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662 > Drugs of Abuse > Flashcards

Drugs of Abuse Flashcards

1
Q

Opiate drug testing

Usual UDS’s test for?

What is the standard cutoff for testing?

A
  • Tests for Codeine and Morphine metabolites usually
  • Cutoff is 2000 ng/ml
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2
Q

What are the barriers to naloxone use?

A
  • State law
  • Physician liability
  • Bystander liability
  • fear of being prosecuted (bystander)
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3
Q

What are the only drugs that will show up on a normal opioid drug screen

A
  • Heroin
  • Codeine
  • Morphine
  • Hydromorphone
  • Hydrocodone
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4
Q

What is the confirmatory test that is done if a patient preimptively tests positive for a substance?

A

Mass spec

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5
Q

Buprenorphine/ Naloxone? Advantages?

A

They cant shoot this up because it wont work due to the naloxone

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6
Q

Treatment of opioid intoxication or OD?

A

Naloxone max 10 mg

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7
Q

Your body has adapted to the medication and if you dont take it youll get withdrawals

A

Physical Dependence

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8
Q

Naltrexone for maintenance

A
  • Must be detoxified prior to using
  • Many compliance issues
  • Monitor LFTs
  • Vivitrol- monly IM injection
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9
Q

Consequence of IV opioids?

A
  • Mood disorder, Dementia
  • Infection, Endocarditis
  • Disease, HIV, Hep, STD
  • Overdose
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10
Q

Symptoms based treatment

Agitation?

Insomnia?

Headache, aches?

Abdominal cramps?

Diarrhea?

A
  • Clonidine
  • Diphenhydramine, Trazodone, Hydroxyzine
  • NSAID, Acetaminophen
  • Dicyclomine
  • Bismuth subcarbonate
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11
Q

Treatment options and supportive care for AWS?

A
  • Thiamine
  • Folic Acid
  • Magnesium
  • Multivitamin
  • Fluids
    • Bananas bag- NS, Thiamine, Folic Acid, MVI
  • Nonpharm
    • Quiet environment, Reduced light
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12
Q

Effects of opiates?

A
  • Mood changes/depression
  • Drowsiness
  • Inability to concentrate
  • Flushing in face and neck
  • Constipation
  • N/V
  • Respiratory depression
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13
Q

WHy is Rx drug abuse increasing?

A
  • Consumer
  • Industry
  • Physician
  • Society
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14
Q

Other OTC or Rx abused meds?

A
  • Cough meds
  • Synthetic drugs (K2, Spice)
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15
Q

Types of narcotics?

A
  • Opium
  • Morphine
  • Codeine
  • Hydromorphone
  • Oxy
  • Fentanyl
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16
Q

What are the symptoms of Karsakoff Psychosis?

A
  • Psychosis
  • Retrograde amnesia
  • Confabulation
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17
Q

Why do people abuse opiates?

A
  • Euphoric feeling
  • Avoid emotional pain
  • Avoid physical pain
  • Supress withdrawal symptoms
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18
Q

What is the long acting benzo used for AWS?

Why could this potentially be harmful?

A
  • Chlordiazepoxide
    • Its metabolized in the liver but is very long acting this can pose problems due to decreased liver function in alcoholics
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19
Q

What increases the risk of developing alcohol withdrawal syndrome? 2 of them

A
  1. At least 3 months of daily alcohol consumption
  2. Consumption of large quantities for the past week
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20
Q

What increases your risk for Delirium Tremens (DT)

A
  • Previous DT
  • Hx of using equivalent to 1 pint of whiskey per day for the last 10-14 days
  • Cirrhosis (enlarged liver)
  • Early onset alcohol withdrawal
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21
Q

What are the common Rxs of abuse?

A
  • Opiates
  • Benzos
  • Stimulants
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22
Q

Medications that can cause positive results for THC UDS

A
  • Efavirenz
    • Metabolite interferes with antibodies in immunoassay
  • NSAIDs
    • Conflicting studies
  • Pantoprazole
  • Dronabinol (Synthetic THC) Its a positive
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23
Q

What is naltrexones role in Alcohol Abstinence?

Been shown to reduce?

What to monitor?

A
  • It may reduce the reward that is associated with drinking
  • Been shown to reduce cravings, number of drinks, and relapse
  • Monitor LFT
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24
Q

Detoxification?

A
  • Methadone
  • Bupronorphine
  • Other opioids
  • Symptomatic treatment (just when symptoms come up)
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25
Q

Before you interpret someones drug test you need?

A
  • Detailed Med Hx
    • Prescription
    • OTC
    • Herbal
  • Documentation of last use
  • Knowledge of which medications, metabolites can complicate accurate interpretation
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26
Q

A limitation of urine drugs tests?

A

That if someone has just smoked or used they must be given at least 2 hours before testing, otherwise the results will be inconclusive.

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27
Q

Treatments of withdrawal?

Difference?

A

Detoxification - get them off the drug

Maintenance- prevent relapse stay on something forever

28
Q

Addiction?

3 Cs

A
  • Chronic Disorder characterized by compulsive use
  • Continue to use despite adverse consequences
  • Lost control
  • Denies there is a problem
29
Q

Wernickes Syndrome can lead to?

Reversible non reversible?

A
  • Karsakoff Psychosis (irreversible)
30
Q

Signs and symptoms of opioid overdose or intoxication?

A
  • Pinpoint pupils
  • Cold clammy skin
  • Blue/pale lips
  • Confusion
  • Severe drowsiness (cant wake up)
  • respiratory depression
31
Q

What can cause a false positive for opioids?

A
  • Fluoroquinolones
  • Dextromethorphan
  • Quinine
  • Rifampin
  • Methadone specific assay
    • Diphenhydramine
    • Verapamil
32
Q

Why do people abuse drugs?

A
  • Getting high
  • Pain relief, anxiety, and increase alertness
  • Peers
  • Easy access
  • Pure and cheap
  • Less “Harmful”
  • Less likely risk of arrest
33
Q

Carbamazepine can be used to decrease incidence of?

A

AW seizures

34
Q

Amphetamine UDS

A
  • Lots of false positives
    • Its all cross reactive
  • Amphetamine
  • Methamphetamine
  • MDMA
35
Q

What are the naloxone rescue kits for patients and families?

A
  • Intranasal
  • Intramuscular
  • Evzio (autoinjector)
36
Q

Prescritption drugs that will give you a true positive for amphetamine?

False positives?

A
  • Selegiline
  • ADHD meds
  • vicks nasal spray
  • Pseudoephedrine, Methylphenidate, Phentermine, Bupropion, Chlorpromazine, Desipramine, Ephendrine, Ranitide, many others
37
Q

Oxycodone abuse?

A
  • Snorting
  • Chewing
  • Injection
38
Q

Detoxification with Buprenorphine/Naloxone

A
  • Once induction is established start dose reduction, 10-14 days usually
39
Q

Who is at risk for OD?

A
  • Using alcohol and BDZ
  • High opioid dosing
  • Polypharm
  • Methadone
  • Recent OD
  • Hx of abuse
  • Comorbidities
40
Q

Treatment of AWS drug of choice?

What does it help?

A
  • Benzos
  • Reduces
    • Severity of withdrawal
    • Incidence of seizure
    • Incidence of delirium
41
Q

Thiamine deficiency can cause?

A
  • Wernickes syndrome
42
Q

Maintenance for Buprenorphine/ Naloxone

A
  • Induction phase
  • Stabilization
  • Long term (can be forever)
43
Q

Most drugs stay in your urine for about?

Ones that are longer than that?

A

PCP-5-7 days

THC up to 30 days maybe even longer

44
Q

Adjunctive treatment?

Increased BP and P

Hallucinations

Never treat these symptoms alone without?

A
  • Clonidine
  • Haloperidol
  • Always need a BZD
45
Q

Methadone?

A
  • Must be 18
  • can only be given via federal approved clinic
  • dependence for 1 year
  • failed prior detox and pregnant women
46
Q

Alcohol withdrawal treatment, Delirium tremens

Medical Emergency

A
  • BZD Infusion
    • Remember that polyethylene glycol toxicity with lorazepam
  • Propofol (Anesthetic)
    • Concerns that the patient is just being sedated
  • Antipsychotics
    • Monitor for QTC
47
Q

Symptoms of withdrawal from opioids?

A
  • Lacrimation
  • Rhinorrhea
  • Mydriasis
  • Yawning
  • Sweating
  • N/V
  • Diarrhea
  • Insomnia
  • Piloerection
  • fever
  • Aches
  • Restlessness
  • Irritability
48
Q

Pharmacologic treatment for alcohol abstinence?

A
  • Disulfram
  • Naltrexone
  • Acamprosate
49
Q

Signs and symptoms of drug abuse?

A
  • Tremor
  • Bloodshot or glassy eyes
  • Leaving randomly
  • Pale
  • Long sleeves
50
Q

What Benzos are best for liver disease?

A

LOT

Lorazepam, Oxazepam and Tomazepam? Check that

51
Q

Acamprosate

When can it be started?

Combination with?

AE?

A
  • Must be used during maintenance not right after detox
  • Social support is needed without that it isnt effective at all
  • Combo with Naltrexone or Dilsulfram
  • Diarrhea
52
Q

Using medications outside of society norms?

A

Drug Abuse

53
Q

High doses of Gabapentin has been know to have significant positive effects in patients that are?

A
  • Heavy drinkers
54
Q

You crave the drug get scared if you dont have it

A

Psychological dependence

55
Q

Disulfram causes someone to be sick if they consume alcohol while on the medication. Why could this be an issue with this medication?

What should be monitored?

Reactions with this medication can last for how many days after discontinuation?

A
  • Compliance limits this, if someone decides they want to drink then they just dont take the med
  • Thats why its good to tell the patient to take it in the AM so they dont have the choice to say they’ll drink
  • LFTs should be monitored extensive 1st pass metabolism
  • 14 days after discontinuation
56
Q

Naloxone?

What is it

A
  • Opiate antagonist
  • poorly absorbed sublingually
  • Dissove in water and injected, the full effects of it are observed
57
Q

Risk factors for addiction?

A
  • Family history
  • Male
  • Peers
  • Psychiatric illness
  • Lack of family involvement
  • Taking a super addictive drug
58
Q

What are the CAGE questions how many do you have to answer yes to?

A
  • Have you ever felt you should Cut down on your drinking?
  • Have people Annoyed you by criticizing your drinking
  • Have you ever felt bad or guilty about your drinking?
  • Have tou ever had a drink first thing in the morning to steady your nerves to get rid of hangovers? (Eye-opener)
59
Q

Go over the stages of withdrawal

A
  1. Mild withdrawal
    • Headache, tremors, High BP, P, agitation, insomnia,
  2. Hallucination
  3. Seizures
  4. DT
60
Q

Maintenance?

A
  • Methadone
  • Buprenorphine/naloxone
  • Naltrexone
61
Q

What are some complications associated with Alcoholism?

A
  • Gastritis
  • GI Bleed
  • Liver disease
  • Cardiomyopathy
  • Pancreatitis
  • Electrolyte disturbances
  • Wernickes syndrome
62
Q

Alcohol Withdrawal summary

  • Alcohol withdrawal is a?
  • BZDs are the treatment?
  • Symptom triggered methods usually result?
  • Clonidine and antipsychotics are not recommended for? ANd have not been shown to?
A
  • It is life threatening
  • BZDs first line
  • Lower BZD administration
  • Not recommended as monotherapy since they have not shown to reduce seizures or delirium
63
Q

Theres two types of ways to dose for Benzos what are they?

A
  1. Fixed dosing
  2. Symptoms triggered dosing with the utilization of CIWA-Ar score
64
Q

What is the definition of Alcohol withdrawal?

A

Condition that occurs when regular alcohol consumption over an extended period of time is decreased or stopped abruptly.

65
Q

What labs usually change when evaluating for AWS?

What other labs should be orders if you suspect a patient is having AWS?

A
  • Increased ALT/AST
  • Increased GGTP
  • Increased MCV
  • Alcohol level
  • UDS
  • Electrolytes
  • INR- increased in late stages of liver disease
66
Q

3 steps in overdose?

A
  1. Call 911 give naloxone, if no rxn after 2 minutes give second dose
  2. Rescue breathing or chest compression
    1. Follow dispatcher
  3. After naloxone, stay until help arrives
67
Q

Tips when starting to use Buprenorphine/ Naloxone

A
  • Stop short acting
  • If withdrawal symptoms are present within 12-24 hours
  • Admin 4/1 observe for 2 hours
  • Symtoms relieved? thats the dose
  • Max 8/2 in 24 hours

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