Marijuana: most commonly abused illegal drug. Look for a teenager who listens to rock music, has red eyes, and acts "weird."Other symptoms include "amotivational syndrome" (chronic use may cause laziness and lack of motivation), time distortion and "munchies" (eating binge when intoxicated). No physical withdrawal symptoms are noted, although patients may have psychological cravings. Overdose is not dangerous, although patients may have temporary dysphoria. Marijuana is not a teratogen.

Cocaine: look for sympathetic stimulation (insomnia, tachycardia, mydriasis, hypertension, sweating) with hyperalertness and possible paranoia, aggressiveness, delirium, psychosis, or formications ("cocaine bugs"—patients think that bugs are crawling on them). Overdose can be fatal (arrhythmia, myocardial infarction, seizure, or stroke). On. withdrawal, patients become sleepy, hungry (vs. anorexic with intoxication), and irritable, possibly with severe depression. Withdrawal is not dangerous, but psychological cravings usually are severe. Cocaine is teratogenic (vascular disruptions in fetus).

Amphetamines: classically associated with psychotic symptoms (patients may appear to be lull-blown schizophrenics), but effects are similar to cocaine.

Opioids: heroin and other opioids cause euphoria, analgesia, drowsiness, miosis, constipation, and central nervous system depression. Overdose can be fatal, (respiratory depression); treat with naloxone. Because the drug is usually taken intravenously, there are associated morbidities or mortalities (endocarditis, HIV, cellulitis, talc damage). Withdrawal is not life-threatening, but patients act as though they are going to die. Symptoms include gooseflesh, diarrhea, insomnia, and cramping/pain. Methadone treatment sometimes is given for addicts. Methadone is a longer-acting opioid that allows patients to function by keeping them on a chronic, free, low-dose. Its use is controversial.

Lysergic acid diethylamide (LSI)) and mushrooms: symptoms of intoxication include hallucinations, mydriasis, tachycardia, diaphoresis, and perception/mood disturbances. Hallucinations usually are visual rather than auditory, whereas in schizophrenia they are auditory. Overdose is not dangerous (unless the patient thinks that: lie or she can. fly and jumps out a window). No withdrawal symptoms are noted. Patients may get "flashbacks" months to years later (brief feeling of being on drug again, although none was taken) or a "bad trip" (acute panic reaction or dysphoria). Treat bad trips with reassurance or benzodiazepine/antipsychotic medication (if needed).

Phencyclidine (PCP): LSD/mushroom symptoms in intoxication plus confusion, agitation, and aggressive behavior. Also look for vertical and/or horizontal nystagmus, plus possible schizophrenic-like symptoms (paranoia, auditory hallucinations, disorganized behavior and speech). Overdose can be fatal (convulsions, coma, respiratory arrest),Treat with supportive care and urine acidification to hasten elimination. No withdrawal symptoms are noted.

Inhalants (e.g., gasoline, glue, varnish remover): intoxication causes euphoria, dizziness, slurred speech, a feeling of floating, ataxia, and/or a sense of heightened power. Intoxication usually is seen in younger teenagers (11-15 years). Can be fatal in overdose (respiratory depression, cardiac arrhythmias, asphyxiation) or cause severe permanent sequelae (central nervous system, liver, kidney toxicity, peripheral neuropathy). There is no known withdrawal syndrome.

Benzodiazepjnes/barbiturates: cause sedation and drowsiness as well as reduced anxiety and disinhibition. Overdose may be fatal (respiratory depression). Treat with llumazenil if symptoms are due to benzodiazepine. Withdrawal also may be fatal (just as with alcohol) because of seizures and/or cardiovascular collapse. Treat withdrawal on an inpatient basis with a long-acting benzodiazepine; gradually taper the dose over several days. Benzodiazepines and barbiturates are especially dangerous when mixed with alcohol (all three are central nervous system depressants).

Note; Caffeine can cause headaches and fatigue in withdrawal.

Pelvic inflammatory disease (PID): look for a female aged 13 -35 years with abdominal pai n , adnexal tenderness, ami cervical motion tenderness (all three must be present). PID also requires one or more of the following: elevated erythrocyte sedimentation rate, leukocytosis, fever, purulent cervical discharge, or purulent fluid from euldoccntesis. Treat with more than one antibiotic (e.g., cefoxitin/ceftriaxone and doxy ey dine. on outpatient basis; clindamycin and gentamicin on an inpatient basis) to cover multiple organisms (e.g., Neisseria (jonorrhoeae, Chlamydia sp., Escherichia coli). With a history of intrauterine device use, think Atinomyccs- israelii.

Important points:

1. PID is the most common cause of preventable infertility (causes scarring of tubes).

2. Watch for progression to t uboovarian abscess (palpable on exam) and its rupture.Treat with emergent laparotomy with excision of affected tube (unilateral disease) or total abdominal hysterectomy and bilateral salpingo--oophorectomy (bilateral disease)

PID is the most likely cause of infertility in a normally menstruating woman under age 30. Vaginal Infections 101:

Getting to Know Anxiety

Getting to Know Anxiety

Stop Letting Anxiety Rule Your Life And Take Back The Control You Desire Right Now! You don't have to keep letting your anxiety disorder run your life. You can take back your inner power and change your life for the better starting today! In order to have control of a thing, you first must understand it. And that is what this handy little guide will help you do. Understand this illness for what it is. And, what it isn't.

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