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CSI > addiction > Flashcards

addiction Flashcards

1
Q

Many patients could have a severe and life-threatening abuse problem without

A

ever being dependent on a drug

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2
Q

Maladaptive pattern of substance use defined as 2 or more of the following signs in 1 year:

A

Tolerance, Wtihdrawal, Substance taken in larger amount or over longer time than desired, Persistent desire or unsuccessful attempts to cut down, Significant energy spent obtaining/using/or recovering from substance, Important social/occupational/recreational activities reduced because of substance use, Continued use despite knowing substance causes physical and/or psychological problems, Craving, Recurrent use in physically dangerous situations, Failure to fulfill major obligations at work/school/home due to use, social/interpersonal conflicts related to substance use

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3
Q

kindling can result in

A

mood swings, panic, psychosis, and occasionally overt seizure activity

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4
Q

acute manifest.: mild intoxication

A

Mild intoxication-euphoria, drowsiness, constricted pupils

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5
Q

acute manifest.: Severe intoxication

A

hypotension, bradycardia, hypothermia, coma, respiratory arrest, pulmonary edema

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6
Q

drugs to tx opioid abuse

A

buprenorphine-partial agonist, eases craving

methadone-stronger, may become addicted

naltrexone, nalaxone- blocking, reversal, used in OD, use quickly, fast acting, monitor 36 hrs

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7
Q

sedatives

A

anxiolytics- benzos

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8
Q

acute manifest w/ benzos

A

Disinhibition, ataxia, dysarthria, nystagmus, delerium

High doses can lead to respiratory depression, hypotension, shock, coma, death

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9
Q

special consid. benzos

A

Paradoxical agitation, anxiety, psychosis, confusion, mood lability, anterograde amnesia have been reported

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10
Q

this benzodiazepine antagonist, is effective in overdose of benzos

A

Flumazenil

but can potentiate seizures

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11
Q

benzo w/drawal symps

A

Somatic (disturbed sleep, tremor, nausea, muscle aches)
Psychological (anxiety, poor concentration, irritability, mild depression)
Perceptual (poor coordination, mild paranoia, mild confusion)

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12
Q

psychedelics

A

Common psychedelics (LSD, mescaline, psilocybin, dimethyltryptamine, and other derivatives of phenylalanine and tryptophan) can produce similar behavioral and physiologic effects

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13
Q

psychedelic acute manifests.

A

1-2 hours-Initial feeling of tension is followed by emotional release such as crying or laughing
2-3 hours-Perceptual distortions , visual illusions, hallucinations, and fear of ego disintegration
3-4 hours-Major changes in time sense and mood lability then occur
4-6 hours-Feeling of detachment and a sense of destiny and control occur

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14
Q

psychedelics spec. consids

A

“bad trip”:panic, depression, confusion, or psychotic symptoms

  • flashback effects
  • consider preexisting emotional probs, attitude, setting
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15
Q

PCP (phencyclidine)

A

traditional psychedelic drug

PCP is a common deceptive substitute for LSD, tetrahydrocannabinol, and mescaline

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16
Q

acute manifest PCP:

A

Mild intoxication-euphoria accompanied by a feeling of numbness
Moderate intoxication-disorientation, detachment from surroundings, distortion of body image, combativeness, unusual feats of strength, and loss of ability to integrate sensory input, especially touch and proprioception
Severe intoxication-seizures, deepening coma, hypertensive crisis, and severe psychotic ideation

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17
Q

PCP: spec. consids.

clinical symps

A

dizziness, ataxia, dysarthria, nystagmus, retracted upper eyelid with blank stare, hyperreflexia, tachycardia, hypertension, increased respiratory rate, muscle tone, urine production
*don’t use in 1st trimester–>spont. abort, cong defects

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18
Q

PCP: spec. consids.:

A

Acute rhabdomyolysis has been reported and can result in myoglobinuric kidney failure

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19
Q

THC manifests

A

Effects occur in 10–20 minutes and last 2–3 hours

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20
Q

THC spec. consids.

joints soaked in formaldehyde and dried…

A

(“AMP”) unusual effects, including autonomic discharge and severe though transient cognitive impairment
Type of cyclic vomiting syndrome
-“do hot showers help?”

21
Q

amphetamines

A

Methamphetamine (“speed”)-one variant is a smokable form called “ice,” which gives an intense and fairly long-lasting high
Methylphenidate and dextroamphetamine-prescriptions

22
Q

acute manifests: amphetamines

A

Sweating, tachycardia, elevated blood pressure, mydriasis, hyperactivity, and an acute brain syndrome with confusion and disorientation

23
Q

spec. consids. amphetamines

A

Tolerance develops quickly
As dosage is increased, hypervigilance, paranoid ideation, stereotypy, bruxism, tactile hallucinations, full-blown psychoses occur

24
Q

stimulant w/drawal

A

depression with symptoms of hyperphagia and hypersomnia

25
Q

cocaine -stimulant, crack:

A 
A purer (and stronger) derivative called “crack,” is prepared by simple extraction from cocaine hydrochloride.
Acute manifestations
26
Q

acute manifests. cocaine

A

Euphoria, excitement, increased energy

27
Q

Coca leaf chewing-onset

A

5–10 minutes and lasting for about an hour, mild high

28
Q

cocaine: Intranasal use-onset

A

2–3 minutes and lasting 30 minutes, moderate high

29
Q

cocaine: Intravenous use –onset

A

30 seconds and lasting 15 minutes, fairly intense

30
Q

cocaine:

Smoking freebase-onset

A

seconds and lasting several minutes, intense high

31
Q

spec. consids. cocaine

A

Intranasal use-causes vasoconstriction which may eventually cause tissue necrosis and septal perforation
Pulmonary complications

32
Q

CXR cocaine

A

pneumomediastinum

33
Q

laxatives

A

Electrolyte disturbances that may contribute to the manifestations of a delirium
Elderly, eating disorders

34
Q

anabolic steroids

A

Acute manifestations-significant mood swings, aggressiveness, and paranoid delusions
Withdrawal symptoms-fatigue, depressed mood, restlessness, and insomnia

35
Q

antihistamines

A

Produce some central nervous system depression

Mixture of antihistamines with sedatives exacerbates CNS effects

36
Q

inhaling gases

A

gasoline, toluene, petroleum ether, lighter fluids, cleaning fluids, paint thinners, and solvents

euphoria, slurred speech, hallucinations, and confusion

37
Q

inhaling gases bad effects

A

High doses unconsciousness and cardiorespiratory depression or failure
Chronic exposure produces a variety of symptoms related to the liver, kidney, bone marrow, or heart

38
Q

amyl nitrites

A

Used as an “orgasm expander”

Changes in time perception, “rush,” and mild euphoria last from 5 seconds to 15 minutes

39
Q

“Designer drugs”

A

Synthetic substitutes for commonly used recreational drugs
Methyl analogues of fentanyl-used as heroin supplements
MDMA (methylenedioxymethamphetamine)-often not detected by standard toxicology screens

40
Q

“Designer drugs” problem for physicians..

A

faced with symptoms from a totally unknown cause

41
Q

overcoming substance addiction stages

A
  1. Precontemplation
  2. Contemplation
  3. Preparation/determination
  4. Action/willpower
  5. Maintenance*
  6. Relapse
42
Q

tox screen

A

alcholol, cannabis, cocaine, opioids

acid/LSD,PCP

43
Q

tox screen: cannibis

A

cannabis 4-7wks, 12 wks(max w/ heavy use)

44
Q

tox screen: alcohol

A
45
Q

tox screen: cocaine

A

3-7 days, 10 days(w/ heavy use)

46
Q

tox screen: opioids

A

2-3 days

47
Q

why hospitals cannot prescribe THC even tho legal

A

medicaid does not pay for it

48
Q

legal narcotics are schedule ???

A

2,3,4

regulated by DEA, pts tracked

49
Q

DSM-5

A

need 2 out of 11 criteria in 12 mo period

CSI (75 decks)

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