14% Substance-related Disorders Flashcards
(PPP 600)
three pharm management possibilities for tobacco use disorder
NRT
bupropion
varenicline
(PPP 600)
what is the MOA of the antidepressant drug used for tobacco use disorder?
bupropion: dopamine & NE reuptake inhibitor that reduces nicotine cravings and withdrawal symptoms
(PPP 600)
what is a major adverse effect of the drug that blocks nicotine receptors for tobacco use disorder?
increased suicidality (varenicline) (other AEs: HA, nausea, insomnia, other neuropsychiatric conditions)
(PPP 600)
major contraindication for bupropion use
epilepsy
conditions with increased sz risk (eg eating disorders such as bulimia and anorexia nervosa)
(avoid in pts with recent MAOI use)
(PPP 600)
can bupropion be stopped suddenly?
no - “avoid abrupt withdrawal”
RoshReview
what are the five A’s of tobacco cessation counseling?
Ask - Identify and document tobacco use status for every patient at every visit. (You may wish to develop your own vital signs sticker, based on the sample below).
Advise - In a clear, strong, and personalized manner, urge every tobacco user to quit.
Assess - Is the tobacco user willing to make a quit attempt at this time?
Assist - For the patient willing to make a quit attempt, use counseling and pharmacotherapy to help him or her quit.
Arrange - Schedule followup contact, in person or by telephone, preferably within the first week after the quit date.
(RoshReview)
a pt comes to ER reporting ingesting angel dust - which of the following is most likely found on PE?
a) Argyll Robertson pupil
b) miosis
c) mydriasis
d) rotary nystagmus
d) ROTARY NYSTAGMUS
phencyclidine (PCP) noncompetitively binds NMDA receptors, stimulates sigma receptors, blocks reuptake of biogenic amines
exhibits nystagmus which can be horizontal, vertical or rotary
(RoshReview)
“Which modern anesthetic is derived from phencyclidine?”
ketamine
(RoshReview) "A 27-year-old man presents to the emergency department in a coma after being found on the side of a street in a parked car. Vital signs are significant for a respiratory rate of 10 breaths per minute. You examine him and notice pinpoint pupils. A standard urine drug test is performed. Which of the following drugs is most likely to return a positive result for the drug class that is suspected to have caused this patient’s presentation?" a) fentanyl b) methadone c) morphine d) oxycodone
c) MORPHINE
Urine toxicology is not indicated in patients with suspected opioid overdose because it lacks sensitivity. The standard urine drug tests can detect cocaine, amphetamines, benzodiazepines, barbiturates, natural opioids (morphine and codeine), cannabis, and phencyclidine, but they often cannot identify synthetic opioids (such as fentanyl and methadone) and some semisynthetic opioids (such as oxycodone).
(RoshReview)
“What are the causes of false positives for opioids on a urine drug test?”
Ingestion of poppy seeds, rifampin, and fluoroquinolones (ciprofloxacin, moxifloxacin, and levofloxacin).
(RoshReview) "Which of the following is the most commonly abused substance by schizophrenic patients? a) alcohol b) cannabis c) cocaine d) tobacco"
d) tobacco
“Those at a higher risk of substance abuse include comorbidities of depressive, anxiety, or bipolar disorders, posttraumatic stress disorder, eating disorder, attention deficit hyperactivity disorder, or schizophrenia. In an epidemiologic study, researchers found 90% of schizophrenic patients use nicotine.”
(RoshReview)
“What medication is contraindicated in treating cocaine-induced hypertension?”
“Propranolol due to unopposed alpha-constriction.”
(RoshReview)
19 y/o pt who ate a brownie with an unknown substance 1 hr ago; he presents w/ slurred speech, mild paranoia, tachycardia, slightly elevated bp, conjunctival injection, horizontal gaze nystagmus. What component of this unknown substance is primarily responsible for its psychoactive response, given most likely cause for this presentation?
delta-9-tetrahydrocanniabinol
pts w/ acute cannabis intox may have tachycardia, elevated bp, elevated RR, conjunctival injection, nystagmus. Pupils are not affected.
(RoshReview)
what is the clinical scale used to guide treatment once diagnosis of alcohol withdrawal syndrome has been made?
CIWA-Ar Clinical Institute Withdrawal Assessment for Alcohol - revised
(RoshReview)
how does the scoring work for CIWA-Ar?
mild == <8
moderate = 9 - 15
severe withdrawal = >15
(RoshReview)
what’s the point of scoring alcohol withdrawal with CIWA-Ar?
the scoring system provides timing recommendations for the next dose of medication
mild - no meds necessary
moderate - q 2 hrs
severe - q 1 hr
(RoshReview)
mild s/s of alcohol withdrawal syndrome
tachycardia diaphoresis tremors n/v anxiety/mild agitation insomnia alcohol craving HA
(RoshReview)
moderate to severe symptoms for alcohol withdrawal syndrome
hallucinations
DTs
szs which may be fatal
(RoshReview)
clinical s/s of phencyclidine OD
behavior problems anger, aggression, irritability impaired judgement vertical OR rotary nystagmus bp elevated, HR elevated
(RoshReview)
PCP MOA
glutamate receptor (NMDA) antagonist
(RoshReview)
cocaine intoxication s/s (possibly early ones)
mydriasis bruxism (grinding/clenching teeth) HA n/v tremors hallucinations pallor
(RoshReview)
cocaine intoxication does what to BP, temp, RR?
all of ‘em get elevated
(RoshReview)
three pathophys mechanisms of cocaine intoxication
biogenic amines - blockade of reuptake
sodium channels - blockade of sodium channels
AA stim - excitatory amino acid stimulation
(RoshReview)
what should be avoided when a pt presents with cocaine intoxication?
BETA BLOCKERS
due to concern for HTN and coronary artery vasoconstriction which occur due to UNOPPOSED ALPHA-ADRENERGIC STIMULATION
(RoshReview)
what do BBs do in situations with cocaine intoxication?
they have been shown to WORSEN CORONARY ARTERY VASOCONSTRICTION
and are associated w/ poor clinical outcomes
(RoshReview)
what is the difference b/w Ach toxidrome and sympathomimetic toxidrome (cocaine and amphetamines)?
Ach toxidrome differs by DRY SKIN and DECREASED BOWEL SOUNDS
(RoshReview)
T/F: people who use cocaine and experience acute coronary syndrome have a higher troponin level than people who do not use cocaine.
TRUE
(RoshReview)
“T/F: bupropion is recommended for tobacco cessation in pregnant patients”
FALSE.
“behavioral interventions should be the cornerstone of tobacco cessation efforts in pregnant women.”
(RoshReview)
“which of the following clinical scenarios in a pt with chronic ethanol use should prompt admission to the hospital?”
a) fever, tachycardia, HTN
b) intoxication w/ vomiting
c) mild tachycardia, tongue fasciculations
d) normal vital signs, one sz six hours ago
A) FEVER, TACYCARDIA, HTN
abnormal v/s = major alcohol withdrawal
major ETOH withdrawal = anxiety, irritability, tremors, tachycardia, fever, HTN, decreased sz threshold, A/VH
condition is life-threatening, requires benzos, possibly antipsychotics
(if a pt had an isolated sz and is sz-free for a period of 6 hrs w/o signs of ongoing withdrawal, they are eligible for discharge from ER)
(RoshReview)
what is the time frame in which DTs typically develop?
> 72 hrs
(RoshReview)
“what are the three clinical findings that comprise the triad associated with Wernicke encephalopathy?”
encephalopathy
oculomotor dysfunction
gait ataxia
(RoshReview)
a guy comes into the ER after a bar fight, wound up, agitated, bp 208/115, having OD’d on amphetamines. What is first-line tx for his elevated bp?
“hypertension related to amphetamines is usually controlled with benzodiazepines, such as lorazepam”
“However, nitroprusside or phentolamine can be used as second-line agents in patients whos bp is refractory to benzos”
(RoshReview)
“which antidepressant medication can cause a false positive for amphetamines on a urine drug assay?”
bupropion
