Sept 17 - Substance Use Disorder

Question 1

What are some common chief complaints a person with substance use disorder might state?

Answer 1

Withdrawal symptoms (anxiety, etc.)
Depression or sadness
Symptoms that impact daily activities

Question 2

What is the primary goal of obtaining the history of present illness.

Answer 2

To learn the patient’s story

Question 3

What is the significance of determining a substance use disorder patient’s triggers?

Answer 3

Substance use is often a coping mechanism. Finding their triggers helps find a healthy coping mechanism

Question 4

T/F: Substance use disorder patients typically use only one substance.

Answer 4

False

Question 5

When asking a substance use patient when they last used a substance, why are alcohol and benzos specifically important to ask about?

Answer 5

Withdrawal from alcohol and benzos can be fatal

Question 6

What are two reasons for asking the patient’s number of days substance free?

Answer 6

1. Determine likelihood of withdrawal symptoms

2. Can determine what helped them avoid use during that time

Question 7

What is the CAGE acronym used to screen for substance use disorder?

Answer 7

C: Have you ever felt you should cut down?
A: Ever felt annoyed by ppl criticizing your drinking?
G: Have you ever felt guilty about your drinking?
E: Eye opener –> ever drink first thing in the AM?

Question 8

Describe the AUDIT screening tool.

Answer 8

Alcohol Use Disorders Identification Test –> questions assessed on a likert scale to assess for alcohol use

Question 9

Why is it important to ask about comorbidities when assessing a patient for substance use disorder?

Answer 9

There is a high association between mental health disorders and substance use disorder.

Question 10

List 4 mental health disorders specifically associated with substance use disorder.

Answer 10

Anxiety, depression, ADHD, PTSD

Question 11

Why is it important to discuss social history with a substance use disorder patient?

Answer 11

Always important to know if a patient may be pregnant. Blood pregnancy test is more sensitive than urine pregnancy test.

Question 12

List the physical exam findings consistent with chronic alcohol use.

Answer 12

Flushing on face, Scleral icterus, Palmar erythema, Spider nevi (angioma)

Question 13

What is the greatest musculoskeletal risk for IV drug users?

Answer 13

Infections and abscesses

Question 14

What physical exam findings are consistent with methamphetamine use?

Answer 14

Poor dentition, scratch marks from tactile hallucinations.

Question 15

What substances cause constricted pupils?

Answer 15

Heroin, morphine, oxycodone, fentanyl, methadone, codeine, hydrocodone

Question 16

What substances cause dilated pupils?

Answer 16

Methamphetamines, cocaine, hallucinogens, opiates (during withdrawal), marijuana, speed

Question 17

List 12 substance use disorders defined in the DSM-5 that we discussed in class.

Answer 17

Alcohol, cannibas, hallucinogen, inhalant, opioid, sedative, hypnotic, anxiolytic, stimulant, tobacco, caffiene, gambling

Question 18

What symptoms are common among all substance use disorders?

Answer 18

Increased use over an increased period of time, Not able to decrease or stop, Impact on daily activities, Craving, Using despite negative outcomes, Decreased participation in activities, Tolerance, Withdrawal

Question 19

Which two substance use disorders do not have a withdrawal syndrome diagnosis?

Answer 19

Hallucinogens and Inhalants

Question 20

How does the DSM-5 classify the severity of substance use disorders?

Answer 20

Mild: 2 - 3 symptoms
Moderate: 4 - 5 symptoms
Severe: > 6 symptoms

Question 21

Which substance use disorder does not have a severity classification in the DSM-5?

Answer 21

Caffeine

Question 22

Define tolerance

Answer 22

Increased amount of a substance needed to achieve the same affect

Question 23

Why are patients that recovered from opiate use, then relapse, at increased risk of overdose?

Answer 23

They use the same dose as before but no longer have the same tolerance.

Question 24

Describe delirium tremens.

Answer 24

Symptoms occur within 2-5 days since last drink.
S/S: hallucinations, confusion, tachy, HTN, hyperthermia, agitation, diaphoresis
Treatment: benzodiazepines (CIWA Protocol)

Question 25

Describe Wernicke’s encephalopathy.

Answer 25

S/S: confusion, ophthalmoplegia (weakness in eye muscles), ataxia (muscle weakness)
Life threatening and reversible
Caused by thiamine deficiency

Question 26

Describe Korsakoff’s syndrome

Answer 26

S/S: retrograde amnesia (past events), anterograde amnesia (what you’re learning), confabulation
Not reversible, caused by thiamine deficiency

Question 27

List and describe four non-controlled medications used to treat substance use disorder.

Answer 27

Disulfiram: PO med for alcohol use disorder
Acamprosate: PO for alcohol use disorder
Naltrexone: PO, qd for opioid use disorder
Vivitrol: Injected q month for opioid use disorder

Question 28

What caution must a patient be educated on before being prescribed disulfiram?

Answer 28

Cannot use with any alcohol (including mouthwashes, alcohol wipes, etc.) –> causes N/V

Question 29

What lab must be assessed before before prescribing naltrexone or vivitrol?

Answer 29

LFT –> meds elevate liver enzymes

Question 30

State and describe a controlled substance used to treat opioid use disorder.

Answer 30

Buprenorphine - partial opiate agonist that can be administered: buccal, SL, tablet, SC, IV, IM, or subdermal implant

Question 31

Differentiate suboxone from buprenorphine and describe the clinical significance.

Answer 31

Suboxone = buprenorphine + naloxone. The naloxone helps prevent opiate OD.

Question 32

List 2 drugs that are being researched for treatment of stimulant use disorder.

Answer 32

Bupropion and mirtazapine

Question 33

List and describe 5 psychotherapy treatments that can be applied to substance use disorder.

Answer 33

CBT: replaces irrational thought with a rational one
Contingency mgmt: positive reinforcement - IE, reward for a negative drug screen
Motivational Interviewing
Family Therapy
12-step Facilitation