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Behavioral Med 1 > Substance Abuse > Flashcards

Substance Abuse Flashcards

1
Q

Substance abuse occurs in ___% of pts in the ambulatory setting

A

~ 20%

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2
Q

Chemical dependence (non-tobacco) affects ____% of Americans

A

24.8%

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3
Q

____% of hospital admits are assoc. w/ EtOH/drugs and accounts for 100,000 deaths/yr

A

40

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4
Q

Intoxication is associated w/ __% of all MVAs, __% of all DV cases and __% of all murders

A

50%, 50%, 50%

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5
Q

D/o are more common in (men/women), (younger/older) individuals (age of onset ____ y/o), and (low/high) income populations, but actual abuse is probably much greater than this

A

men; younger; 16-20 y/o; low

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6
Q

What is a substance that is commonly abused in the attempt to self-medicate for panic?

A

EtOH

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7
Q

What is a substance that is commonly abused in the attempt to self-medicate for anger?

A

opioids

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8
Q

What is a substance that is commonly abused in the attempt to self-medicate for depression?

A

amphetamines

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9
Q

Is there a genetic component to substance abuse?

A

Yes

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10
Q

What is conditioning (in reference to substance abuse)?

A

Behavior maintained by its consequences

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11
Q

What questionnaire should be used for substance abuse assessment? What does it stand for?

A

Cut down?
Annoyed by confrontation?
Guilt?
Eye opener?

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12
Q

If possible and allower for by the pt, who should you obtain a hx from on the patient’s substance abuse?

A

obtain hx from spouse, children, other family members and friends

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13
Q

T/F “Addiction” is used as a dx term in DSM-5

A

False, it is not

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14
Q

Define substance abuse d/o

A

Any inappropriate use of a substance

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15
Q

In order to be dx w/ substance abuse d/o, a pt must have ___ out of ___ behaviors present, must occur in a ____ month period, and must lead to significant impairment or distress in _____ _____ and ______

A

2+ out of 11; 12 mo; social functioning and work

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16
Q

________ is a reversible syndrome due to recent use of substance

A

Intoxication

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17
Q

______ is characterized by the need to use an increased amount of a substance in order to achieve the desired effect, and/or a markedly diminished effect w/ continued use of the same amount of the substance

A

Tolerance

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18
Q

_______ occurs when nml fxn only becomes possible w/ active use of a substance and cessation of it causes adverse physiological consequences

A

Dependence

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19
Q

_____ is a cluster of sx w/ an onset closely following the cessation (or reduction in dose) that is specific to a drug(s) –> sx can be both physiological and cognitive

A

Withdrawal

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20
Q

What are opioids? Examples?

A

Natural and synthetic substances w/ morphine-like properties

Morphine, Heroin, Hydrocodone, Oxycodone, Codeine, Tramadol, Meperidine, Opium, Methadone

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21
Q

Opioid Rx users have a (very low/low/high/very high) chance of becoming addicted to their medications

A

very high

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22
Q

_____x as many people abuse Rx pain meds than use heroin

A

> 5x

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23
Q

Opioid addicts have a higher chance of developing illness, such as ____, _____, and ____

A

Hep B, Hep C, and HIV

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24
Q

Opioid abuse is more common in (men/women), urban settings, African Americans; and addiction of pain meds is more common in (men/women)

A

men; women

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25
Q

Why is opioid addiction higher in medical professionals?

A

Access

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26
Q

Opioid addiction is extremely disabling and is assoc. w/ ↑ mortality rates due to ____, ____, and _____

A

suicide, OD, and accidental death

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27
Q

Describe what a pt may experience/present with while intoxicated, on opioids.

A

Sensation of euphoria, sense of well-being, pinpoint pupils, flushing, sedation, constipation, ↓ HR, hypoTN, ↓ RR, N/V

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28
Q

Is withdrawal from opioids life-threatening? Explain.

A

not life threatening unless severe medical illness but extremely uncomfortable.

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29
Q

Name some characteristics of opioid withdrawal

A

Dilated pupils, lacrimation, goosebumps, N/V/D, myalgias, arthralgias, dysphoria or agitation

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30
Q

Withdrawal in chronic users starts how long after last dose w/ short acting opioids?

A

~10 hours

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31
Q

What is recommended for tx of sx of opioid withdrawal?

A

Antiemetic, antacid, antidiarrheal, muscle relaxant (methocarbamol), NSAIDS, BZD

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32
Q

_____ is a long-acting opioid with a half-life of 22-56 hrs, used in the tx of opioid use d/o

A

Methadone

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33
Q

What is the initial dosage of methadone based on?

A

Extent of withdrawal sx

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34
Q

What is the titration of methadone dosage?

A

Increase until sx are controlled, then taper 20% per day for long-acting opioids, and 10% per day for short-acting opioids

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35
Q

How long is the typical course (length of time) of methadone? What does the course length depend on?

A

Will take 7 days to 3 weeks, depending on opioid

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36
Q

_____ is a long acting opioid antagonist administered at 50-100 mg/day that blocks the pleasurable effects of opioid drugs

A

Naltrexone

37
Q

_____ is a mixed opioid agonist-antagonist usually used in combination w/ Naloxone

A

Buprenorphine

38
Q

Buprenorphine is helpful for what type of pts?

A

highly motivated pts who do not need high doses

39
Q

How should you assess a pt with alcoholism?

A

CAGE questionnaire

40
Q

When assessing a pt with alcoholism, and you order a CBC, what might the results be?

A

alcohol-related bone marrow depression, anemia, MCV

41
Q

When assessing a pt with alcoholism, and you order a CMP, what are you looking for?

A

LFTs (ALT, AST, TB and gamma-glutamyltransferase [ggt])

42
Q

When assessing a pt with alcoholism, and you order a carbohydrate deficient transferrin, what might the results be? What can this lab test be used for distinguishing?

A

low after excessive consumption
EtOH consumption > 50-80 g/d for x2-3 wks appears to ↑ serum concentrations of CDT, which tends to distinguish chronic heavy drinkers from light social drinkers

43
Q

When assessing a pt with alcoholism, and you order a thiamine level, what are you evaluating the pt for?

A

Wernicke encephalopathy

44
Q

When assessing a pt with alcoholism, and you order a folate level, what might the results be/sx the pt presents with?

A

anemia, HA, fatigue, glossitis

45
Q

What is the direct test for alcohol in the body?

A

Blood Alcohol Level (BAL)

46
Q

What is EtG? How long can it be detected? What is it an important biomarker of?

A

Ethyl glucuronide is a direct metabolite of EtOH
After complete cessation of EtOH intake, EtG can be detected in urine for up to 5 days after heavy binge drinking
Important biomarker of recent EtOH intake

47
Q 
BAL				       Effect
0-100 mg/dL		       \_\_\_\_\_\_\_\_
100-150 mg/dL	       \_\_\_\_\_\_\_\_
150-250 mg/dL	       \_\_\_\_\_\_\_\_
250 mg/dL and up	       \_\_\_\_\_\_\_\_
350 mg/dL and up	       \_\_\_\_\_\_\_\_
A

BAL Effect
0-100 mg/dL Sense of well being, sedation
100-150 mg/dL Uncoordinated, irritable
150-250 mg/dL Slurred speech, ataxia
250 mg/dL and up Passing out/unconscious
350 mg/dL and up Coma and death

*in a pt with no tolerance

48
Q

Hazardous Use/At Risk (using “too much” but no significant negative consequences) is considered ____ drinks/week in men and _____ on one occasion. In women, _____ drinks/week and _____ drinks on one occasion.
How many adults fit this criteria? (fraction)

A

Men: > 14 drinks/week, >4 drinks on one occasion
Women: > 7 drinks/week, > 3 drinks on one occasion

3/10 adults fit this criteria

49
Q

______ is alcohol use leading to impairment or distress, mild-mod substance use d/o
______ is alcohol use leading to impairment or distress, more pervasive and persistent than ___(above)___, +/- physical dependence and withdrawal sx

A

Abuse
Dependence
(abuse)

50
Q

What are some early sx that a person might present with in chronic alcoholism? Late?

A

Early sx: Rosacea, Palmar erythema, Respiratory infxns, Palpable liver from fatty liver dz, Easy bruising

Late sx: Caput medusae, Ascites, Jaundice, Esophageal varices/hemoptysis/hematochezia

51
Q

How would you tx a pt with intoxication?

A

supportive measures, hydration, rest, mild OTC pain meds

52
Q

In uncomplicated alcohol withdrawal, the “shakes” begin w/in _____ hrs after cessation, and are worst at ______ hrs, then subsides over ______ days w/o medical tx

A

12-18 hrs
24-48 hrs
5-7 days

53
Q

How do you tx a pt with uncomplicated alcohol withdrawal?

A

BZD, hydration, nutrition, careful monitoring (family/friends)

54
Q

If a markedly chronic EtOH abuser is going through EtOH withdrawal and is having sz, how many houra ago did they stop drinking? When will the sz peak? How many and what type of sz will they be having? (ranges)

A

begins w/in 7-38 hrs after cessation, peak 24-28 hrs, often a burst of 1-6 generalized sz

55
Q

If a pt is going through EtOH withdrawal and is having sz, how should you tx this patient?

A

hospitalization, BZD, hydration, nutritional supplementation (banana bag, folate, thiamine, MVI), careful monitoring

56
Q

When would alcoholic hallucinosis begin in a chronic alcoholic who has stopped drinking? How long does this last for?

A

begins w/in 48 hrs of cessation, sensorium is clear, auditory, visual or tactile hallucinations that are very unpleasant; lasts ~1 wk, can become chronic

57
Q

If a pt is going through EtOH withdrawal and is experiencing alcoholic hallucinosis, how should you tx this patient?

A

hospitalize, BZD, hydrate, nutritional supplements, monitoring

58
Q

What are the sx of EtOH withdrawal “Delirium Tremens”?

A

confusion, agitation, mild fever, N, irritability, tremor, autonomic hyperarousal

59
Q

When do alcoholic DTs begin when going through withdrawal? Peak?

A

begins 2-3 days after cessation, peaks in 4-5 days

~ 5% of hospitalized pts, ~ ⅓ of those w/ sz

60
Q

How do you tx a pt with DTs?

A

Hospitalization, BZD, hydration, nutritional supplements, careful monitoring, possible restraints, haldol

61
Q

What are medication tx options for patients with alcoholism? How do they work/what do they do?

A

Disulfiram (Antabuse): Inhibits EtOH dehydrogenase, accumulation of acetaldehyde, which causes N/V, HA, hypoTN

Naltrexone: mu-opioid receptor partial antagonist, ↓ pleasurable effects of EtOH and the craving

Acamprosate: glutamate receptor modulator, decrease craving

62
Q

What medical condition can you NOT use Naltrexone?

A

Liver dz

63
Q

What levels should be checked if a pt is taking Acamprosate?

A

renal function

64
Q

__% of all alcoholic pts will relapse, and relapse is most common w/in ___ mo following initial tx; most require multiple detoxes/rehab sessions before maintaining sobriety

A

50%, 6 mo

65
Q

All pts with alcoholism should be referred to ____

A

AA (alcoholics anonymous)

66
Q

What are some examples of medications that are commonly abused in a pt with a sedative, hypnotic, or anxiolytic-related substance abuse d/o?

A

BZD (Libirum, valium, clorazepate, ativan, xanax), BZD-like meds
Barbiturates (phenobarbital, barbital), Barbiturate-like meds
Zolpidem (Ambien)

67
Q

Are opioids or sedative/hypnotic/anxiolytic medications more addicting?

A

Opioids

68
Q

Describe what sedative/hypnotic/anxiolytic intoxication would be like. (Similar to? Initially? Severe?)

A

Similar to alcohol but less cognitive/motor impairment

Initially, lethargy, impaired cognition, poor memory, irritability, emotional disinhibition

Severe intoxication can lead to slurred speech, ataxia, lack of coordination, and on to respiratory depression

69
Q

A common detox mistake when it comes to sedative/hypnotic/anxiolytic medications is ______. Why?

A

tapering too fast

sx worse at end of taper

70
Q

What are some examples of commonly abused stimulants?

A

Cocaine, Crack, Methylphenidate (Ritalin), Methamphetamine (Crank, Speed)

71
Q

What are common sx of stimulant intoxication?

A

Autonomic hyperarousal, tachycardia, ↑ BP and HR, pupillary dilation (mydriasis)

72
Q

Cocaine intoxication can induce what sx?

A

tactile hallucinations,sense of euphoria and disinhibition, sexual arousal, ↑ self-esteem, aggression, agitation, impaired judgment

73
Q

What serious and life-threatening conditions can be caused by cocaine use?

A

myocardial infarction, rhabdomyolysis w/ compartment syndrome from hypermetabolic state, and psychosis associated w/ intoxication that resolves

74
Q

What are the sx of stimulant withdrawal? When is the peak? Is it self limiting?

A

Fatigue, depression, nightmares, HA, sweating, muscle cramps, hunger
Peak in 2-4 days from last dose
Yes

75
Q

What are the medications that can be used in the tx of stimulant withdrawal and sx?

A

No medications FDA-approved for tx
If medication used, also need a psychosocial tx component
Can use diazepam, lorazepam for agitation sxs
Antipsychotics if psychotic sxs present

76
Q

________ may arise 2 weeks after cessation of stimulant abuse. How would you tx this?

A

Depression

anti-depressants

77
Q

What are some commonly abused hallucinogens?

A

LSD (lysergic acid diethylamide)
Peyote, mescaline
MDMA (3,4-methylenedioxymethamphetamine)
PCP (phencyclidine)

78
Q

Describe intoxication with hallucinogen abuse. how long will the sx last?

A

Hallucinations, perceptual disturbances, feelings of unreality, HTN, tachycardia, sweating, blurry vision, pupillary dilation, tremors
3-6 hr duration

79
Q

What sx may a person on Ecstasy (MDMA) experience?

A

sense of connectedness, attachment, and high energy

80
Q

T/F There are no concerning withdrawal sx of hallucinogen abuse

A

True

81
Q

OD on hallucinogens can cause life threatening conditions, such as…

A

Hyperpyrexia, tachycardia, arrhythmias, stroke, death

82
Q

Does tolerance develop slowly or quickly with hallucinogens? What does this mean for likelihood of hallucinogenic substance abuse?

A

Tolerance develops quickly and there are notable unpleasant side effects w/ continued use (teeth grinding on MDMA, etc) so dependence less likely

83
Q

T/F There are no approved medications for tx of hallucinogenic substance abuse

A

True

84
Q

What is the most commonly abused illicit drug in America?

A

THC (delta-9-tetrahydrocannabinol)

85
Q

T/F THC is lipid soluble

A

true

86
Q

THC levels reach peak ___-___ min

A

THC levels reach peak 10-30 min

87
Q

What are some sx of THC intoxication?

A

increased appetite and thirst, colors/sounds/tastes are clearer, increased confidence, euphoria, libido
Relaxation, slowed reaction time/ motor speed
Transient depression, anxiety, paranoia
Tachycardia, dry mouth, conjunctival injection
Impaired cognition, Psychosis

88
Q

What are sx of THC withdrawal?

A

Irritability, nervousness, poor appetite, restlessness, depressed mood, tremors, fevers, sweating, chills, headache

89
Q

{She said we would not be tested on tobacco abuse, but if you want to know more go to google doc :) that’s all folks! Freebie notecard! <3}

A

Aww, you flipped the card–adorable ;)

Behavioral Med 1 (8 decks)

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