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TRANSCRIPT
Effects of Illicit Drugs on the Heart
and Brain
Presented by: Jeffrey Sather, MD, FACEP
Trinity Health
2014 Stroke/Cardiac
System of Care
Conference
Disclosures
No Financial incentives
No off label use of any drug or medical
device to be discussed
Case Study
21 Year old male presents to critical access
hospital agitated and confused
Possibly ingested 2 grams of
Methamphetamine
Extremely agitated
Ativan 2 mg IV
Ativan 2 mg IV
Haldol 5 mg IV
Haldol 5 mg IV
Ativan 2 mg IV
Hypertensive
Labetolol 5 mg IV
Labetolol 5 mg IV
Extremely agitated
Seizing
Temperature reaches 104
All of the above happening over 30 minutes.
Then intubated to be transferred by fixed
wing aircraft.
Cardiac arrest
Cardiac arrest while being loaded to
airplane.
Returned to CAH hospital for resuscitation
About 10 minutes of CPR first arrest
About 2 minutes of CPR second arrest
Labs
Labs
Drugs of abuse screen
Objectives
What does a drug screen indicate?
What are common drugs abused?
What are the effects of drugs on the heart
and brain?
How does it effect treatment?
North Dakota:
Leader of the Pack
North Dakota Ranks #1 in
Binge Drinking
Teen Alcohol Statistics
95% of the alcohol consumed by youth under the age of 21 in the U.S.
is in the form of binge drinks.
Binge drinking is associated with many health problems, including—
Unintentional injuries (e.g., car crashes, falls, burns, drowning)
Intentional injuries (e.g., firearm injuries, sexual assault, domestic violence)
Alcohol poisoning
Sexually transmitted diseases
Unintended pregnancy
Children born with Fetal Alcohol Spectrum Disorders
High blood pressure, stroke, and other cardiovascular diseases
Liver disease
Neurological damage
Sexual dysfunction, and
Poor control of diabetes.
Drug Use - Study
In 2009, the safety agency issued the
National Roadside Survey of Drug and
Alcohol Use by Drivers:
Alcohol was the most likely intoxicant
8.6 percent of the total tested had used
marijuana
3.9 percent had used cocaine
1.3 percent tested positive for
methamphetamine
Drug Use
Two studies (44,000 collisions):
One out of four drivers involved in crashes
had marijuana, cocaine, amphetamines, or
some combination of those drugs in their
system
Approximately 14 percent of all drivers on
the road have an illegal drug in their
system
Marijuana
Marijuana
Raises the heart rate 20-100%
4.8 fold increase in the risk of AMI in the first
hour after smoking.
This risk increases as other risk factors increase.
Effects thinking and memory
Stunts brain development
Causes a decrease in IQ in subjects using through
teens and twenties.
Increased respiratory illness
Marijuana
Linked to increased mental illness such as:
Depression
Anxiety
Suicide
Psychosis
Impairs judgment and contributes to
increased risk of injury or death.
Specific link to lung cancer not well
established at this point
Marijuana
No Specific antidote
Symptomatic Treatment
Narcotics
One of the oldest pharmacological
substances
Histamine releasing properties
Produce bradycardia and hypotension by
increasing parasympathetic and decreasing
sympathetic response
Strong respiratory depressant
Can produce coma
Infection from injection
Narcotic Treatment
Symptomatic treatment
Antidote is Naloxone
Half life can be shorter than the narcotic
Cocaine
Strong central nervous system stimulant that
increases levels of dopamine
Changes the short and long term reward
system in the brain
Cocaine Effects
Constricts blood vessels
Increases heart rate
Increases blood pressure
Increases body temperature
Increased risk of AMI and Stroke
Increased risk of sudden cardiac arrest.
Cocaine Treatment
No specific antidote
Symptomatic Treatment
Synthetic Drugs
“Fake Substances . . . Real Dangers”
K2, Spice, Bath Salts, Smiles . . .
Synthetic Drugs
What are they?Synthetic marijuana (often known as “K2” or “Spice”) and
bath salts products are often sold in legal retail outlets as
“herbal incense” and “plant food,” respectively, and
labeled “not for human consumption” to mask their
intended purpose and avoid FDA regulatory oversight of
the manufacturing process.
Synthetic Drugs
How frequently is synthetic marijuana used?Use of synthetic marijuana is alarmingly high
o 11.4 percent of 12th graders used Spice or K2 in the past year
*second most commonly used illicit drug among seniors
Synthetic Drugs
What are they?
Bath salts contain manmade chemicals related to
amphetamines, also known as substituted
cathinones.
Cathinone derivatives are claimed to have effects
similar to cocaine, amphetamine or MDMA (ecstasy).
Smiles (not the good kind)
“Designer Drug” – 2C-
IThe drug, a hallucinogen, has been
linked to two deaths in Grand
Forks, North Dakota. Though
little is known about this drug's
dangers.
Smile’s effects: combination
of MDMA (ecstasy) and LSD
“speedy charge along with
intense visual and auditory
hallucinations”
Synthetic Treatment
No specific antidote
Symptomatic Treatment
Methamphetamine
2012
0.4% of population or 1.2 million report using
103,000 ED visits directly related in 2011
4th most commonly mentioned abused drug
by ED patients nationally behind Marijuana,
Cocaine, and Heroin
Methamphetamine effects
Increased attention and decreased fatigue
Increased activity and wakefulness
Decreased appetite
Euphoria and rush
Rapid/irregular heartbeat
Vasoconstriction
Hypertension
Hyperthermia
Methamphetamine chronic
effects
Anxiety
Confusion
Insomnia
Mood disturbances
Violent behavior
Psychosis
Hallucinations visual and auditory
Paranoia
Effects of Meth on the Brain
Meth rewires the brain. Prolonged
use not only modifies behavior, but
literally changes the brain in
fundamental and long-lasting ways.
Even while recovery may be
possible, the brain won’t be the
same.
Effects of Meth on the Brain
PET Scan of a
meth user and a
control subject
Face lift courtesy of meth
2 months later 1 year, 5 months later
2 years, 5 months later1 year, 5 months later
Effects of Meth
Dental DecaySkin
Lesions
Psychosis
Unnecessary Deaths
Teenage male collapses from unknown causes.
Dies one day later.
Dx: Sudden cardiac death secondary to “bad” meth.
Unnecessary Deaths
17-year-old male and 23-year-old female
with AMI. Both heavy meth users.
19-year-old presents with blood pressure of
290/160. Dies from a stroke after meth
injection.
Methamphetamine
Treatment
No specific antidote
Symptomatic Treatment
Drugs of Abuse Screen
Screening test not a definitive test
Must be metabolized and excreted to be
present
Metabolites present for variable periods
Most 2-3 days
Does not test for all abused substances
For example fentanyl a synthetic opiate does not
trigger positive for opiates.
Pearls
No specific antidote for most abused drugs
except for Narcotics and Benzodiazepines.
Pearls
Flumazenil should not be given to
benzodiazepine abusers and should only be
used for iatrogenic overdose.
Pearls
Naloxone reverses narcotics
Reversing narcotic overdose usually results
in “bad behavior”
Half life is shorter than many abused
narcotics and repeated dosing may be
needed.
Pearls
Gastric lavage has almost no utility
Treatment is generally symptomatic
Drug screen utility is to add evidence to
clinical findings
Case Study
Case Study
Arrives intubated with no neurologic
response.
In Rhabdomyolysis and has hyperkalemia.
Case Study
Case Study
Case Study
Hypothermia protocol for 24 hours
Treated for Rhabdo and hyperklemia
Rewarmed
No neurologic recovery
MRI shows diffuse edema and herniation
Brain death testing protocol
Support pulled and patient died
Diagnosis: Death due to anoxic encephalopathy
secondary to methamphetamine overdose