Chapter 7 pt 1 Flashcards
what are substance use disorders
cognitive, behavioral, and physiological symptoms indicating continuing use of a substance despite significant substance-related problems
what is the DSM-5 criteria for substance use disorder
problematic pattern of substance use w. impairment or distress manifested by at least tow of the following within a 12-month period
- using substance more than originally intended
- persistent desire or unsuccessful efforts to cut down on use
- significant time spent in obtaining, using, or recovering from substnace
- craving to use substance
- failure to fulfill obligations at work, school, or home
- continued use despite social or interpersonal problems due to the substance use
- declined social, occupational, or recreational activities because of substance use
- use in dangerous situations (driving)
- continued use despite subsequent physical or psychological problem
- tolerance
- withdrawal
what is prevalence of substance use disorder
8%
more common n men than women
what are most commonly used substances
alcohol and nicotine
what is withdrawal
development of a substance-speficied syndrome due to the cessation (or reduction) of substance use
what is tolerance
need for increased amounts of the substance to achieve the desired effect or diminished effect if using the same amount of substance
what testing can be done for PCP use
UDS positive for 4-7 days
CPK and AST often elevated
how long are barbiturates in the system
short acting (pentobarbital): 24 hours long acting (phenobarbital): 3 weeks
how long are benzos in the system
short acting (lorazepam): up to 5 days long acting (diazepam): up to 30 days
what opioids require a separate panel
methadone and oxycodone (come up negative on general screen)
what should be part of every substance use disorder treatment
behavioral counseling
how does alcohol work
activates GABA, dopamine, and serotonin receptors
inhibits glutamate and voltage-gated calcium channels
what is the most common co-ingested drug in overdose
alcohol
how is alcohol metabolized
alcohol to acetaldehyde (alcohol dehydrogenase)
acetaldehyde to acetic acid (aldehyde dehydrogenase)
-upregulation of these enzymes in heavy drinkers
most adults show signs of intoxication with BAL over what
BAL > 100 mg/dL
obvious signs with BAL > 150 mg/dL
what causes flushing and nausea in asians who drink
lack of aldehyde dehydrogenase
what affects the presentation of alcohol intox
age, sex, body weight, chronic nature of use, duration of consumption, food in stomach, state of nutrition, liver health
how is alcohol intoxication treated
monitor: ABCs, glucose, electrolytes, acid-base status
THIAMINE and FOLATE
NALOXONE (reverse effects of co-ingested opioids)
households where the male is involved in some kind of substance use disorder are more likely to experience what
spousal abuse
what are the clinical effects of alcohol intoxication
decrease in fine motor control (BAL 20-50)
impaired judgement and coordination (BAL 50-100)
ataxic gait and poor balance (BAL 100-150)
lethargy, difficulty sitting upright, difficulty with memory, nausea/vomiting (150-250)
coma in the novice drinker (300)
respiratory depression, death possible (400)
when is GI evacuation indicated for EtOH overdose
significant amount ingested within the preceding 30-60 minutes
what is the issue with alcohol withdrawal
it can be fucking LETHAL
what are signs and symptoms of alcohol withdrawal
insomnia (mild) anxiety (mild) hand tremor (mild) irritability (mild) anorexia nausea vomiting autonomic hyperactivity (diaphoresis, tachycardia, hypertension) (MODERATE) psychomotor agitaiton fever (MODERATE) seizure (SEVERE) hallucinations (SEVERE) delirium (SEVEREE)
when do EtOH withdrawal symptoms start and how long they last
start 6-34 hours
last 2-7 days
when does one see generalized tonic clonic seizures due to alcohol withdrawal
12-48 hours after cessation of drinking
peak at 12-24 hours
1/3 of people with seizures develop DTs
what is delirium tremens (DTs)
most serious form of alcohol withdrawal
begins 48-96 hours after last drink
physical illness predisposes the condition
afre over 30 and prior DTs increase the risk
what is seen in delirium tremens (DTs)
delirium hallucinations (visual most common) agitation gross tremor autonomic instability fluctuating levels of psychomotor activity
how ate DTs treated
benzos
