Stimulant Use Disorder

Question 1

is stimulant use disorder more common in men or women

Answer 1

equal–> IV use 3-4x more common in men

Question 2

what is the most commonly used illicit substance in the world

Answer 2

cannabis–> stimulants are 2nd most common

Question 3

list 6 predictors of cocaine use among teenagers

Answer 3

*especially women

1. prenatal cocaine exposure
2. postnatal cocaine use by parents
3. exposure to community violence during childhood
4. unstable home environment
5. psychiatric condition
6. assoc. with dealers, users

Question 4

how quickly does stimulant use disorder develop

Answer 4

can be quick (within 1 week) but not always

Question 5

what changes in vital signs can be seen in stimlant intoxication

Answer 5

tachy

temp of 38-39

Question 6

how does stimulant intoxication present

Answer 6

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

Question 7

how might someone present if long term stimulant use disorder

Answer 7

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

Question 8

how long might stimulant withdrawal last

Answer 8

after cocaine cessation may last hours/days or can persist for up to a month

Question 9

how does stimulant withdrawal present

Answer 9

depression, anhedonia, irritability, lability

SUICIDAL IDEATION/BEHAVIOUR

impaired attention, concentration

Question 10

what should you suspect if an otherwise healthy, young person develops chest pain during acute stimulant intoxication

Answer 10

MI

palpitations, arrhythmias

can have sudden death from resp/cardiac arrest

Question 11

list 4 commonly comorbid psych disorders with stimulant use disorder

Answer 11

PTSD

ADHD

ASPD

gambling disorder

Question 12

what might you see on CBC in stimulant use disorder

Answer 12

elevated WBCs (consider sepsis if injection drug use, but can have elevated WBC just due to substance use)
–> stimulants cause demarginalization of neutrophils

Question 13

what electrolyte disturbance may be seen in stimulant use disorder

Answer 13

hyperkalemia

Question 14

what is the treatment of choice for stimulant use disorder

Answer 14

contingency management/psychosocial treatment

*insufficient evidence to support any Rx for stimulant use disorder

Question 15

should you order regulat antipsychotic in stimulant induced psychosis

Answer 15

consider NOT ordering regular–> only order regular if unclear if there may also be primary psychosis

Question 16

why should you consider AVOIDING antipsychotics in first 6 hours after stimulant use

Answer 16

during first 6 hours there is increased risk of STROKE, SEIZURES with APs

Question 17

do APs treat or prevent psychosis due to stimulant use disorder

Answer 17

no–> but can still be useful in reducing residual symptoms, preventing kindling effect

Question 18

list some meds that can be used PRN for stimulant use disorder

Answer 18

loxapine

haldol

benadryl

ativan

Question 19

is dexamphetamine or methylphenidate useful in treating stimulant use disorder

Answer 19

dexamphetamine–> NO

methylphenidate-> equivocal

–not effective in terms of abstinence, treatment retention

Question 20

what antidepressant may show some benefit in treating stimulant use disorder

Answer 20

mirtazapine

less meth use, decreased sexual risk despite low med adherence

Question 21

what other SUD drug may be helpful in treating stimulant use disorder

Answer 21

suboxone–> was effective in motivated volunteers

Question 22

how do you treat concurrent ADHD with stimulant use disorder

Answer 22

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

Question 23

how does contingency management work

Answer 23

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

Question 24

what % of those with stimulant use disorder will convert to schizophrenia after 20 years

Answer 24

23%