MISC. REWIEW QUESTIONS Flashcards
STAGES OF ALCOHOL WITHDRAWAL
alcohol withdrawal stages
Stage 1 (mild): anxiety, insomnia, nausea, abdominal pain and/or vomiting, loss of appetite, fatigue, tremors, depression, foggy thinking, mood swings, and heart palpitations
Stage 2 (moderate): increased blood pressure, body temperature and respiration, irregular heart rate, mental confusion, sweating, irritability, and heightened mood disturbances
Stage 3 (severe/delirium tremens): hallucinations, fever, seizures, severe confusion, and agitation
time line of alcohol withdrawal symptoms
Roughly 8 hours after first drink: The first stage withdrawal symptoms may begin.
After 24-72 hours: Symptoms generally peak in this time period, and stage 2 and 3 symptoms can rapidly manifest.
5-7 days later: Symptoms may start to taper off and decrease in intensity.
Beyond the first week: Some side effects, particularly the psychological ones, may continue for several weeks without treatment.
drugs approved for treatment of PTSD
–sertraline
–paroxetine
symptoms of withdrawal from heavy marijuana use
–irritability –Drug craving –Sleep disturbance –Concentration problems –depressed mood –Diarrhea –Nausea
symptoms of marijuana intoxication
–distorted perception –increased appetite –Euphoria –Hallucinations –injected sclera –Increased heart rate –Decreased blood pressure
drug most likely causing symptoms resolving with hot bath
cannabis
where is the brains reward system?
nucleus accumbens
clinical difference between cocaine intoxication and bipolar mania
–mania must last for week or more
–Hypomania last 4 or more days and is milder
–Cocaine symptoms are intermittent
volume of distribution of nicotine
180 L
R their racial differences in nicotine absorption and accumulations
–African-Americans absorbed 30% more nicotine think Caucasians
–Chinese Americans have lower nicotine levels
–Women nicotine faster than men
age group with the highest use of inhalants
young adults 18–25
what is precontemplation
–not yet considering change
–Resistance to change
–needs coalition to show up for change
what is contemplation
–ambivalence
–vacillation
–Wants to change but resist needed changes
what is preparation
–begin needed steps
–Increased confidence in decision to quit
what is action
–actually begins needed steps
–Needs support
–Over actions to change environment or to quit
what is maintenance
–consolidation of gains
–Learning alternative coping mechanisms
–Learning the triggers of emotion precipitate abuse
what is relapse and recycling
–possible but not necessary
–avoiding being stuck
–Learning from mistakes
what his termination
–ultimate stage
–Patient exits treatment without fear of relapse
difference between neuroleptic malignant syndrome and serotonin syndrome
both have
–Confusion
–Hyperthermia
–Increased muscle tone
neuroleptic malignant syndrome
–Akinesia
–Mutism
–rigidity
Serotonin syndrome
–Rambling speech
drugs causing erectile dysfunction
–During intoxication
–During withdrawal
opioids cause sexual dysfunction during both intoxication and withdrawal
cocaine and stimulants cause sexual dysfunction only during intoxication
which Tri-Cyclic antidepressant is most appropriate for treating daytime pain
desipramine is the least sedating tryicyclic antidepressants
first-line drugs for treatment of generalized anxiety disorder
–paroxetine
– escitalopram
–Sertraline
–venlafaxine
FDA approved uses for duloxetine
–major depressive disorder –Generalized anxiety disorder –Diabetic neuropathy –Fibromyalgia –Chronic musculoskeletal pain
methamphetamine effects on neurotransmitters
synaptic levels dopamine and norepinephrine and serotonin are increased with methamphetamine
CT or MRI evidence of alcoholic brain degeneration
atrophy of cerebellar vermis
most common drug used to alter cocaine
levamisole, a veterinary anti-helminth drug is found and 69% of cocaine in the United States.
–It does not recorded as an adulterant on Street tests of purity of cocaine.
it produces…
– leukopenia
–Positive autoimmune factors
–Often with reticular purpuric lesions, particularly on the ears, but may be on the extremities
ASAM levels of care
Six dimensions:
o Dimension I: Acute Intoxication/Withdrawal Potential
o Dimension II: Biomedical Conditions and Complications
o Dimension III: Emotional, Behavioral or Cognitive Conditions and
Complications
o Dimension IV: Readiness to Change
o Dimension V: Relapse, Continued Use or Continued Problem Potential
o Dimension VI: Recovery Environment
• Five levels of care:
o Level 0.5: Early Intervention
o Level I: Outpatient Treatment
o Level II: Intensive Outpatient/Partial Hospitalization
o Level III: Residential/Inpatient Treatment
o Level IV: Medically-Managed Intensive Inpatient Treatment
sub specifiers in ASAM levels of care
D = need for detoxification
BIO = need for management of concurrent medical illness
OMT = need for opioid maintenance therapy
AOD = need for drug or substance use therapy only
DDC and DDE= psychiatric dual diagnosis present
physician specialties with the most drug abuse
–psychiatry
–Emergency physicians
–Anesthesiologists
drug abuse patterns among physicians
–most common drug of abuse is alcohol
–Cannabis is the most common illegal drug
–Physician drug abuse mimics general population at 8-15%
mechanism of disulfiram
disulfiram irreversibly inhibits the oxidation of acetyl aldehyde by competing with the cofactor nicotinamide adenosine dinucleotide for binding sites on acetyl alcoholcetyl alcohol dehydrogenase causing a 5–10 time increase in acetalcohol causing the severe classic “hangover”
what area of the brain is involved in the reinforcement of drugs and alcohol?
the basal forebrain is involved in the reinforcement effects of drugs and alcohol.
It consists of the “extended amygdala” which contains
bupropion mimics a psycho pharmacologic action of nicotine by increasing…
bupropion mimics the psychopharmacological action of nicotine by increasing dopamine and norepinephrine
what are the byproducts of metabolism of disulfiram which can be tested by breath analyzer?
disulfiram users will have carbon disulfide and acetone in there breath when tested by a breath analyzer
benzodiazepines work by attaching which receptor?
benzodiazepine attach to the GABA–a receptor
what is the test to determine the severity of nicotine addiction?
nicotine addiction severity is measured by the Fagerstrom test for nicotine dependence
mechanism of action of pregabalin and gabapentin
both pregabalin and gabapentin modulate calcium influx into neurons affecting nociception
how does sedative withdrawal cause hypertension?
sedative withdrawal causes hypertension by allowing a increase in norepinephrine and dopamine
mechanism of action of disulfiram for alcohol control
blocks dopamine beta hydroxylase in the brain
which receptor complex is involved in addiction to sedatives?
GABA a is a receptor complex involved in an addiction to sedatives.
Acts by hyper polarizing cell membrane by increasing the intracellular chloride
mechanism of topiramate in the treatment of alcoholism
topiramate antagonizes glutamate and suppresses alcohol-induced dopamine release
