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EOR behavioral health > Psychiatry EOR: Substance-Related Disorders (Pearls) > Flashcards

Psychiatry EOR: Substance-Related Disorders (Pearls) Flashcards

1
Q

a 31 year old with anxiety, tremors, sadness, and hematemesis describes what kind of patient

A

Alcohol use disorder

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2
Q

What vitamins should all alcoholics receive?

A

Thiamine, magnesium, multivitamin and dextrose (particularly if chronic alcoholism)

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3
Q

If someone is experiencing alcohol withdrawal what medication should you give them?

A

Benzodiazepines

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4
Q

What medications are used to help treat the addiction of alcohol?

A
  1. Disulfiram (Antabuse)
  2. Oral Naltrexone
  3. Extended-Release Naltrexone
  4. Acamprosate
  5. Topiramate
  6. Gabapentin
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5
Q

How does Disulfiram (antabuse) work and what is the dosing?

A
  1. Works by inhibiting acetaldehyde dehydrogenase, aversive conditioning
  2. 500 mg once daily for 1-2 weeks then decrease to the maintenance dose (range 125-500mg once daily)

Can not be used in those who are actively drinking

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6
Q

How does oral Naltrexone work to treat addiction? What is the dose?

A
  1. Decreases desire
  2. 50mg once daily

can not be giving to patients taking opioids

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7
Q

What is the dose for extended-release Naltrexone?

A

380mg IM every 4 weeks, administer in the gluteal area with 1.5 inch 20 gauge needle

can not be given to patients taking opioids

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8
Q

How does Acamprostate work and what is the dose?

A
  1. Changes brain chemistry in a way that reduces anxiety, irritability and restlessness associated with early sobriety
  2. 666mg three times daily

dose reduction required with renal impairment

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9
Q

How does topiramate work for alcohol addiction. What are the doses?

A

1, Reduces drinking at least as well as naltrexone and acamprosate

  1. Begin at 25 mg daily and increase up to 150mg BID
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10
Q

How does Gabapentin work for alcohol addiction? what is the dose?

A
  1. it decreases desire

2. Begin at 300mg once daily and increase up to 600mg TID

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11
Q

Within in 6 hours of withdrawal from alcohol what symptoms might you see?

A
  1. trembling
  2. Irritability
  3. Anxiety
  4. HA
  5. Tachy
  6. Insomnia
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12
Q

How do you treat minor withdrawal (symptoms 6 hours after last drink)

A
  1. Thiamine
  2. Folate
  3. Multivitamin
  4. Dextrose
  5. IV-fluids
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13
Q

12-24 hours after onset of withdrawal what symptoms might you see? how do you treat it?

A

This is when alcoholic hallucinations can present.

Begin benzos and make sure to taper to avoid seizure

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14
Q

48 hours after withdrawal begin what is the patient at risk of having?

A

tonic-clonic seizures, might want to get a head CT on top of benzos

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15
Q

48-96 hours into withdrawal symptoms is when what can occur?

A

Delirium tremens which can present with autonomic instability, disorientation, hallucinations, agitation

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16
Q

Patient that is extremely aggressive and becomes enraged when sudden movements or loud sounds are made

This describes a pt on what type of drug

A

PCP

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17
Q

How does PCP work?

A

NMDA receptor antagonist

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18
Q

What is the treatment for someone on PCP?

A

Antipsychotics (haloperidol)

Benzodiazepines

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19
Q

Patient wants to hurt himself. They say that he has “been freaking out” and seeing things that are not there

Describes a pt taking what type of drug?

A

LSD

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20
Q

How does LSD work?

A

action at 5-HT receptor

21
Q

Treatment for someone having a bad trip and loosing their shit on LSD?

A
  1. Haloperidol
  2. Benzos
  3. Talking down, supportive care
22
Q

A young child from low socioeconomic background arrives in the ED with a headache, loss of appetite, rhinorrhea, injected sclera, dizziness, photophobia, or a cough

This describes someone who most likely administered drugs in what way?

A

inhalant-related disorders

23
Q

PE for someone high on inhalants i.e (paint, petroleum, toluene, glues and nail polish)

A
  1. watery eyes, impaired vision, rhinorrhea, perinasal and perioral rash, HA and nausea
24
Q

If someone inhales high doses of inhalant drugs, what are they possibly at risk of?

A

cardiopulmonary failure, liver problems, kidney problems, and bone marrow suppresion

25
Q

What is the treatment for someone fucked up on inhalants?

A

Antipsychotics (haloperidol)

26
Q

Signs of someone being intoxicated on opioids?

A
  1. Constipation
  2. Respiratory depression
  3. Seizures
27
Q

If someone is high on opioids what will their pupils look like?

A

They will be pinpoint pupils

28
Q

If someone is experiencing withdrawal from opioids what symptoms might they have?

A

Anxiety, insomnia, anorexia, sweating, piloerection (“cold turkey”)
Fever, rhinorrhea, nausea, stomach cramps, diarrhea (“flu like” symptoms)
Yawning
Unpleasant but not life-threatening

29
Q

What is one PE finding that will tell if someone is high or withdrawing from opioids.

A

Their pupils will be dilated if they are going through withdrawal and pinpoint if high

withdraw from opioids

30
Q

What is the treatment for opioid intoxication?

A

Naloxone/Naltrexone

31
Q

Tx for withdrawal symptoms from opioids?

A
  1. Clonidine- an alpha 2 agonist that decreases NE and sympathetic output making autonomic symptoms less intense
  2. Methadone (long acting)
  3. Buprenorphine + naloxone
  4. Zofran for nausea/vomiting
32
Q

Tx for addiction of opioids?

A
  1. Methadone- Long acting
  2. Suboxone- long acting

Naloxone is not active when taken orally, so withdrawal symptoms occur only if injected - Intended to prevent overdose when Suboxone is injected

33
Q

a 45-year-old female with a PMH of anxiety and panic attacks was brought in by her husband for being “unresponsive for about 30 minutes now.” He states that the patient had been “popping Xanax” because she was “having one of her episodes of panic attacks.” On physical exam, she is hypotensive with a respiratory rate of 4/min.

This patient is presenting as someone who is on what type of drugs?

A

Benzodiazepines

34
Q

How do benzodiazepines work?

A

The mechanism is through GABAa channel-increased frequency of opening

35
Q

What do you treat the life threatening intoxication of benzos with?

A

Flumazenil- which is a competitive GABA antagonist

36
Q

What do you treat the withdrawal symptoms of benzos with?

A

Treat withdrawal with long-acting benzo such as clonazepam with an appropriate taper.

37
Q

a 35-year-old female who arrives at the ED with impaired memory, poor concentration, and extreme drowsiness. Pupils are not dilated on exam and the patient is minimally responsive. Of greatest concern is the patient’s respiratory rate of 5/min.

What is this patient most likely high on?

A

Barbiturates

38
Q

What is the mechanism? signs of intoxication? and Withdrawal with barbiturates?

A

Mechanism: GABAa channel - increased duration of opening.

Intoxication: respiratory/CNS depression - can be fatal. Does not have a depression “ceiling” in contrast to benzodiazepines.

Withdrawal: anxiety, seizures, delirium, similar to alcohol, life-threatening cardiovascular collapse

39
Q

What is the Tx for barbiturate intoxication?

A

symptom management, support BP, assist respiration, intubation, and bemegride

40
Q

What is the Tx for withdrawal of barbiturates?

A

long acting benzos with taper

41
Q

Patient with pupillary dilation, aggression, diaphoresis, prolonged wakefulness, and sympathetic activation

Describes a patient on what kind of drug?

A

Cocaine

42
Q

Signs and symptoms of Cocaine intoxication?

A
  1. decreased appetite, tachy, pupillary dilation, hypertension and angina
  2. Severe vasospasm- MI, Placental infarction, nasal septum perforation, stroke
43
Q

Tx for intoxication on cocaine

A

Antipsychotics (haloperidol)
Benzodiazepines
Antihypertensives (labetalol - need alpha-1 blockade)
Vitamin C - promotes excretion
Do not restrain patients - may result in rhabdomyolysis

44
Q

Tx for withdrawal from cocaine?

A

bupropion
bromocriptine
SSRI’s for depression

45
Q

Treatment for amphetamine intoxication?

A

Antipsychotics (haloperidol), benzodiazepines, vitamin C (promotes excretion), antihypertensives, propranolol (BP + tachycardia control)

46
Q

What electrolyte can be decreased when someone is on MDMA?

A

sodium

47
Q

What is the leading cause of death in the united states?

A

smoking

48
Q

Treatment for cessation of smoking/tobacco?

A

Bupropion
Varenicline (Chantix): Partial nicotine receptor agonist. Mediates partial reward of nicotine yet blocks reward of nicotine
The highest success rate of all anti-smoking drugs, particularly when stacked with nicotine patches
Nicotine administration via other routes

EOR behavioral health (9 decks)

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