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
The neuromodulator effect of cannabis is due to decreased uptake of which NT’s?
GABA and Dopamine
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)
What 6 criteria define a Substance Use disorder?
- Use large amount for longer than needed
- Unsuccessful attempts to control use
- Lots of time using
- Craving
- Can’t fulfill major roles (school, work)
- Interpersonal issues bc of use
Define early remission?
Sustained remission?
Controlled environment?
Early remission = no criteria for substance abuse between 3-12mo (except craving)
Late remission = none for over 12mo
Controlled env = access to substance is restricted (jail)
What BAC qualifies as alcohol intoxication?
BAC = .08%
What 3 drug classes may be used for alcohol withdrawal and why?
- Benzo: reduce seizure risk, make pt more comfortable
- Anticonvulsants: reduce seizure risk, Carbamazepine/Valproic acid
- Thiamine
2 drugs for EtOH use disorder
- Naltrexone: hepatotoxic at high levels
- Acamprosate: interacts w GABA and glutamate. Check kidney fxn
Signs on opioid intox?
Withdrawal?
Intox = pinpoint pupil, resp depression, hypoTN/brady
Withdrawal = not life threatening, but very uncomfortable (hot, anxious, wet)
Signs of stimulant intox?
Withdrawal?
Intox = tachy, dilated pupil, HTN, diaphoresis, weight loss
Withdrawal = suicidal depression
What are some risks with cocaine intox?
- Vasocx effects: CVA and MI (get EKG)
- Rhabdomyolysis: compartment syndrome
- Psychosis
- Neuroadaptation: bc prevents reuptake of DA
Signs of MDMA intox?
Common short term problem?
Intox = sensitive to touch, enhanced empathy, tearful, panic, illusions
Problem = extremely HIGH fever
