Chapter 7_Substance Related and Addictive Disorders

Question 1

T/F: Either tolerance or withdrawal is a requirement for substance use disorder

Answer 1

FALSE

Question 2

How long must you have symptoms of substance use in order to be a disorder?

Answer 2

12 month period

Question 3

Two most commonly abused substances?

Answer 3

Alcohol and nicotine

Question 4

Comorbid conditions occurring with substance use

Answer 4

Mood symptoms, MDD and anxiety, psychosis

Question 5

Components of therapy for substance use?

Answer 5

• behavioral counseling
• psychosocial treatments (motivational interviewing, CBT, contingency mgmt, individual/group therapy)
• 12 step programs (AA, NA)
• pharmacotherapy for some drugs

Question 6

Mechanism of alcohol

Answer 6

activates GABA, dopamine and serotonin in CNS
inhibits glutamate and voltage gated Ca channels

= potent CNS depressant

Question 7

How is alcohol metabolized?

Answer 7

Alcohol —> (alcohol dehydrogenase; asians dont have much of this! —> acetaldehyde —> (aledyhyde dehydrogenase) —> acetic acid

Question 8

Alcohol metabolism enzymes are up or downregulated in heavy drinkers?

Answer 8

UPREGULATED

Question 9

What two lab values are usually elevated in PCP intoxication?

Answer 9

Creatine phosphokinase (CPK) and aspartate aminotransferase (AST)

Question 10

Which opoids come up negative on a general screen?

Answer 10

Methadone and oxycodone (must order separate panel)

Question 11

How to prevent Weirnicke’s encephalopathy in setting of alcohol intoxication?

Answer 11

Give thiamine

Question 12

Symptoms of alcohol withdrawal

Answer 12

insomnia, anxiety, tremor, irritability, autonomoic hyperactivity, nausea, vomiting…

can proceed to DT, seizures, hallucinations, delirium

Question 13

How to treat alcohol withdrawal seizures

Answer 13

benzos NOT ANTICONVULSANTS!

Question 14

When does alcohol withdrawal symptoms usually start?

Answer 14

6-24 hours and can last 2-7 days depending on severity

Question 15

When does DT usually present?

Answer 15

48-96 hrs (2-4 days) after last drink

Question 16

How to treat alcohol withdrawal

Answer 16

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

Question 17

What lab levels would suggest heavy alcohol use?

Answer 17

AST:ALT > 2:!, elevated GGT

Question 18

Besides elevation in LFTs, what else can alcohol elevate?

Answer 18

MCV (macrocytosis)

Question 19

2 first line treatments for alcohol use disorder?

Answer 19

naltrexone acamprosate

Question 20

Mechanism of naltrexone

Answer 20

• opoid receptor antagonist
• decreases craving/pleasure from alcohol

-DO NOT GIVE TO PATIENTS WITH OPOID DEPENDENCE ->will induce withdrawal

Question 21

mecahnism of acamprosate

Answer 21

• modulates glutamate

- prevents relapses in patients who have stopped drinking

Question 22

second line treatments for alcohol use disorder

Answer 22

disulfiram and topiramate

Question 23

disulfiram mechanism

Answer 23

blocks enzyme aldehyde dehydrogenase = accumulation of aldehyde = flushing, nausea, vomiting if alcohol is consumed

Question 24

Long term complication of alcohol abuse and what it can progress to?

Answer 24

Weirneck’e encephalopathy - thiamine deficiency; ataxia, confusion, ocular abnormalties (nystagmus)

if left untreated can progress to Korsakokff syndrome (impaired recent memory, anterorade amnesia, confabulation

Question 25

mechanism of cocaine

Answer 25

blocks reuptake of dopamine, serotonin, epi, and norepi in synaptic cleft = STIMULANT!

Question 26

How can cocaine OD cause death?

Answer 26

secondary to cardiac arrythmia, MI, seizure, or respiratory depression…vasoconstrictive effect

Question 27

How to manage cocaine OD?

Answer 27

benzos, antipsychotics if very agitated or psychotic, symptomatic support (control HTN, arrhythmias), ice bath for fevers

Question 28

Mechanism of PCP

Answer 28

antagonizes NMDA glutamate receptors and activates dopminergic neurons can have stimulant or CNS depressant effects depending on dose taken

Question 29

PCP intoxication symptoms

Answer 29

ROTARY NYSTAGMUS

agitation, aggression, skin erythema, ataxia, HTN, tachycadia, high tolerance to pain (feel like you’re invincible)

Question 30

How to treat PCP intoxication?

Answer 30

benzos and antipsychotics, supportive therapy

Question 31

less potent version of PCP

Answer 31

ketamine, “date rape” drug

Question 32

Of all the kinds of drug withdrawals, withdrawal from ____ has the highest mortality rate

Answer 32

barbituates

Question 33

GHB gamma hydroxybutyrate

Answer 33

dose specific CNS depressant tha tproduces confusion, dizziness, drowsiness memory less, date-rape drug

Question 34

How to treat barbituate intoxication

Answer 34

alkalinize urine with sodium bicarb to promote renal excretion

activated charcoal/gastic lavage if taken within the past 4-6 hrs

Question 35

how to treat BZD overdose?

Answer 35

FLUMAZENIL (short acting BDZ antagonist)