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Preventive And Social Medicine II > M4CN1 Substance Abuse > Flashcards

M4CN1 Substance Abuse Flashcards

1
Q

What is the use of a chemical subs example a drug outside of its intended use?

A

Substance abuse

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2
Q

What is a term of using a drug in dosages or frequency more than the usual?

A

Drug misuse

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3
Q

Theories in etiology

A 
Childhood
Psychoanalytic
Sociocultural
Behavioral/learning
Genetic
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4
Q

About 10% of consumed alcohol is absorbed from the

A

Stomach, w the reminder absorbed from the SI

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5
Q

How many mins does the peak bld conc reach?

A

30-90 mins

Usually 45-60 mins depends if empty stomach (wc enhances abs)

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6
Q

If you eat before drinking, what happens to the absorption?

A

Delayed

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7
Q

About 90% of absorbed alcohol is metabolized through what?

A

Oxidation in liver

Remaining 10% ecreted unchanged by the kidneys and lungs

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8
Q

What alcohol level in bld that thought, judgement, and restraint are loosened and sometimes disrupted?

A

0.05%

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9
Q

What level of alcohol does voluntary motor actions usually become perceptibly clumsy?

A

0.1%

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10
Q

What is the accepted legal intoxication level?

A

0.1-0.15%

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11
Q

What level does the entire motor area of the brain is measurably depressed?

A

0.2%

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12
Q

What level is a person commonly confused or stuporous?

A

0.3%

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13
Q

What level is a person commonly confused or stuporous?

A

0.3%

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14
Q

Level of a person in coma

A

0.4-0.5%

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15
Q

Alcoholic syndromes

A
  • intoxication
  • idiosyncratic intoxication
  • hallucinosis
  • withdrawal
  • encephalopathy
  • amnestic disorder
  • dementia
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16
Q

What are the 3 general steps in treating the alcoholic person after the disorder has been diagnosed?

A
  1. Intervention
  2. Detoxification
  3. Rehabilitation
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17
Q

In this case, tx are applied after the psychiatric disorder has been stabilized as much as possible

A

Alcoholic w independent psychiatric syndromes

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18
Q

Confrontation, or aimed at maximizing the motivation for tx and continued abstinence

A

Intervention

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19
Q

What has the goal to break thru feelings of denial and help px recognize the consequences likely to occur if the disorder is not treated?

A

Intervention

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20
Q

What step involves convincing that they’re responsible for their own actions?

A

Intervention

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21
Q

If the px is in relatively good health, adequately nourished, abd has a good social support sys, the depressant withdrawal syndrome usually resembles what?

A

Mild case of flu

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22
Q

What is the first essential step in detoxification?

A

Physical examination

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23
Q

Is there likely to have severe alcohol withdrawal in the absence of a serious medical disorder or combined drug abuse?

A

Nope, unlikely

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24
Q

What is the second step in detoxification?

A

Rest, adequate nutrition, and multiple vit esp cont thiamine

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25
Q

What develops bcs the brain has physically adapted to the presence of a brain depressant and cannot fxn adequately in the absence of the drug?

A

Mild or moderate withdrawal

26
Q

Giving enough brain depressant on the first day to diminish symptoms and then wearing the px off the drug over the next 5 days off what to most px?

A

Optimal relief and minimize possibility that severe withdrawal will develop

27
Q

What depressants can work?

A

Alcohol, barbiturates, or any benzodiazepines

Clinicians choose a benzodiazepine for its relative safety

28
Q

In mild/mod withdrawal, adequate tx can be given w either short-acting drugs or long-acting subs, give examples of each

A

short-acting drugs: lorazepam

long-acting subs: chlordiazepoxide and diazepam

29
Q

Example of tx is administration of 25mg chlordiazepoxide by mouth 3 or 4x a day on the first day, w a notation to skip a dose if px is what?

A

Asleep or feelin sleepy 😴

30
Q

An additional one or two 25mg doses can be given during first 24 hrs if px is what?

A

Jittery or show signs of increasing tremor or autonomic dysfxn

31
Q

Whatever benzodiazepine dosage is required on the first day can be decreased by 20% each subsequent day, with resulting need for no further medication after how many days?

A

4 or 5 days

32
Q

When giving long acting agents (s/a chlordiazepoxide), the clinician must avoid what?

A

Producing excessive sleepiness through over medication

If px is sleepy, next dose must be omitted

33
Q

When taking a short acting drug, why does the px must not miss any dose?

A

Bcs rapid changes in benzodiazepine conc in bld may ppt severe withdrawal

34
Q

Mild/mod withdrawal: Some clinicians have also recommended 3-adrenergic receptor antagonists (e.g propanol (Inderal) or a-adrenergic receptor antagonist (e.g., clonidine), although these meds don’t appear to be what?

A

Don’t appear to be superior to the benzodiazepine

- do little to decrease risk of seizures or delirium

35
Q

In severe withdrawal, symptoms can be minimized thru the use of either what?

A

Benzodiazepine (in wc case high doses are sometimes required) or
Antipsychotic agents such as haloperidol

36
Q

On the first or second day, doses are used to what?

A

Control behavior

37
Q

Patient can be weaned off the medication by about what day?

A

5th day

38
Q

In severe withdrawal, another 1-3% px may have what?

A

Single grand mal convulsion

39
Q

The rare person has multiple fits, w peak incidence on what day of withdrawal?

A

2nd day of withdrawal

40
Q

In rehabilitation, what are the 3 components?

A

(1) continued efforts to increase and maintain high lvls of motivation for abstinence
(2) work to help px readjust to a lifestyle free alcohol
(3) relapse prevention

41
Q

The tx process involves:

A

Intervention
Optimizing physical & psychological fxning
Enhancing motivation
Reaching out to fan
Using first 2-4 wks of care as an intensive pd of help

42
Q

The efforts in the tx process must be followed by at least how many months?

A

3-6 months of less frequent outpatient care

43
Q

What uses a combination of individual and grp counseling, judicious avoidance of psychotropic meds unless needed for independent disorders, and involvement in such selfhelp grps as AA?

A

Outpatient care

44
Q

What helps px maintain a high lvl of motivation for abstinence and to enhance their fxning?

A

Counseling efforts

45
Q

What have not shown to be of benefit during early months of recovery and at least theoretically, may impair efforts at maintaining abstinence?

A

Psychotherapy techniques that provoke anxiety or that require deep insights

46
Q

Whether in/outpx, individual or grp counseling is usually offered a minimum of how many weeks?

A

3x a week for the first 2-4 wks
Followed by
Less intense efforts: once a wk for the subsequent 3-6 mos

47
Q

What is the third major component that first identifies situations in wc the risk for relapse is high?

A

Relapse prevention

48
Q

Rehabilitation is an ongoing process that lasts for how many months?

A

6-12 months or even more

49
Q

What do you prescribe px if detoxification has been completed and the px is not one of the 10-15% alcoholics who hav an independent mood disorder, schizophrenia, or anxiety disorder?

A

Little evidence favors prescribing psychotropic meds

50
Q

Meds effects for symptoms s/a lingering lvls of anxiety and insomnia

A

Including benzodiazepines - likely to lose their effectiveness much faster than insomnia disappears

THUS px may increase dose & hav subsequent probs

51
Q

What is the alcohol-sensitizing agent that is given in daily doses of 250mg before px is discharged from the intensive first phase of outpx rehabilitation or inpx care?

A

Disulfiram

52
Q

What are some of the dangers of Disulfiram?

A

Mood swings
Rare instances of psychosis
Possibility of increased peripheral neuropathies
Relatively rare occurrence of other neuropathies
Fatal hepatitis

53
Q

What preexisting dse cannot be given disulfiram bcs an alcohol rxn to the disulfiram could be fatal?

A

Heart dse
Cerebral thrombosis
Diabetes

54
Q

What possibly decreases the craving for alcohol or blunt the rewarding effects of drinking?

A

Opioid antagonist naltrexone (ReVia)

50mg/day although short term (3 mos)

55
Q

Dosage approx. 2,000mg/day

When used 10-20% in the context of the usual psychological and behavioral tx regimen for alcoholism

A

Acamprosate (Campral)

56
Q

What may directly or indirectly at GABA receptors or at NMDA sites, the side effects of wc alter the development of tolerance or physical dependence upon alcohol?

A

Acamprosate (Campral)

57
Q

What is another med w potential promise in alcoholism tx?

A

Buspirone (BuSpar)

58
Q

Impression and DD:

  • 18 years of alc intake
  • daily alc intake
  • consuming 2 or more lapad errday eyyy team tandu
A

Alcohol Induced Disorder

59
Q

Impression and DD:

R/I: hx of alcoholism

R/O:

  • no recent alc intake
  • (-) unsteady gait
  • (-) nystagmus
  • no impairment of attention or memory
  • pt is conscious
A

Alcohol Intoxication

60
Q

Impression and DD:

R/I:

  • hx of alcoholism
  • (+) V/A and tactile hallucinations

R/O:

  • disturbances don’t occur exclusively during course of delirium
  • no hx of recurrent non-subs rel d/o
A

Alcohol Induced Psychotic Disorder with Hallucinations

61
Q

Impression and DD:

  • hx of chronic alcoholism
  • symptoms appearing if (-) alc intake
    Mangurog
    Panington
    Dili makatog
  • transient visual, tactile, auditory hallucinations
  • insomnia
  • restlessness
  • no medical probs
A

Alcohol Withdrawal

62
Q

What is the personality profile of alcoholism wc is also applicable to eating disorders and habitual smoking?

A

Dependent Personality Disorder

Preventive And Social Medicine II (32 decks)

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