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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
what increases the likelihood of etoh withdrawal seizure
previous hx seizure
26
delirium tremens begins __ hr after last drink and can occur up to __ days out
24-72 hr 10 days
27
delirium tremens includes (5)
confusion hallucinations -> tactile and visual tremor ANS dysfxn CV instability
28
t/f: delirium tremens can be fatal
t!
29
what do you think when you see an alcoholic w. confusion, ataxia, and ophthalmoplegia
wernicke encephalopathy
30
ophthalmoplegia involves which nerve
CN VI
31
major sequela of wernicke
korsakoff -> psychosis
32
t/f: wernicke is reversible
t!
33
t/f: korsakoff is reversible
f! it is irreversible
34
tx for wernicke/korsakoff
thiamine! (b1)
35
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
36
severe sx of etoh withdrawal begin __ hr after last drink and include (6)
48-72 hr agitation disorientation hallucinations rapid heartbeat excessive sweating fever
37
the average person clears __ etoh /hr
15-20 mg/dL
38
t/f: etoh withdrawal can occur at any BAC
t!
39
three oral meds to help w. etoh dependence tx
naltrexone acamprosate disulfiram (antabuse)
40
injectable med that can help w. etoh dependence tx
ER injectable naltrexone
41
what do meds for etoh dependence tx achieve (3)
reduce drinking avoid relapse achieve/maintain abstinence
42
duration of tx for etoh dependence drugs
at least 3 mo
43
what should you do if one etoh dependence drug does not work for pt
try a different one
44
t/f: combos of drugs used for etoh dependence treatment are effective
f!
45
which etoh dependence drug works by stopping pleasurable effects of etoh
naltrexone
46
which etoh dependence drug works by reducing cravings
acamprosate
47
which etoh dependence drug works by blocking metabolism of etoh
disulfram (antabuse)
48
which two etoh dependence drug can be taken by patients working towards abstinence, but still drinking
naltrexone acamprosate
49
injectable form of naltrexone
vivitrol
50
which etoh dependance drugs require pt to be sober
disulfram (antabuse)
51
which etoh dependance drug can be very toxic to pt's that are still drinking
disulfram (antabuse)
52
2 tools used to assess status of pt's withdrawing from etoh
SEWS (severity of ethanol withdrawal) CIWA (clinical institute withdrawal assessment)
53
2 drugs that are mainstay of acute etoh withdrawal
barbituates benzos
54
drug that is mc used for acute etoh withdrawal
phenobarbital barbituates better than benzos due to less risk of withdrawal
55
t/f: CBT for etoh dependance tx must be specialized
f!
56
relapse mc occurs __ after abstinence
w.in the first 12 mo
57
important aspect to consider in etoh abstinent pt
treat depression aggressively
58
7 common opioid-containing meds
hydrocodone oxycodone percocet vicodin morphine codeine fentanyl
59
illicit opioid
heroine
60
maintenance medication opioid
methadone
61
leading cause of accidental death in the US
drug overdose
62
4 substances that increase the risk for heroin use
etoh marijuana cocaine opioids
63
withdrawal from what 2 substances can be fatal
benzos etoh
64
opioid withdrawal involves rapid unblocking of what receptors
mu
65
what does MME stand for
morphine mg equivalents means to compare opiates
66
opioid doses at or above __/day increase the risk of overdose 2x
50 MME
67
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
68
t/f: supervised detox w. provider/patient creating a decreasing usage plan is effective
f!
69
3 effective methods for opioid addiction tx
inpatient care long term outpatient care CBT
70
what does MAT stand for
medication assisted treatment
71
3 meds approved for treating opioid use disorder
methadone buprenorphine -> suboxone naltrexone
72
minimum drug to offer pt with opioid use disorder if they are not willing to stop
naloxone
73
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
74
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

Pharmacotherapeutics - Midterm (11 decks)

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