Cool stuff learned in class this week

1. If you have 2 boys, roughly 13 years of age, show up together in the ER with symptoms of atropine poisoning (anticholinergic or antimuscarinic poisoning): Odds are good--ie, 90%--they heard from someone--like a 14 year old boy--that it's possible to get high by smoking a plant called Jimson Weed. The bad news is, it contains alkaloids related to those found in Atropa belladonna (otherwise known as deadly nightshade) that will make your mucous membranes dry, make you unable to pee, cause hyperthermia (ie, high temperature, but not mediated by the cellular messengers that usually cause fever), and make you kind of delirious and crazy. It's a high, sure, but it's not the nice sort of high you get from a Purple Haze or a White Widow (names, apparently, of carefully cultivated and very expensive varietals of Cannabis sativa. Ahem. Seriously, I read about it in a New Yorker article. And then learned about 'Afternoon Delight' from Arrested Development. Aside: I really don't know why marijuana isn't legal. It's exponentially safer than cigarettes, alcohol--or, for that matter, aspirin).
2. Two teen girls who show up together will probably exhibit an anticholinergic toxidrome related to motion-sickness meds (hey, if you take enough Benadryl or scopolamine you can get high!) or a sympathomimetic toxidrome (ie, be speedy, with pounding hearts and anxiety) related to drugs like amphetamines taken for weight loss.
3. There is a drug called Narcan which exists to bring people out of heroin-induced comas, but according to the lecturer, "People are usually pretty pissed off when they wake up, because you've undone the nice high they paid for."
4. There is a drug called Flumenazil that exists to undo benzodiazepine toxicity, too, but it's used much less often, and for good reason. If someone's been abusing (or even just taking regularly, as one might for insomnia or anxiety disorders) benzos, they'll be kicked into withdrawal, one sign of which is seizure. And what's the first-line treatment for seizure? Benzos, only know you can't use them, because you've blocked the receptor. Oh shit.
5. Despite having to memorize lots of drugs and mechanisms, pharmacology is pretty damn cool.
6. Pediatric neck masses are almost never cancer. In older adults, they almost always are.
7. If someone says they feel like they're 'spinning,' 90% of the time they have an inner ear problem.