Substance Abuse Flashcards by Rom Soff

Substance use disorder is _____? chronic or acute

chronic

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Substance disorder progressive illness affects __-___% of Americans in lifetime

25-29% in lifetime

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Unhealthy alcohol use is associated with elevated risks of medical problems such as:

Hypertension
GI bleeding
Sleep disorder
Major depression
Hemorrhagic stroke
Cirrhosis of liver
HIV acquisition
Several cancers

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Men are able to metabolize alcohol faster because they have highly active forms of enzyme called ______?

Located where?

Alcohol Dehydrogenase (ADH) in stomach and liver

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After one drink it will take you around ______ for the BAC to return to 0

2 hours

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Even if you dont feel the effect of intoxication at ____%, your _______ time will be slowed and ______ will be affected to the extent that your driving will be impaired.

reaction; fine motor skills

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Symptoms of alcohol overdose

mental confusion
difficulty remaining conscious
vomit
seizure
trouble breathing
slow heart rate
clammy skin
no gag reflex
low body temp
possible brain damage or death

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Factors that play a role in what symptoms you will get with alcohol use

Age, sensitivity to alcohol (tolerance), gender, speed of drinking, medications you take , and amount of food eaten

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Overdose chances increase if the person is also using? 3 main things

Ambien
Benzos
Possibly OTC antihistamines

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According to NIAAA, approx.
__ out of __ adults in U.S. drink at levels that put them at risk for physical and mental health problems

3 out of 10

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Define Binge drinking

large quantity of alcohol can overwhelm the body’s ability to break down and clear alcohol from the bloodstream

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Alcohol (low risk) quantity
< ___ drinks per week (males)
<____ drinks per week (females)

Amount for special occasions
> or equal to ___ per occasion (males)
> or equal to ___ per occasion (females)

< 14 drinks per week (males)
< 7 drinks per week (females)

> or equal to 5 per occasion (males)
or equal to 3 per occasion (females)

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CAGE

what does it stand for?

Cut down
Annoyed
Guilty
Eye-opner

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CAGE Scoring

a total of 2 or more is considered clinically significant

however, the Consensus panel recommends that primary care clinicians lower the threshold to 1 to cast a wider net and identify more patients with substance abuse.

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Questions to prescreen every NEW patient with 2 questions.

And the follow up if answer with a yes

Do you sometimes drink beer, wine, or other alcoholic beverages?
How many times in the past year have you used a prescription medication for nonmedical reasons or illegal drugs?

Follow up
1. How many times in the past year have you had 5 or more drinks in a day(men); four or more (women)?
2. How many times in the past year have you used illicit drugs or prescription drugs for nonmedical reasons?

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Substance Abuse Disorder scoring

Mild substance use disorder:
Moderate substance use disorder:
Severe substance use disorder:

Mild substance use disorder: 2 or 3
Moderate substance use disorder: 4 or 5
Severe substance use disorder: 6 or more

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FRAMES is used when?

patient identifies that they are at risk or already have met criteria for abuse disorder

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FRAMES

Feedback is given to individual about personal risk and impairment
Responsibility for change is placed on the pt.
Advice to change is given by the provider
Menu of alternative self-help and treatment
Empathic style is used in counseling
Self-efficacy or optimistic empowerment is engendered in the pt

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Potential menu of treatment options for patients with unhealthy alcohol or drug use

Cut down on the amount and/or frequency of drinking or subsance use
Quiet completely
Use online and mobile applicatoins based resources
Attend mutual help meetings
Addicition counseling
Seek clinical treatment
Enroll in a short term residental program
Enroll in an addition treatment program

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Regular cannabis use (esp among adolescents)

impairs short-term memory and performance in school

potential to impact psychiatric symp. and cognitive development

increase risk of psychosis and psychotic disorder

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Cannabis can be detected for ___ days or longer in the urine of daily smokers

approx ___ days in intermittent smokers

All other illicit drugs are cleared within ____ hours

30 days

7 days

72 hours

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Withdrawal drug:
action:
withdrawal onset:
duration:
characteristic: increased blood pressure, increased heart rate, elevated temperature, nausea, vomiting, diarrhea, seizures, delirium, death

Withdrawal drug: Alcohol
action: sedative
withdrawal onset: 24 - 48 hours
duration: 5-7 days
characteristic: increased blood pressure, increased heart rate, elevated temperature, nausea, vomiting, diarrhea, seizures, delirium, death

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Withdrawal drug:
action:
withdawal onset:
duration:
characteristic: insomnia or hypersomnia, increased appetite, depression, paranoia, decreased energy

Withdrawal drug: Cocaine
action: stimulant
withdrawal onset: hours of last use
duration: 3-4 days
characteristic: insomnia or hypersomnia, increased appetite, depression, paranoia, decreased energy

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Withdrawal drug:
action:
withdrawal onset:
duration:
characteristic: nausea, vomiting, diarrhea, restlessness, muscle and bone pain, leg movement

Withdrawal drug: Opioids
action: sedative
withdrawal onset: within 24 hours last use
duration:4-7 days
characteristic: nausea, vomiting, diarrhea, restlessness, muscle and bone pain, leg movement

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Withdrawal drug: action: withdrawal onset: ? duration: characteristic: irritability, difficulty sleeping, decreased appetite, anxiety

Withdrawal drug: Cannabis action: euphoriant withdrawal onset:? duration: weeks characteristic: irritability, difficulty sleeping, decreased appetite, anxiety

In alcohol when physical dependence develops, initial withdrawal symp of anxiety, sleeping disorder, and tremors are _____

mild

Risk factors for severe alcohol withdrawal

Daily drinking for an extended period of time Sedative, cocaine, or opiate opioid use History od severe withdrawal High alanine aminotransferase (ALT AST) High serum GGT Low platelet count Low potassium level

How much is a drink? oz regular beer oz malt liquor oz table wine oz shot

12oz regular beer 8-9oz malt liquor 5oz table wine 1.5oz shot

Long term alcohol consumption affects ______ which undergo an adaptive change in an attempt to maintain normal function

brain receptors

When should a patient with withdrawal S/S be hospitalized?

Clouded sensorium Fever Hyperventilation Concominant medical problem (e.g., liver failure or pancreatitis) Hx of ETOH-withdrawal seizures 3+ risk factors for severe withdrawal

With chronic alcohol exposure , GABA receptors become ____ responsive and _____ alcohol concentrations are required to achieve the same level os suppression, which is termed "________+

less; higher; tolerance

Medication for out-patient alcohol withdrawal

Chlordiazepoxide - If hepatic impairment give lorazepam

S/S of alcohol withdrawal syndrome

Progressive & worsens with time: 1) Minor withdrawal S/S 2) Hallucinations 3) Withdrawal seizures 4) Delirium tremens

Rate of successful treatment (achievement of abstinence) in treated patients with substance abuse

30-40%

Delirium tremens usually begin about ____ to ____ days after someone whos dependent on ________ end a long _______ binge

2 to 3 ; alcohol; drinking

Delirium tremens mortality rate

If untreated, delirium tremens can cause ________,__________,and _________

heart attack, stroke, and death

Delirium tremens is most common amongst:

adult men - especially white younger unmarried people with hx of seizures those who have gone through alcohol withdrawal before heavy and long term drinkers

Of the following 8 S/S associated with ETOH withdrawal diagnostic criteria, how many must be present in order to diagnose ETOH withdrawal? Autonomic hyperactivity Hand tremor Insomnia N/V Hallucinations Psychmotor agitation Anxiety Grand mal seizures

At least 2 must be present at levels that cause significant distress & are not better explained by any medical condition

10-item assessment tool that helps quantify the severity of ETOH withdrawal syndrome

CIWA-Ar Clinical Insitutue withdrawal assessment for Alcohol

What score on the CIWA-Ar indicates mild withdrawal?

8 or less

What score on the CIWA-Ar indicates severe withdrawal?

greater than 15

What meds may be given outpatient when the CIWA-Ar score is 8-10?

Chlordiazepoxide Diazepam Lorazepam

What is the preferred drug class for treating symptoms of ETOH withdrawal syndrome?

Benzo

Which 2 long-acting BZDs are often used for ETOH withdrawal syndrome?

Chlordiazepoxide Diazepam

Which 2 intermediate-acting BZDs are often used for ETOH withdrawal syndrome?

Lorazepam Oxazepam

What meds may be used to help a patient stop drinking?

Naltrexone or Disulfiram

Naltrexone is contraindicated in ?

Patients needing or receiving opioids for pain relief

Disulfiram is contraindicated in?

Pregnancy, significant liver disease, esophageal varices, history of GI bleeding, psychosis impulses control problems, or suicidality

What is the most common prescription opioid?

Hydrocodone

Most patients in acute pain rarely need more than how many days' worth of opioids?

7 days worth

What patients are considered to have mild opioid use disorder?

Those without physical dependence

What patients are considered to have moderate/severe opioid use disorder?

Those with physical dependence

What treatments may be used to manage mild opioid use disorder?

Naltrexone Psychosocial Tx

What treatments may be used to manage moderate/severe opioid use disorder?

Buprenorphine Methadone Psychosocial Tx

What opioid antagonist is used to treat an OD in an emergency?

Naloxone (Narcan)

Why does severe ETOH overdose turn into a life threat?

Suppression of breathing, heart rate, & temperature control Also reduced gag reflex allows aspiration of vomit

If alcohol is easily smelled in a room, BAC is likely greater than _______?

0.125

What S/S may be seen with severe ETOH impairment?

Blackouts (memory gaps) Loss of inhibition/judgment Vomiting Loss of consciousness

What S/S may be seen with moderate ETOH impairment?

Relaxation leading to intoxication Aggression in some people Significant driving impairments Increased risk of injury

What BAC range is associated with mild impairment moderate impairment severe impairment life-threatening impairment?

mild impairment - 0.0 - 0.05 moderate impairment - 0.0.6- 0.15 severe impairment - 0.16 - 0.30 life-threatening impairment- 0.31 - 0.45

Percentage of people who try an illegal drug before age 13 and develop a substance abuse disorder within 7 years? compared to ___% of those who try an illegal drug after age of 17

70%; 27%

Percentage of people age 12+ who have used illicit drugs in their lifetime

50%

Rate of successful treatment (achievement of abstinence) in treated patients with substance abuse

30-40%

S/S of opioid overdose

Cold, clammy skin Cyanosis Pinpoint pupils Bradypnea Unconsciousness

ETOH withdrawal differential diagnosis labs

CBC Liver function test UA w/ tox BAC CMP (electrolytes)

Non-drug treatments for quitting drinking

Motivational interviewing 12-step programs

Delirium tremens S/S

Hallucinations (mostly visual) Disorientation Tachycardia HTN Low-grade fever Agitation Diaphoresis