Chapter 7_Substance Related and Addictive Disorders Flashcards
T/F: Either tolerance or withdrawal is a requirement for substance use disorder
FALSE
How long must you have symptoms of substance use in order to be a disorder?
12 month period
Two most commonly abused substances?
Alcohol and nicotine
Comorbid conditions occurring with substance use
Mood symptoms, MDD and anxiety, psychosis
Components of therapy for substance use?
- behavioral counseling
- psychosocial treatments (motivational interviewing, CBT, contingency mgmt, individual/group therapy)
- 12 step programs (AA, NA)
- pharmacotherapy for some drugs
Mechanism of alcohol
activates GABA, dopamine and serotonin in CNS
inhibits glutamate and voltage gated Ca channels
= potent CNS depressant
How is alcohol metabolized?
Alcohol —> (alcohol dehydrogenase; asians dont have much of this! —> acetaldehyde —> (aledyhyde dehydrogenase) —> acetic acid
Alcohol metabolism enzymes are up or downregulated in heavy drinkers?
UPREGULATED
What two lab values are usually elevated in PCP intoxication?
Creatine phosphokinase (CPK) and aspartate aminotransferase (AST)
Which opoids come up negative on a general screen?
Methadone and oxycodone (must order separate panel)
How to prevent Weirnicke’s encephalopathy in setting of alcohol intoxication?
Give thiamine
Symptoms of alcohol withdrawal
insomnia, anxiety, tremor, irritability, autonomoic hyperactivity, nausea, vomiting…
can proceed to DT, seizures, hallucinations, delirium
How to treat alcohol withdrawal seizures
benzos NOT ANTICONVULSANTS!
When does alcohol withdrawal symptoms usually start?
6-24 hours and can last 2-7 days depending on severity
When does DT usually present?
48-96 hrs (2-4 days) after last drink
How to treat alcohol withdrawal
benzos (chlordiazepoxide, diazepam, lorazepam), antipsychotics (be careful of lowering seizure threshold), treat nutritional deficiencies with thiamine, folic acid, multivit, check for signs of liver failure
What lab levels would suggest heavy alcohol use?
AST:ALT > 2:!, elevated GGT
Besides elevation in LFTs, what else can alcohol elevate?
MCV (macrocytosis)
2 first line treatments for alcohol use disorder?
naltrexone acamprosate
Mechanism of naltrexone
- opoid receptor antagonist
- decreases craving/pleasure from alcohol
-DO NOT GIVE TO PATIENTS WITH OPOID DEPENDENCE ->will induce withdrawal
mecahnism of acamprosate
- modulates glutamate
- prevents relapses in patients who have stopped drinking
second line treatments for alcohol use disorder
disulfiram and topiramate
disulfiram mechanism
blocks enzyme aldehyde dehydrogenase = accumulation of aldehyde = flushing, nausea, vomiting if alcohol is consumed
Long term complication of alcohol abuse and what it can progress to?
Weirneck’e encephalopathy - thiamine deficiency; ataxia, confusion, ocular abnormalties (nystagmus)
if left untreated can progress to Korsakokff syndrome (impaired recent memory, anterorade amnesia, confabulation
mechanism of cocaine
blocks reuptake of dopamine, serotonin, epi, and norepi in synaptic cleft = STIMULANT!
How can cocaine OD cause death?
secondary to cardiac arrythmia, MI, seizure, or respiratory depression…vasoconstrictive effect
How to manage cocaine OD?
benzos, antipsychotics if very agitated or psychotic, symptomatic support (control HTN, arrhythmias), ice bath for fevers
Mechanism of PCP
antagonizes NMDA glutamate receptors and activates dopminergic neurons can have stimulant or CNS depressant effects depending on dose taken
PCP intoxication symptoms
ROTARY NYSTAGMUS
agitation, aggression, skin erythema, ataxia, HTN, tachycadia, high tolerance to pain (feel like you’re invincible)
How to treat PCP intoxication?
benzos and antipsychotics, supportive therapy
less potent version of PCP
ketamine, “date rape” drug
Of all the kinds of drug withdrawals, withdrawal from ____ has the highest mortality rate
barbituates
GHB gamma hydroxybutyrate
dose specific CNS depressant tha tproduces confusion, dizziness, drowsiness memory less, date-rape drug
How to treat barbituate intoxication
alkalinize urine with sodium bicarb to promote renal excretion
activated charcoal/gastic lavage if taken within the past 4-6 hrs
how to treat BZD overdose?
FLUMAZENIL (short acting BDZ antagonist)
