Addiction

Question 1

how many of the DSM-5 criteria must be met to be considered to have an addiction? in what time period?

Answer 1

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

Question 2

severe addiction is characterized by a “yes” on how many criteria?

Answer 2

6+

Question 3

mild addiction is characterized by a positive on how many criteria?

Answer 3

2-3 sx

Question 4

withdrawal symptoms in absence of drug is called…?

Answer 4

dependence

Question 5

what are some common themes seen in addiction?

Answer 5

early exposure, family history, child abuse or neglect, depression, coping with loss, unsafe recovery environment, inappropriate gateway RX use, co-morbid mental illness

Question 6

addiction is the ___ leading cause of preventable death in the US

Answer 6

3rd

Question 7

what is the lifetime suicide rate seen in addiction vs. the general population?

Answer 7

7 percent in addiction

1 percent general

Question 8

during which timeframe will we begin to see alcoholic hallucinosis?

Answer 8

12-48 hours

vitals will be stable, orientation will be intact

Question 9

during which timeframe will we begin to see delirium tremens?

Answer 9

48-96 hours

vital sign aberrations: elevated BP, tachycardia, fever

Question 10

what is the term for acute, metabolic brain damage relating to thiamine deficiency?

Answer 10

wernicke’s encephalopathy

Question 11

what are symptoms of wernicke’s encephalopathy?

Answer 11

disorientation, inattentiveness, oculomotor dysfunction, gait ataxia

Question 12

what is the term for the chronic neurologic consequence of alcoholism?

Answer 12

korsakoff syndrome

Question 13

what is the pathophysiology behind withdrawal?

Answer 13

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

Question 14

tremulousness, headache, diaphoresis, anorexia, GI upset, and normal mental status characterize what? when does all that show up?

Answer 14

minor withdrawal

onset 6-36 hours

Question 15

what is a warning sign in alcoholic withdrawal of bad things to come?

Answer 15

changes in BP, HR

Question 16

when are seizures likely to occur in alcohol withdrawal?

Answer 16

6-48 hours

usually single seizure with short post-ictal period, status epilepticus rare

Question 17

how do we treat alcohol withdrawal?

Answer 17

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

Question 18

which benzodiazepine is the DOC for alcohol withdrawal PPX in liver failure and severe cirrhosis?

Answer 18

lorazepam (ativan)

less drug accumulation

Question 19

what is the preferred DOC in all alcohol withdrawal? why?

Answer 19

diazepam (valium)

short oral onset, long duration of action

Question 20

what is “step 2” in alcohol withdrawal?

Answer 20

a good discharge plan!

residential, outpatient, individual, peer support, anything!

Question 21

how long does typical inpatient alcohol withdrawal last?

Answer 21

1-5 days

Question 22

what tests should you consider ordering in your patient withdrawing from heroin?

Answer 22

LFT and PCR serology for hepatitis C!

STD testing

Question 23

what are symptoms seen in stage 1 of opiate withdrawal? when do they occur?

Answer 23

up to 8 hours

fear of withdrawal, anxiety, drug craving

Question 24

what symptoms are seen in stage 2 of opiate withdrawal? when do they occur?

Answer 24

8-24 hours

insomnia, restlessness, anxiety, yawning, cramps, lacrimation, rhinorrhea, diaphoresis, mydriasis

Question 25

what symptoms are seen in stage 3 of opiate withdrawal? when are they seen?

Answer 25

vomiting, diarrhea, fever, chills, muscle spasms, tremor, tachycardia, piloerection, hypertension, seizures

up to 2 days

Question 26

which opiate withdrawal medication is okay to use in pregnancy?

Answer 26

subutex

Question 27

how long does it take opiate receptor pathways affected by long-term heavy use to reset?

Answer 27

6-8 weeks

Question 28

what are side effects of benzodiazepine withdrawal?

Answer 28

peripheral sensory disturbances*

restlessness, tachycardia, anxiety

Question 29

what drug should be used for benzodiazepine detox?

Answer 29

long-acting benzo (valium)

phenobarbitol loading dose

Question 30

is withdrawal from crack/cocaine life threatening?

Answer 30

not really!

still TX with benzos to manage aggressive behavior and hyperthermia if needed

Question 31

which illicit drug is associated with the most ER visits?

Answer 31

cocaine

Question 32

what is the leading cause of preventable mortality in the US?

Answer 32

tobacco

Question 33

your patient is addicted to crack and tobacco. should you tell him to quit both?

Answer 33

no! one at a time

Question 34

withdrawal symptoms of tobacco?

Answer 34

weight gain, irritability, depression, insomnia

Question 35

intake of which type of drug can precipitate serotonin syndrome?

Answer 35

hallucinogens!

Question 36

what effect do hallucinogens have on the body?

Answer 36

modulate serotonin, dopamine, glutamate

Question 37

treatment of PCP overdose?

Answer 37

benzos and maybe haldol if they’re euphoric and acting like a nut

Question 38

when should we screen for addiction?

Answer 38

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

Question 39

what is a partial hospitalization program?

Answer 39

outpatient group therapy and counseling with medical monitoring and RX for withdrawal aids

Question 40

what is an intensive outpatient program?

Answer 40

group therapy, counseling, peer volunteer groups

Question 41

what drug can we give to reduce alcohol cravings?

Answer 41

naltrexone!

Question 42

how does relapse prevention work?

Answer 42

CBT that helps identify triggers for relapse and rehearse coping responses for those risk factors