addiction Flashcards
Many patients could have a severe and life-threatening abuse problem without
ever being dependent on a drug
Maladaptive pattern of substance use defined as 2 or more of the following signs in 1 year:
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
kindling can result in
mood swings, panic, psychosis, and occasionally overt seizure activity
acute manifest.: mild intoxication
Mild intoxication-euphoria, drowsiness, constricted pupils
acute manifest.: Severe intoxication
hypotension, bradycardia, hypothermia, coma, respiratory arrest, pulmonary edema
drugs to tx opioid abuse
buprenorphine-partial agonist, eases craving
methadone-stronger, may become addicted
naltrexone, nalaxone- blocking, reversal, used in OD, use quickly, fast acting, monitor 36 hrs
sedatives
anxiolytics- benzos
acute manifest w/ benzos
Disinhibition, ataxia, dysarthria, nystagmus, delerium
High doses can lead to respiratory depression, hypotension, shock, coma, death
special consid. benzos
Paradoxical agitation, anxiety, psychosis, confusion, mood lability, anterograde amnesia have been reported
this benzodiazepine antagonist, is effective in overdose of benzos
Flumazenil
but can potentiate seizures
benzo w/drawal symps
Somatic (disturbed sleep, tremor, nausea, muscle aches)
Psychological (anxiety, poor concentration, irritability, mild depression)
Perceptual (poor coordination, mild paranoia, mild confusion)
psychedelics
Common psychedelics (LSD, mescaline, psilocybin, dimethyltryptamine, and other derivatives of phenylalanine and tryptophan) can produce similar behavioral and physiologic effects
psychedelic acute manifests.
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
psychedelics spec. consids
“bad trip”:panic, depression, confusion, or psychotic symptoms
- flashback effects
- consider preexisting emotional probs, attitude, setting
PCP (phencyclidine)
traditional psychedelic drug
PCP is a common deceptive substitute for LSD, tetrahydrocannabinol, and mescaline
acute manifest PCP:
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
PCP: spec. consids.
clinical symps
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
PCP: spec. consids.:
Acute rhabdomyolysis has been reported and can result in myoglobinuric kidney failure
THC manifests
Effects occur in 10–20 minutes and last 2–3 hours
THC spec. consids.
joints soaked in formaldehyde and dried…
(“AMP”) unusual effects, including autonomic discharge and severe though transient cognitive impairment
Type of cyclic vomiting syndrome
-“do hot showers help?”
amphetamines
Methamphetamine (“speed”)-one variant is a smokable form called “ice,” which gives an intense and fairly long-lasting high
Methylphenidate and dextroamphetamine-prescriptions
acute manifests: amphetamines
Sweating, tachycardia, elevated blood pressure, mydriasis, hyperactivity, and an acute brain syndrome with confusion and disorientation
spec. consids. amphetamines
Tolerance develops quickly
As dosage is increased, hypervigilance, paranoid ideation, stereotypy, bruxism, tactile hallucinations, full-blown psychoses occur
stimulant w/drawal
depression with symptoms of hyperphagia and hypersomnia
cocaine -stimulant, crack:
A purer (and stronger) derivative called “crack,” is prepared by simple extraction from cocaine hydrochloride. Acute manifestations
acute manifests. cocaine
Euphoria, excitement, increased energy
Coca leaf chewing-onset
5–10 minutes and lasting for about an hour, mild high
cocaine: Intranasal use-onset
2–3 minutes and lasting 30 minutes, moderate high
cocaine: Intravenous use –onset
30 seconds and lasting 15 minutes, fairly intense
cocaine:
Smoking freebase-onset
seconds and lasting several minutes, intense high
spec. consids. cocaine
Intranasal use-causes vasoconstriction which may eventually cause tissue necrosis and septal perforation
Pulmonary complications
CXR cocaine
pneumomediastinum
laxatives
Electrolyte disturbances that may contribute to the manifestations of a delirium
Elderly, eating disorders
anabolic steroids
Acute manifestations-significant mood swings, aggressiveness, and paranoid delusions
Withdrawal symptoms-fatigue, depressed mood, restlessness, and insomnia
antihistamines
Produce some central nervous system depression
Mixture of antihistamines with sedatives exacerbates CNS effects
inhaling gases
gasoline, toluene, petroleum ether, lighter fluids, cleaning fluids, paint thinners, and solvents
euphoria, slurred speech, hallucinations, and confusion
inhaling gases bad effects
High doses unconsciousness and cardiorespiratory depression or failure
Chronic exposure produces a variety of symptoms related to the liver, kidney, bone marrow, or heart
amyl nitrites
Used as an “orgasm expander”
Changes in time perception, “rush,” and mild euphoria last from 5 seconds to 15 minutes
“Designer drugs”
Synthetic substitutes for commonly used recreational drugs
Methyl analogues of fentanyl-used as heroin supplements
MDMA (methylenedioxymethamphetamine)-often not detected by standard toxicology screens
“Designer drugs” problem for physicians..
faced with symptoms from a totally unknown cause
overcoming substance addiction stages
- Precontemplation
- Contemplation
- Preparation/determination
- Action/willpower
- Maintenance*
- Relapse
tox screen
alcholol, cannabis, cocaine, opioids
acid/LSD,PCP
tox screen: cannibis
cannabis 4-7wks, 12 wks(max w/ heavy use)
tox screen: alcohol
tox screen: cocaine
3-7 days, 10 days(w/ heavy use)
tox screen: opioids
2-3 days
why hospitals cannot prescribe THC even tho legal
medicaid does not pay for it
legal narcotics are schedule ???
2,3,4
regulated by DEA, pts tracked
DSM-5
need 2 out of 11 criteria in 12 mo period
