1. WG is a 41-year-old female brought into the ER last night with symptoms consistent with alcohol intoxication and a BAC of 0.43%. She tells you she has a long-standing history of alcohol dependence with multiple relapses. She also reports that she has experienced alcohol withdrawal seizures before. Current CIWA-Ar is 17. She denies any past medical history but lab work indicates hepatic insufficiency (LFTs x3 ULN). All other lab work is normal. She denies taking any medications.
How will you manage this patient’s withdrawal syndrome?
2. WG has made it through withdrawal without complications thanks to an appropriate management regimen. She would like to consider pharmacologic management to maintain abstinence from her alcohol dependence. Her LFTs have normalized now that she has been abstinent for the past week. She reports taking disulfiram during previous rehabilitation attempts but was unsuccessful, most likely because of compliance issues.
Select/recommend the most appropriate pharmacologic treatment, nonpharmacologic treatment, and monitoring parameters.
3. JH is a 35-year-old male with a 40 pack year history of smoking (2 packs/day for 20 years). He is motivated to quit smoking but says that he “doesn’t like” the nicotine replacements. Upon further questioning he states the he used the patches and gum before but had “weird dreams”, the patches gave him rashes, and he experienced a lot of stomach upset. You ask him how he used these products before and he tells you that he kept the patches on for 24 hours/day and always put them on his right arm. He would chew the gum “just like any other gum”. His past medical history is significant for depression, currently in remission. Current medications include sertraline and mirtazapine.
Select/recommend the most appropriate pharmacologic treatment, nonpharmacologic treatment, and monitoring parameters.
4. SD is a 23-year-old male found unresponsive in his apartment with the following symptoms: currently unconscious, bradypnea, bradycardia, miosis, BP 85/50. He was found unresponsive by EMTs and they reported finding used needles next to the patient.
What type of substance is this patient most likely acutely intoxicated with?
How would you manage this patient’s acute intoxication?
5. Two days later SD has recovered from intoxication and tells you that he has been using heroin for 4 years. Last use was 48 hours ago. He is now going through withdrawal with a COWS score of 37; most notable symptoms are diarrhea, abdominal cramps, tachycardia, insomnia, and anxiety. Lab work is normal. He is interested in treatment for his opioid dependence.
Select/recommend the most appropriate pharmacologic treatment, nonpharmacologic treatment, and monitoring parameters.
6. LJ is a 25-year-old female brought into the ER with the following symptoms: anxiety, auditory and tactile hallucinations, extremely violent behavior, muscle twitching, mydriasis, BP 190/110, HR 110, temperature 102oF.
What type of substance is this patient most likely acutely intoxicated with?
How would you manage this patient’s acute intoxication? What medications would be INAPPROPRIATE to use for this patient’s acute intoxication?

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