Substance Abuse Flashcards
Up to __% of patients seen in an ambulatory may have associated substance abuse
20%
About __% of american will show clinical dependence on a non-tobacco substance at some point in their lifetime
24.8%
Are substance abuse disorders more common in men or women?
Men
Intoxication associated with __% of MVAs, DV cases, and murders.
50%
T/F: Addiction is a diagnostic term according to DSM-5
False
It is not
How are substance abuse disorders defined in DSM-5?
Any inappropriate use of a substance versus previous definitions that separated this into abuse versus dependence
_________ is defined as a reversible syndrome due to the recent use of substance
Intoxication
_______ is defined by the following…..
1) Need to use an increased amount of a substance in order to achieve the desired effect
2) Markedly diminished effect with continued use of the same amount of the substance
Tolerance
________ is defined as normal function only becomes possible with active use of a substance, and cessation of this substance causes adverse physiological consequences.
Dependence
_______ is defined as a cluster of symptoms with an onset closely following the cessation (or reduction in dose) that is specific to a drug (or drugs). Symptoms can be both physiological and cognitive
Withdrawal
What is the name of the questionnaire used in assessing alcohol dependence?
CAGE Questionnaire
Should you complete a mental status examination when working up substance abuse?
Yes
What co-morbid conditions are likely to accompany a patient with a substance abuse disorder?
Depression
Anxiety
Personality Disorder
Why are the following ordered (to rule in/out) when working up Alcohol Abuse….
CBC
CMP
Thiamine
CBC - Anemia, Bone Marrow Depression
CMP - Liver Function
Thiamina - Wernicke’s Encephalopathy
Which of the following would NOT be considered a direct diagnostic test for alcohol abuse
A) A blood alcohol level in excess of 300 mg/dL
B) A blood alcohol level of greater than 150 mg/dL without gross evidence of intoxication
C) A blood alcohol level of 100 with evidence of clinical intoxication
D) A blood alcohol level of greater than 100 mg/dL upon routine examination indicates alcoholism with a high degree of reliability
C) A blood alcohol level of 100 with evidence of clinical intoxication
What are EARLY manifestations of chronic alcoholism with underlying organ disease?
Rosacea Palmar erythema Palpable liver from fatty liver disease Respiratory infections Easy bruising
What are LATE manifestations of chronic alcoholism with underlying organ disease?
Caput medusae
Ascites
Jaundice
Esophageal varices/hemoptysis/hematochezia
To be diagnosed with an alcohol use disorder…..
A patient must exhibit signs/symptoms/behaviors over a ___ _______ period
12 Month Period
An uncomplicated withdrawal (“Shakes”) typically onsets when?
Peaks when?
Subsides when?
Onset: 7-38 hours after cessation
Peak: 24-48 Hours
Subsides: 5-7 Days
What manifestation during a alcohol withdrawal period would be indicative of marked, chronic alcohol abuse?
Seizures
A patient may develop alcoholic hallucinosis how long after cessation of alcohol?
What types of hallucinations may occur?
Can these be permanent?
Within 48 hours of cessation
Hallucinations can be auditory, visual, or tactile
These can sometimes become permanent
What is the most severe form of alcohol withdrawal?
Delirium Tremens
What are clinical manifestations of delirium tremens?
Confusion Agitation Mild fever Nausea Irritability Tremor Autonomic hyperarousal*
T/F: Delirium Tremens is NOT a medical emergency
False
It is
T/F: Delirium Tremens can progress to cardiovascular collapse
True
What medication class is commonly used in alcohol withdrawal?
Benzodiazepines
T/F: Patients experiencing alcohol withdrawal and seizures, hallucinosis, or DTs should be hospitalized
True
What is the name of the ‘score’ used in alcohol withdrawal assessment?
CIWA-Ar
Other than benzodiazepines…..
What are THREE medications used to treat alcohol abuse disorders?
- Disulfiram (Antabuse)
- Naltrexone (Avoid in liver disease)
- Acamprosate (Compliance issues, need to take TID)
What is the number 1 goal of alcohol abuse rehabilitation?
Complete Sobriety
What percent of patients with alcohol abuse disorder will relapse following treatment?
In what time interval is relapse most likely?
50%
Relapse is most likely within the first 6 months following initial treatment
T/F: All alcohol abuse patients should be referred to AA in order to obtain further support from people going through the same issues
True
Abuse of the following would be considered a ______-abuse disorder
Morphine Heroin Hydrocodone Oxycodone Codeine Tramadol Meperidine Opium Methadone
Opioid
T/F: Opioid prescription users have a very LOW chance of becoming addicted to their medications
False
They have a very high chance
Opioid abuse in general is more common in _____ (men/women).
Men
Prescription pain medication addiction is more common in ____ (men/women)
Women
In a patient intoxicated by opioids would you expect to see…..
Mydriasis or Miosis?
Bradycardia or Tachycardia?
Tachypnea or Bradypnea?
Hypertension or Hypotension?
Excitation or Sedation?
Miosis
Bradycardia
Hypotension
Bradypnea
Hypotension
Sedation
Is opioid withdrawal life threatening?
What are symptoms of opioid withdrawal?
How is this managed?
No (But very uncomfortable)
Symptoms….
Mydriasis Lacrimation N/V/D Myalgias Agitation
Management…..
Symptomatic (Antiemetic, NSAIDs, Antidiarrheal, BZDs)
What is the name of the medication used in opioid withdrawal that is a long acting opioid itself?
This can only be prescribed with a federal license
Methadone
Other than methadone….
What are two additional medications used in opioid withdrawal management?
Naltrexone
Beprenorphine
T/F: Intoxication from sedative, hypnotic, or anxiolytic medications will appear similar to opioid intoxication
False
It will appear similar to alcohol intoxication with less cognitive/motor impairment
What are symptoms of sedative, hypnotic, or anxiolytic intoxication?
Lethargy
Impaired Cognition
Poor Memory
If severe….
Slurred speech
Ataxia
Coordination Lose
Respiratory Depression
What is a common cause of sedative, hypnotic, or anxiolytic withidrawal?
Tapering dose too quickly
What are symptoms of sedative, hypnotic, or anxiolytic withdrawal?
Anxiety Irritability Fatigue Headache Tremor Poor Concentration Diaphoresis
Abuse of the following medications would be considered a _______-abuse related disorder
Cocaine, Crack
Methylphenidate (Ritalin)
Methamphetamine
Stimulant-Abuse Related Disorder
What are common symptoms of stimulant intoxication?
Autonomic hyperarousal
Tachycardia
HTN
Mydriasis
T/F: Cocaine intoxication can induce tactile hallucinations
True
What are TWO concerning potential manifestations of cocaine intoxication/abuse?
Myocardial Infarction
Rhabdomyolysis with compartment syndrome
What are symptoms of stimulant withdrawal?
When would you expect these symptoms to peak?
Fatigue Depression Nightmares HA Diaphoresis Muscle Cramps
Peak in 2-4 days from cessation and are self limiting
Although stimulant withdrawal is typically self-limiting…..
What medications can be used to treat agitation in stimulant withdrawal?
Lorazepam
Diazepam
What are you concerned for 2 WEEKS after stimulant abuse cessation?
Depression
What are examples of common hallucinogens that are abused?
LSD
MDMA
PCP
How may a hallucinogen intoxication present?
Hallucinations Perceptual Disturbances Unreality Tachycardia HTN Diaphoresis Vision Changes Mydriasis
Is it possible for patients to have ‘bad trips’ or flashbacks while intoxicated on hallucinogens?
Yes
Are there often concerning symptoms when a patient is withdrawing from hallucinogens?
What medication class can be used if the patient does develop agitation?
No
Agitation: BZDs
T/F: Hallucinogen OD can result in life threatening symptoms such as arrhythmias or stroke
True
T/F: Hallucinogen withdrawal is treated with supportive care
True
The following are all symptoms of _______ intoxication.
Appetite Increase Relaxation Increased Libido Dry Mouth Tachycardia Impaired Cognition
Cannibis Intoxication
What are Sx of cannibis withdrawal?
Irritability Nervousness Poor Appetite Restlessness Depressed Mood Tremor Fevers Sweating
T/F: Cannibis withdrawal is primarily pharmacologically manged
False
Supportive Care (Hydration, Supervision)
__% of US death have tobacco involvement
20%
What percent of smoker die from a tobacco induce disorder?
45%
__-__% of schizophrenic patients smoke tobacco
75-90%
Is there a tobacco intoxication diagnosis in DSM-5?
No
The following are all symptoms of _____ withdrawal
Dsyphoria Irritability Insomnia Increased Appetite Weight Gain Depression
Tobacco
How is tobacco withdrawal manged?
Cognitive Behavioral Therapy
Agonist Therapy (Nicotine Gum, Lozange, TD Patch)
Medications (Bupropion, Varenicline)
