psych substance related disorders Flashcards
abuse def
pattern of substance use that leads to impairment or distress for at least 12 mos with one or more of the following: failure to fulfill obligations at home or work, use in dangerous situations, recurrent substance related legal problems, continued use despite social or interpersonal problems due to the substance use
dependence def
substance use leading to impairment or distress manifested by at least three of the following in 12 mo period: tolerance, withdrawal,
cocaine use- how long is the urine drug screen pos for?
2-4 days
amphetamines- how long is the urine drug screen pos for?
3-4 days
PCP- how long is the urine drug screen pos for?
3-8 days
what lab values are elevated in PCP use?
CPK and AST
examples of sedative-hypnotics
barbiturates and benzos
short acting barbiturate
pentobarbitol; in your system for 24 hours
long acting barbiturate
phenobarbitol; stays in system for 3 weeks
short acting benzo
lorazepam; in your system for 3 days
long acting benzo
diazepam; in your system for 30 days
examples of opioids
methadone and oxycodon
urine drug test for opioids
pos for 2-3 days, depengind on the opioid used; methadone and oxycodon will come up neg on a general screen (must order separate panel)
urine drug test for marijuana
in heavy users, up to 4 weeks; after single use, about 3 days
what are the mechanisms of alcohol in the CNS?
activates GABA and serotonin; inhibits glutamate and voltage gated calcium channels; it is a potent CNS depressant
how is alcohol metabolized?
alcohol–>acetaldehyde–>acetic acid
enzyme that converts alc to acetaldehyde?
alcohol dehydrogenase
enzyme that converts acetaldehyde to acetic acid
aldehyde dehydrogenase
asians have less of what enzyme?
aldehyde dehydrogenase
the effects/BAL may be decreased if high tolerance has been developed
right
treatment for alcohol intox
ABC; thiamine and folate
when is GI evacuation indicated in alcohol poisoning
when a signif amount of alc was ingested in the past 30-60 mins
symptoms of alc withdrawal
insomnia, anxiety, diaphoresis, and tachycardia; anorexia, n/v, psychomotor agitation, fevers, seizures, hallucinations, and delirium
treatment for alc withdrawal
benzo taper (chlordiazepoxide (librium) is drug of choice); thiamine, folic acid, and multivitamin; correct electrolyte abnormalities; check for signs of hepatic failure
what can kill a person in alc withdrawal
seizures, htn, and arrythmias
when do the earliest signs of alc withdrawal occur?
6 to 24 hours after the patient’s last drink
seizures in alc withdrawal
between 6 and 48 hours after the patient’s last drink, with a peak around 13 to 24 hours
treatment for seizures in alc withdrawal>
benzos
alc withdrawal symptoms usually last how long?
2-7 days
when does delirium tremens begin?
48-72 hours after the last drink, but may occur later
mortality of DT if not treated
15 to 25%
symptoms of DT
delirium, visual hallucinations, gross tremor, autonomic instablity, and fluctuating levels of psychomotor activity
benzos
chlordiazepoxide, diazepam, or lorazepam
CAGE questionaire for alcohol abuse
have you ever wanted to cut down; have you ever felt annoyed by criticism of your drinking; have you ever felt guilty about drinking; have you taken a drink as eye opener
medications for alcohol dependence
disulfuram (antabuse); naltrexone (revia, IM-vivitrol); acamprosate (campral); topiramate (topamax)
disulfuram (anatabuse)
blocks aldehyde dehydrogenase and causes aversive reaction to alcohol; contraindic in cardiac disease, pregnancy, psychosis; need compliance
naltrexone
opioid receptor blocker; workse by decreasing the craving and high assoc with alc; in patients with opioid dependence, it will precipitate withdrawal
acamprosate
similar to GABA; inhibits the glutamatergic system; should be used for relapse preventation in patients who have stopped drinking; can be used in patients with liver disease; contraindic in renal disease patients
topiramate
anticonvulsant that potentiates GABA and inhibits glutamate receptors; reduces cravings for alcohol
features of wernicke’s encephalopathy
ataxia, confusion, ocular abnormalities (nystagmus, gaze palsies)
korsakoff syndrome
chronic amnestic syndrome, reversible in only 20% of patients; impaired recent memory, anterograde amnesia, compensatory confabulation
how does cocaine work?
blocks dopamine reuptake from the synaptic cleft; plays a role in the reward system of the brain
cocaine intoxication features
euphoria, heightened self-esteem; hypo or hypertension; tachycardia or bradycardia, nausea; dilated pupils (sympathetic!); chills and sweating
dangerous effects of cocaine
respiratory depression, seizures, arrhythmias, paranoia, hallucinations (esp tactile)
what is deadly about cocaine
vasoconstrictive effect may result in MI or stroke
management of cocaine intoxication
for mild or moderate, reassurance of patient or benzos; for severe agitation, antipsychotics (haldol); temp greater than 102 is a med emergency and should be treated withice bath, cooling blanket, and other supportive measures
treatment of cocaine dependence
no FDA approved drug; off label you can use disulfiram and ariprazole
withdrawal from coke
not life threatening; produces crash (fatigue, hypersomnolence, depression, constricted pupils, hunger)
how do amphetamines work
block reuptake and facilitate release of dopamine and norepi from nerve endings; causes a stimulant effect
examples of amphetamines
dextroamphetamine (dexedrine); methylphenidate (ritalin); methamphetamine (“speed,” Desoxyn)
what are amphetamines used for medically?
treatment of narcolepsy, ADHD, and depressive disorders
what are the substituted (“designer”) amphetamines?
MDMA (ecstasy); MDEA (“eve”)
what is different about the substituted amphetamines?
release dopamine, norepi, and serotonin; they have both hallucinogenic and stimulant properties; assoc with clubs and raves
risk of serotonin syndrome with substituted amphetamiens
serotonin syndrome can occur if designer amphetamines are combined with SSRIs
symptoms of amphetamine intoxication
similar to those of cocaine; MDMA and MDEA can induce a sense of closeness to others
overdose of amphetamines
hyperthermia, dehydration, and rhabdomyolysis (leading to renal failure)
amphetamine withdrawal
prolonged depression
treatment for amphetamine intoxication
rehydrate, correct electrolyte imbalance, and treat hyperthermia
mechanism of PCP
antagonizes NMDA glutamate receptors and activates dopaminergic neurons; can be stimulant or depressant depending on the dose
relationship between ketamine and PCP
ketamine is less potent PCP
date rate drug
ketamine; it is odorless and tasteless
clinical presentation of PCP patient
agitation, depersonaliztion, hallucinations, synesthesia, impaired judgment, memory impairment, assaultiveness, nystagmus, ataxia, dysarthria, hypertension, tachycardia, muscle rigidity, and high tolerance to pain
overdose of PCP
seizures, coma, and even death
treatment for PCP
minimize sensory stimulation, benzos for agitation, anxiety, muscle spasms, and seizures; use antipsychotics for severe agitation or psychotic symptoms
withdrawal from PCP
no withdrawal syndrome, but flashbacks (recurrence of intoxication symptoms due to release of the drug from lipid stores)
sedative-hypnotic examples
benzos, barbiturates, zolpidem, zaleplon, GHB, meprobate, and others; these are highly abused
how do benzos work?
potentiate GABA by increasing the freq of chloride channel opening
when are barbiturates used?
treatment of epilepsy and as anesthetics
mechanism of barbiturates
potentiate GABA by increasing the duration of chloride channel opening
complication of too much barbiturates
respiratory depression
intox with sedatives- symptoms
drowsiness, confusion, hypotension, slurred speech, incoordination, ataxia, mood lability, impaired judgment, nystagmus, resp depression, and coma or death in overdose
long term sedative use
may lead to dependence and may cause depressive symptoms
treatment for sedative intoxication
maintain ABC; use activated charcoal and gastric lavage to prevent further GI absorption (if drug was ingested in the prior 4-6 hours); supportive care
treatment for barbiturate intox specifically
alkalinize urine with sodium bicarb to promote renal excretion
treamtne for benzo intox
flumazenil in overdose
physiologic dependence on sedatives is more likely in long or short acting?
short acting; but long acting agents can also cause dependence and withdrawal symptoms
withdrawal symptoms from sedatives
same as from alcohol; worst sx in barbiturates
treatment for sedative withdrawal
benzo taper; carbamazepine or valproic acid can be used for seizure prevention
mechanism of opioids
stimulate opiate receptors (mu, kappa, and delta); involved in analgesiaa, sedation, and dependence
examples of opiates
heroin, oxycodone, codeine, dextromethorphan, morphine, methadone, and meperidine (Demerol)
major neurotransmitter involved with opioids
dopamine
most commonly abused opiods
NOT heroin; actually the prescribed opioids like Vicodin, OxyContin, and percocet
clinical presentation of opiate intoxication
drowsiness, n/v, constipation, constricted pupils (parasymp), seizures, and resp depression
serotonin syndrome
can be seen when meperidine and MAOI are taken in combo; sx are hyperthermia, confusion, hyper or hypotension, and muscular rigidity
treatment of opiod overdose
naloxone or naltrexone (opioid antagonists) will improve resp depression but may cause severe withdrawal in an opioid-dep patient
withdrawl from opioids
not life-threatening; unpleasant syndrome characterized by dysphoria, insomnia, lacrimation, rhinorrhea, yawning, weakness, sweating, piloerection, n/v, fever, dilated pupuls
treatment for opioid withdrawal
moderate sx can be treated with clonidine (for autonomic signs and sx of withdrawal), NSAIDs for prain, dicyclomine for abdominal cramps
severe symptoms of opioid withdrawal- what is treatment?
detox wth buprenorphine or methadone
three meds that treat opiod dependence
methadone, buprenorphine, naltrexone
how does methadone work?
long-acting opioid receptor antag; administered once daily, signif reduces morbidity and mortality; gold standard for pregnant women
buprenorphine
partial opioid receptor agonist; sublingual and safer than methadone; comes as Suboxone (buprenorphine plus naloxone)
naltrexone
competitive opioid antagonist; precipitates withdrawal if used within 7 days of heroin use; compliance is an issue
examples of hallucinogenic drugs of abuse
psilocybin (mushrooms); mescaline (peyote cactus), and LSD
proposed mechanism for LSD
serotonergic systems
physical dependence or withdrawal in hallucinogens?
no
intoxication of hallucinogens; symptoms
perceptual changes; labile affect, dilated pupils, tachycardia, hypertension, hyperthermia, tremors, incoordination, sweating, and palpitations; usually lasts 6-12 hours but may last for days
treatment for hallucinogens
monitor for dangerous behavior and reassure patient; use benzos and anti-psychotics if necessary for agitated psychoiss
withdrawal symptoms from hallucinogens
none, but longterm LSD use may cause a patient to have flashbacks later in life
how does marijauna work in the brain?
cannabinoid receptors in the brain inhibit adenylate cyclase
benefits of marijuana
decrease nausea, increase appetite in AIDS patients, and derease intraocular pressure, muscle spasms, and tremor
symptoms of marijuana
euphoria, anxiety, impaired motor coordination, perceptual disturbances, mild tachycardia, red eyes, dry mouth, and increased appetitie
chronic marijuana use
resp problems like asthma and chronic bronchitis, suppression of immune system, and effects on reproductive hormones
withdrawal from marijuana
irritability, anxiety, restlessnes, aggression, depression, strange dreams, headaches, sweating, insomnia, nausea, craving, and decr appetite
mechanism of inhalents
CNS depressants
examples of inhalents
solvents, glue, paint thinners, fuels, isobutyl nitrates (“huff,” “laughing gas,” “rush,” “bolt”)
effects of inhalents
perceptual disturances, psychosis, lethargy, dizziness, n/c. headache, euphoria, hypoxia, cloudiness of consiousness, stupor, or coma
acute intoxication of inhalents lasts how long?
minutes, stupor may last for hours
overdose of inhalents
may be fatal secondary to resp depression or cardiac arrhythmias
long term use of inhalents
permanent brain damage, peripheral nervous system, liver, kidney, heart and muscle
treatment for inhlaent intoxication
ABCs; identify solvent because some (leaded gasoline) may require chelation
mechanism of caffeine
adenosine antagonists causing increase cAMP and a stimulant effect via the dopaminergic system
death by caffein
over 10 g (1000 cups); death may occur secondary to seizures and resp failure
nicotine is addictive through actions on what neurotransmitter
dopamine
Varenicline (chantix)
nicotinic cholinergic receptor partial agonist that mimics the action of nicotine and prevents withdrawal
buproprion (zyban)
antidepressant that is also partial agonist at nACHR and inhib of dopamine reuptake; helps reduce withdrawal symptoms
Nicotine replacement therapy
transdermal patch, gum, lozenge, nasal spray, and inhaler
