ce <strong>lesson</strong>Pharmacy Practice national continuing education programStreet drugs: an overview of trends, availability, toxicity and managementQuestions1 M.G. is brought into the emergency departmentby the paramedics. He was found unconscious,heart rate 60 beats per minute, respiratoryrate of four breaths per minute, mioticpupils, blood pressure at 110/76. What streetdrug has this patient likely taken?a) heroin c) crystal methb) ice d) speed2 Which of the following is converted to GHBin the body?a) sodium hypochlorite c) diacetylmorphineb) 1,4-butanediol d) safrole3 Hyperthermia caused by ecstasy is besttreated with:a) intubation and diphenhydramineb) acetaminophen or ibuprofenc) cooling blankets and fansd) clonidine and supportive care4 Which of the following statements regardingstreet drug patterns and trends is true?a) Street drug trends have remained static for thepast decade.b) Street drugs are always taken by IV injection.c) Street drugs are only produced by clandestinelaboratories.d) Street drugs are usually taken for their euphoriceffects.5 Which of the following street drugs is associatedwith trismus?a) speed c) MPPPb) Eve d) GHB6 K.L. is a known heroin-dependent patientadmitted to the emergency department. Hewas found unconscious with respiratorydepression. What is the most appropriatemedication to manage this patient?a) naloxone c) flumazenilb) diazepam d) risperidone7 What syndrome is associated with the useof MDMA?a) Parkinsonian syndromeb) serotonin syndromec) cannabinoid syndromed) anticholinergic syndrome8 What symptom is not associated with crystalmeth intoxication?a) tachycardia c) deliriumb) psychosis d) bruxismce facultyTo answer online, go to www.pharmacygateway.ca, CE section, CE Online, Pharmacy Practice9 Which of the following statements regardingclandestine drug manufacture is true?a) Clandestine labs are routinely inspected by HealthCanada.b) Clandestine labs can only produce illicit drugson a small scale.c) Clandestine labs expose their chemists to therisk of explosions, burns and toxic fumes.d) Clandestine labs are capable of producing crystalmethamphetamine with the precursor chemicalcaffeine.10 L.N. is extremely agitated, combative andhallucinating from tripping on crystal meth.She is being physically restrained in the emergencydepartment. Friends say she may havehad a seizure before coming to the ER. Thedrug of choice in this situation is:a) naloxoneb) chlorpromazinec) flumazenild) diazepam11 The onset of action of snorting crystalmeth is:a) five minutesb) 15 minutesc) 30 minutesd) 45 minutes12 Diluents are often used by drug dealers to:a) maximize the profit of street drugsb) increase the potency of an active ingredientc) impart a bitter taste to detect the presence of astreet drugd) increase side effects of a street drug13 S.A. was at a bar on Saturday evening withfriends. She consumed only one beer. It issuspected that her drink was tampered withGHB. What effects might she experience thatwould lead one to suspect GHB?a) dizziness, palpitations, tachycardiab) diaphoresis, hyperthermia, dizzinessc) nausea, dizziness, amnesiad) euphoria, increased appetite, dizziness14 As a result of sharing needles, injectiondrug users are subject to all of the followingrisks except:a) hepatitis C c) HIVb) endocarditis d) chlamydia15 R.J. responded to a total dose of 10 mg ofnaloxone. He was able to be roused and nolonger required intubation and ventilation.Which of the following street drugs was likelytaken by R.J.?a) marijuana c) Adamb) china white d) Tina16 Sternbach’s diagnostic criteria are usedto identify at least how many features or symptomsof serotonin syndrome in order to confirmdiagnosis of serotonin syndrome?a) three c) fiveb) four d) six17 Which medication is a potential precursorchemical used in the manufacture of crystalmethamphetamine?a) phenylephrine c) pseudoephedrineb) dextromethorphan d) dimenhydrinate18 Which of the following statements istrue?a) MDMA commonly causes CNS and respiratorydepression which responds to naloxone.b) MPTP is a meperidine analogue found to be associatedwith irreversible Parkinsonian syndrome.c) MPPP produces similar dysphoria and toxiceffects as ecstasy.d) METH is commonly used as a date rape drugbecause of its ability to cause amnesia.19 M.T.’s last dose of an unidentified streetdrug was taken 24 hours ago. He is sweating,shaking with chills and has goosebumps onhis arm. He also keeps yawning. M.T. is likelysuffering from:a) acute cannabinoid toxicityb) serotonin syndromec) chronic MDMA toxicityd) acute opioid withdrawal20 J.T. had spent several hours dancing at arave. Shortly after taking ecstasy, he beganto sweat profusely and complain of being verydizzy and hot. He collapsed on the floor.Friends called 911. What is the most likelycause of and need for J.T.’s symptoms?a) J.T. is suffering from dehydration and only requiresoral rehydration fluids.b) J.T. is suffering from status epilepticus andrequires urgent medical evaluation.c) J.T. is suffering from side effects caused by diluentsand should have a drug screen performed.d) J.T. is suffering from MDMA-induced hyperthermiaand requires immediate assessment andmanagement.This monthStreet drugs: an overview of trends, availability, toxicityand managementAuthorLily Lum is a clinical information resource specialist at theAlberta Poison and Drug Information Service (PADIS) inCalgary, Alta. She received her national certification as aspecialist in poison information (CSPI) from the AmericanAssociation of Poison Control Centers (AAPCC). Lily alsocompleted a hospital residency at the Addiction ResearchFoundation (now known as the Centre for Addiction andMental Health) in Toronto, Ont.CE Clinical EditorBrenda McBean Cochran, B.S.P., M.Sc.(Phm)Pharmacist consultant, Bedford, N.S.CE MANAGING EDITORHoney Fisherhoney.fisher@pharmacygroup.rogers.comThis <strong>lesson</strong> is published by Rogers Publishing Ltd.,One Mount Pleasant Rd., 7th floor, Toronto, ON M4Y 2Y5.Editorial office: Tel: (416) 764-3927 Fax: (416) 764-3931.CE queries: Tel: (416) 764-3879 Fax: (416) 764-3937mayra.ramos@rci.rogers.com. No part of this CE <strong>lesson</strong>may be reproduced, in whole or in part, without thewritten permission of the publisher.The authors, expert reviewers and provider state thatthey have no real or potential conflict to disclose. This <strong>lesson</strong>is supported by an unrestricted grant from Mylan.CE8 pharmacypractice | october 2007answer online at pharmacygateway.ca
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