Jaynstein - Addiction Medicine Flashcards
how do nearly all addictive drugs produce desired effects
dopamine flood
3 major rf for SUD
genetics
psychological disorders
encounter with substances at a young age
what 3 psychological disorders are associated w. SUD
antisocial personality
anxiety
PTSD
which psychological disorder is linked with etoh
antisocial
which psychological disorder is linked with cocaine
anxiety
which psychological disorder is linked with opioids
PTSD
are women or men with PTSD more likely to abuse opiods
women
leading cause of preventable death
smoking
smoking increases risk for what 3 health conditions
lung ca
CAD
stroke
on average, it takes __ attempts before a pt is successful at smoking cessation
4
3 nicotine withdrawal sx
irritable/angry/anxious
brain fog
hungry
are young or old patients more likely to quit smoking
young
2 meds to aid with smoking cessation
varenicline (chantrix)
bupropion (wellbutrin)
t/f: e cigs have FDA regulation
f!
t/f: research shows that e cigs help pt quit smoking
f!
a fifth of etoh is how many shots
16
a handle of etoh is how many shots
40
who should be screened for etoh use (4)
all patients routinely
before prescribing meds that might interact
have dpn, anxiety, or other mental health d.o
have liver dz
what does CAGE stand for
concern about drinking/cut down on drinking
apparent problem to others/annoyed by criticisms
grave consequences/guilt about drinking
evidence of dependence/eye opener for hangover
usefulness of CAGE scores
0 -> good negative predictive value
1-2 -> interpret w. caution
3-4 -> strongly supports dx of etoh abuse
2 screening tools for etoh
CAGE
SBIRT
withdrawal sx for etoh start __ hours after last drink
and last __ hours
start: 8-12 hr
last: 48-72 hr
seizures begin __ hr after last drink
24-48 hr
what type of sz is associated w. etoh withdrawal
generalized tonic-clonic
what increases the likelihood of etoh withdrawal seizure
previous hx seizure
delirium tremens begins __ hr after last drink
and can occur up to __ days out
24-72 hr
10 days
delirium tremens includes (5)
confusion
hallucinations -> tactile and visual
tremor
ANS dysfxn
CV instability
t/f: delirium tremens can be fatal
t!
what do you think when you see an alcoholic w. confusion, ataxia, and ophthalmoplegia
wernicke encephalopathy
ophthalmoplegia involves which nerve
CN VI
major sequela of wernicke
korsakoff -> psychosis
t/f: wernicke is reversible
t!
t/f: korsakoff is reversible
f!
it is irreversible
tx for wernicke/korsakoff
thiamine! (b1)
moderate symptoms of etoh withdrawal begin __ hr after last drink
and include (6)
12-48 hr
mental confusion
hallucinations
elevated bp
irregular heartbeat
breathing difficulty
seizures
severe sx of etoh withdrawal begin __ hr after last drink
and include (6)
48-72 hr
agitation
disorientation
hallucinations
rapid heartbeat
excessive sweating
fever
the average person clears __ etoh /hr
15-20 mg/dL
t/f: etoh withdrawal can occur at any BAC
t!
three oral meds to help w. etoh dependence tx
naltrexone
acamprosate
disulfiram (antabuse)
injectable med that can help w. etoh dependence tx
ER injectable naltrexone
what do meds for etoh dependence tx achieve (3)
reduce drinking
avoid relapse
achieve/maintain abstinence
duration of tx for etoh dependence drugs
at least 3 mo
what should you do if one etoh dependence drug does not work for pt
try a different one
t/f: combos of drugs used for etoh dependence treatment are effective
f!
which etoh dependence drug works by stopping pleasurable effects of etoh
naltrexone
which etoh dependence drug works by reducing cravings
acamprosate
which etoh dependence drug works by blocking metabolism of etoh
disulfram (antabuse)
which two etoh dependence drug can be taken by patients working towards abstinence, but still drinking
naltrexone
acamprosate
injectable form of naltrexone
vivitrol
which etoh dependance drugs require pt to be sober
disulfram (antabuse)
which etoh dependance drug can be very toxic to pt’s that are still drinking
disulfram (antabuse)
2 tools used to assess status of pt’s withdrawing from etoh
SEWS (severity of ethanol withdrawal)
CIWA (clinical institute withdrawal assessment)
2 drugs that are mainstay of acute etoh withdrawal
barbituates
benzos
drug that is mc used for acute etoh withdrawal
phenobarbital
barbituates better than benzos due to less risk of withdrawal
t/f: CBT for etoh dependance tx must be specialized
f!
relapse mc occurs __ after abstinence
w.in the first 12 mo
important aspect to consider in etoh abstinent pt
treat depression aggressively
7 common opioid-containing meds
hydrocodone
oxycodone
percocet
vicodin
morphine
codeine
fentanyl
illicit opioid
heroine
maintenance medication opioid
methadone
leading cause of accidental death in the US
drug overdose
4 substances that increase the risk for heroin use
etoh
marijuana
cocaine
opioids
withdrawal from what 2 substances can be fatal
benzos
etoh
opioid withdrawal involves rapid unblocking of what receptors
mu
what does MME stand for
morphine mg equivalents
means to compare opiates
opioid doses at or above __/day increase the risk of overdose 2x
50 MME
opioid withdrawal timeline
10-24 hr: vomit
36-48 hr: sweating, nausea, runny nose, dilated pupils, watery eyes
48-72 hr: anxiety, insomnia, localized pain
72 hr-1 week: all sx gradually start fading away
t/f: supervised detox w. provider/patient creating a decreasing usage plan is effective
f!
3 effective methods for opioid addiction tx
inpatient care
long term outpatient care
CBT
what does MAT stand for
medication assisted treatment
3 meds approved for treating opioid use disorder
methadone
buprenorphine -> suboxone
naltrexone
minimum drug to offer pt with opioid use disorder if they are not willing to stop
naloxone
initial prescriptions of opioids are limited to a __ day supply if provider has not written an opiod prescription for the pt in the last 12 mo
7
4 exception considerations for 7 day opioid supply limit
chronic pain > 90 days
cancer dx
post surgical pain expected to last > 14 days
palliative care/hospice
