Addiction Medicine Flashcards

1
Q

What is the definition of addiction?

A
  • Primary, chronic disease of brain reward, motivation, memory and related circuitry
  • Pathologically pursuing reward and/or relief by substance use and other behaviors***
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2
Q

How does type I vs. type II alcoholism differ in the addictophrenia model?

A
  • 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
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3
Q

Which type of addictophrenia is more associated with criminal behavior, risk taking, and gambling?

A

Type II

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4
Q

Which type of addictophrenia is associated with a significant history of trauma and there is predominantly alcohol and benzo use?

A

Type III

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5
Q

Which type of addictophrenia is associated with chronic use of high dose drugs known to cause severe physical dependency + presence of severe psychosocial stressors?

A

Type IV

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6
Q

For diagnosis of a substance-induced mental disorder there is evidence from the hx, PE, or labratory findings of what 2 things?

A
  • 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
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7
Q

What are 2 pieces of evidence which would indicate that a mental disorder is independent and not substance-induced?

A
  • 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
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8
Q

What are the 5 criteria of substance-induced mental disorders?

A
  • 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
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9
Q

When do seizures most often arise during alcohol withdrawal?

A

24-48 hrs; most often Grand mal

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10
Q

When does withdrawal delirium (DTs) develop during alcohol withdrawal?

A

48-72 hrs

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11
Q

What is the most severe manifestation of alcohol withdrawal?

A

Delirium Tremens

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12
Q

What are the signs/sx’s of delirium tremems; what is the hallmark?

A
  • Agitation + global confusion + disorientation + hallucinations + fever + HTN + diaphoresis + autonomic hyperactivity = tachycardia + HTN
  • Hallmark = profound global confusion
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13
Q

What does CIWA stand for and what is it used for?

A
  • 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
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14
Q

Which 3 benzodiazepines are metabolized through glucuronidation in liver and can be used in the setting of alcohol and other withdrawals?

A

Oxazepam and Lorazepam and Temazepam

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15
Q

What are 3 reasons that methadone is a high risk medication?

A
  • Can be deadly when used with a benzodiazepine***
  • Frequently causes QTC prolongation - sometimes fatal
  • Dangers ↑ when used with another 3A4 substrate!***
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16
Q

If a methadone maintenance patient is encountered in the ED and needs pain management what is the proper protocol?

A
  • Provider calls on-call service at methadone clinic and verifies dosage
  • The correct methadone dosage is continued while patient is hospitalized
  • If additional pain mangement is required use another opioid: not another CYP3A4 substrate and no benzos!
  • Do not use methadone as this will possibly disrupt the response to current methadone maintenance dosing
17
Q

What is a serious mental AE associated with chronic intoxication of stimulants?

A

Psychosis: sometimes with severe paranoia

18
Q

Cocaine works mainly by preventing the reuptake of what?

A

Dopamine

19
Q

Amphetamines can be fatal at lower doses in the setting of what underlying disease?

A

Brugada syndrome

20
Q

Adolescent males who use cannabis regularly have a 7-fold increased risk of?

A

Psychosis

21
Q

The neuromodulator effect of cannabis is due to decreased uptake of which NT’s?

A

GABA and Dopamine

22
Q

What are the cerebellar sx’s of PCP intoxication?

A

Ataxia, dysarthria, and NYSTAGMUS (vertical and horizontal)

23
Q

What are the 2 neuroadaptive effects of PCP?

A
  • Opiate receptor effects
  • Allosteric modulator of glutamate NMDA receptor
24
Q

What is the hallmark sx of MDMA (ecstacy) intoxication?

A

extremely high fever (38.5-43oC)

–> rhabdomyolysis, renal failure, seizures, disseminated intravascular coagulopathy, cadiac arrhythmias, and death