First Aid Substance Related Disorders I Flashcards
Abuse
impairment or distress for at least 12 mo with 1+:
- failure to fulfill obligations at work, school, or home
- use in dangerous situations
- recurrent substance-related legal problems
- continued use despite social or interpersonal problems due to the substance abuse
dependence
impairment or distress manifested by at lease 3+ in 12 mo period
- tolerance
- withdrawal
- using substance more than originally intended
- persistent desire or unsuccessful efforts to cut down use
- significant time spent on getting/recovering from substance
- dec social occupational or rec activities
- continued use despite problems
withdrawal
development of substance specific syndrome due to the cessation of substance use that has been heavy and prolonged
tolerance
increased amounts of substance to achieve the desired effect or diminished effect if using the same amount of the substance
treatment of substance abuse
behavioral counseling
psychosocial treatments with motivational intervention and CBT
contingency management and group therapy
AA and narcotics anonymous
how long is cocaine in your system
2-4 days
how long are amphetamines in your system
1-3 days
how long is PCP in your system
3-8
how long are sedatives/hypnotics in your system
short acting barb 24 hrs
long acting barb 3 weeks
short acting benzo 3 days
long acting benzo 30 days
how long are opiates in your system
2-3 days
how does alcohol work in CNS
activates GABA inhibits glutamate R and VCaCh
how is alcohol metabolized
to actaldehyde by alcohol dehydrogenase
to acetic acid by aldehyde dehydrogenase
treatment of alcohol intoxication
monitor ABCs, glucose, electrolytes and acid base
give thiamine
naloxone if opioids too
CT for subdural hematoma or brain injury
at what BAL do most patients have ataxic gait
100-150
BAL lethargy and difficult sittin guprigth
150-250
coma BAL level
300
respiratory depression BAL level
400
clinical presentation of alcohol withdrawal
insomnia, anxiety, hand tremor, irritability, anorexia, nausea, vomiting, autonomic hyperactivity (diaphoresis, tachycardia and HTN), psychomotor agitation, fever, seizures, hallucinations and delerium
Sx according to time in withdrawal from alcohol
6-24 hours earliest tonix clonic seizures between 6 and 48 hours, peak around 24 DTs happen in 1/3 people hypoMg predispose to seizures treated with benzo taper
Sx DT
delerium, hallucinations, gross tremor, autonomic instability and fluctuating levels psychomotor activity
treatment DTs
benzo carbamazepine and valproate taper can be used antipsychotics for severe agitation thiamine, folic acid and MVI electrolyte and fluid abnormalities corrected monitar with CIWA scale watch consciousness check signs for hepatic failure
CAGE questionnaire
2+ = positive screen ever wanted to Cut down ever felt Annoyed by criticism felt Guilty about drinking taken a drink as an Eye opener (to prevent shakes)
Disfulfiram
Antabuse
blocks enzyme aldehyde dehydrogenase in liver and auses aversive reaciton to alcohol like flushing HA nausea vomiting, sob
CI in those with severe cardiac disease, pregnancy and psychosis
naltrexone
opioid R blocker
dec craving of alcohol
if have physical opioid dependence it will cause withdrawal
