Sept 17 - Substance Use Disorder Flashcards
What are some common chief complaints a person with substance use disorder might state?
Withdrawal symptoms (anxiety, etc.)
Depression or sadness
Symptoms that impact daily activities
What is the primary goal of obtaining the history of present illness.
To learn the patient’s story
What is the significance of determining a substance use disorder patient’s triggers?
Substance use is often a coping mechanism. Finding their triggers helps find a healthy coping mechanism
T/F: Substance use disorder patients typically use only one substance.
False
When asking a substance use patient when they last used a substance, why are alcohol and benzos specifically important to ask about?
Withdrawal from alcohol and benzos can be fatal
What are two reasons for asking the patient’s number of days substance free?
- Determine likelihood of withdrawal symptoms
2. Can determine what helped them avoid use during that time
What is the CAGE acronym used to screen for substance use disorder?
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?
Describe the AUDIT screening tool.
Alcohol Use Disorders Identification Test –> questions assessed on a likert scale to assess for alcohol use
Why is it important to ask about comorbidities when assessing a patient for substance use disorder?
There is a high association between mental health disorders and substance use disorder.
List 4 mental health disorders specifically associated with substance use disorder.
Anxiety, depression, ADHD, PTSD
Why is it important to discuss social history with a substance use disorder patient?
Always important to know if a patient may be pregnant. Blood pregnancy test is more sensitive than urine pregnancy test.
List the physical exam findings consistent with chronic alcohol use.
Flushing on face, Scleral icterus, Palmar erythema, Spider nevi (angioma)
What is the greatest musculoskeletal risk for IV drug users?
Infections and abscesses
What physical exam findings are consistent with methamphetamine use?
Poor dentition, scratch marks from tactile hallucinations.
What substances cause constricted pupils?
Heroin, morphine, oxycodone, fentanyl, methadone, codeine, hydrocodone
What substances cause dilated pupils?
Methamphetamines, cocaine, hallucinogens, opiates (during withdrawal), marijuana, speed
List 12 substance use disorders defined in the DSM-5 that we discussed in class.
Alcohol, cannibas, hallucinogen, inhalant, opioid, sedative, hypnotic, anxiolytic, stimulant, tobacco, caffiene, gambling
What symptoms are common among all substance use disorders?
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
Which two substance use disorders do not have a withdrawal syndrome diagnosis?
Hallucinogens and Inhalants
How does the DSM-5 classify the severity of substance use disorders?
Mild: 2 - 3 symptoms
Moderate: 4 - 5 symptoms
Severe: > 6 symptoms
Which substance use disorder does not have a severity classification in the DSM-5?
Caffeine
Define tolerance
Increased amount of a substance needed to achieve the same affect
Why are patients that recovered from opiate use, then relapse, at increased risk of overdose?
They use the same dose as before but no longer have the same tolerance.
Describe delirium tremens.
Symptoms occur within 2-5 days since last drink.
S/S: hallucinations, confusion, tachy, HTN, hyperthermia, agitation, diaphoresis
Treatment: benzodiazepines (CIWA Protocol)
Describe Wernicke’s encephalopathy.
S/S: confusion, ophthalmoplegia (weakness in eye muscles), ataxia (muscle weakness)
Life threatening and reversible
Caused by thiamine deficiency
Describe Korsakoff’s syndrome
S/S: retrograde amnesia (past events), anterograde amnesia (what you’re learning), confabulation
Not reversible, caused by thiamine deficiency
List and describe four non-controlled medications used to treat substance use disorder.
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
What caution must a patient be educated on before being prescribed disulfiram?
Cannot use with any alcohol (including mouthwashes, alcohol wipes, etc.) –> causes N/V
What lab must be assessed before before prescribing naltrexone or vivitrol?
LFT –> meds elevate liver enzymes
State and describe a controlled substance used to treat opioid use disorder.
Buprenorphine - partial opiate agonist that can be administered: buccal, SL, tablet, SC, IV, IM, or subdermal implant
Differentiate suboxone from buprenorphine and describe the clinical significance.
Suboxone = buprenorphine + naloxone. The naloxone helps prevent opiate OD.
List 2 drugs that are being researched for treatment of stimulant use disorder.
Bupropion and mirtazapine
List and describe 5 psychotherapy treatments that can be applied to substance use disorder.
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
