5. Substance-related disorders Flashcards

You may prefer our related Brainscape-certified flashcards:
1
Q

What is the lifetime prevalence of substance abuse or dependence in the US?

A

17%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How do you test for alcohol?

A

Blood/urine test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How long does alcohol stay in the system?

A

only a few hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How long is urine tox positive for cocaine?

A

2-4 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How long is urine tox positive for amphetamines?

A

1-3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How long is urine tox positive for PCP?

A

3-8 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What other lab values are also elevated in PCP use? (2)

A

CPK and AST

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How long is short acting barbiturate (pentobarbital) in the blood/urine?

A

24 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How long is long acting barbiturate (phenobarbital) in the blood/urine?

A

3 wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How long is short acting benzo (lorazepam) in the blood/urine?

A

3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How long is long acting barbiturate (diazepam) in the blood/urine?

A

30 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which opioids come up negative on a general screen? (2)

A

methadone, oxycodone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How long is urine tox positive for SINGLE marijuana use?

A

3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why is urine + for chronic marijuana users for up to 4 wks?

A

THC is released from adipose stores

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How does alcohol work in terms of binding sites/receptors? (4)

A
  • activates GABA
  • activates serotonin receptors
  • inhibits glutamate receptors
  • inhibits voltage-gated calcium channels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the lifetime prevalence of alcohol dependence in US for women and men?

A

3-5% women

10% men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the alcohol metabolism?

A

Alcohol –> acetaldehyde –> acetic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the 2 enzymes involved in metabolism of alcohol?

A

Alcohol dehydrogenase

Aldehyde dehydrogenase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Why are Asians less tolerant to alcohol?

A

Have less aldehyde dehydrogenase

  • results in flushing and nausea
  • protecting against alcohol dependence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the most common co-ingestant in drug overdose?

A

Alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

At what BAL do you start seeing signs of intoxication?

A

BAL > 100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the tx for alcohol withdrawal?

A

Benzodiazepine taper

- usually chlordiazepoxide (Librium) considered drug of choice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Signs and symptoms of mild alcohol withdrawal syndrome? (3)

A

irritability, tremor, insomnia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Signs and symptoms of moderate alcohol withdrawal syndrome? (5)

A

diaphoresis, htn, tachycardia, fever, disorientation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Signs and symptoms of severe alcohol withdrawal syndrome? (3)

A

tonic-clonic seizures, DTs, hallucinations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

When does EtOH withdrawal syndrome begin, and how long does it last?

A

begin in 6-24 hrs

lasts 2-7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What electrolyte abnormality can predispose to EtOH withdrawal seizures?

A

hypomagnesemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are seizures in EtOH withdrawal syndrome treated with?

A

Benzodiazepines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What % of patients hospitalized for EtOH withdrawal develop DTs?

A

5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

When does DTs usually begin?

A

48-72 hrs after last drink, but can occur later

90% of cases within 7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Prevalence of DTs in men vs. women

A

Men develop DTs 4-5x more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are some symptoms of delirium tremens? (6)

A

Seizures
Delirium
Hallucinations (most commonly visual; also tactile)
Gross tremor
Autonomic instability (increased RR, HR, BP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What can be used to treat DT? (2)

A

Benzodiazepines

Dilantin (phenytoin) - anticonvulsant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

In addition to benzo taper, what else can be used to treat alcohol withdrawal? (2)

A

Carbamazepine or VPA taper

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are the medications indicated for alcohol dependence? (4)

A
  1. Disulfiram (Antabuse)
  2. Naltrexone (Revia, IM-Vivitrol)
  3. Acamprosate (Campral)
  4. Topiramate (Topamax)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What MCV (mean corpuscular volume) changes are seen in alcohol dependence?

A

macrocytosis (increased MCV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

How does disulfiram work?

A

Blocks aldehyde dehydrogenase in the liver –> causes aversive rxn to alcohol (flushing, headaches, nausea/vomiting, palpitations, SOB)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Who are disulfiram best for?

A

Highly motivated pts (better medication adherence)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

How does Naltrexone work?

A

Blocks opioid receptor

- works by decreasing desire/craving and “high” associated with alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Greatest benefit of Natrexone seen in which patients?

A

pts w/ family hx of alcoholism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How does Acamprosate work?

A

structurally similar to GABA

- thought to inhibit glutamatergic system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is Acamprosate indicated for?

A

Post-detox for relapse prevention in pts who have stopped drinking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the major advantage of Acamprosate?

A

can use in pts with liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Contraindication of Acamprosate?

A

pts with severe renal disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Mechanism of Topiramate in tx of alcohol dependence?

A

Anticonvulsant that potentiates GABA –> inhibits glutamate receptors
- reduces cravings for alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Tx for Wernicke’s encephalopathy?

A

THIAMINE tx! (before giving glucose)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What are features of Wernicke’s encephalopathy? (3)

A
  1. Ataxia
  2. Confusion
  3. Ocular abnormalities (nystagmus, gaze palsies)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is Korsakoff syndrome?

A

Chronic amnestic syndrome = impaired recent memory, anterograde amnesia, compensatory confabulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What % of pts can be reversed from Korsakoff syndrome?

A

Reversible in only 20% of pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is the mechanism of cocaine?

A

blocks pre-synaptic DA reuptake transporter –> increases DA signalling –> increases “reward” system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

General intoxication symptoms of cocaine? (not dangerous)

A

euphoria, heightened self-esteem, change in BP, tachy or brady, nausea, DILATED pupils, weight loss, psychomotor agitation/depression, chills, sweating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Dangerous symptoms of cocaine intoxication? (5)

A

resp depression, seizures, arrhythmias, MI, stroke

53
Q

How to manage cocaine intoxication?

A
  • benzo (for mild-moderate agitation/anxiety)
  • antipsychotics (for severe agitation/psychosis)
  • ice bath/cooling blanket (for temp > 102F)
54
Q

What is the mainstay of cocaine dependence treatment?

A

Psychological interventions (ex. contingency management, group tx)

55
Q

Symptoms of cocaine withdrawal? (7)

A

“Crash” = malaise, fatigue, hypersomnolence, depression, CONSTRICTED pupils, vivid dreams, psychomotor agitation/retardation

56
Q

How long does cocaine w/d last if mild-moderate use?

A

18 hrs

57
Q

How long does cocaine w/d last if heavy/chronic use?

A

can last for weeks, but usually peak in several days

58
Q

How does amphetamines work?

A

Blocks re-uptake and facilitates release of dopamine and NE from nerve endings –> causes stimulant effect

59
Q

What are examples of amphetamines? (3)

A
  • Dextroamphetamine (Dexedrine)
  • Methylphenidate (Ritalin)
  • Methamphetamine (Desoxyn = “ice”, “speed” “crystal meth” “crank”)
60
Q

Symptoms of amphetamine abuse (5)

A

dilated pupils, increased libido, perspiration, resp depression, chest pain

61
Q

What are “club drugs” (substituted/”designer” amphetamines) 2

A

MDMA (ecstasy)

MDEA (eve)

62
Q

Whats the difference of “designer” amphetamines in terms of mechanism (compared to amphetamines)

A

Releases DA, NE AND serotonin from nerve endings

63
Q

What can happen if designer amphetamines are combined with SSRIs?

A

serotonin syndrome

64
Q

What can happen from chronic amphetamine use? (2)

A

acne and accelerated tooth decay (“meth mouth”)

65
Q

Amphetamine intoxication symptoms?

A

Similar as cocaine

66
Q

What can happen from of amphetamine overdose (4)?

A

hyperthermia
dehydration
rhabdomyolysis –> renal failure

67
Q

Amphetamine withdrawal can lead to –? (2)

A

prolonged depression

- occasionally heavy use can lead to amphetamine psychosis (mimic schiz)

68
Q

How does PCP work?

A

antagonizes NMDA glutamate receptors –> activates DA neurons

69
Q

Ketamine use can cause (4)

A

tachycardia, tachypnea, hallucinations, amnesia

70
Q

What does it mean to smoke PCP as “wet” vs. “joint”?

A
"wet" = sprinkled on cigarette 
"joint" = sprinkled on marijuana
71
Q

Symptoms of PCP intoxication “RED DANES”

A
Rage 
Erythema (redness of skin) 
Dilated pupils 
Delusions 
Amnesia 
Nystagmus 
Excitation 
Skin dryness
72
Q

Difference of ketamine vs. PCP? (2)

A

Ketamine is less potent

- sometimes used as a “date rape” drug b/c it’s odorless and tasteless

73
Q

Overdose of PCP can cause – (3)

A

seizures, coma, even death

74
Q

Rotatory nystagmus is pathognomonic for –?

A

PCP intoxication

75
Q

Treatment of PCP intoxication

A
  • benzos (lorazepam) to treat agitation, anxiety, muscle spasms, seizures
  • antipsychotics (haloperidol) to control severe agitation/psychotic symptoms
76
Q

2 drug classes that can cause tactile and visual hallucinations?

A

cocaine, PCP

77
Q

Withdrawal from PCP?

A

no w/d syndrome, but “flashbacks” (recurrence of intoxication symptoms due to release of the drug from body lipid stores)

78
Q

Which drug intoxication causes more violence?

A

PCP

79
Q

How does benzos work vs. barbiturates?

A
  • benzos potentiates effects of GABA by increasing the FREQUENCY of chloride channel opening
  • barbiturates increases the DURATION of chloride channel opening
80
Q

Common uses (medical) of benzos vs. barbiturates?

A
Benzos = anxiety disorders 
Barbiturates = epilepsy, anesthetics
81
Q

Of all kinds of drug withdrawals, which has the highest mortality rate?

A

barbiturate

82
Q

Symptoms of GHB (gamma-hydroxybutyrate) abuse? (3)

A

memory loss, resp distress, coma

83
Q

What are common “date rape” drugs? (2)

A

ketamine, GHB

84
Q

Clinical symptoms of sedative intoxication?

A

drowsiness, confusion, hyPOtension, slurred speech, incoordination, ataxia, mood lability, impaired judgement, nystagmus, resp depression

85
Q

What can long-term sedative use lead to?

A

dependence and may cause depressive symptoms

86
Q

What can be used for treatment of benzo (BDZ) overdose?

A

Flumazenil (very short-acting BNZ antagonist)

87
Q

Why must you use flumazenil with caution?

A

b/c it may precipitate seizures (during BDZ overdose)

88
Q

What is used in opiate overdose?

A

Naloxone

89
Q

What can be done as treatment for benzo/barbiturate use? (2)

A

ABCs, vitals

- activated charcoal and gastric lavage to prevent further GI absorption (if drug was ingested in the last 4-6 hrs)

90
Q

Specific barbiturate treatment?

A

Alkalinize urine w/ sodium bicarb to promote renal excretion

91
Q

Withdrawal symptoms of sedatives?

A

same as alcohol w/d

92
Q

Treatment of sedative w/d? (2)

A

benzo taper

- carbamazepine/VPA taper may be used for seizure prevention

93
Q

Mechanism of action of opioids?

A

Stimulate opiate receptors (mu, kappa, delta)

94
Q

Examples of opioids? (7)

A

heroin, oxycodone, codeine, dextromethorphan, morphine, methadone, meperidine (demerol)

95
Q

What are the most commonly abused opioids? (3)

A
Prescription opioids 
(oxycodone, vicodin [hydrocodone/ acetaminophen], Percocet [oxycodone/acetaminophen])
96
Q

What’s the most common cause of death from street heroin usage?

A

Infection 2/2 needle sharing

97
Q

Classic triad of opioid overdose?

A

pupil CONSTRICTION, resp depression, altered mental status

98
Q

What’s the one opioid that causes miosis?

A

Meperidine (Demerol Dilates pupils)

99
Q

Meperidine and MAOIs in combination can cause —?

A

serotonin syndrome

100
Q

What are symptoms of serotonin syndrome? (4)

A

hyperthermia, confusion, hyper/hypotension, muscular rigidity

101
Q

What 3 drugs can be used in tx of opioid dependence?

A

methadone, buprenorphine, naltrexone

102
Q

Difference in the 3 drugs used for opioid dependence? (in terms of mechanism)

A
  1. methadone = long-acting opioid receptor agonist
  2. buprenorphine = partial opioid receptor agonist
  3. Naltrexone = competitive opioid antagonist
103
Q

What are the pros of using methadone in tx of opioid dependence? (3)

A
  1. administered once/daily
  2. sig reduces morbidity/mortality in opioid-dep persons
  3. “gold standard” tx in pregnant women
104
Q

Cons of using methadone in tx of opioid dependence? (2)

A
  1. restricted to federally licensed substance abuse treatment programs
  2. can cause QTc interval prolongation
105
Q

Pro (1) of using buprenorphine in tx of opioid dependence?

A
  1. sublingual preparation that is safer than methadone (b/c effects reach a plateau and make overdose unlikely)
106
Q

What is suboxone?

A

contains buprenorphine and naloxone

- more commonly used (than buprenorphine)

107
Q

Naltrexone is indicated for which types of pts?

A

Highly motivated pts (for opioid dependence tx)

108
Q

W/d syndrome of opioids? (7)

A

anxiety, insomnia, anorexia, fever, rhinorrhea, piloerection, nausea/vomiting
(note: this is not life threatening)

109
Q

Tx for opioid w/d?

A
  1. Clonidine (for autonomic symptoms of w/d)
  2. NSAIDs (for pain)
  3. Dicyclomine (for abdominal cramps; usually used as tx of IBS)
110
Q

What are examples of hallucinogens? (3)

A

psilocybin (mushrooms), mescaline (peyote cactus), LSD

111
Q

Effects of hallucinogens?

A

perceptual changes, labile affect, dilated pupils, tachycardia, htn, hyperthermia, tremors, incoordination, sweating, palpitations

112
Q

How long are the effects of hallucinogens?

A

6-12 hrs

- but may last for several days

113
Q

What does it mean to have a “bad trip” w/ hallucinogens?

A

get marked anxiety, panic, psychotic symptoms (paranoia, hallucinations)

114
Q

Tx of hallucinogen intoxication?

A

monitor for dangerous behavior and reassurance

- use benzo/antipsychotics prn for agitation

115
Q

What are w/d symptoms of hallucinogens?

A

no w/d or dependence

- but may have “flashbacks” later in life

116
Q

What is LSD flashback?

A

recurrence of symptoms mimicking prior LSD trip that occurs spontaneously; lasts for min to hours

117
Q

What’s the world’s most commonly used illicit substance?

A

Marijuana (cannabis, pot, weed, grass)

118
Q

What’s the main active component in cannabis?

A

THC (tetrahydrocannabinol)

119
Q

Mechanism of action of cannabis?

A

cannabinoid receptors in the brain inhibits adenylate cyclase

120
Q

medical uses of marijuana? (5)

A
  • treat nausea in chemo pts
  • increase appetite in AIDS pts
  • decrease intraocular pressure, muscle spasms, tremor
121
Q

What is dronabinol?

A

pill form of THC that is FDA-approved for certain indications

122
Q

intoxication symptoms of marijuana?

A

euphoria, anxiety, CONJUNCTIVAL INJECTION (red eyes), dry mouth, increased appetite

123
Q

Chronic use of marijuana can cause –? (3)

A
  1. resp problems (asthma, chronic bronchitis)
  2. suppression of immune system
  3. possible effects on repro hormones
124
Q

What are some w/d symptoms of marijuana?

A

irritability, anxiety, aggression, strange dreams, depression, sweating, insomnia, decreased appetite

125
Q

What are examples of inhalants?

A

solvents, glue, paint thinners, fuels, isobutyl nitrate (“huff”, “laughing gas”, “rush”, “bolt”)

126
Q

Intoxication effects of inhalants?

A

perceptual disturbances, psychosis (esp paranoid states), lethargy, dizziness, N/V

127
Q

Overdose of inhalants can be fatal due to–? (2)

A

may be fatal 2/2 resp depression or cardiac arrhythmias

128
Q

Long term use of inhalants can lead to –?

A

permanent damage to CNS (ex. dementia, impaired memory, epilepsy, reduced IQ)
- damage to PNS, liver, kidney, heart, muscle

129
Q

FDA approved pharmacotherapy for nicotine dependence? (2)

A
  • Varenicline (Chantix): nicotinic cholinergic receptor partial agonist
  • Bupropion (Zyban): antidepressant