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FA Psy > substance abuse > Flashcards

substance abuse Flashcards

1
Q

delirium tremens tx

A

benzodiazepines (chlordiazepoxide, lorazepam)

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2
Q

alc intox tx

A

tapering doses of bento
thiamine, folic acid, multivitamin
mgSO4 to prevent post withdrawal seizures

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3
Q

long term complication of alc intake

A

wernicke encephalopathy - bc of poor diet of alcoholics –> thiamine def. ataxia, confusion, ocular abn
can cause korsakoff’s syndrome: impaired recent memory, anterograde amnesia, confabulation

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4
Q

Cocaine pthway

A

blocks dopamine repute from synaptic cleft - stimulant effect. indirect sympathomimetic. mimic fight or flight response

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5
Q

cocaine clinical presentation

A

euphoria, incr or decr BP, tachy or brachy, nausea, dilated pupil, wt loss, psychomotor agitation or depression, chills, sweating. can cause respiratory depression, seizures, arrhythmias, hallucination (tactile).
vasoconstrictive- MI, CVA

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6
Q

cocaine overdose

A

can kill secondary to cardiac arrhythmia, seizures or respiratory depression

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7
Q

cocaine DD

A

amphetamine, phencyclidine (PCP) intox, sedative w/d

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8
Q

cocaine dx

A

urine drug test, pos for 3d

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9
Q

cocaine tx

A

intox:
1) mild-mod: benzo
2) severe/psychosis: haloperidol
3) symptomatic support
dependence
1) psychotx, group
2) TCA
3) dop agonist (amantadine, bromocriptine)

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10
Q

cocaine w/d

A

not life threatening. cause dysphoric (crash)= malaise, fatigue, depression, hunger, constricted pupil, vivid dreams, psychomotor agitation or retardation
tx: supportive

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11
Q

amphetamine types

A

classic and

substituted

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12
Q

classic amphetamine

A

dextroamphetamine (dexedrine), methylphenidate (ritalin), methampheamine (ice, speed, crystal meth, crack)
release dopamine from nerve endings –> stimulant effect. used to tx narcolepsy, ADHD, depressive D

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13
Q

substituted amphetamine

A

aka designer. - MDMA (ecstasy)m MDEA (eve)

release dopamine and 5HT from nerve endings- stimulant and hallucinogenic properties

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14
Q

amphetamine intox presentation, dd, dx, tx, w/d

A

same as cocaine. urine drug screen pos for 1-2d. neg screen doesn’t rule it out bc many aren’t sensitive enough.

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15
Q

PCP pthwy

A

hallucinogen that antagonize n-methyl-d-aspartate (NMDA) glutamate R and activate dopaminergic neurons. similar to ketamine. aka angel dust

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16
Q

PCP intox sx and signs

A

recklessness, impulsivness, impaired judgment, assaultiveness, rotatory nystagmus (pathognomonic), ataxia, HTN, tachym M rigidity, high tolerance to pain. overdose-seizure, coma.cause more violence than any other drug.

17
Q

pcp intox tx

A

monitor BP, T, electrolytes
acidify urine with NH4Cl and ascorbic acid,
benzo or dopamine antagonist- ctrl agitation and anxiety
diazepam - M spasm and seizures
haloperidol- ctrl severe agitation and psychotic sx

18
Q

PCP dx

A

urine drug screen pos for >1wk. CPK and AST often elvated
dd acute psychotic states, schizophrenia
w/d - none but may have flashbacks

19
Q

sedative hypnotics

A

benzos, barbiturates (tx epilepsy and as anesthetic). the two are synergistic. can cause respiratory depression

20
Q

benzodiazepam pthwy

A

potentiate effects of GABA by incr freq of cl ch opening

21
Q

barbituate ptwy

A

potentiate GABA by incr duration of Cl ch opening

at high dose, direct GABA agonist and lower margin of safety compared to BDZs.

22
Q

sedative hypnotic intox

A

sedative= drowsy, slurred speech, incoordination, ataxia, mood lability, impaired judgment, nystagmus, respiratory depression, comma or death in overdose (especially barbiturates)
sx aug by ethos.
dd: alc intoxx, generalized cerebral dysfunc- delirium
dd: urine or serum drug test pos for 1wk. electrolyte, ecg

23
Q

sedative hypnotic tx

A

maintain airway, breathing, circulation
activate charcoal to prevent GI absorption
barbituates- alkalize urine with NaCO3 to promote renal excretion
benzo- flumazenil in overdose
supportive care

24
Q

flumazenil

A

short acting BDZ antagonist. can precipitate seizure

25
Q

sedative hypnotic w/d

A 
life threatening (w/d from stimulants/hallu is not)
autonomic hyperactivity, insomnia, anxiety, tremor, n/v, delirium, hallu, seizure
tx: long acting bend- chloroiasepoxide or diazepam - then taper dose. 
tegretol or valproic acid for seizure ctrl.
26
Q

opiates

A

ex heroin, morphine. stimulate opiate R (mu, kappa, delta) affect dopaminergic system.

27
Q

opiate intox

A

drowsiness, n/v, constipation, slurred speech, constricted pupil, seizure, respiratory depression –> coma –> death.
meperidine + MAOi –> serotonin syndrome (hyperthermia, confusion, hyper/potnesion, M rigidity

28
Q

opioid dd

A

sedative-hypnotic intox. severe etoh intox

dd- rapid recovery of consciousness after admin of IV naloxone. urine/blood test pos for 12-36hr.

29
Q

opioid tx

A

intox- ABC
overdose- naloxone or naltrexone. may need ventilatory support.
dependence: oral methadone daily taper over mo/y. psychotx

30
Q

triad of opiod overdose

A

rebels admire morphine

respiratoyr depression, altered mental status, miosis

31
Q

opiate w/d

A

not life threatening. w/d syndrome- dysphasia, insomnia, lacrimation, rhinorrhea, yawning, weakness, sweating, piloerection, n/v, fever, dilated pupils, muscle ache
tx: moderate sx- clonidine or buprenorphine. severe- detox with methadone over 7d

32
Q

hallucinogens intox, w.d

A

psilocybin (mushrooms)
lsd
pharm effect vary.
tolerance dev quickly but reverses rapidly
no dependence or w/d
perceptual changes, papillary dilation, tachy, tremors, incoordination, sweating, palpitations
tx- guidance and reassurance. severe- antipsychotics or benzo

33
Q

marijuana

A

cannabis is a THC cannabinoid R in brain inhibit adenylate cyclase. effects augmented by EtOH.
can tx nausea in cancer pt and incr appetite in AIDS pt. no sep or w/d

34
Q

marijuana intox

A

euphoria, impaired coordination, mild tachycardia, conjunctival injection, dry mouth, incr appetite
urine test pos for 4 wks
supportive and sx treatment

35
Q

inhalants

A

CNS depressants. user usually adolescent male
intox- impaired judgment, belligerance, everything
overdose may be fatal secondary to respiratory depression or arthymia.
long term use- permanent damage to CNS, PNS, liver kidney, M
tx: ABC, sx, psychotx
dx- serum drug pos for 4-10hr
no w/d

36
Q

caffeine

A

adenosine antagonist. incr cAMP and stimulate effect via dopaminergic system

37
Q

nicotine pthwy

A

stimulate nicotinic R on autonomic ganglia of sympathetic and PSNS. –> CNS stimulant–> restlessness, insomnia, anxiety, incr GI motility. incr attention, mood, decr tension

38
Q

nicotine w/d

A

craving, dysphoria, anxiety, incr appetite, irritability, insomnia

39
Q

smoking cessation

A

behavioral counseling, nicotine replacement therapy (gum, patch), zyban (antidepressant decr craving), clonidine

FA Psy (14 decks)

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