Cooley: Substance Abuse Flashcards
What is the definition of addiction?
- Primary, chronic disease of brain reward, motivation, memory and related circuitry
- Pathologically pursuing reward and/or relief by substance use and other behaviors***
For diagnosis of a substance-induced mental disorder there is evidence from the hx, PE, or labratory findings of what 2 things?
- Disorder developed during or within 1 month of a substance intoxication or withdrawal or taking a medication
and
- The involved substance/medication is capable of producing the mental disorder
What are 2 pieces of evidence which would indicate that a mental disorder is independent and not substance-induced?
- The disorder preceded the onset of severe intoxication or withdrawal or exporsure to the medication
or
- The full mental disorder persisted for a substantial period of time (i.e. at least 1 month) after the cessation of acute withdrawal or severe intoxication or taking the medication
When do seizures most often arise during alcohol withdrawal?
24-48 hrs; most often Grand mal
When does withdrawal delirium (DTs) develop during alcohol withdrawal?
48-72 hrs
What is the most severe manifestation of alcohol withdrawal?
Delirium Tremens
- Occurs 3-10 days after last drink
What are the signs/sx’s of delirium tremems; what is the hallmark?
- Agitation + global confusion + disorientation + hallucinations + fever + HTN + diaphoresis + autonomic hyperactivity = tachycardia + HTN
- Hallmark = profound global confusion
What does CIWA stand for and what is it used for?
Clinical Institute Withdrawal Assessment for Alcohol
- Assigns numerical values to orientation, N/V, tremor, sweating, anxiety, agitation, tactile/auditory/visual disturbances and HA
- Total score >10 indicates more severe withdrawal
Which 3 benzodiazepines are metabolized through glucuronidation in liver and can be used in the setting of alcohol and other withdrawals?
Lorazepam, Temazepam, & Oxazepam
Liver Takes Ox
What are 3 reasons that methadone is a high risk medication?
- Can be deadly when used with a benzodiazepine***
- Frequently causes QTC prolongation - sometimes fatal
- Dangers ↑ when used with another 3A4 substrate!***
If a methadone maintenance patient is encountered in the ED and needs pain management what is the proper protocol?
- Provider calls on-call service at methadone clinic and verifies dosage
- The correct methadone dosage is continued while patient is hospitalized
- If additional pain mangement is required use another opioid: not another CYP3A4 substrate and no benzos!
- Do not use methadone as this will possibly disrupt the response to current methadone maintenance dosing
What is a serious mental AE associated with chronic intoxication of stimulants?
Psychosis: sometimes with severe paranoia
Cocaine works mainly by preventing the reuptake of what?
Dopamine: causes neuroadaptation
Amphetamines can be fatal at lower doses in the setting of what underlying disease?
What is another risk w stimulant use?
- Brugada syndrome: inc the chance of irregular heart rhythms
- Neuroadaptation: bc inh reuptake of DA, NE, and 5HT
Adolescent males who use cannabis regularly have a 7-fold increased risk of?
Psychosis
What are the cerebellar sx’s of PCP intoxication?
With severe OD?
- Ataxia, dysarthria, and NYSTAGMUS (vertical and horizontal)
- Severe OD = HTN, hyperthermia, rhabdomyolysis, seizures, coma, death
What are the 2 neuroadaptive effects of PCP?
- Opiate receptor effects
- Allosteric modulator of glutamate NMDA receptor
What predisposes a pt to the addictophrenia spectrum?
Genetic hx: addictive disorders, mood disorders, personality disorders, criminal behavior
Personal hx: polysubstance abuse, trauma (earlier = more predictive), stressors @ young age, borderline personality
Substance abuse comorbidities (3)
