Substance Abuse Flashcards
If a patient presents to the ED with abdominal pain, agitation, sweating, dilated pupils, and fever, what might be the cause?
Heroin Withdrawl
Current Use would be: Elevated Mood, Sedation, Pupil Constriction (suppresses neural output / miosis)
What is an immediate acting drug that can reverse heroin and other opioid effects?
Naloxone
What agent can be used to help immediate symptoms of Opioid withdraw / Heroin?
Clonidine
What are the common symptoms of stimulant agents such as “Speed” or Amphetamines?
- Increased mood and alertness
- Increased agitation
- Pupil Dilation
- Increased energy and less tired
- CV Effects
- Hypersexuality
- Decreased Appetite
- Increase Pain Threshold
If after an injury a patient is admitted to the hospital, then about 2-3 days later he begins to have constant tachycardia and hypertension with delusional thinking and tremor. What the patient had been taking chronically before admission and is now withdrawing from?
Depressants / Sedatives
- Alcohol
- Benzo
- Barbiturates
What is the typical scenerio for withdraw of stimulants?
- Significant Depressed Mood
- Strong Psychlogical craving and irritability
- Increased Hunger (Amphetamines)
- Pupil Constriction
- Headache
A 32 year old presents to the ED who appears sedated, but elevated mood. He has history of HIV. What is most likely drug?
– Heroin (IV drug use probably gave him HIV)
What is a physical exam finding that can contribute to diagnosing a patient with cocaine abuse?
Erythema within the nose
A 28 year old is hospitalized after trying to jump from one build to another and his friends state he was very angry when they refused to do it with him. What is the likely drug of choice?
PCP – Methamphetamines
Where are the locations that addicting drugs most commonly work to reinforce future use?
- Ventral Tegmental Area (depressants / sedation)
- Nucleus Accumbens (Most stimulants and cannaboids)
- Prefrontal Cortex
What is a significant predictor of likelihood of addiction?
Tolerance to side effects
What are factors that contribute to addiction?
- Predisposition / Triggers – started on pain pills w/ surgery and end up getting addicted
- Genetic
- Impulse control deficits
- Family Reinforces Behavior with Co-dependent
What is the best treatment for addiction?
No single treatment works for everyone, must have a designed treatment specific for each person
During Detox what should be taken for Opioid detoxification?
Clonidine and Loperamide
What should be used in an alcoholic who is detoxing?
Benzodiazepines
What are the steps in Addiction treatment?
Active Treatment – seperating from substance and lifestyle changes
Maintenance – staying changed
Why is relapse especially dangerous?
Patient have been clean for a duration and their tolerance decreases and the patient go back to the dose they were at before they stopped, which is very high and can cause overdose if just jumping right to it.
What are the most common methods of treatment?
Motivational Enhancement Therapy – create conditions to enhance the patient’s efforts and encourage
12-Step Approach – most residental centers use
Self-Help –complements efforts
What are only certain ethnic groups more susceptible to Codeine and Opiate abuse?
Codeine is converted to Morphine by CYP2D6 and different ethnic groups have different concentrations of it
How do Opioids affect respiration mechanisms?
- Reduce respiratory response to elevated CO2
- Eliminates response of respiratory drive to low O2
What are specific correlative signs of opiate intoxication?
- Pupillary Constriction
- Drowsiness / Slurred Speech / Attention Impaired
What are specific signs of opiate withdrawl several days after stoppage?
- Nausea/Vomiting
- Pupillary Dilation
- Piloerection/Sweating
- Yawning – insomnia
How does Methodone treatment work for opioid abuse?
- Long Acting to prevent withdraw and doesn’t give them the high
How does Buprenorphine / Suboxone work to treat opioid abuse?
Partial Agonist – Has constant Opioid effect over log-scale with a very long half life
Thus, maintains a constant level without fluctuations in level, which contribute to patients increasing dose/abuse.
