43: SUD Flashcards
does physical dependence on a drug mean that the pt is addicted?
no - good medical care can cause a pt to become physically dependent and that is okay. physical dependence alone is neither necessary nor sufficient to dx addiction
four big things to look for to dx addiction
- acceleration or escalation
- loss of control over use
- compulsive use
- cravings
four genes associated with increased opioid dependence
- DRD2
- OPRM1
- OPRD1
- BDNF
what gene is associated with severe alcoholism
a1 allele of DRD2 gene
what system in the brain is out of balance in SUD
reward system
GARS
genetic addiction risk score: can accurately predict reward deficiency syndrome (RDS), which is basically genetically-predisposed alcohol disorder
things that damage the reward cascade -> are RFs for SUD
- PTSD, BPD
- ADHD, depression, anxiety
- adverse childhood experiences
- Hx abuse
- gender and sexuality issues
how is PTSD a RF for SUD?
causes hypoactivity in brain’s reward circuitry
tolerance
need for markedly increased amounts to acheive intoxication or desired effect
CAGE questions
- have you thought about Cutting down?
- do you get Annoyed at criticisms of your drinking?
- do you ever feel Guilty about drinking?
- do you take an Early morning drink (eye opener) to get the day started or eliminate the shakes?
what is alcohol abuse comorbid with 80% of the time
depression
labs to order on pt who is very drunk in ED
- CBC, CMP, Mg
- amylase, lipase, Hep C screen
- UA, tox screen, BAC
- TSH, thiamine, folate
when pt is addicted to LSD or PCP, what is most likely
a poly-substance use disorder - typically not just addicted to those
substance-induced mental disorder
significant symptomatic presentation of a relevant mental disorder that develops within 1 month of a substance intoxication
when treating acute pain in opioid-dependent pts - wat to do with buprenorphine vs methadone
- buprenorphine: stop while in hospital, restart on discharge
- methadone: continue treatment + treat acute pain with additional opioid
