First Aid CH7 Substance-Related & Addictions Flashcards
define substance use disorder
cognitive, behavioral, and physiological sxs indicating continuous use of a substance DESPITE sig substance-related problems
is it possible to have a SUD w/o having physiological dependence (withdrawal, tolerance)?
yes
MC used substances?
nicotine and ETOH
what types of disorders are common among those with SUD?
mood disorders (depression, bipolar, anxiety)
define withdrawal
development of a substance-specific syndrome d/t cessation or reduction of the substance
define tolerance
need for increased amounts of substance to achieve desired effect/high
far as substances go, look out for
multiple substance use
ETOH testing
must be performed within a few hours (not in system for long), blood/urine test most accurate
Cocaine testing
positive on urine drug screen 2-4 days
Amphetamine testing
positive on urine drug screen 1-3 days
PCP testing
positive on urine drug screen 4-7 days, CPK and AST often elevated
Sedatives-Hypnotics
positive on urine/blood screen
- SA = 5 days
- LA = 30 days
Opioid testing
positive urine drug screen 1-3 days
- methadone and oxycodone will come up negative on a general screen (must be ordered separately)
Marijuana testing
positive urine drug screen 3 days (single use) to 4 weeks (heavy user) d/t adipose stores
what R’s does ETOH activate? inhibit?
GABA (thus ETOH is a depressant), dopamine, serotonin
glutamate, VG-Ca
up-regulation of which enzymes in heavy drinkers? genetic exception?
alcohol dehydrogenase, aldehyde dehydrogenase
- Asians have less aldehyde dehydrogenase
sxs of too much acetaldehyde after a drinking binge?
flushing (red, hot), nausea
factors that dictate ETPH absorption and elimination
age, sex, body wt, chronic nature of use, duration of consumption, food in the stomach, liver health, overall state of nutrition
does ethanol cause an inc anion gap and metabolic acidosis?
yes
tx for intoxication
ABCs, glucose, electrolytes, thiamine (Wernicke’s encephalopathy) and folate, CT, naloxone (to address possible co-ingestion of opioids)
ultimately, liver will metabolize ETOH w/o other interventions
when is gastric lavage or induction of emesis indicated in ETOH intoxication?
within 30-60min of ETOH ingestion (otherwise it’s already absorbed)
what increases the risk of spousal abuse?
substance abuse, particularly ETOH
what’s the most commonly used intoxicating substance in the US?
ETOH
ETOH withdrawal is
potentially lethal! opposite of depression is.. hyperactivity!
sxs of ETOH withdrawal
insomnia, anxiety, hand tremor, irritability, n/v, anorexia, autonomic hyperactivity (diaphoresis, tachy, HTN), fever, seizures, hallucinations, delirium
how soon do ETOH withdrawal sxs come on? tonic-clonic seizures? DT?
how long can they last?
6-24 hours
12-48 hours
48-96
2 days to 1 week
delirium tremens (DT) and tx
seen in serious ETOH withdrawal, onset 48-96 hours after last drink, mental status and neurological changes (hallucinations, agitation, gross tremor, autonomic instability, delirium)
benzos
seizure tx during ETOH withdrawal
benzo (Lorazepam, Diazepam, Chlordiazepoxide) taper, antipsychotics, restraints, banana bag (thiamine, folic acid, multivitamins), electrolyte and fluid correction
Korsakoff’s psychosis
confabulations (inventing stories) the patient isn’t aware of
AST:ALT ration in excessive ETOH use
2:1
biomarkers useful in detecting recent prolonged drinking
BAL (blood alcohol level), LFTs (AST:ALT), GGT (gamma-glutamyl transpeptidase), MCV (d/t effects on erythroblast dev)
medications for ETOH use disorder
first-line: naltrexone (mu R antagonist to reduce cravings), Acamprosate (relapse prevention, NMDA ant, GABA ag)
second-line: disulfiram (blocks aldehyde dehydrogenase, topiramate (potentiates GABA, inh glutamate)
what’re the risks of naltrexone?
precipitate withdrawal in opioid-dependent pts, not for use in pts w/ liver failure
what’re the risks of acamprosate?
not for use in pts w/ kidney/renal failure
thiamine or glucose first in an ETOH overdose pt?
thiamine (enzyme used in carbohydrate metabolism)
Wernicke’s encephalopathy sx, tx, prognosis
caused by thiamine (vit B1) def, ataxia, confusion, ocular abnormalities (nystagmus, gaze palsies)
- tx: thiamine
- prog: if untreated can progress to Korsakoff syndrome (impaired recent memory and confabulation)
cocaine affects what neurotransmitters?
the reuptake of: dopamine, epi, norepi
- causes stimulant effect
intoxication of cocaine causes
euphoria, inc self-esteem, dilated pupils, wt loss, resp depression, seizures, arrhythmias, hyperthermia, paranoia, hallucinations
- deadly: vasoconstriction > MI, intracranial hemorrhage, stroke
if a cocaine intoxication comes into the ED with an elevated temp, tx?
aggressive tx if fever is over 102, ice bath, cooling blanket
pharm tx for cocaine use disorder?
nothing that’s FAD-approved, off-label = disulfiram, modafinil, topiramate
is cocaine withdrawal dangerous? how long does it last?
not life-threatening, but intoxication is
- sedation, anhedoina
mild-mod use: 3 days
heavy use: 1-2 weeks
amphetamine neurotransmitter involvement
dopamine, norepi
heavy use of amphetamines can cause what? chronic amphetamine use causes what?
psychosis, looks like schizophrenia
accelerated tooth decay (meth-mouth)
designer amphetamines/stimulants
MDMA (ecstasy), MDEA (eve)
- both stim and hallucinogenic properties
- serotonin syndrome possible is combined w/ SSRIs
amphetamine intoxication presentation and tx
similar to cocaine (stimulant)
- hyperthermia, dehydration, rhabdomyolysis, renal failure, psychosis
rehydrate, correct electrolyte imbalance, treat hyperthermia
define PCP (Phencyclidine), what R’s does it function at?
aka angel dust, dissociative hallucinogenic drug
- NMDA antag, dopamine agonist
are ketamine and PCP the same thing?
they’re similar but ketamine is less potent
date rape drugs
ketamine, GHB (gamma-hydroxybutyrate, CNS depressant)
PCP intoxication involves? tx?
agitation, depersonalization and hallucinations, synesthesia (sound produces color), assaultiveness/violence, NYSTAGMUS (rotary, horizontal, vertical), high tolerance to pain
- minimize sensory stim, correct vitals, benzos and antipsychotics
- overdoses can cause death
does PCP have withdrawal sxs?
no, but “flashbacks” may occur (release of stored PCP from adipose tissue cause intoxication-like sxs)
what are the sedative hypnotics?
benzos, barbs, zolpidem, zaleplon
- heavily abused and very available
sedative hypnotic overdose involves what?
drowsiness, confusion, hypotension, slurred speech, ataxia, mood lability, nystagmus, resp depression, death
- synergistic with ETOH or opiods/narcotics
sedative hypnotic OD tx?
ABCs, gastric lavage and charcoal if drug was ingested within last 6 hours
- benzo antidote = Flumazenil (use may precipitate seizures)
is sedative hypnotic withdrawal life-threatening? what’s the tx?
yes! benzo taper
stimulants vs depressants/sedatives
stim withdrawal = NOT life threatening
depressants/sedative withdrawal = life threatening
define opioid
medication that stimulates mu, kappa, and delta Rs (norm stim’s by endogenous opiates), purpose: analgesia, sedation
- can be addictive (also effects on dopaminergic system)
list of opioids
MC: oxycodone, hydrocodone/acetaminophen (Vicodin), oxycodone/acetaminophen (Percocet)
- heroin, codeine, dextromethorphan, morphine, methadone, meperidine
what should alter a doctor to possible opioid misuse?
losing meds, doctor shopping, running out of meds early
opioid intoxication and tx
AMS/drowsiness, n/v, constipation (post-surg concern), constricted pupils, resp depression, seizures
- tx: ABCs, naloxone (opioid antagonist, care for possible withdrawal sxs then)
opioid withdrawal sxs and tx
not life-threatening, dysphoria (unease or dissatisfaction with life), insomnia, rhnorrhea, yawning, weakness, sweating, piloerection (of hairs), n/v, fever, dilated pupils (opposite intoxication), HTN, tachy
- tx: symptomatic tx, if severe consider buprenorphine or methadone
dextromethorphan
inredient in cough syrup
Meperidine/Demerol
dilates pupils, the exception of opioids
opioid use disorder tx
methadone: long-acting opioid R agonist, gold-standards in opioid-dependent pregnant women
- con: QT prolongation
buprenorphine/Suboxone: safer than methadone, sublingual
Naltrexone: competitive opioid ant, daily oral or monthly injection
- compliance is the issue
poppy seed bagels or muffins do what?
can cause positive opioid drug screen
what are the typical hallucinogens? what R’s do they act upon?
mushrooms (psilocybin), LSD (lysergic acid diethylamide)
- serotonergic
do hallucinogens cause dependence or withdrawal?
no
LSD flashback
recurrence of sxs mimicking a prior trip that occurs spontaneously and lasts mins to hours
hallucinogen intoxication sxs and tx
illusions, hallucinations, synesthesia (sensations in non-related body parts), labile affect, DILATED pupils, tachy, HTN, hyperthermia, tremors
- lasts 6-12 hours usually, maybe days
- monitor and reassurance, benzos if pt has psychotic sxs
what defines a bad trip on hallucinogens?
anxiety, panic, psychotic sxs (paranoia, hallucinations)
Dronabinol
pill form of THC that’s FDA-approved
define marijuana
most commonly used illicit substance in the world, main active component is THC (tetrahydrocannabinol) which inh adenylate cyclase in brain
current marijuana medicinal uses
tx n/v in chemo pts, inc appetite in AIDS pts, tx chronic pain from CA, dec intraocular pressure in glaucoma
marijuana intoxication and tx
euphoria, anxiety, impaired motor coordination, perceptual disturbances (slowed time), conjunctival injection (red eyes), dry mouth, inc appetite (munchies)
- supportive
risk of chronic marijuana use
cannabis use diorder, asthma, chrnoic bronchitis, immune system suppression, CA
risk with inhalant intoxication, tx
resp depression or cardiac arrhythmias, permanent CNS dmg, peripheral neuropathy, MI and myocarditis
- ABCs, O2, chelation
define caffeine
MC used psychoactive substance in US, adenosine antagnois > inc cAMP > inc excitatory neurotransmitters
caffeine overdose sxs
> 250mg = 2 cups of coffee = anxiety, insomnia, muscle twitching, diuresis, GI disturbance, tachy
> 1g = tinnitus, severe agitation, cardiac arrhythmias
> 10g = death d/t seizures and resp failure
caffeine withdrawal
sxs occur in 75% of users if cessation is abrupt, HA, fatigue, irritability, n/v, muscle pain, depression
- resolves in 1-2 weeks
define nicotine
derived from tobacco plant, stimulates nicotinic R’s in autonomic ganglia and strongly effects dopaminergic system (addiction)
nicotine use can lead to
tolerance and physical dependence
what is the leading cause of preventable morbidity and mortality in the US?
cigarette smoking
withdrawal sxs of nicotine
intense craving, anxiety, poor concentration, inc appetite, wt gain, irritability and restlessness, insomnia
cigarette smoking during pregnancy is associated w/ what?
low birth wt, SIDS
nicotine dependence tx
Varenicline (Chantix), Bupropion (Zyban), nicotine replacement therapy (NRT), behavioral support/counseling
tx for gambling
Gamblers Anonymous (12-step program) MC, CBT
