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Pharmacotherapeutics - Midterm > Jaynstein - Addiction Medicine > Flashcards

Jaynstein - Addiction Medicine Flashcards

1
Q

how do nearly all addictive drugs produce desired effects

A

dopamine flood

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2
Q

3 major rf for SUD

A

genetics
psychological disorders
encounter with substances at a young age

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3
Q

what 3 psychological disorders are associated w. SUD

A

antisocial personality
anxiety
PTSD

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4
Q

which psychological disorder is linked with etoh

A

antisocial

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5
Q

which psychological disorder is linked with cocaine

A

anxiety

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6
Q

which psychological disorder is linked with opioids

A

PTSD

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7
Q

are women or men with PTSD more likely to abuse opiods

A

women

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8
Q

leading cause of preventable death

A

smoking

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9
Q

smoking increases risk for what 3 health conditions

A

lung ca
CAD
stroke

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10
Q

on average, it takes __ attempts before a pt is successful at smoking cessation

A

4

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11
Q

3 nicotine withdrawal sx

A

irritable/angry/anxious
brain fog
hungry

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12
Q

are young or old patients more likely to quit smoking

A

young

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13
Q

2 meds to aid with smoking cessation

A

varenicline (chantrix)
bupropion (wellbutrin)

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14
Q

t/f: e cigs have FDA regulation

A

f!

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15
Q

t/f: research shows that e cigs help pt quit smoking

A

f!

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16
Q

a fifth of etoh is how many shots

A

16

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17
Q

a handle of etoh is how many shots

A

40

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18
Q

who should be screened for etoh use (4)

A

all patients routinely
before prescribing meds that might interact
have dpn, anxiety, or other mental health d.o
have liver dz

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19
Q

what does CAGE stand for

A

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

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20
Q

usefulness of CAGE scores

A

0 -> good negative predictive value
1-2 -> interpret w. caution
3-4 -> strongly supports dx of etoh abuse

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21
Q

2 screening tools for etoh

A

CAGE
SBIRT

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22
Q

withdrawal sx for etoh start __ hours after last drink
and last __ hours

A

start: 8-12 hr
last: 48-72 hr

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23
Q

seizures begin __ hr after last drink

A

24-48 hr

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24
Q

what type of sz is associated w. etoh withdrawal

A

generalized tonic-clonic

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25
Q

what increases the likelihood of etoh withdrawal seizure

A

previous hx seizure

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26
Q

delirium tremens begins __ hr after last drink
and can occur up to __ days out

A

24-72 hr
10 days

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27
Q

delirium tremens includes (5)

A

confusion
hallucinations -> tactile and visual
tremor
ANS dysfxn
CV instability

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28
Q

t/f: delirium tremens can be fatal

A

t!

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29
Q

what do you think when you see an alcoholic w. confusion, ataxia, and ophthalmoplegia

A

wernicke encephalopathy

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30
Q

ophthalmoplegia involves which nerve

A

CN VI

31
Q

major sequela of wernicke

A

korsakoff -> psychosis

32
Q

t/f: wernicke is reversible

A

t!

33
Q

t/f: korsakoff is reversible

A

f!
it is irreversible

34
Q

tx for wernicke/korsakoff

A

thiamine! (b1)

35
Q

moderate symptoms of etoh withdrawal begin __ hr after last drink
and include (6)

A

12-48 hr

mental confusion
hallucinations
elevated bp
irregular heartbeat
breathing difficulty
seizures

36
Q

severe sx of etoh withdrawal begin __ hr after last drink
and include (6)

A

48-72 hr

agitation
disorientation
hallucinations
rapid heartbeat
excessive sweating
fever

37
Q

the average person clears __ etoh /hr

A

15-20 mg/dL

38
Q

t/f: etoh withdrawal can occur at any BAC

A

t!

39
Q

three oral meds to help w. etoh dependence tx

A

naltrexone
acamprosate
disulfiram (antabuse)

40
Q

injectable med that can help w. etoh dependence tx

A

ER injectable naltrexone

41
Q

what do meds for etoh dependence tx achieve (3)

A

reduce drinking
avoid relapse
achieve/maintain abstinence

42
Q

duration of tx for etoh dependence drugs

A

at least 3 mo

43
Q

what should you do if one etoh dependence drug does not work for pt

A

try a different one

44
Q

t/f: combos of drugs used for etoh dependence treatment are effective

A

f!

45
Q

which etoh dependence drug works by stopping pleasurable effects of etoh

A

naltrexone

46
Q

which etoh dependence drug works by reducing cravings

A

acamprosate

47
Q

which etoh dependence drug works by blocking metabolism of etoh

A

disulfram (antabuse)

48
Q

which two etoh dependence drug can be taken by patients working towards abstinence, but still drinking

A

naltrexone
acamprosate

49
Q

injectable form of naltrexone

A

vivitrol

50
Q

which etoh dependance drugs require pt to be sober

A

disulfram (antabuse)

51
Q

which etoh dependance drug can be very toxic to pt’s that are still drinking

A

disulfram (antabuse)

52
Q

2 tools used to assess status of pt’s withdrawing from etoh

A

SEWS (severity of ethanol withdrawal)
CIWA (clinical institute withdrawal assessment)

53
Q

2 drugs that are mainstay of acute etoh withdrawal

A

barbituates
benzos

54
Q

drug that is mc used for acute etoh withdrawal

A

phenobarbital

barbituates better than benzos due to less risk of withdrawal

55
Q

t/f: CBT for etoh dependance tx must be specialized

A

f!

56
Q

relapse mc occurs __ after abstinence

A

w.in the first 12 mo

57
Q

important aspect to consider in etoh abstinent pt

A

treat depression aggressively

58
Q

7 common opioid-containing meds

A

hydrocodone
oxycodone
percocet
vicodin
morphine
codeine
fentanyl

59
Q

illicit opioid

A

heroine

60
Q

maintenance medication opioid

A

methadone

61
Q

leading cause of accidental death in the US

A

drug overdose

62
Q

4 substances that increase the risk for heroin use

A

etoh
marijuana
cocaine
opioids

63
Q

withdrawal from what 2 substances can be fatal

A

benzos
etoh

64
Q

opioid withdrawal involves rapid unblocking of what receptors

A

mu

65
Q

what does MME stand for

A

morphine mg equivalents

means to compare opiates

66
Q

opioid doses at or above __/day increase the risk of overdose 2x

A

50 MME

67
Q

opioid withdrawal timeline

A

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

68
Q

t/f: supervised detox w. provider/patient creating a decreasing usage plan is effective

A

f!

69
Q

3 effective methods for opioid addiction tx

A

inpatient care
long term outpatient care
CBT

70
Q

what does MAT stand for

A

medication assisted treatment

71
Q

3 meds approved for treating opioid use disorder

A

methadone
buprenorphine -> suboxone
naltrexone

72
Q

minimum drug to offer pt with opioid use disorder if they are not willing to stop

A

naloxone

73
Q

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

A

7

74
Q

4 exception considerations for 7 day opioid supply limit

A

chronic pain > 90 days
cancer dx
post surgical pain expected to last > 14 days
palliative care/hospice

Pharmacotherapeutics - Midterm (11 decks)

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