Detection period 2-4 days, 8 days for long-term use

  • Metabolized to benzoylegonine and ecgonine methyl ester

  • Plasma 1/2-life of cocaine is 1 hour, metabolites 7.5 and 3.6 hours

  • FALSE positive with Health Inca Tea (HIT)



Case 3 l.jpg
Case 3

LD - 16 y/o male

CC: Mom wouldn’t say


Slide32 l.jpg
HPI

Mom reports that Saturday night he was very silly and confused

Spontaneously laughed

Said he saw sound but then changed his story

He’s acting fine now


What now l.jpg

PMH

FH

HEADSS

PE

LABS

What now?


Hallucinogens l.jpg
Hallucinogens

  • LSD

  • MDMA (Ecstasy)

  • GHB

  • PCP

  • Ketamine

  • 1997

    • 15.1% seniors tried in lifetime

      • 13.6% - LSD

      • 6.9% - MDMA

      • 3.9% - PCP

    • 12.8% MDMA 2003


Slide35 l.jpg
LSD

  • Lysergic acid diethylamide

  • “Acid,” “big ‘D,’” “blotters”

  • Rye fungus

  • Highly potent

    • Can be applied to small objects (stamps)

    • Onset 30-60 minutes

    • Lasts 10-12 hours

    • Mechanisms of action unknown




Slide38 l.jpg
LSD

  • Clinical manifestations

    • Somatic

      • Nausea

      • Dizziness

      • Dilated pupils

      • Fever

      • Flushing

      • Tachycardia


Slide39 l.jpg
LSD

  • Clinical manifestations

    • Perceptual

      • Synesthesia

        • “Seeing” smells

        • “Hearing” or “tasting” colors

    • Psychic

      • Delusions

      • Body distortion

      • Suspiciousness

      • Toxic psychosis


In service question often missed l.jpg

In Service question often missed!

How do you treat a bad trip?


Slide41 l.jpg
LSD

  • Treatment

    • “Bad trip”

      • User terrified, panicked

      • Remove person from setting

      • Attempt to re-establish contact with reality

        • Calm verbal interaction

    • “Flashbacks”

      • LSD-induced states after drug worn off

    • No withdrawal syndrome



Case 4 l.jpg
Case 4

  • PP is 16 Y/O female brought in to ED after being “found” at a friends house.


What now44 l.jpg

ABCDE

PE

LABS

What now?


Slide45 l.jpg
PE

  • Pinpoint pupils, poor response to stimulation.

  • Arms with multiple small scars and needle marks


Opiates l.jpg
Opiates

  • Epidemiology

    • Use decreased during 1980s

    • Seniors use

      • 0.9% 1991

      • 2.1% 1997

      • 2.9% 2003

    • Increase may be related to route

      • Snort and smoke more often


Heroin l.jpg
Heroin

  • Pharmacology

    • Heroine hydrolyzed to morphine

    • Onset of action

      • Inhaled (snorting): 30 min

      • SQ (skin-popping): few minutes

      • IV (mainlining): immediate

    • Tolerance

      • Yes to euphoric effect

      • No to inhibit of smooth muscle

        • Constipation and miosis


Heroin48 l.jpg
Heroin

  • Clinical manifestations

    • Euphoria

    • Diminution of pain

    • Pinpoint pupils

    • Loss of libido




Opiates drug screen l.jpg
Opiates Drug Screen

  • Detection period 1-2 days

    • heroin only 8 hours

  • Screen positive with morphine, codeine, dihydrocodeine, hydrocodone, hydromorphone, oxycodone, poppy seeds

  • GC-MS confirmatory test for 6-MAM

    • no false positive


Prescription and otc l.jpg
Prescription and OTC

  • Vicodin, Percocet, Oxycontin, etc

  • Dextromethorphan

    • Coriciden

    • Robotripping



Case 454 l.jpg

Case 4

Crystal 16 y/o female

CC: needs counseling


Slide55 l.jpg
HPI

  • “Out of control.”

  • Run-away numerous times.

  • Brought in by police after missing for 8 days.

  • Paranoid and angry.

  • Has not slept in 7 days.


Methamphetamine l.jpg
Methamphetamine

  • Names

    • Ice,Crystal,Meth,Tweek,Crank, Batu

  • Ease of absorption

    • Snort, smoke, oral, across mucus membranes (e.g. vaginal)




Methamphetamine59 l.jpg
Methamphetamine

  • Better CNS penetration than amphetamine

  • Affects release and breakdown of catecholamines

  • Euphoria, hypomania and hypersexuality (nonfunctional)


Effects60 l.jpg

Hyperalert state

Talkative

Restlessness

elevated temp

Anorexia

Nausea

dry mouth

dilated pupils

Sweating

dizziness

hyperactive reflexes

Tremor

Insomnia

AGGRESSION

skin picking(formication)

Hypertension

Tachycardia

arrhythmias

Effects


Methamphetamine61 l.jpg
Methamphetamine

  • Treatment

    • Agitation and delusional behaviors

      • Haloperidol or droperidol

    • Cooling blanket for hyperthermia

    • Treatment of hypertension, arrhythmias


Amphetamines l.jpg
Amphetamines

  • Detection period: 1-2 days

  • Positive screening test with:

    • amphetamine, dextroamphetamine, methamphetamine, pseudoephedrine, phentermine, ephedrine, phenylpropanolamine, phenylephrine, selegiline(Parkinson’s med)

  • some will dectect MDMA (ecstacy) most will not


Amphetamines63 l.jpg
Amphetamines

  • Urinary excretion is pH dependent; acidification can reduce plasma 1/2-life to 7-8 hours, alkinization may increase the 1/2-life to over 33 hours

  • Lack of specificity of screening test makes confirmatory test essential


Toxidromes l.jpg

Sedative-Hypnotic

Anticholinergic

Sympathomimetic

Cholinergics

Hallucinogens

Phenothiazines

Opiates

Mixed

Toxidromes


Slide66 l.jpg


Slide67 l.jpg


Toxidrome question l.jpg
Toxidrome Question affectionate and had been so “in” to the music he hadn’t left the dance floor all night

  • What class of drug is he using?

    Sedative-Hypnotic Anticholinergics

    Sympathomimetic Cholinergics

    Hallucinogens Phenothiazines

    Opiates Mixed


Toxidrome question69 l.jpg
Toxidrome Question affectionate and had been so “in” to the music he hadn’t left the dance floor all night

  • This picture fits that of a “mixed” drug with both sympathomimetic and hallucinogenic properties

    What is the most likely substance?

    Alcohol LSD

    Marijuana Heroin

    Amphetamine Jimson Weed

    PCP Mushrooms

    MDMA Ephedra Alkaloids


Toxidrome question70 l.jpg
Toxidrome Question affectionate and had been so “in” to the music he hadn’t left the dance floor all night

  • MDMA (ecstacy)

  • Disinhibition of thermoregulation with resultant dehydration, hyperthermia and seizures are the risk of acute use. Long-term memory impairment is the chronic risk


Methylenedioxy methamphetamine l.jpg
Methylenedioxy affectionate and had been so “in” to the music he hadn’t left the dance floor all nightmethamphetamine

  • MDMA

  • Ecstasy

  • E

  • XTC

  • X

  • Adam


Effects72 l.jpg
Effects affectionate and had been so “in” to the music he hadn’t left the dance floor all night

  • Relaxed, euphoric state

    • Increased self-esteem

    • Heightened senses

      • More in tune with music

      • Light shows more spectacular

      • Sense of touch enhanced

    • Increased empathy, breakdown of social barriers

      • Feelings of understanding and accepting others


Negative effects l.jpg
Negative effects affectionate and had been so “in” to the music he hadn’t left the dance floor all night

  • Muscle Hypertonicity

    • Jaw-clenching

  • Disinhibition of thermoregulation

    • Hyperthermia

    • Sweating

    • Dehydration - hyponatremia

    • Seizures

    • arrhythmias


More badness l.jpg

Hypertension affectionate and had been so “in” to the music he hadn’t left the dance floor all night

Nausea

Dizziness

Ataxia

Tremor

Nystagmus

Difficulty Concentrating

With higher or repeated doses

Anxiety

Paranoia

Hallucinations

Suicidal Depression

More Badness


Dancesafe org l.jpg
DanceSafe.org affectionate and had been so “in” to the music he hadn’t left the dance floor all night

  • Many proponents of “safe” ecstasy use

  • Feel that recreational use at dances (classically raves), while ensuring proper rehydration, should be legal

  • Claim no long term negative effects


Long term l.jpg
Long-term affectionate and had been so “in” to the music he hadn’t left the dance floor all night

  • New research:

    • Long-term damage to 5-HT cells. They do regenerate, but abnormally, with abnormal function (PET scans)

    • Long term memory deficits, even with only occasional, recreational use


Toxidrome question77 l.jpg
Toxidrome Question affectionate and had been so “in” to the music he hadn’t left the dance floor all night

  • 14 Y/O male brought in by parents because he’s “acting weird.” Pupils normal, conjunctiva red, lateral nystagmus on exam, nonconvergence to close object, sleepy, slurring of speech. Rapid Urine Drug screen is negative.

  • What class of drug is he using?

    Sedative-Hypnotic Anticholinergics

    Sympathomimetic Cholinergics

    Hallucinogens Phenothiazines

    Opiates Mixed


Toxidrome question78 l.jpg
Toxidrome Question affectionate and had been so “in” to the music he hadn’t left the dance floor all night

  • Sedative-Hypnotic effects from the history

  • What is the most likely substance?

    Alcohol LSD

    Marijuana Heroin

    Amphetamine Jimson Weed

    PCP Mushrooms

    MDMA Ephedra Alkaloids


Toxidrome question79 l.jpg
Toxidrome Question affectionate and had been so “in” to the music he hadn’t left the dance floor all night

  • Alcohol intoxication. The red eyes with nystagmus and nonconvergence

  • Sleepiness, slurred speech and negative urine drug screen fit best with alcohol


Toxidromes80 l.jpg
Toxidromes affectionate and had been so “in” to the music he hadn’t left the dance floor all night

  • Recognizing the potential drugs

  • It also helps to decide what drugs a person may have used in the past based on the description

  • You will see these types of questions on In-service and Board exams


Toxidromes81 l.jpg
Toxidromes affectionate and had been so “in” to the music he hadn’t left the dance floor all night

  • If you have questions about any of these drugs or their presentations, please contact one of the Adolescent Staff (not for samples)

  • THANKS!


Questions l.jpg

Questions? affectionate and had been so “in” to the music he hadn’t left the dance floor all night


None ordered l.jpg

None ordered affectionate and had been so “in” to the music he hadn’t left the dance floor all night