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Addiction Medicine Flashcards

1
Q

diagnosis of substance use disorder

A

2+ in 12 months:
tolerance, withdrawal, more use than intended, craving, unsuccessful effort to cut down, spend excessive time in acquisition, give up activities to use, use despite negative effects, failure to fulfill roles, use in hazardous situations, use despite social problems

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2
Q

how to rate severity of substance use d/o

A

mild: 2-3 criteria
moderate: 4-5
severe: 6+

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3
Q

3 C’s of addiction

A

craving
compulsion
loss of control

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4
Q

diagnostic criteria for gambling disorder

A

4+ in 12 mos not explained by mania:
preoccupation w gambling, inc $ gambled, unsuccessful attempts to cut down/stop, irritability when trying to stop, use to escape problem, continue to try to break even after losing, lying to reveal extent, jeopardizing or losing relationship or career, relying on others for $ issue d/t gambling

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5
Q

substance-induced disorders

A

intoxication, withdrawal, delirium, persisting dementia or amnestic d/o, psychosis, mood or anxiety d/o, sexual or sleep d/o, hallucination/ perception d/o

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6
Q

intoxication

A

reversible substance-specific syndrome d/t ingestion or exposure
maladaptive behavior or physiological change d/t effect of substance on CNS

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7
Q

withdrawal

A

reversible substance-specific syndrome d/t decline in blood level of substance
causes clinically significant distress or functional impairment

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8
Q

how to recognize substance-induced d/o

A

disturbance not better accounted for by non-substance-induced d/o (sx before substance or persist after cessation)

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9
Q

pathway affected by all addictive drugs except LSD

A

mesocorticolimbic dopaminergic reward thresholds

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10
Q

components of addiction and relation to brain structures

A

reward pathway: mesolimbic DA circuit
VTA and NAcc - acute reinforcing effects of drugs
amygdala and hippo - memory and conditioned responses linked to craving

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11
Q

adolescent addiction screening

A 
CRAFFT
C = car intoxicated
R = relax/fit in/peer influence
A = alone
F = forget/blackouts
F = family/friends worry
T = trouble bc of use
If 1+, encourage to stop.
If 2+, screen for substance dependence.
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12
Q

questions to ask about substance use

A 
TRAPPED
Tx history
Route of administration
Amount
Pattern (and change over time)
Prior abstinence
Effects (OD, withdrawal)
Duration of use (inc most recent and fam hx)
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13
Q

medical detox goals

A

safe withdrawal
human withdrawal
prepare pt for ongoing tx of dependence
*does little to change long-term drug use

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14
Q

impact of treatment on substance use

A

reduces drug use 40-60%
reduces crime 40-60%
*as successful as tx for DM, asthma, HTN

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15
Q

5 stages of change

A

precontemplation (unaware or unwilling to change)
contemplation (aware of problem, no commitment to change)
preparation (intend to change)
action (*requires a lot of time and energy)
maintenance (prevent relapse, indefinite)

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16
Q

motivational enhancement therapy

A

helps people recognize and change problem

useful for people ambivalent about change

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17
Q

importance of motivational interviewing

A

resolve ambivalence about changing behavior and instill ownership of change process in pt

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18
Q

AA vs CBT

A

CBT is more effective

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19
Q

detection in urine of THC, amphetamine, barbs, cocaine, methadone, PCP, opiates

A 
THC: 3-30 days
amph: 2-3 d
barb: 1-3 d
coke: 6h-3d
methadone: 7-9 d
PCP: 8 d
opiates: 1-3d
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20
Q

opiates not detected in UA

A

buprenorphine, oxycodone, hydrocodone, fentanyl

*can screen for these specifically

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21
Q

how to test for alcohol use

A 
short t1/2 in urine but detected up to 24 h
ethyl glucuronide (metabolite) may be detected up to 5d
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22
Q

best biomarker of alcohol relapse

A

CDT (carb-deficient transferrin) - synthesis disturbed by EtOH metabolites - elevated in 2 wk and normalizes in 2 wk

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23
Q

12m and lifetime prevalence of EtOH and drug use d/o

A

EtOH: 13.9 and 29.1%
drug: 3.9 and 9.9%

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24
Q

long-term abstinence rates with and w/o treatment

A

without: 20% chance
with: 50-66% chance of 1+ years

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25
sx alcohol withdrawal
``` 2+ of: autonomic hyperactivity (inc HR, sweating), hand tremor, insomnia, n/v, transient hallucinations, agitation or anxiety, grand mal seizures (w/i 48 h) ```
26
formication
tactile hallucinations seen ONLY in cocaine intoxication and EtOH withdrawal ex: delusional parasitosis
27
how to treat seizures in EtOH withdrawal
BZD not anti-convulsants! OTL - "out the liver" - oxazepam, temazepam (not used), lorazepam because glucuronidated not oxidized in liver - little functional liver needed
28
delirium tremens
48-72 hours post EtOH cessation; 20% mortality sympathetic hyperactivity: tachy, HTN, fever, diaphoresis, hallucinations, delusions Tx: prevention, BZD, fluids, support
29
predicting delirium tremens
hx of DT, early withdrawal sx (w/i 6h), use of sedative hypnotics (further decrease GABA-R), med problems (ID, hep, pancreatitis), withdrawal seizures on presentation, genetics
30
Wernicke's encephalopathy
acute amnestic d/o d/t EtOH ataxia, nystagmus, ophthalmoplegia, confusion rare in
31
Korsakoff syndrome
chronic amnestic EtOH d/o a/r-amnesia in responsive pt, +/- confabulation tx: 3-12m thiamine (+ glucose) 21% completely recover, 25% significant recovery
32
disulfiram
for EtOH dependence | inhibits ALDH = inhibits metabolism
33
acamprosate
for EtOH dependence | glutamate receptors and transmission
34
naltrexone MOA, and daily PO vs monthyl IM
for EtOH dependence synthetic opioid antagonist monthly = improved compliance
35
acute cannabis use sx
euphoria, impaired motor coordination, sensation of slowed time, pupillary constriction and photophobia 2+ w/i 2 h of use: conjunctival injection, inc appetite, dry mouth, tachycardia
36
spice MOA and dangers
full potent agonist of CB1 (vs. partial for THC) often contaminated with b2-agonist -> sympathomimetic effects like tremor, tachy, anxiety can also produce psychosis and paranoia
37
chronic cannabis use sx
gynecomastia (relationship b/t CB1 and PRL receptors), reactive airway dz, dec sperm count, wt gain, lethargy
38
cannabis intoxication sx
panic, delirium, psychosis | tx: antipsychotic med
39
cannabis withdrawal diagnosis
3+ w/i 1 week of cessation: irritable or aggressive, nervous/anxiety, sleep difficulty, dec appetite or wt loss, restless, depressed mood 1 of: stomach pain, shaky/tremor, sweating/fever, chills, headache
40
stimulant intoxication sx
2+ of: tachy or bradycardia, pup dilation, high/low BP, sweat or chills, n/v, wt loss, psychomotor agitation or retardation, mm weakness or resp depression, chest pain or arrhythmia confusion, seizure, dyskinesia, dystonia, or coma
41
cocaine or amphetamine intoxication vs schizophrenia
+ symptoms of SZ but no negative sx reality testing intact *if reality testing not intact, consider substance-induced psychotic d/o
42
stimulant withdrawal sx
dysphoric mood + 2+ of fatigue, unpleasant dreams, in/hypersomnia, inc appetite, psychomotor retardation or agitation *won't kill pt (vs. EtOH w/d)
43
life-threatening effects of amphetamines
hyperthermia, arrhythmias, renal failure
44
long-term effects of MDMA
reduced brain 5HT and metabolites | reduced 5HT transporters and degenerating terminals
45
managing stimulant intoxication
``` HTN crisis d/t unopposed alpha - labetolol (a1 and b-blocker) to maintain CO or phentolamine (a-blocker, less common) or nicardipine (2G CCB w high vascular selectivity and cerebral/coronary vasodilation) agitation/sleep problems: short-acting benzo - no anti-psychotics because dec seizure threshold ```
46
tx of stimulant dependence
``` DA agonist (bromocriptine, amantadine) - inconsistent results topiramate - ? glu-antagonist and GABA agonist ```
47
opioid intoxication sx
``` maladaptive behavior (euphoria -> apathy, dysphoria), pupillary constriction (dilation w anoxic brain injury) constipation, bradycardia, hypoTN, resp depression 1+ of: drowsiness, slurred speech, impaired attn/memory ```
48
opioid w/d sx
3+ of: dysphoria, n/v/d, m ache (hamstrings), lacrimation/ rhinorrhea, pup dilation piloerection or sweating, yawning, fever, insomnia
49
clonidine
a2-agonist to reduce opioid w/d signs by decreasing sympathetic outflow
50
methadone
synthetic opioid agonist to help with withdrawal | safe for pregnancy
51
buprenorphine/ suboxone
buprenorphine + naloxone bup: long-acting potent partial mu agonist with mixed ag/antag kappa - dec risk resp dep and fewer autonomic sx induces acute w/d - start when pt in w/d or clean for opioid withdrawal nal: antagonist
52
drug interactions for suboxone (bup+nal)
azoles and protease inhibitors because metabolized by CYP 3A4
53
hallucinogen intoxication sx
anxiety, fear of losing mind, paranoia perceptual changes while awake and alert: depersonalization, derealization, illusion, hallucination, synesthesia 2+: pup dil, tachy, sweating, palpitations, blurred vision, tremor, incoordination
54
physical effects of LSD/acid
hyperthermia, tachycardia, HTN, insomnia, loss of appetite
55
PCP/ phencyclidine intoxication
unpleasant psychological effects (out of body, vivid dream), violence/ suicidality 2+ in an hour: nystagmus (v or h), HTN or tachy, numbness/ diminished pain, ataxia, dysarthria, mm rigidity, seizures or coma, hyperacusis very similar to SZ (+ and - sx and reality testing not intact)
56
ketamine
moderate version of PCP, odorless and tasteless
57
MOA PCP
potent glutamate NMDA antagonist
58
dextromethorphan
NMDA antagonist less potent but similar effects to PCP and ketamine sx: distorted visual perceptions to complete dissociation (for 6 h)
59
tx hallucinogen/PCP
acute LSD: support acute PCP: diazepam for seizure/agitation, phentolamine for HTN chronic: discontinue use OD (panic, paranoia, psychosis): BZD, observation in quiet room, no anti-ACh like phenothiazines (will worsen effect and seizure risk)
60
why not to acidify urine in hallucinogen intoxication
although increased excretion of drug, risk of metabolic acidosis, rhabdomyolysis, etc.
61
hallucinogen persisting perception d/o
"flashbacks" of experiences after discontinuation of hallucinogen use that is not d/t another medical condition
62
inhalant intoxication sx
problematic behavior or psych changes (assault, belligerent, apathetic, impaired judgment) and 2+: dizzy, nystagmus, incoordination, slurred speech, unsteady gait, mm weakness, lethargy, euphoria, depressed reflexes, psychomotor retardation, tremor, blurred vision/ diplopia, stupor/coma
63
MOA of inhalants
agonist of GABA-R, glut-blocker | *can cause dementia d/t this (like EtOH, BZDs)

Psychopathology (7 decks)

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