substance abuse

Question 1

diff dx for symptoms of MI: chest pain, radiates to jaw, HA, sweating, nausea, palpitations
+ fever, ↑ HR, ↑ RR, ↑ bp, dilated pupils, anxiety

Answer 1

cocaine-induced MI (cocaine + alcohol associated with ↑ coronary vasopasm risk vs cocaine alone)
arrhythmia
PE
pneumonia

Question 2

if symptoms of MI (chest pain), get these labs:

Answer 2

first ABC → give O2, aspirin, sublingual nitroglycerin, morphine
then r/o ACS with serial EKG and cardiac enzymes: CK, CK-MB, troponin T
next consider drug intoxication: UTS (recent use, not chronic or dependence)
also order:
CBC
CMP: electrolytes, liver enzymes, BUN, Cr (renal function)
vitamin deficiency
PT, PTT, INR
CXR
place on telemetry, monitor O2

Question 3

maladaptive pattern of substance use that leads to:
clinically significant impairment
ongoing use despite of consequences: work/school, DUI, fights, relationship losses

Answer 3

substance abuse

Question 4

maladaptive pattern of substance use that leads to:
clinically significant impairment/distress
tolerance
withdrawal
inability to cut down on use
use despite physical or pysch problems caused by substance

Answer 4

substance dependence

Question 5

substance abuse and reward pathway of all abused drugs

Answer 5

ALL: initial euphoric phase, then
stimulants (cocaine, PCP): over-excited, power, ↑ esteem
opiates: relaxation, satisfaction

Question 6

risk factors for drug addiction

Answer 6

genetic susceptibility
teen
psych disorder

Question 7

USPSTF says insufficient evidence to assess balance of benefits and harms of screening

Answer 7

teens, adults, pregnant women for illicit drug use

Question 8

life-threatening withdrawal

Answer 8

barbiturates
alcohol, BZD (seizures)
NOT opioids

Question 9

dilated pupils

Answer 9

stimulant use
hallucinogen use
opioid withdrawal

Question 10

constricted pupils

Answer 10

opioid use

Question 11

treatment of drug addiction

Answer 11

first step: detox (initiate abstinence, reduce withdrawal sx to prevent relapse (taper doses of long-acting agent), retain in treatment

treatment: medication (makes more receptive to behavior tx) + behavioral therapy (CBT, 12-step: modify lifestyle, coping)
programs: detox + medically managed withdrawal, long-term residential, short-term residential followed by long-term OP, only OP

Question 12

opioid intoxication: MORPHINE-ABC

Answer 12

Miosis
Out - sedation
Respiratory depression
Pneumonia/aspiration
Hypotension, ↓ T
Infrequency: constipation, ↓ bowel sounds, urinary retention
Nausea
Emesis/euphoria
Analgesic
Bradycardia: ↓HR
Coma/AMS