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Substance abuse Flashcards

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1
Q

abuse

A

impairment or distress for at least 12 months w one or more of following

  • failure to fulfill obligations at work, school, home
  • use in dangerous situations (driving)
  • recurrent substance related legal problems
  • continued use despite social or interpersonal problems due to use

mnemonic is WILD

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2
Q

dependence

A

impairment or distress manifested by at least 3 of following within 12 month period

  • tolerance
  • withdrawal
  • using substance more than originally intended
  • persistent desire or unsuccess. effort to cut down
  • significant time spent getting, using or recovering
  • decreased social, job, or recreational activities b/c of substance
  • continued use despite subsequent physical or pscyhological problem (liver problems)
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3
Q

most adults will show some signs of intoxication with BAL over

A

100

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4
Q

most adults show obvious signs of intoxication with BAL over

A

150

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5
Q

ethanol along with methanol and ethylene glycol can cause what metabolic disturbance?

A

metabolic acidosis with increased anion gap

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6
Q

treatment of alcohol intoxication

A

ABCs
give thiamine, folate
naloxone may be necessary (if co-ingested opioids)
CT head may be necessary (rule out subdural hematoma)

GI evacuation isn’t indicated unless significant amt of ETOH was ingested within preceding 30-60 minutes

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7
Q

what are you most concerned about w alcohol withdrawal

A

seizures, HTN, arrhythmias

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8
Q

generalized tonic clonic seziures usually occur btwn how many hrs after stopping drinking

A

6-48

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9
Q

alcohol withdrawal seizures are treated w

A

benzos

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10
Q

delirium tremens usually beings when

A

48-72 hours after last drink but may occur later

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11
Q

symptoms of delirium tremens

A

dolirium

hallucinations (most commonly visual)
gross tremor
autonomic instability
fluctuatint levels of psychomotor activity

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12
Q

symptoms of eTOH withdrawal begin when after last drink

A

6-24 hrs after

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13
Q

what should be given to pt in alcohol withdrawal?

A

benzos (chloridazepoxide, diazepam, lorazepam) and taper (alternatives would be carbamazepine or valproic acid)

antipsychotics and temporary restraints for severe agitation

thiamine, folic acid, multivitamin

correct electrolyte and fluid abnormalities

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14
Q

how do you monitor withdrawal in alcoholic?

A

Clinical Institute Withdrawal Assessment scale (CIWA)

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15
Q

what should you do for alcohol withdrawal pt?

A

tx
monitor with CIWA
monitor level of consciounsess and investigate possibility of trauma

check for signs of liver failure

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16
Q

biochem markers to detect recent prolonged drinking

A 
BAL
LFTs
gamma glutamyl transpeptidase
CDT
MCV
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17
Q

at risk or heavy drinking for men and women is how much

A

more than 4 drinks daily or more than 14 drinks per week

women-more than 3 drinks daily or 7 drinks per week

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18
Q

signs of cannabis intoxication

A

anxiety, paranoia, conjunctival injection

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19
Q

cocaine intoxication signs

A

tachycardia
diaphoresis
pupillary dilation

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20
Q

onset for delirium tremens is most likely in what period

A

3rd to 5th day after last drink

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21
Q

vital sign abnormalities, hallucinations point to

A

possible delirium

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22
Q

in delirium tremens, why is diazepam less ideal than oxazepam for treatment?

A

diazepam has active metabolites and undergoes extensive metabolism in the liver

oxazepam and lorazepam are not dependent on liver fxn for their metabolism (good for underlying liver dis)

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23
Q

meds for alcohol dependence

A

disulfiram (causes flushing, HA, n/v, palpitations, SOB)

naltrexone

acamprosate

topiramate

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24
Q

MOA of naltrexone for alcohol dependence

A

decreases desire and high assoc w alcohol

greater benefit seen in persons w family hx of alcoholism

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25
Q

acamprosate MOA

A

structurally similar to GABA (inhibits glutamatergic system)

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26
Q

acamprosate should be started

A

postdetoxification for relpase prevention in pts who have stopped drinking

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27
Q

major advantage of acamprosate

A

can be used in pts with liver dis

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28
Q

topiramate MOA

A

potentiates GABA, inhibits glutamate receptors

reduces alcohol cravings

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29
Q

long term complications of alcohol intake

A

Wernicke’s encephalopathy (caused by thiamine defic)

if left untreated, above progresses to Korsakoff syndrome

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30
Q

what ocular abnormalities are seen in Wernicke’s enceph

A

nystagmus, gaze palsies

31
Q

Korsakoff syndrome

A

impaired recent memory
anterograde amnesia
compensatory confabulation ( unconscious)

32
Q

all pts with altered mental status should be given what before glucose

A

thiamine

33
Q

delirium tremens

A

seizures (tonic-clonic)
visual, tactile hallucinations
increased RR, HR, BP

34
Q

hypomagnesemia may predispose to

A

seizures

35
Q

cocaine intoxication symptoms

A 
euphoria
heightened self esteem
increased or dec BP
tachycardia or bradycardia
nausea
dilated pupils
weight loss
psychomotor agitation or depression
chills
sweating
36
Q

cocaine blocks reuptake of what from synaptic cleft

A

dopamine

37
Q

cocaine overdose can cause death secondary to

A

cardiac arrhythmia
MI
seizure
respiratory depression

38
Q

management of cocaine intoxication

A

mild to moderatea agitation and anxiety: reassurance and benzos

severe agitation or psychosis: antipsychotics (haloperidol)

symptomatic support (control HTN, arrhythmias)

temp of greater than 102 is an emergency and should be given ice bath, cooling blanket

39
Q

with mild to moderate cocaine use, withdrawal symptoms resolve within

A

18 hrs

40
Q

MOA of classic amphetamines

A

block reuptake and facilitate release of dopamine and NE, causing stimulnt effect

41
Q

what are amphetamines used medically for

A

ADHD
narcolepsy
depressive disorders

42
Q

substituted amphetamines-name them and their efects

A

MDMA (ecstasy), MDEA

stimulant and hallucinogenic properties
release dopamine, NE, and serotonin

43
Q

symptoms of amphetamine abuse

A 
dilated pupils
increased libido
perspiration
respiratory depression
chest pain
44
Q

chronic amphetamine use leads to

A

acne and accelerated tooth decay (meth mouth)

45
Q

overdose of amphetamines can lead to

A

hyperthermia, dehydration (esp after prolonged dancing in a club), and rhabdomyolysis leading to renal failure

46
Q

tx of amphetamine intoxication

A

rehydrate
correct electrolyte balance
treat hyperthermia

47
Q

PCP intoxication symptoms

A

RED DANES

rage
erythema (redeness of skin)
dilated pupils
delusions
amnesia
NYSTAGMUS
excitation
skin dryness
48
Q

rotary nystagmus is pathognomonic for

A

PCP intoxication

49
Q

tx for PCP intoxication

A

monitor vitals, temp, electroytes
minimize sensory stimulation
benzos for agitation, anxiety, uscle pasms, seizures

antipsychotics for agitation or psychotic ysmptoms

50
Q

tactile and visual hallucinations are found in both

A

cocaine and PCP abuse

51
Q

more than with other durgs, inotixcation w PCP results in

A

violence

52
Q

withdrawal of PCP

A

no withdrawal syndrome, but flashbacks (recurrence of intoxication syptoms due to release of drug from body lpid store) may occur

53
Q

name sedatives/hypnotics

A 
benzos (highly abused)
barbiturates
zolpidem
zaleplon
GHB (gamma hydroxybutyrate)-date rape drug
meprobamate
54
Q

barbiturates are used where

A

epilepsy, anesthetics

55
Q

diff in MOA of barbiturates and benzos

A

benzos increase freq of Cl channel opening

barbiturates increase duration of Cl channel opening

56
Q

clinical presentaiton of sedative/hypnotic intoxication

A 
drowsiness
confusion
hypotension
slurred speech
incoordination
ataxia
mood lability
impaired judgment
nystgamus
respiratory depression
coma or death
57
Q

tx of sedative/hypnotic intoxication

A

maintain ABCs, monitor vitals
activated charcoal and gastric lavage (if ingested in prior 4-6 hrs)

for barbiturates only: alkalinize urine with sodium bicarbonate to promote renal excretion

for benzos only: flumanzenil in overdose

58
Q

withdrawal presentation of sedatives/hypnotics

A

same as ethanol withdrawal symptoms

tonic clonic seizures mya occur, life threatening

59
Q

in general withdrawal from stimulants is

A

not life threatening

60
Q

opioid intoxication symptoms

A 
drowsiness
n/v
constipation
slurred speech
constricted pupils
seizures
respiratory depression
61
Q

MAOIs and what opioid taken together may cause serotonin syndrome?

A

meperidine

62
Q

opioid withdrawal symptoms

A 
dysphoria
insomnia
lacrimation
rhinorrhea
yawning
weakness
sweating
piloerection
n/v
fever
dilated pupils
abd cramps
arthralgia
myalgia
HTN
tachycardia 
craving
63
Q

what do you use to monitor degree of opioid withdrawal

A

COWS (clinical opioid withdrawal scale)

64
Q

which is safer: methadone or buprenorphine?

A

buprenorphine b/c its effects reach a plateau and make overdose unlikely

65
Q

hallucinogens-list

A

psilocybin (mushrooms)
mescaline (peyote cactus)
LSD

66
Q

hallucinogens do not cause physical dependence or withdrawal: true or false

A

true (but users can rarely develop psychological dependence)

67
Q

withdrawal symptoms of opioids

A 
insomnia
anxiety
anorexia
fever
rhinorrhea
piloerection
68
Q

intoxication w marijuana-clinical picture

A 
euphoria
anxiety
impaired motor coordination
perceptual disturbances (slowed time)
mild tachycardia
anxiety
conjunctival injection (red eyes)
dry mouth
increased appetite
69
Q

marijuana dependence occurs in what percent of users

A

5%

70
Q

chronic use of marijuana may cause

A

respiratory problems-asthma and crhonic bronchitis
suppression of immune system
possible effects on reproduc hormones

71
Q

withdrawal symptoms of marijuana

A

irritability, anxiety, restlessness, aggression, strange dreams, depression, HAs, sweating, insomnia, nausea, craving, decreased appetite

72
Q

inhalants generally act as CNS

A

depressants

73
Q

MOA of caffeine

A

adenosine antagonist, increasing cAMP and causing stimulant effect via dopaminergic system

74
Q

tx of nicotine dependence

A

varenicline (Chantix)-a nicotinic cholinergic receptor partial agonist that mimics action of nicotine

bupropion (zyban)-partial agonist at nAChR, inhibitor of dopamine reuptake

nicotine replacement therapy

behavioral counseling should be part of every tx

Psych (20 decks)

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