Final: Substance use disorders Flashcards
immediate referral for SUB in:
- delirium tremens
- withdrawal seizures
- overdose
- suicidal/homicidal
- psychosis
- request for treatment for mod - severe
DSM 5 for substance use
Problematic pattern of substance use leading to clinically significant impairment/distress, manifested by at least two of the following within a 1 year period:
- Substance taken in larger amounts or over longer period of time than was intended
- Persistent desire/unsuccessful attempts to cut down
- Great deal of time spent to obtain the substance, use, or recover from its effects
- Craving or a strong desire for the substance
- Recurrent use resulting in failure to fulfill normal obligations (work, school, home, ect)
- Continued use despite social/interpersonal problems
- Social, occupational, or recreational activities given up or reduced bc of use
- Use continued despite knowledge of having a persistent or recurrent physical/psychological problem is likely
- Tolerance
- Withdrawal
opioids and acute pain
for acute pain, start with immediate release opioids for less than 3 days or 7 days max
re-evaluate every 3 months
opioids and chronic pain CDC guideleines
- non pharm 1st lines
- pain goals established, benefits outweigh risks
- discuss risks/benefits with pt
- when starting opioids, lowest dose immediate release ONLY prescribed (not extended-release/long-acting)
- review PDMP for OD risk every 3 months
- urine drug testing before starting and annually
- NO prescribing opioids and benzos at same time
- offer evidence based tx (pharm + buprenoprhine or methadone with behavioral therapies) with opioid use disorders
when to reevaluate chronic opioids pain management
reeval benefits/harm of opioid therapy within 1-4 wks of starting opioids for chronic pain or dose escalations then every 3 months
if harm > benefits, lower dose/stop
screening tools alcohol and drug use in primary care
alcohol - AUDIT
adolescent for alcohol - CRAFFT
DAST-10 for SUD
SUD diagnostics for opioids, alcohol
- SOAPP - screener and opioid assessment for patients with pain (for long term opioid therapy)
- PDMP - prescription drug monitoring programs
- Alcohol - breath, LFT AST/ALT (2:1 = alcohol r/t liver dz)
- Gamma glutamyl transferase (GGT) - most sensitive marker for excessive alcohol use for few wks
- urine/blood toxicology screening
alcohol use disorder pharm managment
- Withdrawals: gold standard: Benzos
- chlordiazepoxide (Librium)
- lorazepam (Ativan)
- diazepam (Valium)
- CIWA to assess sx’s of withdrawal
opioid use disorder overdose management
- OD = naloxone (Narcan) IV
- methadone for inpt detoxification for withdrawal
- buprenorphine (Naloxone) - only when actively experiencing withdrawal
- clonidine - inpt/outpt for withdrawal (monitor BP)
tobacco use disorder management
- nicotine replacement therapy (gum, lozenge, inhaler, nasal spray, derm patch)
- NO nicotine during therapy = toxic levels
- buproprion (Wellbutrin)
- Varenicline (Chantix)
- behavior therapy for ALL
SUD non pharm management
- motivational interviewing
- harm reduction
- CBT
- contingency management
- therapeutics
- 12 step programs (AA/NA)
- peer recovery supports
