Substance abuse Flashcards
Specifiers for substance abuse
- In early remission: no criteria for >3 months but < 12 months (except craving)
- Sustained remission: no criteria for > 12 months (except craving)
withdrawal of PCP, other hallucinogens, inhalants?
none
what are the groups of people more likely to abuse alcohol
- men
- American Indian
- Whites
- unemployed
- Large metro areas
- Parolees
Describe Alcohol withdrawal
- Early: Anxiety, irritability, tremor, HA, insomnia, nausea, tachycardia, HTN, hyperthermia, hyperactive reflexes
- Seizures: 24-48 hours. most often Grand mal
- Withdrawal Delirium (DTs): 48-72 hours, altered mental status, hallucinations, marked autonomic instability, life-threatening
What score on CIWA indicates more severe alcohol withdrawal?
> 10
Treatment for alcohol withdrawal
- Benzo: GABA agonist, cross-tolerant with alcohol. Reduces risk for Sz; provides comfort/sedation. if liver problems use a benzo with no metabolic metabolites
- Anticonvulsants (Carbamazepine or valproic acid): reduce risk of Sz and may reduce kindling. helpful for protracted withdrawal
- Thiamine supplementation
what do you need to check when patient taking Disulfiram
-check LFT’s and h/o hep C . . hepatotoxicity
MOA of Naltrexone?
Risk for what at high doses?
- Opioid antagonist . .blocks mu receptors
- Hepatoxicity . .check LFTs
What do you need to check in pt using Acamprosate for alcohol use?
-kidney function
what is a common detox mistake for Benzodiazepines?
tapering too fast; symptoms worse at end of taper
-consider carbamazepine or valproic acid if doing rapid taper
What are the benzodiazepines that are metabolized only through glucuronidation in liver and not affected by age/hepatic insufficiency?
- Oxazepam
- Temazepam
- Lorazepam
symptoms of opioid intoxication
- pinpoint pupils
- sedation
- Constipation
- bradycardia
- HYPOtension
- decreased respiratory rate
symptoms of Opioid Withdrawal
- Not life threatening but extremely uncomfortable
- Dilated pupils
- lacrimation
- Goosebumps
- n/v, diarrhea
- Myalgias and arthralgies
- dysphoria or agitation
Give what for opioid withdrawal
- antiemetic
- antacid
- antidiarrhea
- muscle relaxant (methocarbamol)
- NSAIDs
- clonidine and maybe BZD
what is the neuroadaptation with opioid use
-increased DA and decreased NE
what medications for opioid use disorder
- Methadone (mu antagoist)
- Naltrexone (mu agonist)
- Buprenorphine (partial mu agonist with a ceiling effect)
psychological signs of acute stimulant intoxication
- euphoria
- enhanced vigor
- gregariousness
- hyperactivity
- Restlessness
- Interpersonal sensitivity
- anxiety
- Tension
- ANGER
- impaired judgement
- PARANOIA
Physical signs for acute stimulant intoxication
- Tachycardia
- PAPILLARY DILATION
- HTN
- n/v
- diaphoresis
- chills
- weight loss
- chest pain
- cardiac arrhythmias
- confusion
- seizures
- coma
symptoms of chronic stimulant intoxication
- affective blunting
- fatigue
- sadness
- social withdrawal
- hypotension
- bradycardia
- muscle weakness
Stimulant withdrawal
- Not severe
- exhaustion with sleep (crash)
- treat with rest and support
complication of cocaine
- vasoconstrictive . . increase risk for CVA and MI (obtain EKG)
- Can get rhabdomyolysis with compartment syndrome from hypermetabolic state
- Can see psychosis associated with intoxication that resolves
Cocaine prevents reuptake of what?
DA
difference b/t cocaine and amphetamines on vessels
amphetamines have no vasoconstrictive effect
amphetamines inhibit reuptake of what?
-DA, NE, SE . . greatest effect on DA tho
tobacco induces what?
CYP1A2 . .watch for interaction when start or stop . .. example: Olanzapine
neuroadaptation of nicotine
-nicotine acetylcholine receptors on DA neurons in VTA release DA in nucleus accumbens
Nicotine withdrawal
- dysphoria
- irritability
- anxiety
- decreased concentration
- insomnia
- increased appetite
medications for tobacco used disorder
- Bupropion
- Varenicline
what are the hallucinogens
- Naturally occurring: Peyote cactus (mescaline); Magic mushroom (psilocybin) - oral
- synthetic - LSD (Lysergic acid diethyamide) - oral
- DMT (dimethyltryptamine) - smoked, snuffed, IV
- STP - oral
- MDMA: ecstasy - oral
symptoms of MDMA (ecstasy) intoxication
- Illusions
- HYPERACUSIS
- sensitivity of touch, taste/smell altered
- “oneness with the world”
- tearfulness
- euphoria
- panic
- paranoia
- impaired judgment
what is an unpleasant side effect of continued used of MDMA
teeth grinding
neuroadaptation of MDMA
-affects serotonin (5HT), DA, NE but mostly 5HT2 receptor agonist
symptoms of Cannabis intoxication
- Appetite and thirst increase
- Colors/sounds/tastes are clearer
- increased confidence and euphoria
- relaxation
- increased libido
- Transient depression, anxiety, paranoia
- Tachycardia, dry mouth, conjunctival injection
- slowed reaction time/motor speed
- impaired cognition
- psychosis
Neuroadaptation of Cannabis
- CB1 and CB2 coupled with G proteins and adenylate cyclase to Ca channel . . inhibits Ca influx
- decrease uptake of GABA and DA
withdrawal symptoms of Cannabis
- insomnia
- irritability
- anxiety
- poor appetite
- depression
- physical discomfort
symptoms of PCP (Phenacyclidine) “angel dust” intoxication
- Severe dissociative reactions: paranoid delusions, hallucinations, can become very agitated/violent with decreased awareness of pain
- Cerebellar symptoms: ataxia, dysarthria, NYSTAGMUS (vertical and horizontal)
consequences of Severe PCP OD
- mute
- catatonic
- muscle rigidity
- HTN
- HYPERTHERMIA
- RHABDO
- seizures
- COMA
- DEATH
Treatment of PCP use
- Antipsychotic drugs or BZD if required
- Low stimulation environment
- Acidify urine if severe toxicity/coma
Neuroadaptation of PCP
- opiate receptor
- allosteric modulator of glutamate NMDA receptor
PCP withdrawal?
NO tolerance or withdrawal
