Chapter_7_ 2_ SUD Flashcards
What is the mechanism of action of cocaine?
Cocaine blocks the reuptake of dopamine, epinephrine, and norepinephrine, leading to stimulant effects.
What are the key symptoms of cocaine intoxication?
Euphoria, tachycardia, hypertension, dilated pupils, weight loss, psychomotor agitation, hallucinations (tactile), and paranoia.
What are the dangerous effects of cocaine use?
Seizures, myocardial infarction, stroke, hyperthermia, arrhythmias, intracranial hemorrhage.
What kind of hallucinations are common with cocaine intoxication?
Tactile hallucinations (e.g., formication - sensation of bugs crawling on the skin).
Why should beta-blockers be avoided in cocaine intoxication?
Beta-blockers cause unopposed alpha-adrenergic stimulation, leading to severe vasoconstriction and possible MI.
What are the symptoms of cocaine withdrawal?
Fatigue, hypersomnolence, increased appetite, vivid dreams, depression, psychomotor agitation/retardation, suicidal ideation.
Is cocaine withdrawal life-threatening?
No, it is not life-threatening.
How long do withdrawal symptoms last?
Mild-moderate use: 72 hours; Heavy use: 1-2 weeks.
What is the primary treatment for cocaine use disorder?
Supportive care, behavioral therapy (CBT, contingency management), Narcotics Anonymous.
Are there FDA-approved medications for cocaine use disorder?
No FDA-approved medications, but naltrexone, modafinil, and topiramate are sometimes used off-label.
What is the primary neurotransmitter affected by cocaine?
Dopamine (DA) is the main neurotransmitter involved in the reinforcing and addictive effects of cocaine.
What is ‘crack cocaine’ and how does it differ from powdered cocaine?
Crack cocaine is a freebase form that is smoked, leading to a faster and more intense high compared to snorted powdered cocaine.
What are the psychiatric symptoms associated with chronic cocaine use?
Paranoia, hallucinations (mainly tactile), mood swings, aggression, anxiety, repetitive behaviors (stereotypy).
What are the major cardiac risks of cocaine use?
Acute MI, arrhythmias, sudden cardiac death due to coronary vasospasm.
Which psychiatric disorders are most commonly comorbid with cocaine use disorder?
Bipolar disorder, ADHD, antisocial personality disorder, depression.
What is the gold standard test for detecting recent cocaine use?
Urine toxicology screen (detects benzoylecgonine, a metabolite of cocaine).
How long does cocaine stay detectable in urine after last use?
Acute use: 2-4 days, Chronic heavy use: up to 7-14 days.
What is formication and in which condition is it commonly seen?
Formication is a sensation of insects crawling on or under the skin, common in cocaine intoxication.
What is the preferred pharmacologic treatment for agitation and psychosis in cocaine intoxication?
Benzodiazepines (e.g., lorazepam, diazepam) and antipsychotics (haloperidol or second-generation).
What symptoms suggest cocaine-induced rhabdomyolysis?
Muscle pain, dark urine, elevated CK, hyperkalemia, acute renal failure.
What are the key differences between cocaine intoxication and amphetamine intoxication?
Both cause psychomotor agitation and hypertension, but cocaine has a shorter half-life and more tactile hallucinations (formication), while amphetamines cause prolonged psychosis and tooth decay (‘meth mouth’).
What differentiates cocaine withdrawal from opioid withdrawal?
Cocaine withdrawal causes hypersomnia, depression, and intense cravings, while opioid withdrawal causes diarrhea, yawning, and muscle aches.
What is ‘cocaine washout’ and how does it present?
A phase of extreme fatigue, depression, and increased sleep after binge cocaine use.
What is the most effective psychosocial intervention for cocaine addiction?
Cognitive-Behavioral Therapy (CBT), Contingency Management, Motivational Interviewing.
What is the main neuroanatomical site responsible for the reinforcing effects of cocaine?
The nucleus accumbens, part of the brain’s reward system.
What is the mechanism of action of amphetamines?
Amphetamines block reuptake and facilitate release of dopamine and norepinephrine, causing a stimulant effect.
What are the key symptoms of amphetamine intoxication?
Euphoria, dilated pupils, increased libido, tachycardia, perspiration, teeth grinding (bruxism), chest pain.
What are the severe complications of amphetamine use?
Hyperthermia, hypertension, stroke, myocardial infarction, rhabdomyolysis, acute kidney injury.
Which psychiatric symptoms are common in chronic amphetamine users?
Paranoia, hallucinations (visual and auditory), mood swings, aggression, stereotyped behaviors.
What is ‘meth mouth’ and why does it occur?
Severe tooth decay in chronic methamphetamine users due to dry mouth, poor hygiene, and teeth grinding.
Which conditions can amphetamines be prescribed for?
ADHD, narcolepsy, obesity (rare).
What is the first-line treatment for amphetamine intoxication?
Benzodiazepines (lorazepam, diazepam) to control agitation, hypertension, and seizures.
How long can amphetamines be detected in urine?
1-3 days for casual users; up to 7 days for chronic users.
What is the treatment for amphetamine-induced psychosis?
Antipsychotics (haloperidol or atypical antipsychotics) and benzodiazepines.
What are the symptoms of amphetamine withdrawal?
Same like cocain
Fatigue, depression, increased sleep, increased appetite, vivid dreams, psychomotor slowing.
Is amphetamine withdrawal life-threatening?
No, but severe depression and suicidal ideation can occur.
What is the main psychosocial treatment for amphetamine use disorder?
Cognitive-Behavioral Therapy (CBT) and contingency management.
Which drug is sometimes used off-label for amphetamine use disorder?
Modafinil, Bupropion, or Naltrexone (no FDA-approved medication).
What is the most serious medical emergency related to MDMA (ecstasy) use?
Hyperthermia and hyponatremia, which can cause seizures and death.
How does amphetamine toxicity differ from cocaine toxicity?
Both cause stimulant effects, but amphetamine effects last longer and include more severe psychosis and stereotyped behaviors.
What is the classic triad of amphetamine intoxication?
Tachycardia, Mydriasis (dilated pupils), and Hypertension.
What is the key feature that differentiates amphetamine intoxication from serotonin syndrome?
Hyperreflexia and clonus are more common in serotonin syndrome, while amphetamine intoxication presents with increased psychomotor activity and aggression.
Which type of hallucinations are most common in amphetamine intoxication?
Visual and auditory hallucinations.
What is the best initial step in managing a patient with severe agitation due to amphetamine use?
Administer benzodiazepines (e.g., lorazepam, diazepam) to calm the CNS.
What are the long-term neurological effects of chronic amphetamine use?
Cognitive impairment, memory deficits, and neurotoxicity due to dopamine depletion.
‘Meth = Memory Meltdown’.
What medical emergency should you suspect in a patient using MDMA (ecstasy) with confusion, hyperthermia, and seizures?
MDMA-induced hyponatremia and serotonin syndrome.
What is the most common psychiatric disorder comorbid with amphetamine use?
Attention-deficit hyperactivity disorder (ADHD).
How does amphetamine toxicity increase the risk of cardiovascular disease?
Causes vasoconstriction, leading to myocardial infarction, stroke, and sudden cardiac death.
What is the treatment for amphetamine-induced psychosis?
Benzodiazepines and antipsychotics (e.g., haloperidol or second-generation atypical antipsychotics).
What laboratory test is used to detect amphetamine use?
Urine toxicology screen (detects amphetamines for 1-3 days, up to 7 days in chronic users).
How do you differentiate amphetamine withdrawal from opioid withdrawal?
Amphetamine withdrawal causes hypersomnia, depression, and cravings, while opioid withdrawal causes diarrhea, yawning, and muscle aches.
Why are beta-blockers contraindicated in amphetamine intoxication?
They cause unopposed alpha-adrenergic stimulation, leading to severe vasoconstriction and hypertension.
What is the most effective psychosocial intervention for amphetamine addiction?
Cognitive-Behavioral Therapy (CBT) and contingency management.
Which medications are sometimes used off-label for amphetamine use disorder?
Modafinil, Bupropion, or Naltrexone (no FDA-approved medication).
What is a ‘Tweaker’ in the context of methamphetamine use?
A person experiencing severe agitation, paranoia, and erratic behavior due to prolonged meth use.
What is Meth Crystal?
‘Crystal = Clear & Crazy High’ - intense stimulant effects.
A highly purified, crystalline form of methamphetamine that is smoked, snorted, injected, or ingested for a rapid and intense high.
What is Meth Mouth?
‘Meth Mouth = Meth + Missing Teeth’.
Severe dental decay in methamphetamine users due to dry mouth (xerostomia), teeth grinding (bruxism), and poor hygiene.
What is Meth Face?
A condition in chronic meth users characterized by skin sores, acne, and scarring from compulsive skin picking (excoriation).
What are the key symptoms of PCP intoxication?
Violence, nystagmus (vertical/horizontal), psychosis, agitation, tachycardia, hyperreflexia, ataxia.
What is the treatment for PCP intoxication?
Benzodiazepines for agitation, antipsychotics (haloperidol) if needed, acidification of urine (ammonium chloride).
What are the symptoms of benzodiazepine intoxication?
CNS depression, slurred speech, ataxia, memory impairment, respiratory depression (rare alone).
What is the antidote for benzodiazepine overdose?
Flumazenil (rarely used due to seizure risk).
How does barbiturate intoxication differ from benzodiazepine intoxication?
More severe respiratory depression and risk of coma/death.
What are the key symptoms of cannabis intoxication?
Euphoria, relaxation, increased appetite, dry mouth, conjunctival injection (red eyes), tachycardia.
What are the withdrawal symptoms of cannabis?
Irritability, insomnia, anorexia, nausea, sweating, restlessness.
What are common inhalants and their effects?
Glue, paint, nitrous oxide. Causes euphoria, dizziness, slurred speech, liver/kidney damage.
What is the classic sign of chronic inhalant use?
Glue sniffer’s rash (perioral dermatitis).
What are the symptoms of caffeine intoxication?
Restlessness, insomnia, diuresis, tachycardia, palpitations, GI upset.
What are the symptoms of caffeine withdrawal?
Headache, fatigue, irritability, difficulty concentrating.
What are the symptoms of nicotine withdrawal?
Irritability, anxiety, craving, restlessness, increased appetite, weight gain.
What are first-line treatments for nicotine dependence?
Nicotine replacement therapy, varenicline, bupropion.
What are the symptoms of opioid intoxication?
Euphoria, respiratory depression, pinpoint pupils, sedation, constipation.
What is the antidote for opioid overdose?
Naloxone (opioid antagonist).
What are the symptoms of opioid withdrawal?
Yawning, lacrimation, rhinorrhea, sweating, piloerection, diarrhea, myalgias.
What are the diagnostic criteria for gambling disorder?
Persistent gambling despite negative consequences, preoccupation with gambling, inability to stop, financial problems.
What is the best treatment for gambling disorder?
Cognitive-behavioral therapy (CBT), support groups (Gamblers Anonymous).
A patient presents with violent behavior, vertical nystagmus, and psychosis. What is the likely substance involved?
PCP intoxication.
A patient with pinpoint pupils, respiratory depression, and coma is found unresponsive. What is the treatment?
Naloxone administration (opioid overdose).
A patient presents with nausea, sweating, rhinorrhea, dilated pupils, and diarrhea. What is the likely withdrawal?
Opioid withdrawal.
What is the treatment for severe alcohol withdrawal with hallucinations and seizures?
Benzodiazepines (e.g., lorazepam, diazepam).
What is the DSM-5 criteria for Substance Use Disorder?
Impaired control, social impairment, risky use, pharmacological criteria (tolerance, withdrawal). Must meet 2+ criteria within 12 months.
What is the CAGE questionnaire and how is it used?
Screening tool for alcohol use disorder: Cut down, Annoyed, Guilty, Eye-opener. 2+ positive answers suggest problem drinking.
What are the stages of alcohol withdrawal and their timeline?
6-12 hrs: Tremors, anxiety; 12-24 hrs: Hallucinations; 24-48 hrs: Seizures; 48-72 hrs: Delirium tremens.
What medications are used for alcohol use disorder treatment?
Naltrexone (first-line), acamprosate (for abstinence), disulfiram (aversion therapy).
What is the treatment for benzodiazepine withdrawal?
Long-acting benzodiazepines (diazepam, clonazepam) with gradual taper.
What is ‘Meth Mouth’ and why does it occur?
Severe dental decay due to dry mouth, poor hygiene, and bruxism (teeth grinding) from methamphetamine use.
How does MDMA (Ecstasy) affect neurotransmitters?
Increases serotonin, dopamine, and norepinephrine; can cause serotonin syndrome.
What are the classic symptoms of LSD intoxication?
Visual hallucinations, synesthesia, depersonalization, paranoia, euphoria.
What is the treatment for hallucinogen intoxication?
Supportive care, benzodiazepines if needed for agitation.
What is the mechanism of action of varenicline?
Partial agonist at nicotinic acetylcholine receptors, reduces cravings and blocks effects of nicotine.
What is the difference between methadone and buprenorphine for opioid use disorder?
Methadone is a full opioid agonist (long half-life), buprenorphine is a partial agonist with a ceiling effect (less respiratory depression).
What is precipitated withdrawal and when does it occur?
Rapid withdrawal symptoms after administering naloxone or buprenorphine too soon.
What are first-line treatments for gambling disorder?
Cognitive Behavioral Therapy (CBT) and SSRIs, naltrexone for impulsivity.
What are the shared brain pathways between gambling and substance addiction?
Dopamine release in the nucleus accumbens, similar to drug addiction.
A patient presents with dilated pupils, sweating, aggression, and chest pain. What is the likely drug intoxication?
Cocaine or amphetamine intoxication.
A patient in alcohol withdrawal is hallucinating but has a normal sensorium. What is the diagnosis?
Alcoholic hallucinosis (different from delirium tremens, no clouding of consciousness).
A heroin user is found unresponsive with pinpoint pupils and low respiratory rate. What is the immediate treatment?
Naloxone (opioid antagonist).
A patient with chronic pain is suspected of opioid misuse. What screening tool can be used?
The SOAPP (Screener and Opioid Assessment for Patients with Pain) tool.
What is the treatment for life-threatening benzodiazepine withdrawal?
IV benzodiazepines (diazepam, lorazepam) and ICU monitoring.
What is the gold standard treatment for delirium tremens?
IV benzodiazepines (lorazepam, diazepam) and supportive care.
What is the best indicator of severe alcohol withdrawal?
Autonomic instability (tachycardia, hypertension, fever, diaphoresis).
What is the primary treatment for cocaine-induced psychosis?
Benzodiazepines for agitation and antipsychotics if needed.
Which cardiovascular complication is most commonly associated with cocaine use?
Myocardial infarction due to coronary vasospasm.
What is the black box warning for varenicline?
Neuropsychiatric symptoms (suicidal ideation, depression, agitation).
Which medication for nicotine dependence is contraindicated in patients with seizure history?
Bupropion (lowers seizure threshold).
Which medication is preferred for opioid use disorder in pregnant women?
Methadone (buprenorphine is an alternative).
What is the hallmark symptom of opioid withdrawal?
Yawning and piloerection.
What are the distinguishing features of LSD intoxication?
Visual hallucinations, synesthesia, depersonalization, paranoia.
What differentiates PCP intoxication from other hallucinogens?
Aggressive behavior, vertical/horizontal nystagmus, muscle rigidity.
What is the most dangerous complication of benzodiazepine withdrawal?
Seizures and delirium.
What differentiates barbiturate withdrawal from benzodiazepine withdrawal?
More severe cardiovascular collapse and risk of death.
What brain region is most involved in gambling addiction?
Nucleus accumbens (dopamine reward system).
Which pharmacologic treatment is sometimes used for gambling disorder?
Naltrexone (reduces reward-seeking behavior).
What is a serious complication of chronic nitrous oxide use?
B12 deficiency leading to peripheral neuropathy.
What are common signs of inhalant use?
Perioral rash, dizziness, euphoria, ataxia.
A patient presents with restlessness, excessive yawning, lacrimation, piloerection, and diarrhea. What is the likely diagnosis?
Opioid withdrawal.
Which long-term medication is FDA-approved for both alcohol and opioid use disorder?
Naltrexone.
A patient presents with new-onset paranoia, dilated pupils, and palpitations. What is the most likely cause?
Cocaine or amphetamine intoxication.
Which neurotransmitter is most responsible for the reinforcing effects of addictive drugs?
Dopamine.
A heroin user is found unresponsive with pinpoint pupils and slow breathing. What is the first step in management?
Administer naloxone.
A patient who drinks alcohol daily presents with new-onset confusion, ophthalmoplegia, and ataxia. What is the likely diagnosis?
Wernicke’s encephalopathy (thiamine deficiency).
What is the first-line treatment for severe alcohol withdrawal?
Benzodiazepines.
A patient presents with violent behavior, vertical nystagmus, and psychosis. What is the most likely substance involved?
“A) Cocaine, B) PCP, C) Heroin, D) LSD” cell
B) PCP
Which of the following is the best treatment for PCP intoxication?
A) Flumazenil, B) Benzodiazepines, C) Beta-blockers, D) Naloxone”
B) Benzodiazepines
What is the antidote for benzodiazepine overdose?
A) Flumazenil, B) Naloxone, C) Naltrexone, D) Activated charcoal”
A) Flumazenil
Which withdrawal syndrome is the most life-threatening?
“A) Opioid withdrawal, B) Cocaine withdrawal, C) Alcohol/Benzodiazepine withdrawal, D) Nicotine withdrawal”
C) Alcohol/Benzodiazepine withdrawal
Which of the following is NOT a symptom of cannabis intoxication?
A) Euphoria, B) Increased appetite, C) Bradycardia, D) Conjunctival injection”
C) Bradycardia
A patient using marijuana regularly reports irritability, insomnia, and decreased appetite after stopping. What is the diagnosis?
A) Cannabis withdrawal, B) Cannabis intoxication, C) Opioid withdrawal, D) Alcohol withdrawal”
A) Cannabis withdrawal
Which of the following is a common sign of chronic inhalant use?
A) Hyperreflexia, B) Glue sniffer’s rash, C) Miosis, D) Bradycardia”
B) Glue sniffer’s rash
Chronic nitrous oxide use is associated with which deficiency?
A) Vitamin C, B) Vitamin B12, C) Folate, D) Iron”
B) Vitamin B12
Which of the following is a symptom of caffeine intoxication?
“A) Fatigue, B) Bradycardia, C) Palpitations, D) Hypotension”
C) Palpitations
A patient reports headache, irritability, and difficulty concentrating after quitting coffee. What is the likely diagnosis?
A) Caffeine withdrawal, B) Nicotine withdrawal, C) Alcohol withdrawal, D) Opioid withdrawal”
A) Caffeine withdrawal
Which of the following is a first-line pharmacologic treatment for nicotine dependence?
“A) Disulfiram, B) Varenicline, C) Methadone, D) Naloxone”
B) Varenicline
Which medication for nicotine cessation is contraindicated in patients with a history of seizures?
A) Bupropion, B) Varenicline, C) Nicotine patches, D) Buspirone”
A) Bupropion
A patient presents with pinpoint pupils, respiratory depression, and unresponsiveness. What is the treatment?
A) Naloxone, B) Flumazenil, C) Naltrexone, D) Diazepam”
A) Naloxone
Which medication is FDA-approved for both alcohol and opioid use disorder?
A) Acamprosate, B) Disulfiram, C) Naltrexone, D) Bupropion”
C) Naltrexone
Which opioid withdrawal symptom is most characteristic?
A) Pinpoint pupils, B) Respiratory depression, C) Yawning and piloerection, D) Seizures”
C) Yawning and piloerection
What is the preferred opioid maintenance therapy in pregnant women?
) Buprenorphine, B) Methadone, C) Naltrexone, D) Clonidine”
B) Methadone
Which brain region is most associated with gambling addiction?
A) Prefrontal cortex, B) Nucleus accumbens, C) Hippocampus, D) Amygdala”
B) Nucleus accumbens
Which of the following is a first-line treatment for gambling disorder?
A) Naltrexone, B) CBT, C) Disulfiram, D) Antipsychotics”
B) CBT
A patient in alcohol withdrawal is hallucinating but has a normal sensorium. What is the diagnosis?
A) Delirium tremens, B) Alcoholic hallucinosis, C) Wernicke’s encephalopathy, D) Korsakoff syndrome”
B) Alcoholic hallucinosis
Which of the following substances causes serotonin syndrome when combined with MAOIs?
“A) Cocaine, B) MDMA (Ecstasy), C) Alcohol, D) Opioids”
B) MDMA (Ecstasy)
Which stimulant has the highest risk of causing ‘meth mouth’?
“A) PCP, B) Heroin, C) Alcohol, D) Cannabis
B) Methamphetamine
Which substance has the highest likelihood of leading to violent behavior?
“A) Opioids, B) Cannabis, C) Cocaine, D) PCP”
A) PCP
A 30-year-old male presents with paranoia, tachycardia, and dilated pupils. What is the most likely substance used?
A) Opioids, B) Cannabis, C) Cocaine, D) PCP
C) Cocaine
A patient reports taking a drug that made them ‘see sounds’ and ‘hear colors.’ Which substance is most likely?
“A) PCP, B) LSD, C) Methamphetamine, D) Alcohol”
B) LSD
What is the primary neurotransmitter involved in the reward system of substance use disorders?
“A) GABA, B) Dopamine, C) Serotonin, D) Norepinephrine”
B) Dopamine
Which withdrawal syndrome is most likely to cause seizures?
“A) Alcohol, B) Opioids, C) Cannabis, D) Cocaine”
A) Alcohol
A heroin user is found unresponsive with pinpoint pupils and slow breathing. What is the first step in management?
A) Intubation, B) Flumazenil, C) Naloxone, D) Activated charcoal”
C) Naloxone
pupil changes in substance intoxication
Cocaine/Amphetamines
PCP
Cannabis
Opioids
Sedatives/Alcohol
Cocaine/Amphetamines Mydriasis (Dilated)
PCP Normal/Dilated + Nystagmus
Cannabis Mildly Dilated
Opioids Miosis (Pinpoint)
Sedatives/Alcohol Normal/Dilated (Sluggish)
