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_Family Medicine > Reading Nov 22 TBL > Flashcards

Reading Nov 22 TBL Flashcards

1
Q

Drinks day/week for man = increased risk for alcohol-related problems?

A

> 4 per day

>14 per week

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2
Q

Drinks day/week for woman = increased risk for ????

Also for?

A

> 3 per day
7 per week

Increased risk for alcohol-related problems
(also for men > 65)

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3
Q

How many heavy drinkers in US?

- alcohol abuse/dependence?

A

3 out of 10 US adults “at-risk drinking pattern”

- 25% of those = abuse/dependence

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4
Q

1st ask, “Do you sometimes drink beer, wine or other alcoholic beverages?”
Then ask what next?

A

How many times in the past year have you had…
5+ in a day for men
4+ in a day for women

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5
Q

Screening frequency for beer, wine or other alcoholic beverages?

A

Annually

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6
Q

What is a sign of alcohol tolerance?

A

Needing to drink a lot more to get the same effect

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7
Q

If pt achieves drinking goal, how long maintain meds for alcohol dependence?

A

At least 3 months

- possibly longer

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8
Q

What AUDIT score is + for men, women, men over 60?

A

Men up to 60 — 8+ (other area said 6+)

Women, men over 60 — 4+

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9
Q

If drinker exceeds daily and weekly limits, how common are alcohol use disorders int that group?

A

almost 1 in 2

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10
Q

Are brief interventions effective for alcohol?

A

Yes, if the pt is not dependent

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11
Q

When advise patient to abstain from alcohol/

A 
Are or may become pregnant
Taking contraindicated medication
Have med/psych disorder caused by or exacerbated by drinking
Have an alcohol use disorder
Sleep disorders
Sexual dysfunction
Family hx alcohol abuse
Injuries related to drinking
Advanced age
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12
Q

Why are limits lower for women?

A

They have less body water and thus achieve a higher BAC after drinking same amount.

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13
Q

How treat alcohol abuse disorder?

A

DBT
Motivational enhancement
12-step facilitation
Naltrexone

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14
Q

Alcohol withdrawal symptoms:

– few hours of stopping

A 
Tremors, sweating
Tachycardia, HTN
Nausea
Anxiety
Insomnia
Generalized seizures
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15
Q

Alcohol withdrawal delirium symptoms:

A

Begins 1-3 days after last drink:

  • altered mental status
  • disorientation
  • poor short-term memory
  • hallucinations
  • altered wake-sleep cycle
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16
Q

What 2 tests could you run on alcoholic?

A

GGT - elevated

MCV of RBC’s - should be > 100

17
Q

Effectiveness of alcohol treatment?

A

1/3 abstain or drink moderately

2/3 see reduction in consumption and alcohol-related problems by 50%

18
Q

Prevalence of chronic pain?

  • adults?
  • older adults?
A

30%

> 40%

19
Q

What % of adult population has longer-term opioid therapy (> 3 weeks)?

A

3-4%

So 9-11 million people

20
Q

44,000 overdose deaths in 2013

- what % pharm opioids?

A

37%

19% heroin

21
Q

Opioid addiction in US?

A

2.5 million adults

22
Q

Brain reward regions:

A

Ventral segmental area
Nucleus accumbens

    Underlie the perception of pleasure & well-being
23
Q

Brain pain regions:

A

Periaqueductal gray
Thalamus
Cingulate Cortex
INSULA!!

24
Q

Pain-induced emotional responses?

A

Amygdala

25
Q

High concentration of mu-opioid receptors in:

  • brain stem
  • spinal cord
A

Nuclei that regulate breathing

Dorsal horn

26
Q

Tolerance

A

Decrease in opioid potency with repeated administration

27
Q

Opioid withdrawal symptoms:

A 
Rhinorrhea/lacrimation
Piloerection
Chills, N/V, diarrhea
Muscle aches
Insomnia
28
Q

Addiction

A

Craving for the drug
Obsessive thinking about the drug
Compulsive drug taking
Erosion of inhibition

29
Q

Genetic variability accounts for ____ of the risk associated w/ addiction.

A

35-40%

30
Q

Why adolescents higher risk for addiction?

A

Under-developed frontal cortex

Enhanced neuroplasticity of their brains

31
Q

Discontinue opioids, what happens to tolerance and addiction?

A

Tolerance is rapidly reversed - days to weeks

Addiction - persists for months to years

32
Q

What % drug overdose deaths involve opioid (including heroin)?

A

61% — almost 29,000 deaths annually

33
Q

Opioid doses of ____ MME are disproportionately associated w/ overdose-related hospital admissions and deaths.

A

100+ MME

34
Q

Risk factors for opioid overdose:

A
  1. ) History overdose
  2. ) Hx of addiction of any substance (EtOH, BDZ, opioids)
  3. ) Health problems assoc w/ respiratory depression
  4. ) Renal / hepatic dysfunction
  5. ) Hx suicide or MDD
35
Q

What do before every opioid prescription is written?

A

Urine drug testing

36
Q

General guideline for opioid prescribing:

A

Shorter than 8 weeks
Lowest possible effective dose (< 100 MME)
Urine drug test first

_Family Medicine (9 decks)

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