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Substance abuse Flashcards

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
acamprosate MOA
structurally similar to GABA (inhibits glutamatergic system)
26
acamprosate should be started
postdetoxification for relpase prevention in pts who have stopped drinking
27
major advantage of acamprosate
can be used in pts with liver dis
28
topiramate MOA
potentiates GABA, inhibits glutamate receptors | reduces alcohol cravings
29
long term complications of alcohol intake
Wernicke's encephalopathy (caused by thiamine defic) if left untreated, above progresses to Korsakoff syndrome
30
what ocular abnormalities are seen in Wernicke's enceph
nystagmus, gaze palsies
31
Korsakoff syndrome
impaired recent memory anterograde amnesia compensatory confabulation ( unconscious)
32
all pts with altered mental status should be given what before glucose
thiamine
33
delirium tremens
seizures (tonic-clonic) visual, tactile hallucinations increased RR, HR, BP
34
hypomagnesemia may predispose to
seizures
35
cocaine intoxication symptoms
``` euphoria heightened self esteem increased or dec BP tachycardia or bradycardia nausea dilated pupils weight loss psychomotor agitation or depression chills sweating ```
36
cocaine blocks reuptake of what from synaptic cleft
dopamine
37
cocaine overdose can cause death secondary to
cardiac arrhythmia MI seizure respiratory depression
38
management of cocaine intoxication
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
with mild to moderate cocaine use, withdrawal symptoms resolve within
18 hrs
40
MOA of classic amphetamines
block reuptake and facilitate release of dopamine and NE, causing stimulnt effect
41
what are amphetamines used medically for
ADHD narcolepsy depressive disorders
42
substituted amphetamines-name them and their efects
MDMA (ecstasy), MDEA stimulant and hallucinogenic properties release dopamine, NE, and serotonin
43
symptoms of amphetamine abuse
``` dilated pupils increased libido perspiration respiratory depression chest pain ```
44
chronic amphetamine use leads to
acne and accelerated tooth decay (meth mouth)
45
overdose of amphetamines can lead to
hyperthermia, dehydration (esp after prolonged dancing in a club), and rhabdomyolysis leading to renal failure
46
tx of amphetamine intoxication
rehydrate correct electrolyte balance treat hyperthermia
47
PCP intoxication symptoms
RED DANES ``` rage erythema (redeness of skin) dilated pupils delusions amnesia NYSTAGMUS excitation skin dryness ```
48
rotary nystagmus is pathognomonic for
PCP intoxication
49
tx for PCP intoxication
monitor vitals, temp, electroytes minimize sensory stimulation benzos for agitation, anxiety, uscle pasms, seizures antipsychotics for agitation or psychotic ysmptoms
50
tactile and visual hallucinations are found in both
cocaine and PCP abuse
51
more than with other durgs, inotixcation w PCP results in
violence
52
withdrawal of PCP
no withdrawal syndrome, but flashbacks (recurrence of intoxication syptoms due to release of drug from body lpid store) may occur
53
name sedatives/hypnotics
``` benzos (highly abused) barbiturates zolpidem zaleplon GHB (gamma hydroxybutyrate)-date rape drug meprobamate ```
54
barbiturates are used where
epilepsy, anesthetics
55
diff in MOA of barbiturates and benzos
benzos increase freq of Cl channel opening barbiturates increase duration of Cl channel opening
56
clinical presentaiton of sedative/hypnotic intoxication
``` drowsiness confusion hypotension slurred speech incoordination ataxia mood lability impaired judgment nystgamus respiratory depression coma or death ```
57
tx of sedative/hypnotic intoxication
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
withdrawal presentation of sedatives/hypnotics
same as ethanol withdrawal symptoms | tonic clonic seizures mya occur, life threatening
59
in general withdrawal from stimulants is
not life threatening
60
opioid intoxication symptoms
``` drowsiness n/v constipation slurred speech constricted pupils seizures respiratory depression ```
61
MAOIs and what opioid taken together may cause serotonin syndrome?
meperidine
62
opioid withdrawal symptoms
``` dysphoria insomnia lacrimation rhinorrhea yawning weakness sweating piloerection n/v fever dilated pupils abd cramps arthralgia myalgia HTN tachycardia craving ```
63
what do you use to monitor degree of opioid withdrawal
COWS (clinical opioid withdrawal scale)
64
which is safer: methadone or buprenorphine?
buprenorphine b/c its effects reach a plateau and make overdose unlikely
65
hallucinogens-list
psilocybin (mushrooms) mescaline (peyote cactus) LSD
66
hallucinogens do not cause physical dependence or withdrawal: true or false
true (but users can rarely develop psychological dependence)
67
withdrawal symptoms of opioids
``` insomnia anxiety anorexia fever rhinorrhea piloerection ```
68
intoxication w marijuana-clinical picture
``` euphoria anxiety impaired motor coordination perceptual disturbances (slowed time) mild tachycardia anxiety conjunctival injection (red eyes) dry mouth increased appetite ```
69
marijuana dependence occurs in what percent of users
5%
70
chronic use of marijuana may cause
respiratory problems-asthma and crhonic bronchitis suppression of immune system possible effects on reproduc hormones
71
withdrawal symptoms of marijuana
irritability, anxiety, restlessness, aggression, strange dreams, depression, HAs, sweating, insomnia, nausea, craving, decreased appetite
72
inhalants generally act as CNS
depressants
73
MOA of caffeine
adenosine antagonist, increasing cAMP and causing stimulant effect via dopaminergic system
74
tx of nicotine dependence
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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