M4CN1 Substance Abuse Flashcards
What is the use of a chemical subs example a drug outside of its intended use?
Substance abuse
What is a term of using a drug in dosages or frequency more than the usual?
Drug misuse
Theories in etiology
Childhood Psychoanalytic Sociocultural Behavioral/learning Genetic
About 10% of consumed alcohol is absorbed from the
Stomach, w the reminder absorbed from the SI
How many mins does the peak bld conc reach?
30-90 mins
Usually 45-60 mins depends if empty stomach (wc enhances abs)
If you eat before drinking, what happens to the absorption?
Delayed
About 90% of absorbed alcohol is metabolized through what?
Oxidation in liver
Remaining 10% ecreted unchanged by the kidneys and lungs
What alcohol level in bld that thought, judgement, and restraint are loosened and sometimes disrupted?
0.05%
What level of alcohol does voluntary motor actions usually become perceptibly clumsy?
0.1%
What is the accepted legal intoxication level?
0.1-0.15%
What level does the entire motor area of the brain is measurably depressed?
0.2%
What level is a person commonly confused or stuporous?
0.3%
What level is a person commonly confused or stuporous?
0.3%
Level of a person in coma
0.4-0.5%
Alcoholic syndromes
- intoxication
- idiosyncratic intoxication
- hallucinosis
- withdrawal
- encephalopathy
- amnestic disorder
- dementia
What are the 3 general steps in treating the alcoholic person after the disorder has been diagnosed?
- Intervention
- Detoxification
- Rehabilitation
In this case, tx are applied after the psychiatric disorder has been stabilized as much as possible
Alcoholic w independent psychiatric syndromes
Confrontation, or aimed at maximizing the motivation for tx and continued abstinence
Intervention
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?
Intervention
What step involves convincing that they’re responsible for their own actions?
Intervention
If the px is in relatively good health, adequately nourished, abd has a good social support sys, the depressant withdrawal syndrome usually resembles what?
Mild case of flu
What is the first essential step in detoxification?
Physical examination
Is there likely to have severe alcohol withdrawal in the absence of a serious medical disorder or combined drug abuse?
Nope, unlikely
What is the second step in detoxification?
Rest, adequate nutrition, and multiple vit esp cont thiamine
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?
Mild or moderate withdrawal
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?
Optimal relief and minimize possibility that severe withdrawal will develop
What depressants can work?
Alcohol, barbiturates, or any benzodiazepines
Clinicians choose a benzodiazepine for its relative safety
In mild/mod withdrawal, adequate tx can be given w either short-acting drugs or long-acting subs, give examples of each
short-acting drugs: lorazepam
long-acting subs: chlordiazepoxide and diazepam
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?
Asleep or feelin sleepy 😴
An additional one or two 25mg doses can be given during first 24 hrs if px is what?
Jittery or show signs of increasing tremor or autonomic dysfxn
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?
4 or 5 days
When giving long acting agents (s/a chlordiazepoxide), the clinician must avoid what?
Producing excessive sleepiness through over medication
If px is sleepy, next dose must be omitted
When taking a short acting drug, why does the px must not miss any dose?
Bcs rapid changes in benzodiazepine conc in bld may ppt severe withdrawal
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?
Don’t appear to be superior to the benzodiazepine
- do little to decrease risk of seizures or delirium
In severe withdrawal, symptoms can be minimized thru the use of either what?
Benzodiazepine (in wc case high doses are sometimes required) or
Antipsychotic agents such as haloperidol
On the first or second day, doses are used to what?
Control behavior
Patient can be weaned off the medication by about what day?
5th day
In severe withdrawal, another 1-3% px may have what?
Single grand mal convulsion
The rare person has multiple fits, w peak incidence on what day of withdrawal?
2nd day of withdrawal
In rehabilitation, what are the 3 components?
(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
The tx process involves:
Intervention
Optimizing physical & psychological fxning
Enhancing motivation
Reaching out to fan
Using first 2-4 wks of care as an intensive pd of help
The efforts in the tx process must be followed by at least how many months?
3-6 months of less frequent outpatient care
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?
Outpatient care
What helps px maintain a high lvl of motivation for abstinence and to enhance their fxning?
Counseling efforts
What have not shown to be of benefit during early months of recovery and at least theoretically, may impair efforts at maintaining abstinence?
Psychotherapy techniques that provoke anxiety or that require deep insights
Whether in/outpx, individual or grp counseling is usually offered a minimum of how many weeks?
3x a week for the first 2-4 wks
Followed by
Less intense efforts: once a wk for the subsequent 3-6 mos
What is the third major component that first identifies situations in wc the risk for relapse is high?
Relapse prevention
Rehabilitation is an ongoing process that lasts for how many months?
6-12 months or even more
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?
Little evidence favors prescribing psychotropic meds
Meds effects for symptoms s/a lingering lvls of anxiety and insomnia
Including benzodiazepines - likely to lose their effectiveness much faster than insomnia disappears
THUS px may increase dose & hav subsequent probs
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?
Disulfiram
What are some of the dangers of Disulfiram?
Mood swings
Rare instances of psychosis
Possibility of increased peripheral neuropathies
Relatively rare occurrence of other neuropathies
Fatal hepatitis
What preexisting dse cannot be given disulfiram bcs an alcohol rxn to the disulfiram could be fatal?
Heart dse
Cerebral thrombosis
Diabetes
What possibly decreases the craving for alcohol or blunt the rewarding effects of drinking?
Opioid antagonist naltrexone (ReVia)
50mg/day although short term (3 mos)
Dosage approx. 2,000mg/day
When used 10-20% in the context of the usual psychological and behavioral tx regimen for alcoholism
Acamprosate (Campral)
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?
Acamprosate (Campral)
What is another med w potential promise in alcoholism tx?
Buspirone (BuSpar)
Impression and DD:
- 18 years of alc intake
- daily alc intake
- consuming 2 or more lapad errday eyyy team tandu
Alcohol Induced Disorder
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
Alcohol Intoxication
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
Alcohol Induced Psychotic Disorder with Hallucinations
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
Alcohol Withdrawal
What is the personality profile of alcoholism wc is also applicable to eating disorders and habitual smoking?
Dependent Personality Disorder
