Brooks- Substance Use Disorders Flashcards
1
Q
Genetics + environment
Societal and family values
A
etiology of substance use
2
Q
3 main parts of brain that deal with substance abuse
A
Dopamine
nucleus accumbens
ventral tegmental area
3
Q
A problematic pattern of substance use leading to clinically significant impairment or distress, as manifested by 2 (or more) of the following occurring within a 12-month period
MAIN points: pattern leading to impairment or distress
A
Criterion A for substance use disorder
4
Q
severity of 2-3 symptoms
A
mild
5
Q
severity of 4-5 symptoms
A
moderate
6
Q
severity of 6 or more symptoms
A
severe
7
Q
Alcohol Use Disorder, Mild
A
Alcohol Abuse
8
Q
Alcohol Use Disorder, Moderate to Severe
A
Alcohol Dependence
9
Q
no criteria for > 3 months but < 12 months (except craving)
A
early remission
10
Q
no criteria for > 12 months (except craving)
A
sustained remission
11
Q
access to substance restricted (ex. Jail)
A
in controlled environment
12
Q
is the diagnosis used to describe a syndrome (e.g. simple drunkenness) characterized by specific signs and symptoms resulting from recent ingestion or exposure to that substance
A
substance intoxication
13
Q
Behavioral or psychological changes due to effects on CNS developing after use
A
substance intoxication
14
Q
the diagnosis used to describe a substance-specific syndrome that results from the abrupt cessation (or reduction) of heavy and prolonged use of a substance
A
substance withdrawal
15
Q
Causes clinically significant distress or impairment in social, occupational, or other important areas in functioning
A
substance withdrawal
16
Q
Phencyclidine; other hallucinogens; inhalants
A
no withdrawal syndrome
17
Q
The symptoms (like psychosis) developed during or soon after substance intoxication, substance withdrawal, or exposure to or withdrawal from a medication
A
substance-induced mental disorders
18
Q
It is estimated that one in five intensive care unit admits in some urban hospitals is related to _____
A
alcohol
19
Q
enhances effect of GABA
A
alcohol
20
Q
impairs gluconeogenesis after glycogen stores are used up
A
alcohol
21
Q
screening test for an alcohol use disorder
A
CAGE
22
Q
Clinically significant problematic behavioral or psychological changes after ingesting alcohol
A
alcohol intoxication
23
Q
Slurred speech
Incoordination
Unsteady Gait
Nystagmus
Impairment in attention or memory
Stupor or Coma
A
alcohol intoxication
24
Q
Legal definition of intoxication in most states is ____ mg ethanol per deciliter of blood (mg/dL) which is the same as 0.08 g/dL
A
80 mg/dL
25
a sense of well being, sedation, tranquility (alcohol concentration)
0-100 mg/dL
26
coma and death (alcohol concentration)
>350 mg/dL
27
the body is able to metabolize approximately ____ drink per hour
one
28
how to treat alcohol intoxication
supportive
29
Cessation of (or reduction in) alcohol use that has been heavy and prolonged
alcohol withdrawal
30
Autonomic hyperactivity
Increased hand tremor
Insomnia
Nausea or vomiting
Transient visual/tactile/auditory hallucinations or illusions
Psychomotor agitation
Anxiety
Generalized tonic-clonic seizures
alcohol withdrawal
31
can look like a pt comes in and says they are experiencing bugs crawling on them (moms patient at victory); visual and tactile most common
transient hallucinations/illusions during alcohol withdrawal
32
most feared alcohol withdrawal symptom
seizures
33
commonly known as "the shakes," typically starts 12 to 18 hours after a person stops drinking. It reaches its peak intensity between 24 and 48 hours and generally resolves within 5 to 7 days (can be done outpatient)
uncomplicated alcohol withdrawal
34
Patients may experience a single episode of one to six generalized seizures
alcohol withdrawal seizures
35
involves vivid and distressing auditory, visual, or tactile hallucinations that begin within 48 hours after stopping alcohol consumption. These hallucinations occur while the individual is otherwise mentally clear and typically last about a week
alcoholic hallucinosis
36
also known as delirium tremens or "DTs," affects about 5% of hospitalized patients with alcohol use disorder, but occurs in approximately one-third of those who experience withdrawal seizures. Symptoms include confusion, agitation, perceptual disturbances, fever, and autonomic hyperarousal
alcohol withdrawal delirium
37
______withdrawal requires careful monitoring and hospitalization
complicated
38
Rx w/ nutrient supplementation, and the use of benzodiazepines
alcohol withdrawal treatment
39
what are the nutrient supplementations used in alcohol withdrawal
thiamine, folic acid
40
alcohol use can cause this syndrome due to thiamine (vitamin B1) deficiency
Wernicke-Korsakoff syndrome
41
encephalopathy is characterized by symptoms such as confusion, ataxia, and ophthalmoplegia
Wernicke's
42
______psychosis involves severe memory impairment and confabulation
Korsakoff's
43
reversible cause of cognitive impairment if treated
Wernicke-Korsakoff syndrome
44
what to order and look at for patient who has wernicke-korsakoff syndrome
MRI--- look at mammillary bodies
45
two main goals
1. that the patient remains sober
2. that coexisting disorders be identified and treated
rehab for alcohol use
46
A worldwide self-help group for recovering alcoholic persons founded in 1935. ____ uses a program of 12 steps.
AA
47
used for aversive conditioning (associate alcohol with feeling sick) and no longer do it
Disulfiram
48
inhibits aldehyde dehydrogenase (buildup of acetylaldehyde)
Disulfiram
49
an opioid antagonist, appears to reduce the pleasurable effects of and craving for alcohol
Naltrexone
50
a glutamate receptor modulator, helps curb urges to drink
Acamprosate
51
uncomplicated vs complicated treatment of alcohol disorder
uncomplicated: outpatient
complicated: hospital
52
The most widely consumed psychoactive substance in the world
caffeine
53
1 cup of coffee = _____ mg caffeine
100 mg
54
average consumption of caffeine is ____ mg a day
280
55
antagonism of adenosine receptors
caffeine
56
Restlessness
Nervousness
Excitement
Insomnia
Flushed Face
Diuresis
Gastrointestinal disturbance
Muscle Twitching
Rambling flow of thought and speech
Tachycardia or cardiac arrhythmia
Periods of inexhaustibility
Psychomotor agitation
caffeine intoxication
57
main symptom of caffeine withdrawal
headache
58
how to treat caffeine intoxication
gradually eliminate it
NSAIDs for HA
59
One most common and underrecognized cause of insomnia and anxiety
Can contribute to excess gastric acidity and thereby worsen esophageal and gastric disorders
caffeine
60
______is the most widely used illegal drug in the world
cannabis
61
is the primary component of cannabis with psychoactive effects
THC
62
Conjunctival Injection
Increased Appetite
Dry Mouth
Tachycardia
cannabis intoxication
63
Irritability, anger, or aggression
Nervousness or anxiety
Sleep difficulty
Decreased appetite or weight loss
Restlessness
Depressed mood
cannabis withdrawal
64
Self-limiting
Anti-anxiety meds
Support
Educate
Monitor outpatient
treatment for cannabis related disorders
65
how long can urine drug screen detect cannabis
up to 4 weeks after use
66
Throwing up, heavy _____ smoker, in ER, only thing that helps is a hot shower
cannabis
67
no known withdrawal symptoms
psychedelics
68
moa of LSD
5HT2A agonist
69
Perceptual changes occurring in a state of full wakefulness and alertness
hallucinogen intoxication
70
pupillary DILATION
sweating tachycardia
hallucinogen intoxication
71
Supportive care for duration of intoxication
Benzodiazepines for acute anxiety if necessary
Treat psychosis with short-term antipsychotics
treat hallucinogen-related disorder
72
Phencyclidine aka
PCP (angel dust)
73
Produce feelings of separation from mind and body
PCP (angel dust)
74
moa of ketamine
NMDA antagonist
75
Vertical or horizontal nystagmus
seen in patient in ED
PCP intoxication
76
how to treat acute psychosis/agitation-
benzodiazepines
77
Only substance use disorder that is more prevalent in kids than adults
inhalant-related disorders
78
sniff paint thinner, airplane glue, typewriter correction fluid
inhalant-related disorders
79
PE includes rash around nose or mouth
inhalant-related disorders
80
what intoxication is hard to distinguish
inhalant intoxication
81
Can get permanent neurologic damage due to ____ in inhalants
heavy metals
82
There is no specific treatment for intoxication
This is no recognized withdrawal syndrome
inhalants
83
pain meds
opioids
84
agonism of mu receptors
opioids
85
pinpoint pupils
drowsiness
respiratory depression
opioid intoxication
86
antidote for opioid overdose, and will put pt in opioid withdrawal
Naloxone
87
basically patient will feel like they have a severe case of the flu
opioid withdrawal
88
for withdrawal of ______can give long-acting opioids (why?) GOLD STANDARD
treat cravings and decrease drug seeking behavior
or clonidine (alpha2 receptors)
NSAIDs
loperamide for diarrhea
opioids
89
most commonly used drug for opioid use disorder (an opioid substitution); hard to overdose on
partial mu agonist
Buprenorphine
90
full mu agonist
easy to overdose on
but used for opioid use disorder
methadone
91
really morphine with 2 acetyl groups (di-acetyl morphine)
heroine
92
commonly see sexual dysfunction with this (they are anti-testosterone)
opioid use disorder
93
nodding off
opioid intoxication
94
skin popping
95
track marks
96
main complications of IV drug use
infective endocarditis
Hepatitis C
HIV
97
4th wave of fentanyl overdose deaths in US involves what
fentanyl + methamphetamine
98
sedative, hypnotic, or anxiolytic-related disorder
(very hard to overdose)
bind GABA A (increase frequency)
benzodiazepines
99
sedative, hypnotic, or anxiolytic-related disorder
very narrow therapeutic window (overdosed and die easily)
bind GABA A (increase duration)
rarely used
barbiturates
100
looks similar to alcohol intoxication
(these are used to help come off of alcohol)
benzodiazepines
101
sedative, hypnotic, or anxiolytic withdrawal sx you worry about most
seizures
102
give flumazenil, but really give ______ to make seizures go away if caused by flumazenil
benzodiazepine overdose
103
best way to get off of benzodiazepines
gradual taper
104
Effective for sedation and anxiolytic
but prescribed with caution
sedative-hypnotic drugs (benzodiazepines)
105
increase dopamine release and block reuptake of neurotransmitters (blocks VMAT)
amphetamines
106
DAT and NET blocker
cocaine
107
DAT and NET blocker
methylphenidates
108
dilated pupils
tachy or bradycardia
N/V
sweating or chills
weight loss
stimulant intoxication
109
Bad dental and gum disease for prolonged ____use
stimulant
110
CRASH: feeling sad, dysphoric, depressed
stimulant withdrawal
111
Supportive care for intoxication and withdrawal as this is generally self limiting
Contingency Management has the most evidence for treatment of a methamphetamine use disorder (+ reinforcement)
treat stimulant use disorder
112
new: can use ____ to help people stay off illicit stimulants (extended release)
stimulants
113
people who use ____ can have myocardial infarctions (vasoconstriction and procoag effects)
cocaine
114
psychoactive component of tobacco
nicotine
115
stimulates presynaptic acetylcholine receptors thereby enhancing Ach release and metabolism (a4b2)
nicotine
116
most addictive
Biggest issue: people tend to gain weight with withdrawal
nicotine
117
first line treatment for nicotine use disorder
dual nicotine replacement (long and short acting)
118
treat nicotine use disorder and helps with weight gain
bupropion
119
partial agonist at nicotinic Ach receptor a4b2 subunit
Varenicline
120
What percentage of people with schizophrenia smoke?
95%
121
Stabilize schizophrenic pt on dose of clozapine, they get discharged, and they are psychotic again
what happened?
they smoked and increased metabolism of drug
122
Have to do weekly blood draws to avoid neutropenia with what drug
clozapine
123
this disorder is becoming more culturally accepted
come in b/c family member is concerned
gambling disorder
124
severity:
4-5 criteria met for this disorder
gambling
mild
125
severity:
6-7 criteria met
gambling
moderate
126
severity:
8-9 criteria met
gambling
severe
