DRUG ABUSE (Cases 4 to 8)
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4) A 19-year-old college student presents with confusion, hyperactivity, and hallucinations. He reports taking "study pills" obtained from a friend to help him stay awake and focus during finals week. His heart rate is 150 bpm, blood pressure is 160/100 mmHg, and he is diaphoretic. What is the most appropriate initial management?
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5) A middle-aged man presents with erratic behavior and says he is hearing voices. He is confused, delirious, and appears paranoid. A friend reports the patient attended a party where he was taking numerous pills. On exam, the patient is tachycardic and hypertensive. What is the recommended first-line treatment for this patient's condition?
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6) A 28-year-old male presents with chest pain, palpitations, and severe anxiety. He admits to taking large doses of amphetamines to enhance his athletic performance. An ECG shows sinus tachycardia and prolonged QT interval. Which medication should be avoided in the management of his symptoms?
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7) A 24-year-old man presents with a wide-complex tachyarrhythmia after smoking a white powdery substance. Resuscitation attempts are unsuccessful, and he expires in the emergency department. Based on the description of the drug and the patient's clinical presentation, which of the following agents is most likely to cause fatal cardiac tachydysrhythmias?
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8) A 33-year-old man presents with ataxia, rotary nystagmus, slurred speech, and does not react to painful stimuli. His history is significant for use of an unknown quantity of cocaine. Vital signs are heart rate 140 bpm and blood pressure 190/110 mmHg. Which of the following adulterants is the most likely cause of the patient's presentation?
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