Substance Abuse

Question 1

substance abuse

Answer 1

a need for a substance ranging in intensity from a simple desire to a compulsion that consumes a person’s life

Question 2

how do drugs affect the brain

Answer 2

-affect the brain’s reward circuit which controls feelings of pleasure and motivates a person to repeat behaviors

Question 3

tolerance

Answer 3

reduced pleasure compared to the first high

Question 4

parts of the brain affected by substance abuse

Answer 4

basal ganglia, amygdala, prefrontal cortex, brain stem

Question 5

most common ages for overdose

Answer 5

25-64 years

Question 6

most common gender for overdose

Answer 6

male

Question 7

most common substance combo

Answer 7

alcohol and cannabis

Question 8

cocaine effects

Answer 8

increased mental alertness, paranoia, body temp; tremors; nose bleeds; vein scarring

Question 9

ecstasy effects

Answer 9

increased energy, BP, mood, body temp; jaw clenching

Question 10

heroin effects

Answer 10

euphoria; cloudy mental state; lung complications, endocarditis

Question 11

meth effects

Answer 11

wakefulness; increased physical activity; overheating; itching of face and arms; decreased saliva production-meth mouth

Question 12

amphetamine & pregnancy maternal risks

Answer 12

HTN, HF, PROM, placenta previa/abruption, premature delivery, amnioitis

Question 13

amphetamine & pregnancy neonatal risks

Answer 13

fetal demise, small for GA, neonatal abstinence syndrome (NAS), NICU admission

Question 14

inhalants effects

Answer 14

HA, N/V, memory loss, CV & nervous system impairment, hematopoietic dysfxn, sudden death

Question 15

stimulants

Answer 15

amphetamine
cocaine
exstasy
methamphetamine
methylphenidate (Ritalin)
nicotine
caffeine

Question 16

stimulants & anesthesia

Answer 16

-pre-medicate anxiety
-treat tachycardia (alpha-blocker & CCB)
-treat hypotension with direct-acting vasopressors
-IV hydration
-beware poor dentition
-avoid ketamine & pancuronium
-consider a-line

Question 17

acute stimulant use and anesthesia

Answer 17

increases MAC
-arrhythmias
-HTN d/t increase in NE & Dopamine

Question 18

chronic stimulant use and anesthesia

Answer 18

decreases MAC
-potential hypotension (depleted sympathomimetic NTs)

Question 19

hallucinogens and anesthesia

Answer 19

-surgery may illicit panic response
-treat psychotic effects with benzos, barbs, Haldol
-treat tachycardia/HTN with AB/BB/CCB
-prolonged analgesic & resp. depressant effects of opioids

Question 20

PCP effects

Answer 20

think Hulk
increased HR, BP, motor function; memory loss; numbness; N/V; angry and violent

Question 21

dissociative anesthetics & anesthesia

Answer 21

-HTN & tachycardia (blocked reuptake of NE & serotonin)
-can inhibit pseudocholinesterase
-IV hydration

Question 22

marijuana effects

Answer 22

increased SNS tone; decreased PNS tone; coughing and breathing problems; memory & learning impairment

Question 23

cannabis and anesthesia

Answer 23

-prolonged opioid resp. depression effect
-increased N/V (dec. gastric emptying?)

Question 24

commonly abused prescription meds

Answer 24

-dextroamphetamine
-methylphenidate (Ritalin)
-barbiturates
-benzodiazepines
-opioids

Question 25

Carfentanil

Answer 25

100x potency of Fentanyl

Question 26

opioid use and anesthesia

Answer 26

-continue opioids during procedure
-increased respiratory depression
-give effective doses of mu agonists
-multimodal approach
-opioid antagonists should not be given and case may need to be delayed

Question 27

depressants and anesthesia

Answer 27

acute intoxication: decreases MAC
chronic use: increases MAC
-increased need for IV anesthetics (hepatic enzyme induction)

Question 28

nicotine and anesthesia

Answer 28

cessation 12-18 hours prior decreases carboxyhemoglobin
cessation 6-8 weeks allows mucociliary function and decreases airway reactivity
-increased airway reactivity (give albuterol)
-increased viscous secretions (suction at end)

Question 29

caffeine

Answer 29

blockes adenosine receptors that stimulate GABA
-increased BP, plasma catecholamines, urine production, and gastric acid secretion

Question 30

caffeine and anesthesia

Answer 30

-100 mg IV caffeine in pre-op or during surgery
-IV narcotic for pre-op headache

Question 31

steroids effects

Answer 31

blood coagulation impairment, aggression, delusions, HTN, prostate CA, menstrual irregularities, teen-stunted growth and height

Question 32

acute alcohol and anesthesia

Answer 32

-MAC decreased
-less IV anesthetics
-gastric regurgitation
-no LMA
-hypothermia
-hypoglycemia

Question 33

chronic alcohol and anesthesia

Answer 33

-MAC increased
-increased INR
-decreased platelets
-avoid hypotension
-delayed gastric emptying
-third spacing

Question 34

alcoholic cirrhosis effects

Answer 34

-increased CO
-congestive heart failure
-restrictive lung disease
-pneumonias
-esophageal varices
-peptic ulcer disease
-encephalopathy
-decreased albumin
-decreased vitamin K absorption

Question 35

delirium tremens

Answer 35

from alcohol withdrawal
-tremors, diaphoresis, hyperpyrexia, tachycardia, HTN
-treat: BANANA BAG & benzos

Question 36

preoperative mgmt of substance use disorder

Answer 36

consider regional or local anesthetic
anticipate hyperalgesia
use scheduled opioids
clonidine to help with withdrawal

Question 37

chronic substance abuse on anesthetic requirements

Answer 37

increased: opioids, barbiturates, alcohol, benzodiazepines
decreased: amphetamines

Question 38

acute substance abuse on anesthetic requirements

Answer 38

increased: amphetamines, cocaine
decreased: opioids, barbiturates, alcohol, marijuana, benzodiazepines, PCP