Quiz 1 Flashcards
what is the legal driving limit of BAL?
0.08
what level of BAL do you see changes in behavior and cognition?
0.02-0.03
coma and possible death are expected at a BAL of what level?
0.4
what term is described as abnormal need for a substance?
DEPENDENCE
- psychological: craving the behavior the drug gives
- physiological: having withdrawals if D/C drug
What is the term used to describe the need to increase the dose to achieve the same effect OR a diminished effect with continued use?
Tolerance
Abnormal physical and physiological symptoms that follow abrupt D/C of a substance
Withdrawals
Of the criteria to diagnose a substance use disorder, >2 are needed over what period of time for diagnosis?
12 months
patient presents with a positive urine drug screen. What is the next step?
do Gas Chromatography to confirm and rule out false positive.
T or F: blood tests are more definitive than urine tests for drug screening
True!
controlled substance use requires blood tests for screening how often?
every 3-6 months
Which part of marijuana causes the “HIGH”
THC
which part of marijuana is used for pain?
CBD
why does THC stay in the system for a long period of time?
THC is stored in fat
urine testing positive for 4-6 days in short term users and 20-50 days in long-term users
what is the most commonly used illegal stimulant in minnesota
methamphetamines
patient presents to the clinic with delusions of parasitosis and aggression. On physical exam you notice dental decay. What is at the top of your diagnosis?
Methamphetamine abuse
dental decay is also known as “meth mouth”
What 2 meds are used to treat ACUTE intoxication of stimulants?
benzodiazepines + antipsychotics (if needed)
how long to keep a patient with an ACUTE stimulant intoxication?
72 hour hold with psych hospitalization (incase they are a threat to self or others)
T or F: low to moderate doses of caffeine per day improve attention and task performance
True
30-200 mg per day are good!
at what level of caffeine can you diagnose a patient with caffeinism?
> 500 mg per day
can mimic an anxiety disorder
What are the 4 most commonly used substances?
alcohol, marijuana, opiates, meth
how would you describe At-Risk drinking?
repetitive use of alcohol as coping for anxiety, depression, etc.
what number of drinks for men and women are used to describe alcohol abuse?
MEN: >4 drinks per day or 14 per week
WOMEN: >3 drinks per day or 7 per week
patient presents with Wernicke-Korsakoff syndrome. What does this mean and what is going on with the patient?
thiamine deficiency
he has alcoholism
your patient has confusion, speech difficulty. On exam, he has asterixis. What are you thinking?
Hepatic encephalopathy (end stage alcoholism)
treat with lactulose to lower ammonia levels
when a patient extends his wrist, you notice a flapping movement of the hands. What is this?
asterixis “liver flap”
hallmark of end-stage alcoholism/hepatic encephalopathy
patient presents with confusion + ataxia (balance troubles) + ophthalmoplegia (6th nerve palsy). What is this?
Wernicke encephalopathy (classic triad)
what is the classic triad of Wernicke encephalopathy?
confusion + ataxia + ophthalmoplegia
in alcoholism, what will the AST/ALT ratio be like?
> 2:1 ratio
GGT elevated
Ammonia elevated
which lab values will be LOW in alcoholism?
Potassium and Magnesium
a person has small eyes, thin upper lip, and flat philtrum. His mother reports learning and attention problems. What do you think he has?
fetal alcohol spectrum disorder
overdose is defined as a BAL of what?
> 0.35 for most people
characterized by respiratory depression, seizure, shock, coma
T or F: acute alcohol intoxication will yield hyperglycemia
FALSE: hypoglycemia in kids and diabetics
What is the treatment for acute intoxication?
supportive (let them sleep it off in safe environment)
-antiemetics, fluids, resp support if needed
which symptoms is NOT part of alcohol withdrawal:
tachycardia, drop in BP, fever, tremor, headache, anxiety
drop in BP - you will see elevated BP
what is the time frame for onset of symptoms of alcohol withdrawal?
6-36 hours after last drink
peak intensity of alcohol withdrawal?
48-72 hours after last drink
alcohol withdrawal seizures typically occur how long after stopping alcohol?
6-48 hours
describe what the alcohol withdrawal seizures are like
brief
nonfocal
occur 1-2 times
self-limited
T or F: a seizure is often the first sign of alcohol withdrawal
True
what can alcohol withdrawal seizures progress to?
Delirium Tremens
what is Delirium tremens and how is it managed?
most severe form of alcohol withdrawal: confusion, hallucinations, fever, tachy, htn
-give LARGE DOSE of Benzodiazepines
what is the mainstay of alcohol withdrawal treatment?
benzodiazepines
although benzos are the mainstay of alcohol withdrawal treatment, what is given FIRST??
IV thiamine (to prevent development of Wernicke encephalopathy)
do you screen your 19 year old patient for alcohol misuse?
YES - everyone over 18
which 2 drugs are used to treat alcoholism?
Disulfiram (Antabuse) - causes vomiting with alcohol use
Naltrexone - reduces cravings
it is difficult to see opiate intoxication on physical exam. What one finding might you see?
miosis - pinpoint pupils
patient might also feel euphoria, drowsiness, nausea
this opiate medication can cause QT prolongation and torsades
methadone
what is used for treatment of opiate intoxication?
Naloxone (Narcan)
given IM or IV; may need to be repeated due to short duration
what might your patient experience with mild opiate withdrawal?
cravings, yawning, rhinorrhea, restlessness
moderate-severe: above plus piloerection, mydriasis, tachycardia
which 3 drugs are used in long term treatment of opiate withdrawal
methadone
suboxone + buprenorphine
naltrexone
When diagnosing a patient with depression, they need 5/9 symptoms for what duration?
almost all day every day for 2 weeks
must include anhedonia and/or depressed mood
how long is an adequate trial of antidepressants?
4-12 months
what psych disorder is characterized by alternating shifts in emotions from periods of depression to periods of mania (highs)
bipolar disorder
what should never be used alone in treating depression?
antidepressants - always combine w/ antipsychotics or benzos
T or F: bipolar disorder is genetic
TRUE: 10x more likely to get it if family member has it.
what is bereavement?
grief after loss through death
diagnosing bereavement and deciding to treat it requires a grief period of over how long?
> 6 months + 1 of the symptoms:
intense yearning for person and feelings of emptiness, recurrent thoughts that life is meaningless and urge to join them
which demographics are most common for suicide?
native americans
native Alaskans
children
