Obstetrics and Gynecology Board Review Pearls of Wisdom

424 Obstetrics and Gynecology Board Review •••

❍ What is Wernicke encephalopathy?
A syndrome due to thiamine deficiency most often seen in alcoholics.
Consists of:
(1) Ataxia
(2) Ophthalmoplegia
(3) Nystagmus
(4) Confusion
(5) Impairment of short-term memory

❍ What is the temporal order of the symptoms of alcohol withdrawal (time since last drink)?
(1) Autonomic hyperactivity → 6 to 8 hours
(2) Hallucinations → 24 hours
(3) Delirium tremens → 24 to 72 hours

❍ What is the only medication approved for the treatment of opioid dependence that may be dispensed in an
office-based setting?
Buprenorphine. This drug is a partial agonist of the opioid receptors and is approved for use during pregnancy.
Unlike methadone, buprenorphine can be prescribed in an office setting by a credentialed physician.

❍ What medication should never be used to treat the tachycardia found in cocaine intoxication? Why?
B-blockers. Allow for unopposed alpha-adrenergic activity thus increasing hypertension, reducing coronary blood
flow, and reducing cardiac output.

Table 42.1 Signs, Symptoms, and Treatment of Substance Intoxication and Withdrawal

Intoxication Withdrawal

Signs and Symptoms Treatment Signs and Symptoms Treatment

alcohol Slurred speech, disinhibition,

ataxia, emotional lability,

memory and judgment

impairment, blackouts, coma

Supportive

measures,

thiamine,

multivitamin,

folic acid

Tremor, tachycardia,

hypertension, seizures,

delirium tremens, death

Benzodiazepines

Opiates Euphoria, apathy, pupillary

constriction, CNS

depression, constipation,

respiratory depression

(possibly life threatening)

Naloxone Nausea, vomiting, mydriasis,

diarrhea, anorexia,

piloerection, yawning,

abdominal pain, muscle

spasms, and leukocytosis

Methadone

Cocaine Psychomotor agitation,

pupillary dilation, euphoria,

impaired judgment,

tachycardia, hypertension,

hallucinations, possible

sudden death

Haloperidol,

symptom-

specific

treatment,

and supportive

measures

Hypersomnolence,

depression, severe

cravings/increased appetite,

malaise, suicidality,

nightmares

Supportive

measures