Addiction

Question 1

Disorders associate with alcohol dependence?

Answer 1

• abuse of other substances
• Schizophrenia
• Anxiety
• Personality Disorders

Question 2

Medical Comorbidities related to alcohol dependence?

Answer 2

CNS:
Wernicke’s encephalopathy and Korsakoff’s psychosis.
GIT system: esophagitis, gastritis, pancreatitis, alcoholic hepatitis, liver cirrhosis.
Tuberculosis, all types of accidents, suicide, and homicide

Question 3

1) Alcohol and CNS depressants

2) Cocaine and amphetamines

Answer 3

1) act on GABA receptors*.

2) act on the dopamine system.

Question 4

Korsakoff’s (psychosis) is characterized by?

Answer 4

mental confusion, confabulation, and amnesia

Question 5

Cause of Wernicke-Korsakoff Syndrome?

Answer 5

Alcohol abuse

Question 6

Wernicke’s encephalopathy is characterized by?

Answer 6

ophthalmoplegia, ataxia, and confusion.

Question 7

Signs of Heroin dependence?

Answer 7

Hyperpyrexia.
Seizures.
Sexual.
Euphoria

Question 8

Signs of Heroin Withdrawal?

Answer 8

Watery eyes.
Runny nose.
Loss of appetite.
Vomiting, diarrhea, fever/joint pain.
 Yawning.

Question 9

4 phases of heroin intoxication?

Answer 9

1) euphoria - facial flushing and deepening of voice
2) the High - sense of well-being
3) “the nod”- escape from reality ranging from lethargy to unconsciousness
4) Period B4 withdrawal - seek more of drug to avoid withdrawal

Question 10

3 or more of these are needed for a diagnosis of dependence?

Answer 10

• Tolerance.
• Withdrawal symptoms.
• Large amounts for longer period than intended.
• Unsuccessful or persistent desire to cut down or control use.
• increase in getting, taking and seeking the substance
• substance use despite knowledge of risks or problems it causes

Question 11

Symptoms of Alcohol Intoxication?

Answer 11

• Slurred speech.
• Incoordination.
• Unsteady gait.
• Nystagmus.
• Impaired in attention and memory.
• Symptoms not due to another medication.

Question 12

Signs of alcohol withdrawal? (2 or more needed)

Answer 12

• Nausea and vomiting.
• Anxiety.
• Transient visual, tactile, and auditory hallucinations.
• Autonomic hyperactivity**
• Psychomotor agitation.
• Insomnia.
• Increased hand tremor.
• Grand mal seizures.

Question 13

After 5-10 yrs of heavy alcohol use, what manifestation may be seen?

Answer 13

withdrawal delirium, is considered a emergency

Question 14

signs of alcohol withdrawal delirium?

Answer 14

• Autonomic hyperactivity (tachyHR, HTN)
• Severe disturbance in sensorium.
• Perceptual disturbances.
• Fluctuating levels of consciousness.
• Delusions (paranoid), agitated behaviors & fever.

Question 15

Effects after 1-2- drinks

Answer 15

changes in mood/behavior, judgement is impaired

Question 16

effects after 5-6

Answer 16

legal level of intoxication in most states

Question 17

effects of 10-12 drinks

Answer 17

ataxia, emotional liability

Question 18

effects of 15-18 drinks

Answer 18

confusion, stupor

Question 19

effects of 20-24 drinks

Answer 19

coma

Question 20

effects of >24 drinks

Answer 20

death due to respiratory depression

Question 21

excessive emotional or psychological reliance on a partner, typically a partner who requires support due to an illness or addiction.

Answer 21

co-dependence

Question 22

psychological symptoms of chemical dependency?

Answer 22

Denial, depression, anxiety, dependency, hopelessness, low self esteem

Question 23

Psychotherapy for dependence?

Answer 23

• Alternative coping mechanisms to reduce reliance on substances.*
• Confidentiality must be maintained.**
• Many changes occur during the first 6 months of sobriety.***
• Psychotherapy needs to be directive, open and honest and caring.

Question 24

Three basic fundamental concepts of 12 step programs?

Answer 24

• Individuals with addictive problems are powerless.
• Not responsible for their disease but responsible for their recovery.
• They must face their problems and their feelings.

Question 25

Drug category of choice for to treat alcohol withdrawaland why?

Answer 25

• Benzodiazepines

- Are cross addicting, provide safe withdrawal and have anticonvulsant effects.

Question 26

List of benzos used to treat alcohol withdrawal?

Answer 26

• Chlordiazepoxide (Librium)
• Diazepam (valium)*
• Oxazepam (Serax)**
• Lorazepam (Ativan)**

Question 27

Chlordiazepoxide (Librium) dosage for tx of alcohol withdrawal?

Answer 27

25-100 mg PO q 4h tapered to zero over 5-7 days.

Question 28

Diazepam (valium) dosage for tx of alcohol withdrawal?

Answer 28

5-10 mg PO q 2-4h in tapering doses

Question 29

Oxazepam (Serax) dosage for tx of alcohol withdrawal?

Answer 29

15-30 mg tid or qid.

Question 30

Lorazepam (Ativan) dosage for tx of alcohol withdrawal?

Answer 30

2-6 mg daily in divided doses

Question 31

Treatment of Alcohol Withdrawal Delirium (Thiamine (Vitamin B1))?

Answer 31

100 mg PO qd for 3 days.
Given IM or IV before Glucose loading.
Prevents Wernicke’s encephalopathy

Question 32

Treatment of Alcohol Withdrawal Delirium (Magnesium Sulfate)?

Answer 32

1 gm IM q6h for 2 days.
Especially if history of seizures.
Increases effectiveness of vitamin B1.
Help reduce postwithdrawal seizures.

Question 33

Why is Phenobarbital used in the treatment of Alcohol Withdrawal Delirium?

Answer 33

For seizure control

Question 34

An agent use for narcotic addiction and sometimes used in the treatment of alcoholism especially for those with high levels of craving and somatic symptoms.

Answer 34

Naltrexone (Trexan, Revia)

Question 35

Helps the client to abstain from alcohol although the action is not understood.

Answer 35

Acamprosate (Campral)

Question 36

Drug works on the classical conditioning principles of inhibiting impulsive drinking?

Answer 36

Disulfiram (Antabuse)