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Psychiatry Clerkship > First Aid CH7 Substance-Related & Addictions > Flashcards

First Aid CH7 Substance-Related & Addictions Flashcards

1
Q

define substance use disorder

A

cognitive, behavioral, and physiological sxs indicating continuous use of a substance DESPITE sig substance-related problems

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2
Q

is it possible to have a SUD w/o having physiological dependence (withdrawal, tolerance)?

A

yes

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3
Q

MC used substances?

A

nicotine and ETOH

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4
Q

what types of disorders are common among those with SUD?

A

mood disorders (depression, bipolar, anxiety)

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5
Q

define withdrawal

A

development of a substance-specific syndrome d/t cessation or reduction of the substance

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6
Q

define tolerance

A

need for increased amounts of substance to achieve desired effect/high

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7
Q

far as substances go, look out for

A

multiple substance use

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8
Q

ETOH testing

A

must be performed within a few hours (not in system for long), blood/urine test most accurate

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9
Q

Cocaine testing

A

positive on urine drug screen 2-4 days

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10
Q

Amphetamine testing

A

positive on urine drug screen 1-3 days

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11
Q

PCP testing

A

positive on urine drug screen 4-7 days, CPK and AST often elevated

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12
Q

Sedatives-Hypnotics

A

positive on urine/blood screen

  • SA = 5 days
  • LA = 30 days
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13
Q

Opioid testing

A

positive urine drug screen 1-3 days

- methadone and oxycodone will come up negative on a general screen (must be ordered separately)

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14
Q

Marijuana testing

A

positive urine drug screen 3 days (single use) to 4 weeks (heavy user) d/t adipose stores

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15
Q

what R’s does ETOH activate? inhibit?

A

GABA (thus ETOH is a depressant), dopamine, serotonin

glutamate, VG-Ca

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16
Q

up-regulation of which enzymes in heavy drinkers? genetic exception?

A

alcohol dehydrogenase, aldehyde dehydrogenase

- Asians have less aldehyde dehydrogenase

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17
Q

sxs of too much acetaldehyde after a drinking binge?

A

flushing (red, hot), nausea

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18
Q

factors that dictate ETPH absorption and elimination

A

age, sex, body wt, chronic nature of use, duration of consumption, food in the stomach, liver health, overall state of nutrition

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19
Q

does ethanol cause an inc anion gap and metabolic acidosis?

A

yes

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20
Q

tx for intoxication

A

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

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21
Q

when is gastric lavage or induction of emesis indicated in ETOH intoxication?

A

within 30-60min of ETOH ingestion (otherwise it’s already absorbed)

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22
Q

what increases the risk of spousal abuse?

A

substance abuse, particularly ETOH

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23
Q

what’s the most commonly used intoxicating substance in the US?

A

ETOH

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24
Q

ETOH withdrawal is

A

potentially lethal! opposite of depression is.. hyperactivity!

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25
Q

sxs of ETOH withdrawal

A

insomnia, anxiety, hand tremor, irritability, n/v, anorexia, autonomic hyperactivity (diaphoresis, tachy, HTN), fever, seizures, hallucinations, delirium

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26
Q

how soon do ETOH withdrawal sxs come on? tonic-clonic seizures? DT?

how long can they last?

A

6-24 hours
12-48 hours
48-96

2 days to 1 week

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27
Q

delirium tremens (DT) and tx

A

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

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28
Q

seizure tx during ETOH withdrawal

A

benzo (Lorazepam, Diazepam, Chlordiazepoxide) taper, antipsychotics, restraints, banana bag (thiamine, folic acid, multivitamins), electrolyte and fluid correction

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29
Q

Korsakoff’s psychosis

A

confabulations (inventing stories) the patient isn’t aware of

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30
Q

AST:ALT ration in excessive ETOH use

A

2:1

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31
Q

biomarkers useful in detecting recent prolonged drinking

A

BAL (blood alcohol level), LFTs (AST:ALT), GGT (gamma-glutamyl transpeptidase), MCV (d/t effects on erythroblast dev)

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32
Q

medications for ETOH use disorder

A

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)

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33
Q

what’re the risks of naltrexone?

A

precipitate withdrawal in opioid-dependent pts, not for use in pts w/ liver failure

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34
Q

what’re the risks of acamprosate?

A

not for use in pts w/ kidney/renal failure

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35
Q

thiamine or glucose first in an ETOH overdose pt?

A

thiamine (enzyme used in carbohydrate metabolism)

36
Q

Wernicke’s encephalopathy sx, tx, prognosis

A

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)
37
Q

cocaine affects what neurotransmitters?

A

the reuptake of: dopamine, epi, norepi

- causes stimulant effect

38
Q

intoxication of cocaine causes

A

euphoria, inc self-esteem, dilated pupils, wt loss, resp depression, seizures, arrhythmias, hyperthermia, paranoia, hallucinations
- deadly: vasoconstriction > MI, intracranial hemorrhage, stroke

39
Q

if a cocaine intoxication comes into the ED with an elevated temp, tx?

A

aggressive tx if fever is over 102, ice bath, cooling blanket

40
Q

pharm tx for cocaine use disorder?

A

nothing that’s FAD-approved, off-label = disulfiram, modafinil, topiramate

41
Q

is cocaine withdrawal dangerous? how long does it last?

A

not life-threatening, but intoxication is
- sedation, anhedoina

mild-mod use: 3 days
heavy use: 1-2 weeks

42
Q

amphetamine neurotransmitter involvement

A

dopamine, norepi

43
Q

heavy use of amphetamines can cause what? chronic amphetamine use causes what?

A

psychosis, looks like schizophrenia

accelerated tooth decay (meth-mouth)

44
Q

designer amphetamines/stimulants

A

MDMA (ecstasy), MDEA (eve)

  • both stim and hallucinogenic properties
  • serotonin syndrome possible is combined w/ SSRIs
45
Q

amphetamine intoxication presentation and tx

A

similar to cocaine (stimulant)
- hyperthermia, dehydration, rhabdomyolysis, renal failure, psychosis

rehydrate, correct electrolyte imbalance, treat hyperthermia

46
Q

define PCP (Phencyclidine), what R’s does it function at?

A

aka angel dust, dissociative hallucinogenic drug

- NMDA antag, dopamine agonist

47
Q

are ketamine and PCP the same thing?

A

they’re similar but ketamine is less potent

48
Q

date rape drugs

A

ketamine, GHB (gamma-hydroxybutyrate, CNS depressant)

49
Q

PCP intoxication involves? tx?

A

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
50
Q

does PCP have withdrawal sxs?

A

no, but “flashbacks” may occur (release of stored PCP from adipose tissue cause intoxication-like sxs)

51
Q

what are the sedative hypnotics?

A

benzos, barbs, zolpidem, zaleplon

- heavily abused and very available

52
Q

sedative hypnotic overdose involves what?

A

drowsiness, confusion, hypotension, slurred speech, ataxia, mood lability, nystagmus, resp depression, death
- synergistic with ETOH or opiods/narcotics

53
Q

sedative hypnotic OD tx?

A

ABCs, gastric lavage and charcoal if drug was ingested within last 6 hours
- benzo antidote = Flumazenil (use may precipitate seizures)

54
Q

is sedative hypnotic withdrawal life-threatening? what’s the tx?

A

yes! benzo taper

55
Q

stimulants vs depressants/sedatives

A

stim withdrawal = NOT life threatening

depressants/sedative withdrawal = life threatening

56
Q

define opioid

A

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)

57
Q

list of opioids

A

MC: oxycodone, hydrocodone/acetaminophen (Vicodin), oxycodone/acetaminophen (Percocet)
- heroin, codeine, dextromethorphan, morphine, methadone, meperidine

58
Q

what should alter a doctor to possible opioid misuse?

A

losing meds, doctor shopping, running out of meds early

59
Q

opioid intoxication and tx

A

AMS/drowsiness, n/v, constipation (post-surg concern), constricted pupils, resp depression, seizures
- tx: ABCs, naloxone (opioid antagonist, care for possible withdrawal sxs then)

60
Q

opioid withdrawal sxs and tx

A

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

61
Q

dextromethorphan

A

inredient in cough syrup

62
Q

Meperidine/Demerol

A

dilates pupils, the exception of opioids

63
Q

opioid use disorder tx

A

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

64
Q

poppy seed bagels or muffins do what?

A

can cause positive opioid drug screen

65
Q

what are the typical hallucinogens? what R’s do they act upon?

A

mushrooms (psilocybin), LSD (lysergic acid diethylamide)

- serotonergic

66
Q

do hallucinogens cause dependence or withdrawal?

A

no

67
Q

LSD flashback

A

recurrence of sxs mimicking a prior trip that occurs spontaneously and lasts mins to hours

68
Q

hallucinogen intoxication sxs and tx

A

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
69
Q

what defines a bad trip on hallucinogens?

A

anxiety, panic, psychotic sxs (paranoia, hallucinations)

70
Q

Dronabinol

A

pill form of THC that’s FDA-approved

71
Q

define marijuana

A

most commonly used illicit substance in the world, main active component is THC (tetrahydrocannabinol) which inh adenylate cyclase in brain

72
Q

current marijuana medicinal uses

A

tx n/v in chemo pts, inc appetite in AIDS pts, tx chronic pain from CA, dec intraocular pressure in glaucoma

73
Q

marijuana intoxication and tx

A

euphoria, anxiety, impaired motor coordination, perceptual disturbances (slowed time), conjunctival injection (red eyes), dry mouth, inc appetite (munchies)
- supportive

74
Q

risk of chronic marijuana use

A

cannabis use diorder, asthma, chrnoic bronchitis, immune system suppression, CA

75
Q

risk with inhalant intoxication, tx

A

resp depression or cardiac arrhythmias, permanent CNS dmg, peripheral neuropathy, MI and myocarditis
- ABCs, O2, chelation

76
Q

define caffeine

A

MC used psychoactive substance in US, adenosine antagnois > inc cAMP > inc excitatory neurotransmitters

77
Q

caffeine overdose sxs

A

> 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

78
Q

caffeine withdrawal

A

sxs occur in 75% of users if cessation is abrupt, HA, fatigue, irritability, n/v, muscle pain, depression
- resolves in 1-2 weeks

79
Q

define nicotine

A

derived from tobacco plant, stimulates nicotinic R’s in autonomic ganglia and strongly effects dopaminergic system (addiction)

80
Q

nicotine use can lead to

A

tolerance and physical dependence

81
Q

what is the leading cause of preventable morbidity and mortality in the US?

A

cigarette smoking

82
Q

withdrawal sxs of nicotine

A

intense craving, anxiety, poor concentration, inc appetite, wt gain, irritability and restlessness, insomnia

83
Q

cigarette smoking during pregnancy is associated w/ what?

A

low birth wt, SIDS

84
Q

nicotine dependence tx

A

Varenicline (Chantix), Bupropion (Zyban), nicotine replacement therapy (NRT), behavioral support/counseling

85
Q

tx for gambling

A

Gamblers Anonymous (12-step program) MC, CBT

Psychiatry Clerkship (17 decks)

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