alcohol + substance abuse Flashcards
diagnosis of substance use disorder
2 of following over 1 year:
1) tolerance: more drug to achieve same effect
2) withdrawal sx: sx opposite of intoxication
3) persistent desire or unsuccessful attempt to cut down
4) significant energy spent obtaining, using, recovering
5) social, occupational activities reduced
6) continued use in spite of knowledge
7) craving
8) recurrent use in dangerous situations: drink + drive
9) failure to fulfill obligations at work, school, home
10) social or interpersonal conflicts
stages of change in overcoming addiction
1) precontemplation: don’t acknowledge there is a problem
2) contemplation: acknowledge there is a problem, not ready/willing to change
3) preparation/determination: ready to make change
4) action/willpower: changing behavior
5) maintenance: of behavior change
6) relapse: return to old behaviors
alcohol effects: CNS depressant
mood elevation disinhibition ↓ anxiety sedation if severe: somnolence: sleepy resp depression
alcohol withdrawal sx
agitation anxiety insomnia tremor tachycardia
mechanism of action of alcohol
GABA R (like BZD, barbiturates)
treatment for alcohol intoxication
wait for it to get out - give fluids
life-threatening alcohol withdrawal syndrome
peaks at 2-3 days after last drink
initially: feel like ants crawling on them
then: autonomic system hyperactivity (tachycardia, tremors, fever, hypotension/hypotension, diaphoresis, anxiety, seizures)
pychotic: hallucinations (visual or auditory), nightmares
delirium tremens
2-3 days post op seizure
consider delirium tremens
treatment for delerium tremens
BZD: longer acting better to prevent withdrawal
alcohol
complications of alcoholism
liver damage: ↑ GGT, AST>ALT (>2:1)
alcoholic cirrhosis
hepatitis
pancreatitis (gallstone + alcohol 2 main causes)
peripheral neuropathy
testicular atrophy
“saturday night palsy”: compression of radial artery/nerve in spiral groove (when pass out on couch with arm overhanging)
aspiration pneumonia (anaerobes, klebsiella: alcoholics have weak IS)
screening for alcoholism
CAGE questionnaire Cut back - ever had need Annoyance - get annoyed when people ask Guilt Eye opener - had a drink in morning after waking up?
caused by thiamine deficiency (B1)
Wernicke-Korsakoff syndrome
characterized by
wernicke encephalopathy: acute, life-threatening neuropathology
Korsakoff syndrome: long-term consequence of wernicke encephalopathy
Wernicke-Korsakoff syndrome
confusion nystagmus opthalmoplegia ataxia coma, death if untreated
wernicke encephalopathy
anterograde amnesia: can’t form new memories
retrograde amnesia: loss of existing memories
confabulation: false perception
hallucinations
korsakoff syndrome
damage to:
medial thalamus
mammillary bodies of posterior hypothalamus
Wernicke-Korsakoff syndrome
treatment of Wernicke-Korsakoff syndrome
IV thiamine BEFORE glucose: resolve wernicke encephalopathy
alcohol impairs livers ability to undergo…
gluconeogenesis (and alcoholics don’t have good diet) → hypoglycemic
thiamine is a cofactor for glucose metabolism - but missing → if give glucose load in ER: become ueglycemic → comatose
always give THIAMINE before glucose for patient with AMS or malnourished or alcoholic
longitudinal laceration of GE junction caused by excessive vomiting
presenting sx: hematemesis
mallory-weiss syndrome
extremely dilated submucosal veins in lower third of esophagus
caused by portal HTN due to cirrhosis
“coffee ground” emesis
LIFE THREATENING
esophageal varices
long-term treatment of alcoholics: prevent relapse in recovering alcoholic
AA: DOC for relapse prevention
naltrexone: opioid antagonist, endogenous opioids are associated with + feelings that come with alcohol use → don’t feel as good when drink
disulfiram: take before party so not tempted to drink →↑ acetylaldehyde: N/V, flush
topiramate: affects glutamate R (migraines + seizures too)
acamprosate: modulate glutamate R
BZD and barbiturate effects
CNS depression ↓ anxiety disinhibition coma severe respiratory depression
barbiturates, BZD effect on GABA R
BZD: ↑ FREQUENCY of Cl channel opening
barbiturates: ↑ DURATION of Cl- channel opening (wish BARs open longer)
withdrawal of BZD or barbiturates
agitation
anxiety
seizures
treatment for BZD overdose
flumazenil (BZD antagonist): reverse effect
can induce withdrawal → seizure
opioid (morphine, heroin, methadon) effects
CNS depression euphoria n/v constipation pupillary CONSTRICTION (miosis) higher dose: seizures OD: resp depression
pupillary constriction
opioid
treatment of opioid overdose
will be VERY ANGRY that stopped high:
naloxone
naltrexone
opioid withdrawal
sweating dilated pupils piloerections yawning rhinorrhea flu-like symptoms not life-threatening
complications of IV heroin
IVDU:
hepatitis
HIV
right sided endocarditis
treatment of opioid addiction
methadone: low-dose, long-acting opiate, prevents sx of opiod withdrawal
suboxone (naloxone + buprenorphine: partial opioid agonist): decrease withdrawal sx
naltrexone: opioid antagonist - prevent relapse once detoxified
opiod for pain control with less addiction
tramadol
amphetamines: CNS stimulant
↑ NE, epi, dopamine release
cocaine: CNS stimulant
block reuptake of NE, epi, dopamine
effect of amphetamines and cocaine
EUPHORIC ↑ energy agitation anxiety insomnia ↑ bp, tachycardia, cardiac arrest, stroke pupillary DILATION uses: ↑ attention, ↓ appetite (weight loss)
withdrawal sx of amphetamines and cocaine
↓ catecholamines in synapse: ↓ neuronal firing severe depression lethargy insomnia/hypersomnia weight gain headache
cocaine overdose
BZD: if agitation only (calm patient)
haloperidol: if agitation with paranoia
caffeine + nicotine: CNS stimulants
excitability restlessness diuresis premature atrial contractions premature ventricular contractions avoid in MIs (susceptible to arrhythmias)
caffeine + nicotine withdrawal
irritability
anxiety
craving
weight gain
treatment for nicotine withdrawal
nicotine replacement
treatment for nicotine prevention
prevent relapse/craving:
buproprion
varenicline
types of hallucinogens
PCP
LSD
marijuana
PCP (phencyclidine) MOA
NMDA receptor antagonist
inhibit nicotinic Ach receptors
dopamine reuptake inhibitor
PCP (phencyclidine) effect
BELLIGERENT impulsiveness agitation NYSTAGMUS (horizontal + vertical) homicidal ideation violence pyschosis delerium
treatment of PCP
calm patient:
BZD
antipsychotic
PCP withdrawal
depression
anxiety
irritability
VIOLENCE
LSD MOA
5HT receptors
LSD effect
anxiety paranoia delusions visual hallucinations FLASHBACKS (wks, mo, yrs after using lsd) pupillary DILATION can't die from drug
treatment for LSD intoxication
BZD: calm patient
marijuana MOA
tetrahydrocannabinol: effects THC receptors and CD1 R
marijuana effects
euphoria anxiety paranoid delusions perception of slowed time impaired judgement prolonged use: social withdrawal ↑ appetite dry mouth high dose: hallucinations red eyes
marijuana withdrawal
peak at 48 yrs and last 5-7 days detected in urine 1 mo after last use irritable insomnia nausea
MDMA “ectasy” effect
↑ 5HT release
MDMA effect
euphoria ↓anxiety sense of intimacy with others tachycardia jaw clenching like to DANCE → dehydration
treatment for MDMA “ectasy”
supportive care
organophosphate effect
MIOSIS
sweating
drooling
rebound anxiety, tremors, seizures, life-threatening
withdrawal from:
alcohol
BZD
barbiturates
