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Emergency Med > 14 - Drugs of Abuse > Flashcards

14 - Drugs of Abuse Flashcards

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1
Q

Use disorder – DSM V

A
  • Use more than planned
  • Worry about cutting back or unsuccessful
  • Lots of time using or recovering or getting
  • Craving
  • Life is affected
  • Continued to use even though life is affected
  • Risky behaviors
  • Tolerance
  • Withdrawal
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2
Q

Mild, moderate, severe substance disorder

A
  • A mild substance use disorder is suggested by the presence of 2-3 symptoms
  • Moderate by 4-5 symptoms
  • Severe by 6 or more symptoms
  • No longer trying to sort out addiction (which is physical) from abuse, but defining much how it affects person’s life
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3
Q

Various drugs

A
  • Stimulants
  • Benzodiazepines
  • Opioids
  • Hallucinogens
  • Dissociative drugs
  • Marijuana
  • Solvents/Inhalants
  • Alcohol
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4
Q

Stimulants

A
  • Nicotine
  • Caffeine
  • Cocaine
  • Amphetamines
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5
Q

How stimulants work

A
  • Release DA and NE
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6
Q

Stimulants route of administration

A
  • Oral = Slow onset, low potency, no “rush”
  • Intranasal = Faster onset
  • Intravenous = Faster onset, “rush”
  • Smoking = Fastest onset, most addictive
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7
Q

Stimulant effects (low to moderate doses)

A
  • Insomnia
  • Increased endurance
  • Increased activity
  • Euphoria and mood enhancing
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8
Q

Stimulant effects (high doses)

A
  • Paranoia
  • Hallucinations
  • Suspiciousness
  • delusions
  • Picking
  • Pancreatitis/DM
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9
Q

Stimulant: Other negative effects

A
  • Stroke
  • Seizures
  • MI
  • Psychotic Symptoms
  • Lung and Nasal problems
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10
Q

Cocaine

A
  • Blow, coke, crack, rock, snow
  • Snort or rub on gums
  • Crack is heated and inhaled or injected
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11
Q

Biggest worry

A
  • MI – 1% of all MIs – increases plaque formation and causes vasospasm
  • Don’t use Beta Blocker if concerned of cocaine use
  • Can cause issues with nose, lungs
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12
Q

Amphetamine (speed)

A

Methamphetamine
o Added methyl to facilitate crossing the blood-brain barrier
o Ice or crystal meth is the crystalized form
o Crank is made in home labs

Amphetamines
o Better oral absorption than cocaine and longer duration than cocaine

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13
Q

Snorting Adderall

A
  • Pulmonary talcosis

- Manufacturers use talc as a binder

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14
Q

Stimulants: Withdrawal and Dependence

A

3 stages of Abstinence:
o 1-5 days: “crash” with intense craving, exhaustion, and intense depression
o 1-10 weeks: “withdrawal” depression, craving, hedonic state (relapse is strong)
o Indefinite: occasional depression, moderate craving, loss of pleasure

Withdrawal and dependence:
o	Depression
o	Fatigue
o	Hunger
o	Aches and pain
o	Loss of pleasure
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15
Q

These help with stimulant withdrawal

A
  • Benzos
  • SSRIs – need careful monitoring
  • Anti-psychotics
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16
Q

Smoking

A
  • About 18% of the adult population now
  • Very fast acting (very addictive)
  • DA release
  • Also the physical habit
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17
Q

Why you don’t want your patient smoking?

A
  • Increased risk of death
  • Increased risk of heart/lung issue
  • Anesthesia
  • Poor circulation means poor healing
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18
Q

Quitting smoking

A
  • About ½ of smokers tried to quit for at least 1 day in previous year
  • 7 meds FDA approved to help (Chantix, Zyban, replacements)
  • Cold turkey about 4%
  • CBT
  • Trying 2 or more methods at once helpful
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19
Q

Benzodiazepines (benzos)

A
  • Depressant effect on CNS by sitting on GABA receptor and stimulating GABA
  • Used to relieve anxiety, muscle relaxation and to treat seizures
  • Addictive
  • Will reset the “anxiety” level in the brain over time
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20
Q

BENZOS KNOW THIS

A
  • Can be dangerous with ETOH
  • Fast withdrawal maybe fatal – weaning and close supervision if prolonged use and high doses.
  • Romazicon 0.2ml IV – use with caution and be prepared!!! Seizures possible
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21
Q

Opioid examples

A

Examples:

  • Heroin, morphine, codeine, oxycodone, hydromorphone, hydrocodone, fentanyl, oxymorphone, tramadol (yes tramadol), Dilaudid and others
  • Morphine-like effects by binding to brain opioid receptors
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22
Q

Opioid effects

A
  • Change in mood
  • Mental clouding
  • Slow breathing
  • Sleepiness
  • Analgesia
  • Constipation
  • Urinary retention
  • Withdrawal not life threatening
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23
Q

Opioid withdrawal symptoms

A
  • Irritable, agitated, anxious
  • Pain
  • Sweaty
  • Nausea
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24
Q

Help with opioid withdrawal

A
  • Can get them on “safer” opioid – methadone
  • Wean
  • Benzos
  • Zofran
  • Clonidine
  • Suboxone (mix of narcotic and naltrexone)
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25
Q

Opioid reversal agent

A
  • IV – Narcan (they may come up swinging)

- Oral – naltrexone – many other uses

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26
Q

Prescribing opioids long term

A
  • UDS, PMP
  • Have goals
  • Try to cut back, use non-opioid therapies, contracts
27
Q

Hallucinogens

A
  • Psychedelics
  • Alter consciousness
  • Abuse leads to cardiovascular and respiratory collapse
  • Synthetic Hallucinogens: LSD, peyote
  • Long term flash backs, paranoia
28
Q

Dissociative anesthetics

A
  • PCP and Ketamine - Sense of timelessness (being dead, not having limbs, floating in space), depersonalization
  • High doses DXM
  • Nitrous Oxide
  • NMDA/glutamate complex antagonized - Can cause depression leading to suicide, or self-inflicted wounds or violence
  • Profound anesthesia
29
Q

Dissociative Desired Effects

A
  • Dreamy and carefree state, altered perception, mood elevation
  • ***Perceptual distortions, diminished pain sensitivity, depersonalization
  • ***Ketamine being used in trauma
30
Q

Dissociative undesired effects

A
  • Mood swings, partial amnesia, and impaired judgement, disorientation, preoccupation with abnormal body sensations, amnesia, nystagmus, panic, motor impairment, and confusion, catatonia, delirium, psychotic behavior, hypertensive crisis, severe motor impairment…death
31
Q

Dissociative PCP treatment if out of control

A
  • Isolate patient with restraints
  • Haldol
  • Valium
  • Acidify urine
32
Q

Marijuana

A
  • Cannaboid receptors all over the body (not just brain)
33
Q

Medical uses of marijuana

A
  • Glaucoma
  • Muscle spasms
  • Seizures
  • Nausea/appetite
  • Insomnia
  • Pain
34
Q

Marijuana: Starting Young and IQ

A
  • Duke Study
  • Weekly use before age 18 – lose 8 IQ points
  • Potentially someone in 50th percentile now the 29th
  • Less likely to get educated after high school
35
Q

Marijuana drug

A
  • Active ingredient in cannabis is THC
  • Impairs motor coordination and perception
  • About 9-15% addictive (younger you start more addictive)
  • Mild withdrawal symptoms that last 1 to 2 weeks if big user
36
Q

Solvents and inhalants

A
  • Volatile intoxicants, anesthetics
  • Cheap
  • Accessible
  • Children and teenagers are the most frequent users
37
Q

Inhalants

A
  • 18% of high school seniors - 30% of those reported use before age 10
  • 20% of eighth graders
38
Q

Solvents and inhalants

A
  • Volatile intoxicants, anesthetics
  • Low income communities particularly affected
  • Affluent communities also affected
  • Toluene can cause permanent neurological damage
39
Q

Four major groups of solvents and inhalants

A
  1. Volatile Solvents: Glue sniffing: lighter fluid, airplane glue, lacquer thinners, industrial solvents, ketones, propane and butane fuel, toluene, esters, and cleaning solutions
  2. Aerosols: Aerosol propellants such as fluorocarbons. Spray paint, products containing chlorofluorocarbons, ketones, organic metal and n-hexane are particularly dangerous—they can cause cardiotoxicity, neuropathies, and hepatotoxicity
  3. Anesthetic agents: Chloroform, methylchloride, nitrous oxide, trichloroethylene, and ethyl ether. Oil and grease dissolvers can contain some of this.
  4. Butyl, Isobutyl nitrite, and amyl: Isobutyl nitrite used as a room deodorizer, Amyl nitrite used for angina. Called “poppers”
40
Q

Solvents and inhalants

A
  • Alcohol increases the effect
  • No dependence
  • Onset is rapid and short duration
  • Low doses cause euphoria, dizziness, slurred speech, ataxia, perceptual distortions, and impaired judgement
  • High doses cause a generalized depressant effect
41
Q

Overdose of solvents and inhalants

A
  • Photophobia, diplopia, sneezing, nausea, chest pain, diarrhea, eye irritation, respiratory depression
  • Die of asphyxia
42
Q

Alcohol

A
  • 10 % raised by alcoholic

- 43% have an alcoholic in life

43
Q

CNS effects of alcohol

A
  • Alcohol is a CNS depressant
  • Euphoria, decreased mechanical efficiency, and impaired thought processes
  • Stimulatory effects from depression of inhibitory control mechanisms
44
Q

Alcohol withdrawal syndrome

A
  • Can happen with abrupt stop or big decrease in use that is sudden
  • “Panic attack” – anxiety, palpitations, sweaty, nausea, shaking
  • More severe – MAY be fatal and needs medical management
    o Seizures
    o Delirium tremens: auditory and visual hallucinations, disorientation
45
Q

How to withdrawal someone from AUD?

A
  • Benzos
  • +/- fluids
  • Nausea meds
  • Thiamine, Magnesium, Niacin “banana bag”
46
Q

Alcohol

A
  • Alcohol disorders involve about 17-18 million individuals

- Alcohol abuse costs an estimated 184.6 billion dollars

47
Q

Alcohol withdrawal syndrome

A
  • Readjustment of the CNS to the neuroadaptation that occurs with prolonged intoxication
  • Decreased GABA activity
  • Increased Glutamate and NMDA activity
48
Q

Alcohol and anxiety

A
  • In an attempt to reduce anxiety, chronic alcohol use increases the brain chronic anxiety state
  • When alcoholics cut down or quit – will feel that higher set point of anxiety
49
Q

Alcohol withdrawal

A

6-96 hours after hrs after drink (or big reduction)
o Anxiety, tremulousness, HA, diaphoresis, palpitations, GI upset
o Tachycardia, hypertension, fever
o Generalized, tonic-clonic seizures, status epilepticus
o Auditory and visual hallucinations

A rapid stopping or reduction in alcohol in someone who is chronic abuser can be fatal and needs to be medically managed

50
Q

Physical exam findings in abuse

A
  • Ascites
  • Caput Medusa (abdominal wall collaterals)
  • Jaundice
  • Malnutrition
  • Splenomegaly
  • Gynecomastia
  • Digital clubbing
  • Testicular atrophy
  • Dupuytren’s contractures
  • Tremors
51
Q

Alcohol long term – Liver

A
  • 50% Cirrhosis is caused by EtOH

- Healthy liver  Liver cirrhosis with EtOH

52
Q

Alcohol and cancer

A
  • The entire GI track (anything that is “touched” by elimination of EtOH) has an increased risk with heavy use
53
Q

Alcohol and pancreatitis

A
  • 50% of pancreatitis is EtOH related
54
Q

Alcohol long term brain effects

A
  • Causes brain atrophy – increases risk of brain bleed if fall
  • Dementia – alcohol abuse big risk for early dementia
  • Causes “scar tissue” between neurons
55
Q

Alcohol treatment

A

Medical:
o Topiramate, ondansetron, naltrexone, acamprosate

Cognitive/behavioral:
o Controlled drinking
o Avoiding triggers
o Understanding WHY drink

Community based treatment:
o AA: well known

56
Q

Study on alcoholism

A
  • A 2007 study by the National Council on Alcoholism’s medical journal reported that people attending 12-step treatment programs had a 49.5% abstinence rate after a single year. Those who were in CBT programs were less successful, maintaining a 37% abstinence rate.
  • Some report AA success at 5-10% - all in how you define success
  • Where AA states you have no control, other programs try to teach how to have control
57
Q

What we have learned about alcohol abuse

A
  • A person’s use over time can be extremely variable

- Harm reduction strategies can work in some people

58
Q

NIH

A
  • Only 25% with AUD get help (including AA)

- Over time, 2/3 to ¾ of those with AUD will quit or reduce to moderate and stable

59
Q

Study on alcoholism

A
  • 100 alcohol dependent men – ½ got 3 week inpatient treatment and intense follow up versus 1 “brief advice” session followed by monthly telephone calls
  • One year later – same results; two years later better results in the brief intervention
60
Q

Harm reduction model

A
  • Person continues to drink but effort to reduce the risk and harm – concentrates on riskiest first (like drunk driving)
  • GOAL ORIENTED
61
Q

Moderation

A
  • Many programs out there to get people to cut back

- Some people with AUD can do this and some people cannot

62
Q

Things they don’t tell you in medical school

A
  • People overcome addiction and use disorders (high school EtOH/Viet Nam and heroin) and MOST do it without treatment
  • They quit or cut down to achieve normalcy
  • Physicians can help
  • Shame doesn’t work (neither personally or professionally)
  • Developing coping mechanisms is huge
63
Q

Children of alcoholics (or of hoarders or gamblers) may have these tendencies

A
  • Feel that issues overshadowed your needs as a child
  • Had to be caretaker earlier
  • Independence
  • Resilience
  • Anxiety/anger/depression
  • Sometimes choose partners with use disorders
  • Duty to care for others
  • Comfort of chaos
64
Q

NOTE

A

f you have a use issue – this is the time to work on that as use disorders can crash a medical career (counseling, lots of websites, change who you spend time with)
- If you have someone important in your life with abuse disorder, get your own help

Emergency Med (14 decks)

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