Exam 1 Flashcards
Maladaptive pattern of substance use characterized by repeated adverse consequences related to repeated use of the substance
Drug Abuse
5 C’s of Addiction
Chronic Control impairment Compulsive Continued use despite harm Craving
State of adaptation that is manifested by a drug class-specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist
Physical Dependence
State of adaptation in which exposure to a drug induces changes that can result in a diminution of one or more of the drugs effects over time
Tolerance
Usually predictable, given the pharmacology of the drug
Acute Problems
____ abuse of chemical substances can cause a wide array of physical, psychological and psychiatric morbidities. The substance-induced disorders discussed here mainly include _____ & _____.
Chronic
Intoxication & Withdrawal
Essential feature of substance dependence…
Continued use of a substance despite adverse substance-related problems
Severity of substance use disorder
0-1 symptoms = no dgx
2-3 = mild substance use disorder
4-5 = moderate
6+ = severe
Clinicians can also add “in early remission,” “in sustained remission,” “on maintenance therapy” and “in a controlled environment.”
Miosis indicates
Opioid
Nystagmus, miosis when severe
Sedative hypnotics or anxiolytics
Diaphoresis, flushed face and skin indicate
Sedative hypnotics or anxiolytics
Pt who is former alcoholic, should not take…
BZDs due to risk of relapse
Alprazolam physical dependence daily dose and time needed to produce dependence
8-16 mg x 42 days
Clorazepate physical dependence daily dose and time needed to produce dependence
45-180 mg x 42-120 days
Diazepam physical dependence daily dose and time needed to produce dependence
10-100 mg x 42-120 days
Alprazolam peak withdrawal symptoms appear in ____ days
2-3 days
Clorazepate peak withdrawal symptoms appear in ____ days
5-8 days
Diazepam peak withdrawal symptoms appear in ____ days
5-8 days
Main ADE we want to prevent when stopping BZDs
Seizures
How do you stop BZDs?
- Convert to long half life BZDs (chlordiazepoxide, diazepam)
- Taper by 20-25% per week over 2-3 months
- Pts who are unable to DC, extend period up to 6 months
1 mg alprazolam = _____ mg chlordiazepoxide = ____ mg diazepam
25 mg chlordiazepoxide
10 mg diazepam
Antiseizure adjuncts for BZD withdrawal
Carbamazepine
Valproic Acid
Anxiolytic adjuncts for BZD withdrawal
Hydroxyzine
Diphenhydramine
Drugs to help with insomnia during BZD withdrawal
Trazadone
Sedating antidepressant
Diphenhydramine
Hydroxyzine
Crushing oxy, OC, opiates, etc and snorting/injecting
Immediate narcotic effect lasting 12 hours or more.
Leads to OD and death
Street cost for OCs or oxy
$1 = 1 mg
Supportive therapy for opioid withdrawal
Clonidine
Temporary substitution with longer acting opioid
Opioid withdrawal symptoms
Flu symptoms
Outpatient abuse therapy for opioids
Methadone
Buprenorphine
CAGE tool stands for…
Cut-down
Annoyed
Guilty
Eye-opener
Standard drink
12 oz beer
8 oz wine
1.5 oz 80 proof spirits
Recommendations to prevent excessive/risky drinking
- Women 7 or less /week and 3 or fewer /occasion
- Men 14 or less /week and 4 or fewer /occasion
Resiliency factors are those which act to:
Mitigate or decrease the impact of risk factors
Relapse rates for addiction are similar to relapse rates of
Diabetes
Addiction is a brain disease that is expressed as ______ and _______ behavior.
Impulsive and Compulsive
Fastest way for cocaine to reach the brain
Smoking crack
THC acts on…
CB-1 in CNS
CB-1 and CB-2 in periphery
THC is most concentrated in
Flowers of cannabis
Acute marijuana intoxication causes
Panic reactions
Produces use-dependent inhibition of NMDA-glutamate receptors
Phencyclidine
Angel dust aka
Phencyclidine
Most widely used sedative hypnotic drug
Alcohol
Acceptance
Experience of a situation without an attempt to change, protest or withdraw
Percent of adolescents aged 17-19 can be diagnose with alcohol, tobacco or marijuana dependence
1.2-1.6%
SBIRT
Screening Brief Intervention Referral Treatment
Specificity
True negatives
Sensitivity
False negatives