lect 1 Flashcards
what is misuse?
the use of any prescribed medication for non prescribed reasons:
-recreational use
-self treating acute pain
-to give to someone else
-sell
addiction
what is abuse?
a condition characterized by a self destructive pattern of using a substance that leads to a significant problems and distress
what is dependence
-characterized by SX of tolerance and withdrawal
person needs more and more of something to get the same effect (tolerance), and they experience unpleasant symptoms when they stop using it (withdrawal).
tolerance?
withdrawal?
T: decrease response to a drug used repeatedly
W: unpleasant physical and mental effects that a person experiences after they stop using substance
what is addiction?
marked by a change if behavior caused by biochemical changes in the brain after continued substance abuse.
-becomes the main priority of the addict regardless of the harm they cause to themselves or others
-makes them act irrational
substance use disorder is?
abuse, dependence and addiction
Substance Use disorder DSM-5
->2 in the last 12 months
-hazardous use
-social/interpersonal problems
-neglected major roles to use
-withdrawal
-tolerance
-used larger amounts for longer periods of time
-repeated attempts to control or quit
-much time spent using
-physical or psychological problems related to use
-activities given up to use
-cravings
severity of disorder
2-3 criteria:
4-5 criteria:
> 6 criteria:
2-3 criteria: mild
4-5 criteria: mod
> 6 criteria: severe
8 most common substances of abuse
-opioid
-alcohol
-tobacco
-cannabis
-stimulant
-hallucinogen
-inhalant
-sedative, hyponotic
the # of criteria @ initial diagnosis is INVERSLEY proportional to success of rehab
opioid misuse statistics:
11 million misuse opioids yearly
52 million misuse it lifetime
screening for opioid:
-revised screener and opioid assessment for pts w pain (SOAPP-R):
> 18 is an increase risk for opioid misuse
-best sensitivity
Opioid risk tool: MC used
-4-7 mod risk
->7 high risk
-most commonly used
-takesgender differences into account
in opioid risk tool: the males and females differ?
-males who do Opi has an assoc. of alcohol and illegal drugs
-females :16-45
-preadolescent sexual abuse
Questions to ask for OPI pts:
-use of OPI
-other substances
-family hx
-psychiatric
-specific diagnoses (hep B)
-nicotine dependence
-unexplained pain
Opioid DSM-5
2 of the following occur w/in 12 months that lead to impairment or distress:
-opioid taken in larger amounts or over long period of time
-desire to cut down
-much time using opioid
-craving/urge
-failure to fulfill obligations
-continues use despite the problems of opioid use
-recreational use caused social activities up
-tolerance
-withdrawal
do not prescribe OPI:
-if pt has opi use disorder
-pre existing substance abuse
-hx of suicide attempt
-already on opi for chronic pain
-hx of overdose
proper use of opi per cdc
-check database first
-NSAID first since its = to opi effects for pain
-if nsaids dont help, opi is second line
NO MORE THAN 3-7 days
calculating MME categories:
safe: < 50 MME
borderline: 90 MME
tolerant: >200 MME
overdose is > 100 mme is 9x taking 20 MME
50% of pts on opi for 90 days develop opi disorder
what is the proper use of opi per cdc
-chronic pain
-terminal conditions
-hospice
any other chronic condition STOP
how to stop opi :
what meds to use to get them off opi?
fast taper: if not appropiately used
slow taper: pts with long term use or w tolerance
medications:
naltrexone-opiod blocker [DONT USE ifpt was using opi in the LAST 7 days]
treatin opioid withdrawal:
sweats, tremor, anxiety, htn:
insomnia, anxiety, restlessness:
fever, pain:
nausea and vomiting:
diarrhea:
muscle spasm:
dyspepsia:
sweats, tremor, anxiety, htn: clonindine (3x)
insomnia, anxiety, restlessness: : diphendramine, hydroxyzine
fever, pain: NSAID / acetaminophen
nausea and vomiting: promethazine, metaclopramide
diarrhea: loperamide
muscle spasm: methocarbamol
dyspepsia: symptomatic measure
alcohol misuse:
drinking alot that causes harm to n others
drinking underage or pregnant
binge drinking
NIAAA defines it as a:
-pattern of drinking that brings BAC to 0.08 g/dl or higher
-woman consumes 4 or more drinks– 2 hrs
-man 5 drinks or more –> 2 hrs
binge drinking per SAMHSA:
-consuming more than 5 or more drinks in the same occasion or atleast one day a month
high intensity drinking
consumption of 2 or more times gender specific thresholds for binge drinking which is to say 10 or more standard drinks for males and 8 or more for females
-high intensity drinking is consistent at binge levels II and III.
alcohol stats for :
ppl in ED visits bc of alcohol:
traffic accidents:
cost national:
pregnant women:
fetal alcohol spectrum disorders:
ppl in ED visits bc of alcohol: 10.2%
traffic accidents: 18.5%
cost national: 249 billion
pregnant women: 9.5%
fetal alcohol spectrum disorders:1-5% 6000 first graders
DSM-5 Alcohol Use Order
-a maladaptive pattern substance leading to impairment by 2 + in the 12 month period:
-alcohol often taken in longer period of times or larger amts.
-persistent desire to cut down
-great amount of time in activities getting alcohol or recovering
-failure to do activities
-craving, desire or urge for alcohol
-recreational use caused social activities up
-tolerance
-withdrawal
Substance use disorder:
severity of disorder
-2-3: mild substance dis.
-4-5: mod.
>=6: severe
severe alcohol use order= alcoholism
alcohol use disorder TX:
-pt must recognized he has a problem
-clinician recognizes severity
MHM: negotiate
Screening tools for Alcohol use disorder:
-CAGE- specific high
-AUDIT [highest sens]
women>4 ;m>8
-AUDIT-C [3 ?s]
CAGE:
-cut down
-annoyed
-guilty
-eye opener
1: low risk
2-3: high susp.
4: diagnosis for alcoholism
Alcohol brief intervention:
enhance motivation instead of blaming, evoke a change in a person, trusting environment [no judges],
outpatient rehabilitation:
-pts who have severe alcohol use or cant decrease
-includes psychotherapy
- or group therapy
inpatient rehab
psychotherapy:
-for severe/dependent alcohol pts and those with comorbid psychoactive, abuse problems.
-teach pts. to avoid circumstances that could lead to drinking
Disulfiram:
ABYSMAL COMPLIANCE- pt is non adherent n fails to take tx
interferes w ACETALDEHYDE accumulates
drinking alcohol w/in 12 hrs taken disulfiram:
-vasodilation, flushing, sweating, tachy
disulfiram purposely causes unpleasant side effects if alcohol is consumed.
Naltrexone: opioid antagonist
Gaba
clonindine:dec htn n tachy withdrawal
decreases relapse rate, must be off opioid 7 days,
