Stimulant Use Disorder Flashcards
is stimulant use disorder more common in men or women
equal–> IV use 3-4x more common in men
what is the most commonly used illicit substance in the world
cannabis–> stimulants are 2nd most common
list 6 predictors of cocaine use among teenagers
*especially women
- prenatal cocaine exposure
- postnatal cocaine use by parents
- exposure to community violence during childhood
- unstable home environment
- psychiatric condition
- assoc. with dealers, users
how quickly does stimulant use disorder develop
can be quick (within 1 week) but not always
what changes in vital signs can be seen in stimlant intoxication
tachy
temp of 38-39
how does stimulant intoxication present
instant feeling of wellbeing, confidence, euphoria
rambling speech
headache
tinnitus
transient IORs, paranoid ideation, hallucinations
–> usually have intact reality testing, recognize drugs effects
may have rapid, dramatic behavioural changes i.e aggression
how might someone present if long term stimulant use disorder
chaotic behaviour, isolation, aggression
sexual dysfunction
weight loss, malnutrition, poor hygiene
neurocog impairment–> COMMON
poor oral health (meth mouth)
–> due to toxic effects of smoking + bruxism while intoxicated
how long might stimulant withdrawal last
after cocaine cessation may last hours/days or can persist for up to a month
how does stimulant withdrawal present
depression, anhedonia, irritability, lability
SUICIDAL IDEATION/BEHAVIOUR
impaired attention, concentration
what should you suspect if an otherwise healthy, young person develops chest pain during acute stimulant intoxication
MI
palpitations, arrhythmias
can have sudden death from resp/cardiac arrest
list 4 commonly comorbid psych disorders with stimulant use disorder
PTSD
ADHD
ASPD
gambling disorder
what might you see on CBC in stimulant use disorder
elevated WBCs (consider sepsis if injection drug use, but can have elevated WBC just due to substance use)
–> stimulants cause demarginalization of neutrophils
what electrolyte disturbance may be seen in stimulant use disorder
hyperkalemia
what is the treatment of choice for stimulant use disorder
contingency management/psychosocial treatment
*insufficient evidence to support any Rx for stimulant use disorder
should you order regulat antipsychotic in stimulant induced psychosis
consider NOT ordering regular–> only order regular if unclear if there may also be primary psychosis
why should you consider AVOIDING antipsychotics in first 6 hours after stimulant use
during first 6 hours there is increased risk of STROKE, SEIZURES with APs
do APs treat or prevent psychosis due to stimulant use disorder
no–> but can still be useful in reducing residual symptoms, preventing kindling effect
list some meds that can be used PRN for stimulant use disorder
loxapine
haldol
benadryl
ativan
is dexamphetamine or methylphenidate useful in treating stimulant use disorder
dexamphetamine–> NO
methylphenidate-> equivocal
–not effective in terms of abstinence, treatment retention
what antidepressant may show some benefit in treating stimulant use disorder
mirtazapine
less meth use, decreased sexual risk despite low med adherence
what other SUD drug may be helpful in treating stimulant use disorder
suboxone–> was effective in motivated volunteers
how do you treat concurrent ADHD with stimulant use disorder
use atomoxetine, guanfacine (no abuse potential)
–> guidelines say you can still use stimulants to treat ADHD if comorbid with stimulant use disorder but that there is high risk for diversion or misuse
–> there is a risk of inducing relapse of patients with stimulant use disorder in remission if give stimulants to treat ADHD
how does contingency management work
application of OPERANT CONDITIONING which uses STIMULUS CONTROL and consequences to change behavior
“voucher programs” is method of contingency management that is most reliably effective method for producing cocaine abstinence in controlled clinical trials
what % of those with stimulant use disorder will convert to schizophrenia after 20 years
23%
