A 40 year old patient having history of taking Marijuana constantly since 20 years; now he comes to you with withdrawal symptoms. Which is the most frequently encountered symptom?
(D) NoneSubstanceIntoxicationWithdrawalTreatmentAmphetamines(release DA)Euphoria, Anxiety, Hyper vigilance, Grandiosity, paranoia,Stereotyped behavior, tachycardia, pupillary dilationDepression, fatigue, unpleasant dreams, increased appetiteAnti psychotics or BenzodiazepinesBromocriptines amantadine, DesipramineCocaine (prevent re-uptake of DA) CaffeineRestlessness, agitation, insomnia, diuresis, GI disturbances, excitementHeadache, fatigue, drowsiness, nausea or vomiting (1-4 days)Avoid caffeine, analgesicsCannabis (e.g., Marijuana, hashish)Impaired motor coordination, anxiety, slowed reaction time, impaired judgment, conjunctival injection, dry mouth, increased appetiteNoneAbstinence and supportHallucinogens (e.g., LSD, mescaline, Ketamine)Hallucinations, illusions, anxiety, ideas of reference, de- personalization, pupillary dilation, tremors, uncoordinationNoneSupportive counseling, talking down, antipsychotics or benzodiazepinesInhalants (glue, paint thinner)Belligerence, impaired judgment, nystagmus, uncoordination, lethargy, unsteady gait, crusting around nose/mouthNoneEducation and counselingNicotineNone in usual doses but more depression (2X), impotency, traffic accidents, and more days lost from workIrritability, depressed mood and heart rate, increased appetite, insomnia, anxietyNicotine patch, education, bupropion, varenicline, bromocriptine; I trial success to quit = 9-10% 7-8 K for successOpiates (Heroin, Codeine, Oxycodone)Pupillary constriction, constipation, drowsiness, slurred speech, respiratory depression, bradycardia, comaFlu-like muscle aches, nausea or vomiting, yawning, piloerection, lacrimation, rhinorrhea, fever, insomnia, pupillary dilation (7-10 days)Naloxone (short halflife); naltrexone (longer half-life); clonidine (ease withdrawal); methadone, LAMM (Levo-ac-aretylmethadol): substitut e addictions, longer withdrawal period; buprenorphine (detox)Phencyclidine (PCP, angel dust)Assaultive, combative, impulsive, agitated, nystagmus, ataxia, hypersalivation, muscle rigidity, decreased response to pain, hyperacusis, paranoia, unpredictable violence, psychosisNoneNon stimulating environment, restraints, vitamin C, benzodiazepine other antipsychoticsSedative hypnotics (barbiturates, benzodiazepines)Impaired judgment, slurred speech, uncoordination, unsteady gait, stupor, coma, deathAutonomic hyperactivity tremors, hyperactivity; hallucinations, anxiety, grand mal seizures, deathBarbiturates: pentobarbital challenge test Benzodiazepines: slowly taper dose
Yawning
Seizures
Irritability
None
Miscellaneous