Approach to Substance Disorders Flashcards
Primary chronic disease of brain reward, motivation, memory and related circuitry
Addiction
What 4 things should you look for when looking for Addictophrenia?
- Acceleration and Escalation
- Loss of control over use
- Compulsive use
- Cravings
What 4 things should you look for when looking for Addictophrenia?
- Acceleration and Escalation
- Loss of control over use
- Compulsive use
- Cravings
Does Physical Dependence = Addiction? Describe.
NO
- physical dependence can occur with normal meds
- ex. cannot abruptly stop beta blockers etc.
What genetic alteration has been associated with developing severe alcoholism?
A1 allele of DRD2 gene
The A1 allele of DRD2 gene can cause Reward Deficiency Syndrome. What neurotransmitter is low and what behaviors does that cause?
Hypodopaminergia
=> addictive, impulsive, compulsive behaviors
What can the Genetic Addiction Risk Score (GARS) predict?
Reward Deficiency Syndrome
– decreased DRD2 receptors
In general, what characterizes Alcohol Use Disorder?
Recurrent use/cravings despite the negative consequences
What is the CAGE screening for?
Alcohol use
CAGE screening questions
- Have you felt you should CUT DOWN?
- Do you ever get ANNOYED with criticism of drinking?
- Do you feel GUILTY about your alcohol use?
- Do you drink in the EARLY-MORNING?
Alcohol level of 0.05
Judgement and restraint impaired
Alcohol level of 0.08
Legally intoxicated
Alcohol level of 0.3
Stupor
Alcohol level of 0.4 and above?
Coma –> Death
What are 2 possible Alcohol Withdrawal conditions?
- Delirium Tremens
2. Wernicke-Encephalopathy
What are 2 possible Alcohol Withdrawal conditions?
- Delirium Tremens
2. Wernicke-Encephalopathy
What are the signs of Delirium Tremens that can occur with Alcohol Withdrawal?
Tremulousness (tremors)
Delusions
Seizures
Tremors, delusions and seizures that occur with Alcohol Withdrawal is what condition?
Delirium Tremens
What are the signs of Wernicke-Encephalopathy with Alcohol Withdrawal?
Confusion
Ataxia
Ophthalmoparesis with nystagmus
Confusion, ataxia and ophthalmoparesis with nystagmus after alcohol withdrawal is what condition?
Wernicke-Encephalopathy
If a patient presents with severe Alcohol Withdrawal symptoms, you should admit to the detox unit and use what to guide treatment?
CIWA
What 4 things can be used for treatment for Alcohol Withdrawal?
- Benzodiazepines
- Antipsychotics
- IV fluids
- Restraints
When giving IV fluids (banana bag) to Alcohol Withdrawal patients, what things are included and what must be given AFTER Thiamine?
Mg++, K+, Thiamine, Folic Acid
* Glucose must be given after Thiamine *
Acamprosate can be used to treat Alcohol Dependence. What is its MOA and effect?
(-) GABA
= Decreases ingestion and maintains abstinence from alcohol
Naltrexone can be used to treat Alcohol Dependence. What is its MOA and effect?
Opioid Antagonist
= cuts cravings and improves abstinence
GABApentin can be used off label for Alcohol Dependence treatment. When especially, is it good for treatment?
Especially with withdrawal symptoms
- Decreases ingestion
Disulfram can be used to treat Alcohol Dependence. What are its effects?
Produces unpleasant adverse effects when the patient drinks alcohol
What are some signs of intoxication with Amphetamines and Cocaine?
Increased alertness and agitation
Hyperthermia and Hallucinations
What are some signs of withdrawal of Amphetamines and Cocaine?
Increased sleep, appetite and depression
– potentially SUICIDAL
How do you treat withdrawal symptoms of Amphetamines and Cocaine?
Antidepressants and hospitalization
What are some signs of intoxication with Benzodiazepines and Barbiturates?
Sedation, coma, respiratory depression
What are some signs of withdrawal from Benzodiazepines and Barbiturates?
Agitation, tremors, sweating, delirium and seizures
Can withdrawal be fatal with Benzodiazepines and Barbiturates?
YES
– Seizures, delirium, sweating
What are some signs of intoxication with LSD and PCP (hallucinogens)?
Hallucinations and paranoia
What extra symptoms besides hallucinations can be seen with intoxication of PCP?
Violent behavior
Muscle rigidity
Seizures
What is a sign of withdrawal from LSD and PCP?
Flashbacks
– Re-experiences of hallucinogenic state
With what drugs can flashbacks (re-experiences of hallucinogenic states) occur?
LSD
PCP
Substance-Induced Mental Disorders are developed when?
Developed within 1 month of a substance intoxication
What are 4 common agents that can cause Substance-Induced Mental Disorders?
LSD
PCP
Amphetamines and Cocaine
What are some signs of intoxication with Opioids?
Analgesia +/- LOC
Itching and respiratory depression
What are some symptoms of withdrawal from Opioids?
Sweating and lacrimation, irritability
YAWNING
Can withdrawal from Opioids be fatal?
NO
– just miserable
= yawning, irritability, lacrimation and sweating
How do you treat acute pain in opioid dependent patients if they are on Buprenorphinie/Naloxone?
STOP while they are in hospital
– Restart with discharge
How do you treat acute pain in opioid dependent patients if they are on Methadone?
DO NOT STOP
– add additional opioid for the acute pain (ex. morphine)
