Addiction Medicine Flashcards
What is the definition of addiction?
- Primary, chronic disease of brain reward, motivation, memory and related circuitry
- Pathologically pursuing reward and/or relief by substance use and other behaviors***
How does type I vs. type II alcoholism differ in the addictophrenia model?
- Type I: affects both men and women, requires presence of a genetic as well as an enviornmental predisposition, commences later in life after years of heavy drinking
- Type II: affects mainly sons of male alcoholics, is influenced only weakly by enviornmental factors; usually associated with criminal behavior
Which type of addictophrenia is more associated with criminal behavior, risk taking, and gambling?
Type II
Which type of addictophrenia is associated with a significant history of trauma and there is predominantly alcohol and benzo use?
Type III
Which type of addictophrenia is associated with chronic use of high dose drugs known to cause severe physical dependency + presence of severe psychosocial stressors?
Type IV
For diagnosis of a substance-induced mental disorder there is evidence from the hx, PE, or labratory findings of what 2 things?
- Disorder developed during or within 1 month of a substance intoxication or withdrawal or taking a medication
and
- The involved substance/medication is capable of producing the mental disorder
What are 2 pieces of evidence which would indicate that a mental disorder is independent and not substance-induced?
- The disorder preceded the onset of severe intoxication or withdrawal or exporsure to the medication
or
- The full mental disorder persisted for a substantial period of time (i.e. at least 1 month) after the cessation of acute withdrawal or severe intoxication or taking the medication
What are the 5 criteria of substance-induced mental disorders?
- Disorder represents a clinically significant symptomatic presentation of a relevant mental disorder
- Evidence from the hx, PE, or lab findings: disorder developed during or within 1 month of intoxication, withdrawal or use
- Disorder is not better explained by an independent mental disorder
- Disorder does not occur exclusively during the course of delirium
- Disorder causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
When do seizures most often arise during alcohol withdrawal?
24-48 hrs; most often Grand mal
When does withdrawal delirium (DTs) develop during alcohol withdrawal?
48-72 hrs
What is the most severe manifestation of alcohol withdrawal?
Delirium Tremens
What are the signs/sx’s of delirium tremems; what is the hallmark?
- Agitation + global confusion + disorientation + hallucinations + fever + HTN + diaphoresis + autonomic hyperactivity = tachycardia + HTN
- Hallmark = profound global confusion
What does CIWA stand for and what is it used for?
- Clinical Institute Withdrawal Assessment for Alcohol
- Assigns numerical values to orientation, N/V, tremor, sweating, anxiety, agitation, tactile/auditory/visual disturbances and HA
- Total score >10 indicates more severe withdrawal
Which 3 benzodiazepines are metabolized through glucuronidation in liver and can be used in the setting of alcohol and other withdrawals?
Oxazepam and Lorazepam and Temazepam
What are 3 reasons that methadone is a high risk medication?
- Can be deadly when used with a benzodiazepine***
- Frequently causes QTC prolongation - sometimes fatal
- Dangers ↑ when used with another 3A4 substrate!***