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Maddy - NMSP Exam I - psych pharm > Clin - Substance Abuse > Flashcards

Clin - Substance Abuse Flashcards

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1
Q

compare addiction and physical dependency

A

addiction: chronic disease of brain reward, motivation, memory, and related circuitry –> pathological pursuit of reward and/or relief by substance

physical dependency: development of tolerance and physical dependence denote normal physiological adaptations of the body to the presence of an opioid

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2
Q

describe the reward deficiency syndrome

A

a result of dopamine-system malfunction
–> a clinically significant deficiency of the essential neurotransmitter–Dopamine in the brain’s Reward Center

causes vulnerability to addiction

can be caused by genetics or environmental factors

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3
Q

aspects of a pts history that can lead to addictophrenia spectrum

A
  • addictive disorders
  • intractable mood disorders
  • personality disorder or habitual criminal behavior
  • polysubstance abuse
  • trauma
  • chronic psychosocial stressors
  • borderline personality disorder
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4
Q

describe substance abuse comorbidity

A 
50% of addicts have a 
comorbid psychiatric disorder
- antisocial PD
- depression
- suicide
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5
Q

what is the diagnostic criteria for substance use disorders

A

1) using larger amounts for longer time than intended
2) persistent desire or unsuccessful attempts to cut down or control use
3) great deal of time obtaining, using, or recovering
4) craving
5) fail to fulfill major roles (work, school, home)
6) persistent social or interpersonal problems caused by substance abuse
7) important social, occupational, recreational activities given up or reduced
8) use in physically hazardous situations
9) use despite physical or psychological problems caused by use
10) tolerance
11) withdrawal

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6
Q

how to define severity of substance abuse

A

mild: 2-3 sx
moderate: 4-5 sx
severe: 6+ sx

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7
Q

compare early remission and sustained remission for substance use

A

early remission: no criteria for >3 months but <12 months

sustained remission: no criteria for >12 months except craving

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8
Q

diagnostic criteria for substance-induced mental disorders

A

1) disorder developed during or within 1 month of a substance intoxication or withdrawal
2) the involved substance/med is capable of producing the mental disorder
3) disorder does not occur during the course of a delirium

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9
Q

what is neuroadaptation

A

underlying CNS changes that occur following repeated use such that the person develops tolerance and/or withdrawal

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10
Q

when do you hospitalize a substance abuse patient

A

due to drug OD, risk of severe withdrawal, medical co-morbidities, requires restricted access to drugs, or psych illness with suicidal ideation

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11
Q

when do you use a residential treatment unit for a substance abuse patient

A
  • no intensive medical/psych monitoring needs
  • require a restricted environment
  • partial hospitalization
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12
Q

when do you use an outpatient program for a substance abuse patient

A

when there is no risk of med/psych morbidity and have a highly motivated patient

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13
Q

what are outpatient treatment options for substance abuse patients

A
  • motivational interviewing in primary care setting
  • 12 step
  • AA
  • narcotics anonymous
  • CBT
  • therapeutic communities
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14
Q

describe the features of alcohol withdrawal

A

early: anxiety, irritability, tremors, HA, insomnia, nausea, tachycardia

24-48 hours: seizures (grand mal)

48-72 hours: withdrawal delirium

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15
Q

describe the most severe manifestation of alcohol withdrawal and when does it occur

A

delirium tremens: agitation, profound global confusion, disorientation, hallucinations, fever, HTN, diaphoresis

occurs 3-10 days after last drink

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16
Q

what does the CIWA (clinical institute withdrawal assessment for alcohol) do

A

assigns numerical values to orientation, N/V, tremors, sweating, anxiety, agitation, tactile/auditory/visual disturbances and HA

total score >10 indicates more severe withdrawal

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17
Q

what medications are given for alcohol withdrawal

A
  • benzos
  • anticonvulsants
  • thiamine supplementation
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18
Q

what harm can disulfiram cause

A
  • when alcohol ingested: vasodilation, flushing, N/V, hypotension/HTN, coma/death
  • hepatotoxicity
  • polyneuropathy/paresthesias
  • psychosis, depression, confusion, anxiety
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19
Q

what medications are given for alcohol use disorder

A
  • naltrexone 50mg PO daily

- acamprosate 666mg PO TID

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20
Q

benzo withdrawal sx

A

anxiety, irritability, insomnia, fatigue, HA, tremor, sweating, poor concentration

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21
Q

how to outpatient taper a pt off of benzos

A

decrease dose every 1-2 weeks and not more than 5mg diazepam equivalent

5 diazepam = 0.5 alprazolam = 25 chlordiazepoxide = 0.25 clonazepam = 1 lorazepam

22
Q

what medications should you use for rapid taper off of benzos

A

carbamazepine or valproic acid

23
Q

sx of opioid intoxication

A

pinpoint pupils, sedation, constipation, bradycardia, hypotension, decrease respiratory rate

24
Q

sx of opioid withdrawal

A

NOT LIFE THREATENING

  • extremely uncomfortable
  • dilated pupils
  • lacrimation
  • goosebumps
  • N/V/diarrhea
  • myalgias, arthralgias
25
Q

treatment for opioid withdrawal

A

symptomatically w/ antiemetic antacid, antidiarrheal, muscle relaxant, NSAIDs, clonidine

26
Q

medications for opiate use disorder

A
  • methadone
  • naltrexone
  • buprenorphine
27
Q

what are the potential problems with methadone treatment for opioid use disorder

A

HIGH RISK MEDICATION

  • can be deadly when used with a benzo
  • frequently causes QTC prolongation
  • dangers increase when used with another 3A4 substrate
  • can be fatal
28
Q

signs of chronic stimulant intoxicatoin

A

affective blunting, fatigue, sadness, social withdrawal, hypotension, bradycardia, muscle weakness
- psychosis —> sometimes with paranoia

29
Q

severe complications of cocaine use

A

can get rhabdomyolysis with compartment syndrome from the hypermetabolic state

30
Q

treatment for stimulant use disorder

A
  • narcotics anonymous

- chemical dependency treatment including support, education, life skills

31
Q

effects of chronic amphetamine use

A

neurotoxicity possibly from glutamate and axonal degeneration

fatality in the setting of brugada syndrome

32
Q

drug interactions with tobacco

A

induces CYP1A2

33
Q

tobacco withdrawal symptoms

A

dysphoria, irritability, anxiety, decreased concentration, insomnia, increased appetite

34
Q

treatment for tobacco use disorder

A
  • CBT

- agonist substitution therapy (nicotine gum, patch)

35
Q

medication for tobacco use disorder

A

bupropion or varenicline

36
Q

list the hallucinogens

A
  • naturally occurring: peyote cactus, magic mushrooms
  • LSD
  • DM
  • STP
  • MDMA
37
Q

sx of MDMA (ecstacy) intoxication

A

illusions, hyperacusis (hearing), sensitivity of touch/taste/smell, tearfulness, euphoria

3-6 hours

38
Q

what are some short term problem with MDMA use

A

EXTREMELY HIGH FEVER

  • tachycardia
  • sweating
  • muscle spasms
39
Q

if patient presents appearing intoxicated with an extremely high fever, what should you suspect

A

MDMA use

40
Q

severe effects from MDMDA use

A

high fever can progress to rhabdomyolysis, renal failure, seizures, DIC, arrhythmias, death

41
Q

withdrawal sx of cannabis use

A

insomnia, irritability, anxiety, poor appetite, depression, physical discomfort

42
Q

treatment for cannabis withdrawal

A
  • detox and rehab
  • behavioral model
  • no specific pharm tx
43
Q

sx of PCP intoxication

A

severe dissociative reactions –> paranoid delusions, hallucinations, agitation/violence, decreased awareness of pain

44
Q

severe sx of PCP intoxication

A

NYSTAGMUS (HORIZONTAL AND VERTICAL)

also mute, catatonic, muscle rigidity, HTN, hyperthermia, rhabdomyolysis, seizures, coma/death

45
Q

pt comes in with signs of intoxication and nystagmus, what should you suspect

A

PCP intoxication

46
Q

treatment for PCP use

A
  • antipsychotic drugs or BZD
  • low stimulation environment
  • acidify urine if severe toxicity
47
Q

is there tolerance or withdrawal with PCP use?

A

nope

48
Q

describe the neuroadaptation of PCP use

A

allosteric modulator of glutamate NDMA receptor

49
Q

describe the neuroadaptation of MDMA use

A

affects serotonin, dopamine, NE receptors

predominantly serotonin receptor agonist

50
Q

describe the neuroadaptation of amphetamine use

A

inhibits reuptake of dopamine, NE, and serotonin

greatest effect on dopamine

51
Q

describe the neuroadaptation of cocaine use

A

prevents reuptake of dopamine

Maddy - NMSP Exam I - psych pharm (23 decks)

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