Lecture 6: Addiction Medicine Flashcards
What is the definition of addiction?
- Primary, chronic disease of brain reward, motivation, memory and related circuitry
- Pathologically pursuing reward and/or relief by substance use and other behaviors***
For diagnosis of a substance-induced mental disorder there is evidence from the hx, PE, or labratory findings of what 2 things?
- Disorder developed during or within 1 month of a substance intoxication or withdrawal or taking a medication
and
- The involved substance/medication is capable of producing the mental disorder
What are 2 pieces of evidence which would indicate that a mental disorder is independent and not substance-induced?
- The disorder preceded the onset of severe intoxication or withdrawal or exporsure to the medication
or
- The full mental disorder persisted for a substantial period of time (i.e. at least 1 month) after the cessation of acute withdrawal or severe intoxication or taking the medication
What are the 5 criteria of substance-induced mental disorders?
- Disorder represents a clinically significant symptomatic presentation of a relevant mental disorder
- Evidence from the hx, PE, or lab findings: disorder developed during or within 1 month of intoxication, withdrawal or use
- Disorder is not better explained by an independent mental disorder
- Disorder does not occur exclusively during the course of delirium
- Disorder causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
When do seizures most often arise during alcohol withdrawal?
24-48 hrs; most often Grand mal
When does withdrawal delirium (DTs) develop during alcohol withdrawal?
48-72 hrs
What is the most severe manifestation of alcohol withdrawal?
Delirium Tremens
What are the signs/sx’s of delirium tremems; what is the hallmark?
- Agitation + global confusion + disorientation + hallucinations + fever + HTN + diaphoresis + autonomic hyperactivity = tachycardia + HTN
- Hallmark = profound global confusion
What does CIWA stand for and what is it used for?
- Clinical Institute Withdrawal Assessment for Alcohol
- Assigns numerical values to orientation, N/V, tremor, sweating, anxiety, agitation, tactile/auditory/visual disturbances and HA
- Total score >10 indicates more severe withdrawal
Which 3 benzodiazepines are metabolized through glucuronidation in liver and can be used in the setting of alcohol and other withdrawals?
Oxazepam and Lorazepam and Temazepam
What are 3 reasons that methadone is a high risk medication?
- Can be deadly when used with a benzodiazepine***
- Frequently causes QTC prolongation - sometimes fatal
- Dangers ↑ when used with another 3A4 substrate!***
If a methadone maintenance patient is encountered in the ED and needs pain management what is the proper protocol?
- Provider calls on-call service at methadone clinic and verifies dosage
- The correct methadone dosage is continued while patient is hospitalized
- If additional pain mangement is required use another opioid: not another CYP3A4 substrate and no benzos!
- Do not use methadone as this will possibly disrupt the response to current methadone maintenance dosing
What is a serious mental AE associated with chronic intoxication of stimulants?
Psychosis: sometimes with severe paranoia
Cocaine works mainly by preventing the reuptake of what?
Dopamine
Amphetamines can be fatal at lower doses in the setting of what underlying disease?
Brugada syndrome
What are the cerebellar sx’s of PCP intoxication?
Ataxia, dysarthria, and NYSTAGMUS (vertical and horizontal)
What are the 2 neuroadaptive effects of PCP?
- Opiate receptor effects
- Allosteric modulator of glutamate NMDA receptor
