Addiction Medicine Lecture Flashcards
Withdrawal symptoms in the absence of the drug
Physical dependence
A neurologic disease with genetic and psychosocial contributions leading to compulsive use and cravings, despite harmful circumstances
Addiction
Increased/decreased tolerance
Increased susceptibility to craving or dependence
Modified physiologic consequences
Genetic influences on addiction
Early exposure, depression, difficulty coping with loss
Unsafe recovery environment
Family history, childhood abuse and neglect
Inappropriate gateway prescription use
Common themes seen in addiction
What is the third leading cause of preventable deaths in US?
Excessive alcohol consumption
More than half of alcohol related deaths are due to…
binge drinking
8 or more drinks more than 4 times per month
binge drinking
Drug of choice
Route of administration
First use, last use
When did it become a problem
Negative consequences of use (ie ever been arrested)
Most recent pattern of use
Prior treatment
Important questions to ask
Group therapy, conseling, peer volunteer groups, medical monitoring, prescriptons for withdrawal aids
Partial hospitalization program (PHP)
Group therapy, counseling, peer volunteer groups
Intesive outpatient program (IOP)
Naltrexone
Acamprosate
Baclofen
Anti-depressants
Opiate replacements
Anti-craving medications
HTN
GI symptoms( Esophagitis / Gastritis)
Arrhythmia (ie..A. Fib)
Neuropathy
Sleep disturbance
Alcoholic liver disease
Pancreatitis
Bone marrow suppression
Electrolyte disturbance
Immunosupression
Increased cancer risk
Injury
Exacerbation of depression, anxiety
Issues related to alcohol use
Tremor
Seizure
Alcohol hallucinations (12-48 hrs, intact orientation, stable vitals)
Delirium Tremens (48-96 hours, delirium, vital aberrations)
Unable vitals (elevated BP, tachycardia, fever)
Arrhythmia
Encephalopathy
Electrolyte disturbance
Alcohol withdrawal symptoms
Alcoholic ketoacidosis
Liver failure (ascites, spontaneous bacterial peritonitis)
GI bleed
Pancreatitis
Pancytopenia
Anxiety
Death
Alcohol withdrawal
Disorientation, inattentiveness, oculomotor dysfunction
gait ataxia due to acute, metabolic brain damage relating to thiamine deficiency
Wernicke Encephalopathy
(tx= thiamine)
Chronic neurologic consequences of Wernicke’s Encephalopathy
Korsakoff Syndrome
ETOH binds ______ receptors
GABA
ETOH intereferes with ________ receptor activation
Glutamate triggered NMDA receptor
Sudden ETOH cessation leads to….
decreased ________
increased ________
decreased inhibitory tone
increased excitatory activity
Onset after last drink= 6 to 36 hours
Tremulousness, mild anxiety, HA, diaphoresis, palpitations, anorexia, GI upset, normal mental status
BP, HR and temp aberrations may be present (warning sign)
Minor withdrawal
Onset after last drink: 6 to 48 hours
Single or brief flurry of generalized, tonic-clonic seizures, short post-ictal period
status epilepticus rare
Seizure stage of alcohol withdrawal
Onset after last drink: 12 to 48 hours
Visual, auditory and/or tactile hallucinations with intact orientation and normal vital signs
Alcoholic hallucinations
Onset after last drink: 48-96 hours
Delirium, agitation, tachycardia, HTN, fever, diaphoresis
Delirium tremens
Serum EtOH
CBC, CMP, Mg, Phosphorus, UA, UDS
Lipase, PT/INR, Ammonia level, TSH
Labs to get on pt with alcohol withdraw sx
IV fluids
Vitamins, electrolytes
PRN meds for: nausea, GI uset, pain, insomina, anxiety, etc
Tx for alcohol withdrawal
Should you give a withdrawing pt Bupropion?
NO!
lowers seizure threshold
Fear of withdrawal, anxiety, drug craving
can last up to 8 hours
what stage of opiate withdrawal?
Stage 1
Insomnia, restlessness, anxiety, yawning
stomach cramps, lacrimation, rhinorrhea, diaphoresis, mydriasis
can last 8-24 hours
what stage of opiate withdrawal?
Stage 2
Vomiting, diarrhea, fever, chills, muscle spasms, tremor, tachycardia,
piloerection, HTN, seizures (in neonates)
can last up to 3 days
what stage of opiate withdrawal?
Stage 3
Peak symptoms of Heroin withdrawal?
3-4 days
Suboxone
Subutex
Methadone
Opiate replacement drugs that can be used in opiate withdrawal
Opiate receptor pathways affected by long term heavy use require time to reset
aprox how many weeks?
6-8 weeks
The worst withdrawal for abrupt cessation of opiates is from __-__ days…
1-5 days
Best way to stop opiate use?
Slowly tapering down over course of weeks to months
Addictive
Stopping high doses carries a risk of seizure
Withdrawal is characterized by:
Increased anxiety
Palpitations
Tachycardia
Restlessness
Peripheral sensory disturbances
Benzodiazepines
Benzos enhance _____ mediated inhibitory tone
GABA
True or false…
Long acting benzos (ie valium) can be used for detox in gradually decreasing dose
True
True or false…
Phenobarbital “loading” can be used for benzo detox
True
