Addiction Flashcards
how many of the DSM-5 criteria must be met to be considered to have an addiction? in what time period?
2 or more within 12 months
1) taken in larger amounts over longer period of time than expected
2) persistent desire or unsuccessful effort to cut down
3) great deal of time spent trying to obtain, use, or recover from the substance
4) craving to use the substance
5) failure to fulfill major obligations at work, school, or home
6) continued use despite interpersonal problems
7) favorite activities are given up or reduced
8) recurrent use in situations that are hazardous
9) use continued despite knowledge of having problem
10) tolerance
11) withdrawal
severe addiction is characterized by a “yes” on how many criteria?
6+
mild addiction is characterized by a positive on how many criteria?
2-3 sx
withdrawal symptoms in absence of drug is called…?
dependence
what are some common themes seen in addiction?
early exposure, family history, child abuse or neglect, depression, coping with loss, unsafe recovery environment, inappropriate gateway RX use, co-morbid mental illness
addiction is the ___ leading cause of preventable death in the US
3rd
what is the lifetime suicide rate seen in addiction vs. the general population?
7 percent in addiction
1 percent general
during which timeframe will we begin to see alcoholic hallucinosis?
12-48 hours
vitals will be stable, orientation will be intact
during which timeframe will we begin to see delirium tremens?
48-96 hours
vital sign aberrations: elevated BP, tachycardia, fever
what is the term for acute, metabolic brain damage relating to thiamine deficiency?
wernicke’s encephalopathy
what are symptoms of wernicke’s encephalopathy?
disorientation, inattentiveness, oculomotor dysfunction, gait ataxia
what is the term for the chronic neurologic consequence of alcoholism?
korsakoff syndrome
what is the pathophysiology behind withdrawal?
ETOH normally binds to GABA, sudden ETOH cessation = decreased inhibitory tone
ETOH usually blocks NMDA receptor activation and glutamate release; sudden cessation leads to increased excitatory activity
tremulousness, headache, diaphoresis, anorexia, GI upset, and normal mental status characterize what? when does all that show up?
minor withdrawal
onset 6-36 hours
what is a warning sign in alcoholic withdrawal of bad things to come?
changes in BP, HR
when are seizures likely to occur in alcohol withdrawal?
6-48 hours
usually single seizure with short post-ictal period, status epilepticus rare
how do we treat alcohol withdrawal?
IV fluids (correct metabolic acidosis)
benzodiazepines
give thiamine to prevent brain damage from wernicke’s
give magnesium (hypomagnesium =Vfib, Vtach)
give potassium (hypokalemia=a fib)
lots of meds for symptomatic tx
which benzodiazepine is the DOC for alcohol withdrawal PPX in liver failure and severe cirrhosis?
lorazepam (ativan)
less drug accumulation
what is the preferred DOC in all alcohol withdrawal? why?
diazepam (valium)
short oral onset, long duration of action
what is “step 2” in alcohol withdrawal?
a good discharge plan!
residential, outpatient, individual, peer support, anything!
how long does typical inpatient alcohol withdrawal last?
1-5 days
what tests should you consider ordering in your patient withdrawing from heroin?
LFT and PCR serology for hepatitis C!
STD testing
what are symptoms seen in stage 1 of opiate withdrawal? when do they occur?
up to 8 hours
fear of withdrawal, anxiety, drug craving
what symptoms are seen in stage 2 of opiate withdrawal? when do they occur?
8-24 hours
insomnia, restlessness, anxiety, yawning, cramps, lacrimation, rhinorrhea, diaphoresis, mydriasis
what symptoms are seen in stage 3 of opiate withdrawal? when are they seen?
vomiting, diarrhea, fever, chills, muscle spasms, tremor, tachycardia, piloerection, hypertension, seizures
up to 2 days
which opiate withdrawal medication is okay to use in pregnancy?
subutex
how long does it take opiate receptor pathways affected by long-term heavy use to reset?
6-8 weeks
what are side effects of benzodiazepine withdrawal?
peripheral sensory disturbances*
restlessness, tachycardia, anxiety
what drug should be used for benzodiazepine detox?
long-acting benzo (valium)
phenobarbitol loading dose
is withdrawal from crack/cocaine life threatening?
not really!
still TX with benzos to manage aggressive behavior and hyperthermia if needed
which illicit drug is associated with the most ER visits?
cocaine
what is the leading cause of preventable mortality in the US?
tobacco
your patient is addicted to crack and tobacco. should you tell him to quit both?
no! one at a time
withdrawal symptoms of tobacco?
weight gain, irritability, depression, insomnia
intake of which type of drug can precipitate serotonin syndrome?
hallucinogens!
what effect do hallucinogens have on the body?
modulate serotonin, dopamine, glutamate
treatment of PCP overdose?
benzos and maybe haldol if they’re euphoric and acting like a nut
when should we screen for addiction?
pretty much at all routine physicals but alsooooo
1) patient reporting new or increasing difficulty at work, with relationships, or legal issues
2) areas of high prevalence
3) when about to prescribe potentially addictive medications
what is a partial hospitalization program?
outpatient group therapy and counseling with medical monitoring and RX for withdrawal aids
what is an intensive outpatient program?
group therapy, counseling, peer volunteer groups
what drug can we give to reduce alcohol cravings?
naltrexone!
how does relapse prevention work?
CBT that helps identify triggers for relapse and rehearse coping responses for those risk factors
