Substance Abuse Flashcards
List some of the substances listed under abuse in DSM-5
Alochol, caffeine, Cannabis, hallucinogens, PCP, Tobacco, Opiods
Proper presentation and naming of substance abuse
[Substance] Use Disorder
Gotta stay Politically Correct
Substance use disorder symptoms
Withdrawal Tolerance Unsuccessful attempt to cut down Great time spent obtaining/using Cravings Use even when hazardous Reduced occupational productivity. Failure fulfilling roles
Categories of substance use disorders
Mild- 2 or 3 symptoms
Moderate- 4 or 5 symptoms
Severe- 6 or more symptoms
Schedule 1 substances
NO MEDICAL USE
Heroin, Marijuana, LSD, GHB
Schedule 2 substances
High potential for abuse…has medical uses though
Cocaine, Morphine, Methylphenidate, Methamphetamine
Schedule 3 substances
Less potential for abuse
Rohypnol, Ketamine, Codeine, Dronabinol
Schedule 4 substances
Benzodiazepines, Zolpidem
Schedule 5 substances
Codeine Cough Medicine
Alcohol Screening questions
CAGE Cut down? Annoyed by criticism from others? Guilty feelings? Eye Opener?
Alochol Use Disorder PHysical exam findings (early stage)
Gastritis FAtty liver OBesity Thrombocytopenia Falls/trauma Vitamin/electrolyte deficiency
Alcohol Use disorder Physical exam findings (late stage)
Cardiomyopathy Cancer Portal Hypertension WErnicke-Korsakoff Testicular atrophy Esophageal Bleeding Cirrhosis DEmentia
Lab Findings in AUD
LFTs
BAL
Platelets
What is in a standard drug screen?
Cocaine Methamphetamine PCP Marijuana Opiates Barbituates Benzodiazepine (Sometimes)
AST:ALT Ratio in Alcoholics
GGT levels in Alcoholics
AST:ALT
2:1
GGT
>35
Wernicke Encephalopathy
Acute Thiamine (B1) deficiency
Confusion, Ataxia, opthalmoplegia
Wernicke-Korsakoff’s Syndrome
Chronic Thiamine (B1) Deficiency
Impaired memory and alertness
Confabulation (make up stories)
Retrograde and/or anterograde memory loss
Delerium Tremens
Happens 3-4 days after Alcohol abstinence. Sign of Alcohol Withdrawal.
MEDICAL EMERGENCY 20% MORTALITY
Usually preceded by a seizure
Treatments of Alcohol Withdrawal
Benzodiazepine taper (4-6 days)
Carbamazepine/phenobarbital also
Thiamine + Fluid + Electrolytes
Frequent monitoring of vital signs
Opiates vs Opiods
Opiates are directly derived from Opium
Opiods is a blanket term for all similar substances including natural (opiates), synthetic, and semi-synthetic.
Signs of Opiate OD/intoxication
Miosis Respiratory Depression (OD) Hypotension Hypothermia Bradycardia Constipation Slurred Speech Drowsiness/coma
Opiate Withdrawal
NOT LIFE THREATENING. Just treat the Symptoms Anxiety Yawning Diaphoresis (sweating) Nausea Diarrhea
Naloxone
Narcan.
Used in Opiod overdose.
Is metabolized if given orally.
Thats why it is combined with other opiates prescribed to be taken orally…if the patient tries to shoot it up then they get serious withdrawal symptoms. If they take it orally the medication works as intended.
Naltrexone
Oral acting.
Approved in the use of treating Alcohol and opiate dependence
Full Agonists, Partial Agonists, Antagonists
Full: Morphine, Oxycodone (also Methadone)
Partial: Buprenorphine
Antagonists: Naloxone, Naltrexone
Buprenorphine
Partial Agonist.
Long duration of action and tapers itself
Office based treatment of opiate dependence.
Suboxone
Buprenorphine + Naloxone
Oral medication that if shot up…will produce serious withdrawal symptoms.
Subutex
Buprenorphine tablet (without the Naloxone like in Suboxone)
Who can prescribe MEthadone for pain management?
Any licensed Doctor.
Who can prescribe Methadone for opiate addiction?
Only at a licensed facility.
PCP
Hallucinogen that is screened for in Urine Drug Screen
Long half life (24 hours)
Dissociative anasthetic
NMDA receptor/ glutamate
Symptoms of Cocaine Intoxication
Hyperalertness Restlessness/pacing Talkative Aggression Impulsivity Chest pain/ other ischemia.
