Addiction Medicine Lecture

Question 1

Withdrawal symptoms in the absence of the drug

Answer 1

Physical dependence

Question 2

A neurologic disease with genetic and psychosocial contributions leading to compulsive use and cravings, despite harmful circumstances

Answer 2

Addiction

Question 3

Increased/decreased tolerance
Increased susceptibility to craving or dependence
Modified physiologic consequences

Answer 3

Genetic influences on addiction

Question 4

Early exposure, depression, difficulty coping with loss

Unsafe recovery environment

Family history, childhood abuse and neglect

Inappropriate gateway prescription use

Answer 4

Common themes seen in addiction

Question 5

What is the third leading cause of preventable deaths in US?

Answer 5

Excessive alcohol consumption

Question 6

More than half of alcohol related deaths are due to…

Answer 6

binge drinking

Question 7

8 or more drinks more than 4 times per month

Answer 7

binge drinking

Question 8

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

Answer 8

Important questions to ask

Question 9

Group therapy, conseling, peer volunteer groups, medical monitoring, prescriptons for withdrawal aids

Answer 9

Partial hospitalization program (PHP)

Question 10

Group therapy, counseling, peer volunteer groups

Answer 10

Intesive outpatient program (IOP)

Question 11

Naltrexone
Acamprosate
Baclofen
Anti-depressants
Opiate replacements

Answer 11

Anti-craving medications

Question 12

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

Answer 12

Issues related to alcohol use

Question 13

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

Answer 13

Alcohol withdrawal symptoms

Question 14

Alcoholic ketoacidosis
Liver failure (ascites, spontaneous bacterial peritonitis)
GI bleed
Pancreatitis
Pancytopenia
Anxiety
Death

Answer 14

Alcohol withdrawal

Question 15

Disorientation, inattentiveness, oculomotor dysfunction
gait ataxia due to acute, metabolic brain damage relating to thiamine deficiency

Answer 15

Wernicke Encephalopathy

(tx= thiamine)

Question 16

Chronic neurologic consequences of Wernicke’s Encephalopathy

Answer 16

Korsakoff Syndrome

Question 17

ETOH binds ______ receptors

Answer 17

GABA

Question 18

ETOH intereferes with ________ receptor activation

Answer 18

Glutamate triggered NMDA receptor

Question 19

Sudden ETOH cessation leads to….

decreased ________
increased ________

Answer 19

decreased inhibitory tone

increased excitatory activity

Question 20

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)

Answer 20

Minor withdrawal

Question 21

Onset after last drink: 6 to 48 hours

Single or brief flurry of generalized, tonic-clonic seizures, short post-ictal period
status epilepticus rare

Answer 21

Seizure stage of alcohol withdrawal

Question 22

Onset after last drink: 12 to 48 hours

Visual, auditory and/or tactile hallucinations with intact orientation and normal vital signs

Answer 22

Alcoholic hallucinations

Question 23

Onset after last drink: 48-96 hours

Delirium, agitation, tachycardia, HTN, fever, diaphoresis

Answer 23

Delirium tremens

Question 24

Serum EtOH
CBC, CMP, Mg, Phosphorus, UA, UDS
Lipase, PT/INR, Ammonia level, TSH

Answer 24

Labs to get on pt with alcohol withdraw sx

Question 25

IV fluids
Vitamins, electrolytes
PRN meds for: nausea, GI uset, pain, insomina, anxiety, etc

Answer 25

Tx for alcohol withdrawal

Question 26

Should you give a withdrawing pt Bupropion?

Answer 26

NO!

lowers seizure threshold

Question 27

Fear of withdrawal, anxiety, drug craving
can last up to 8 hours

what stage of opiate withdrawal?

Answer 27

Stage 1

Question 28

Insomnia, restlessness, anxiety, yawning
stomach cramps, lacrimation, rhinorrhea, diaphoresis, mydriasis

can last 8-24 hours

what stage of opiate withdrawal?

Answer 28

Stage 2

Question 29

Vomiting, diarrhea, fever, chills, muscle spasms, tremor, tachycardia,
piloerection, HTN, seizures (in neonates)

can last up to 3 days

what stage of opiate withdrawal?

Answer 29

Stage 3

Question 30

Peak symptoms of Heroin withdrawal?

Answer 30

3-4 days

Question 31

Suboxone
Subutex
Methadone

Answer 31

Opiate replacement drugs that can be used in opiate withdrawal

Question 32

Opiate receptor pathways affected by long term heavy use require time to reset

aprox how many weeks?

Answer 32

6-8 weeks

Question 33

The worst withdrawal for abrupt cessation of opiates is from __-__ days…

Answer 33

1-5 days

Question 34

Best way to stop opiate use?

Answer 34

Slowly tapering down over course of weeks to months

Question 35

Addictive
Stopping high doses carries a risk of seizure

Withdrawal is characterized by:
Increased anxiety
Palpitations
Tachycardia
Restlessness
Peripheral sensory disturbances

Answer 35

Benzodiazepines

Question 36

Benzos enhance _____ mediated inhibitory tone

Answer 36

GABA

Question 37

True or false…

Long acting benzos (ie valium) can be used for detox in gradually decreasing dose

Answer 37

True

Question 38

True or false…

Phenobarbital “loading” can be used for benzo detox

Answer 38

True