Substance abuse 0427 Flashcards
substance dependence
maladaptive pattern of substance use w/ 3 or more in 1 yr:
- tolerance
- withdrawal
- substance taken in larger amts or for longer time
- persistent desire or unsuccessful attempts to cut down
- significant energy spent over substance
- important social, occupational, recreational activities reduced
- continued use despite knowing problems caused by substance
substance abuse
maladaptive pattern leading to clinically significant impairment or distress
- recurrent use resulting in failure to fulfill major obligations at work, school, home
- recurrent use in physically hazardous situations
- recurrent substance-related legal problems
- continued use despite persistent problems caused by use
depressants
alcohol
opioids (morphine, heroine, methadone)
barbiturates
benzodiazepines
nonspecific effects of depressant intoxication
mood elevation decreased anxiety sedation behav disinhibition resp depression
nonspecific effects of depressant withdrawal
anxiety
tremor
seizures
insomnia
alcohol intoxication
emotional lability slurred speech ataxia coma blackouts
indicator: serum gamma-glutamyltransferase.
AST is double ALT.
alcohol withdrawal
mild: similar to other depressants
severe: delirium tremens (treat with benzos)
opioid intoxication
CNS depression nausea, vomiting bradycardia constipation PINPOINT PUPILS seizures
tx: naloxone, naltrexone
opioid withdrawal
sweating dilated pupils piloerection "cold turkey" fever rhinorrhea nausea, cramps, diarrhea FLU LIKE SX
tx: symptomatic
barbs intoxication
low safety margin
marked resp depression
tx: symptomatic
barbs withdrawal
delirium
life-threatening CV COLLAPSE
benzos intoxication
greater safety margin
ataxia
minor resp depression
tx: flumazenil
stimulants
amphetamines
cocaine
caffeine
nicotine
nonspecific effects of stimulant intoxication
mood elevation psychomotor agitation insomnia cardiac arrhythmias tachycardia anxiety
nonspecific effects of stimulant withdrawal
post-use "crash" depression lethargy weight gain headache
amphetamine intox
impaired judgment pupillary dilation prolonged wakefulness and attention delusions hallucinations fever
amphetamine withdrawal
stomach cramps
hunger
hypersomnolence
cocaine intox
impaired judgment pupillary dilation hallucinations (tactile) paranoid ideations angina sudden cardiac death
tx: benzos
cocaine withdrawal
suicidality
hypersomnolence
malaise
severe psychological craving
caffeine intox
restlessness
increased diuresis
muscle twitching
nicotine intox
restlessness
nicotine withdrawal
irritability
anxiety
craving
tx: nicotine patch, gum, lozenges.
buproppion/varenicline
hallucinogens
PCP (phencyclidine)
LSD
marijuana
PCP intox
BELLIGERENCE impulsiveness fever psychomotor agitation vertical/horizontal nystagmus tachycardia homicidality psychosis delirium
