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aaa Emergency Med - Exam 2 > Drugs of Abuse > Flashcards

Drugs of Abuse Flashcards

1
Q

Use disorder – DSM V

A
  • Use more than planned- Worry about cutting back or unsuccessful - Lots of time using or recovering or getting- Craving- Life is affected - Continued to use even though life is affected - Risky behaviors - Tolerance- Withdrawal
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2
Q

Mild, moderate, severe substance disorder

A
  • A mild substance use disorder is suggested by the presence of 2-3 symptoms- Moderate by 4-5 symptoms- Severe by 6 or more symptoms- No longer trying to sort out addiction (which is physical) from abuse, but defining much how it affects person’s life
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3
Q

Various drugs

A
  • Stimulants- Benzodiazepines- Opioids- Hallucinogens- Dissociative drugs - Marijuana- Solvents/Inhalants- Alcohol
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4
Q

Stimulants

A
  • Nicotine- Caffeine- Cocaine- Amphetamines
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5
Q

How stimulants work

A
  • Release DA and NE
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6
Q

Stimulants route of administration

A
  • Oral = Slow onset, low potency, no “rush”- Intranasal = Faster onset- Intravenous = Faster onset, “rush”- Smoking = Fastest onset, most addictive
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7
Q

Stimulant effects (low to moderate doses)

A
  • Insomnia- Increased endurance- Increased activity- Euphoria and mood enhancing
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8
Q

Stimulant effects (high doses)

A
  • Paranoia- Hallucinations- Suspiciousness- delusions- Picking- Pancreatitis/DM
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9
Q

Stimulant: Other negative effects

A
  • Stroke- Seizures- MI- Psychotic Symptoms- Lung and Nasal problems
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10
Q

Cocaine

A
  • Blow, coke, crack, rock, snow- Snort or rub on gums- Crack is heated and inhaled or injected
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11
Q

Biggest worry

A
  • MI – 1% of all MIs – increases plaque formation and causes vasospasm- Don’t use Beta Blocker if concerned of cocaine use- Can cause issues with nose, lungs
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12
Q

Amphetamine (speed)

A

Methamphetamineo Added methyl to facilitate crossing the blood-brain barriero Ice or crystal meth is the crystalized formo Crank is made in home labsAmphetamineso Better oral absorption than cocaine and longer duration than cocaine

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13
Q

Snorting Adderall

A
  • Pulmonary talcosis- Manufacturers use talc as a binder
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14
Q

Stimulants: Withdrawal and Dependence

A

3 stages of Abstinence:o 1-5 days: “crash” with intense craving, exhaustion, and intense depressiono 1-10 weeks: “withdrawal” depression, craving, hedonic state (relapse is strong)o Indefinite: occasional depression, moderate craving, loss of pleasureWithdrawal and dependence:o Depressiono Fatigueo Hungero Aches and paino Loss of pleasure

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15
Q

These help with stimulant withdrawal

A
  • Benzos- SSRIs – need careful monitoring- Anti-psychotics
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16
Q

Smoking

A
  • About 18% of the adult population now- Very fast acting (very addictive)- DA release- Also the physical habit
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17
Q

Why you don’t want your patient smoking?

A
  • Increased risk of death- Increased risk of heart/lung issue- Anesthesia- Poor circulation means poor healing
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18
Q

Quitting smoking

A
  • About ½ of smokers tried to quit for at least 1 day in previous year- 7 meds FDA approved to help (Chantix, Zyban, replacements)- Cold turkey about 4%- CBT- Trying 2 or more methods at once helpful
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19
Q

Benzodiazepines (benzos)

A
  • Depressant effect on CNS by sitting on GABA receptor and stimulating GABA- Used to relieve anxiety, muscle relaxation and to treat seizures- Addictive- Will reset the “anxiety” level in the brain over time
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20
Q

BENZOS KNOW THIS

A
  • Can be dangerous with ETOH- Fast withdrawal maybe fatal – weaning and close supervision if prolonged use and high doses.- Romazicon 0.2ml IV – use with caution and be prepared!!! Seizures possible
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21
Q

Opioid examples

A

Examples:- Heroin, morphine, codeine, oxycodone, hydromorphone, hydrocodone, fentanyl, oxymorphone, tramadol (yes tramadol), Dilaudid and others- Morphine-like effects by binding to brain opioid receptors

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22
Q

Opioid effects

A
  • Change in mood- Mental clouding- Slow breathing- Sleepiness- Analgesia- Constipation- Urinary retention- Withdrawal not life threatening
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23
Q

Opioid withdrawal symptoms

A
  • Irritable, agitated, anxious- Pain- Sweaty- Nausea
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24
Q

Help with opioid withdrawal

A
  • Can get them on “safer” opioid – methadone- Wean- Benzos- Zofran- Clonidine- Suboxone (mix of narcotic and naltrexone)
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25
Q

Opioid reversal agent

A
  • IV – Narcan (they may come up swinging)- Oral – naltrexone – many other uses
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26
Q

Prescribing opioids long term

A
  • UDS, PMP- Have goals- Try to cut back, use non-opioid therapies, contracts
27
Q

Hallucinogens

A
  • Psychedelics- Alter consciousness- Abuse leads to cardiovascular and respiratory collapse- Synthetic Hallucinogens: LSD, peyote- Long term flash backs, paranoia
28
Q

Dissociative anesthetics

A
  • PCP and Ketamine - Sense of timelessness (being dead, not having limbs, floating in space), depersonalization- High doses DXM- Nitrous Oxide - NMDA/glutamate complex antagonized - Can cause depression leading to suicide, or self-inflicted wounds or violence- Profound anesthesia
29
Q

Dissociative Desired Effects

A
  • Dreamy and carefree state, altered perception, mood elevation- **Perceptual distortions, diminished pain sensitivity, depersonalization - **Ketamine being used in trauma
30
Q

Dissociative undesired effects

A
  • Mood swings, partial amnesia, and impaired judgement, disorientation, preoccupation with abnormal body sensations, amnesia, nystagmus, panic, motor impairment, and confusion, catatonia, delirium, psychotic behavior, hypertensive crisis, severe motor impairment…death
31
Q

Dissociative PCP treatment if out of control

A
  • Isolate patient with restraints- Haldol- Valium- Acidify urine
32
Q

Marijuana

A
  • Cannaboid receptors all over the body (not just brain)
33
Q

Medical uses of marijuana

A
  • Glaucoma- Muscle spasms- Seizures- Nausea/appetite- Insomnia- Pain
34
Q

Marijuana: Starting Young and IQ

A
  • Duke Study- Weekly use before age 18 – lose 8 IQ points- Potentially someone in 50th percentile now the 29th- Less likely to get educated after high school
35
Q

Marijuana drug

A
  • Active ingredient in cannabis is THC- Impairs motor coordination and perception- About 9-15% addictive (younger you start more addictive)- Mild withdrawal symptoms that last 1 to 2 weeks if big user
36
Q

Solvents and inhalants

A
  • Volatile intoxicants, anesthetics- Cheap- Accessible- Children and teenagers are the most frequent users
37
Q

Inhalants

A
  • 18% of high school seniors - 30% of those reported use before age 10- 20% of eighth graders
38
Q

Solvents and inhalants

A
  • Volatile intoxicants, anesthetics- Low income communities particularly affected- Affluent communities also affected- Toluene can cause permanent neurological damage
39
Q

Four major groups of solvents and inhalants

A
  1. Volatile Solvents: Glue sniffing: lighter fluid, airplane glue, lacquer thinners, industrial solvents, ketones, propane and butane fuel, toluene, esters, and cleaning solutions2. Aerosols: Aerosol propellants such as fluorocarbons. Spray paint, products containing chlorofluorocarbons, ketones, organic metal and n-hexane are particularly dangerous—they can cause cardiotoxicity, neuropathies, and hepatotoxicity3. Anesthetic agents: Chloroform, methylchloride, nitrous oxide, trichloroethylene, and ethyl ether. Oil and grease dissolvers can contain some of this.4. Butyl, Isobutyl nitrite, and amyl: Isobutyl nitrite used as a room deodorizer, Amyl nitrite used for angina. Called “poppers”
40
Q

Solvents and inhalants

A
  • Alcohol increases the effect- No dependence- Onset is rapid and short duration- Low doses cause euphoria, dizziness, slurred speech, ataxia, perceptual distortions, and impaired judgement- High doses cause a generalized depressant effect
41
Q

Overdose of solvents and inhalants

A
  • Photophobia, diplopia, sneezing, nausea, chest pain, diarrhea, eye irritation, respiratory depression- Die of asphyxia
42
Q

Alcohol

A
  • 10 % raised by alcoholic- 43% have an alcoholic in life
43
Q

CNS effects of alcohol

A
  • Alcohol is a CNS depressant- Euphoria, decreased mechanical efficiency, and impaired thought processes- Stimulatory effects from depression of inhibitory control mechanisms
44
Q

Alcohol withdrawal syndrome

A
  • Can happen with abrupt stop or big decrease in use that is sudden- “Panic attack” – anxiety, palpitations, sweaty, nausea, shaking- More severe – MAY be fatal and needs medical managemento Seizureso Delirium tremens: auditory and visual hallucinations, disorientation
45
Q

How to withdrawal someone from AUD?

A
  • Benzos- +/- fluids- Nausea meds- Thiamine, Magnesium, Niacin “banana bag”
46
Q

Alcohol

A
  • Alcohol disorders involve about 17-18 million individuals- Alcohol abuse costs an estimated 184.6 billion dollars
47
Q

Alcohol withdrawal syndrome

A
  • Readjustment of the CNS to the neuroadaptation that occurs with prolonged intoxication- Decreased GABA activity- Increased Glutamate and NMDA activity
48
Q

Alcohol and anxiety

A
  • In an attempt to reduce anxiety, chronic alcohol use increases the brain chronic anxiety state- When alcoholics cut down or quit – will feel that higher set point of anxiety
49
Q

Alcohol withdrawal

A

6-96 hours after hrs after drink (or big reduction)o Anxiety, tremulousness, HA, diaphoresis, palpitations, GI upseto Tachycardia, hypertension, fevero Generalized, tonic-clonic seizures, status epilepticus o Auditory and visual hallucinationsA rapid stopping or reduction in alcohol in someone who is chronic abuser can be fatal and needs to be medically managed

50
Q

Physical exam findings in abuse

A
  • Ascites- Caput Medusa (abdominal wall collaterals)- Jaundice- Malnutrition- Splenomegaly- Gynecomastia - Digital clubbing- Testicular atrophy- Dupuytren’s contractures- Tremors
51
Q

Alcohol long term – Liver

A
  • 50% Cirrhosis is caused by EtOH- Healthy liver  Liver cirrhosis with EtOH
52
Q

Alcohol and cancer

A
  • The entire GI track (anything that is “touched” by elimination of EtOH) has an increased risk with heavy use
53
Q

Alcohol and pancreatitis

A
  • 50% of pancreatitis is EtOH related
54
Q

Alcohol long term brain effects

A
  • Causes brain atrophy – increases risk of brain bleed if fall- Dementia – alcohol abuse big risk for early dementia- Causes “scar tissue” between neurons
55
Q

Alcohol treatment

A

Medical:o Topiramate, ondansetron, naltrexone, acamprosateCognitive/behavioral:o Controlled drinkingo Avoiding triggerso Understanding WHY drinkCommunity based treatment:o AA: well known

56
Q

Study on alcoholism

A
  • A 2007 study by the National Council on Alcoholism’s medical journal reported that people attending 12-step treatment programs had a 49.5% abstinence rate after a single year. Those who were in CBT programs were less successful, maintaining a 37% abstinence rate. - Some report AA success at 5-10% - all in how you define success- Where AA states you have no control, other programs try to teach how to have control
57
Q

What we have learned about alcohol abuse

A
  • A person’s use over time can be extremely variable- Harm reduction strategies can work in some people
58
Q

NIH

A
  • Only 25% with AUD get help (including AA)- Over time, 2/3 to ¾ of those with AUD will quit or reduce to moderate and stable
59
Q

Study on alcoholism

A
  • 100 alcohol dependent men – ½ got 3 week inpatient treatment and intense follow up versus 1 “brief advice” session followed by monthly telephone calls- One year later – same results; two years later better results in the brief intervention
60
Q

Harm reduction model

A
  • Person continues to drink but effort to reduce the risk and harm – concentrates on riskiest first (like drunk driving)- GOAL ORIENTED
61
Q

Moderation

A
  • Many programs out there to get people to cut back- Some people with AUD can do this and some people cannot
62
Q

Things they don’t tell you in medical school

A
  • People overcome addiction and use disorders (high school EtOH/Viet Nam and heroin) and MOST do it without treatment- They quit or cut down to achieve normalcy- Physicians can help- Shame doesn’t work (neither personally or professionally)- Developing coping mechanisms is huge
63
Q

Children of alcoholics (or of hoarders or gamblers) may have these tendencies

A
  • Feel that issues overshadowed your needs as a child- Had to be caretaker earlier- Independence- Resilience- Anxiety/anger/depression- Sometimes choose partners with use disorders- Duty to care for others- Comfort of chaos
64
Q

NOTE

A

f you have a use issue – this is the time to work on that as use disorders can crash a medical career (counseling, lots of websites, change who you spend time with)- If you have someone important in your life with abuse disorder, get your own help

aaa Emergency Med - Exam 2 (9 decks)

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