Substance abuse Flashcards
Substance abuse ds
Problematic pattern of substance abuse -> significant impairment or distress
Substance abuse criteria
2 sx for >1 yr
tolerance
withdrawal sx
persistent desire or unsuccessful attempts to cut down
significant time spent obtaining, using, or recovering
social, occupational, or recreational activity reduced
continued use in spite of knowledge of problems
craving
recurrent use in physically dangerous situations
failure to fulfill obligations at work, school or home
social or interpersonal conflicts
larger or longer use than was originally intended
Stages of change
Precontemplation – no problem
Contemplation – problem but doesn’t want to change
Prep/determination – ready to change
Action/will power
Maintenance
Relapse
Alcoholism
Long term consequences
Liver damage – elevated GGT, elevated AST:ALT (>=2:1)
-> alcoholic cirrhosis
hepatitis
pancreatitis
peripheral neuropathy
testicular atrophy
“Saturday night palsy”
risk aspiration pneumonia – anaerobic, Klebsiella
Mallory-Weiss sn
Longitudinal laceration of GE jxn caused by excessive vomiting
Hematemesis
Stop on own
Esophageal varices
Extremely dilated submucosal v. of lower esophagus
Dt portal htn
Coffee ground emesis
Life threatening
CAGE questions
Cut back
Annoyed
Guilt
Eyeopener
Alcohol intoxication
Mood elevation
Disinhibition
Decreased anxiety
Sedation
Severe intoxication:
Severe mental impairment
Somnolence
Respiratory depression
Tx:
Time, IV fluids, ABCs
No reversing agent
EtOH effects GABA receptors
Alcohol withdrawal sx
Agitation
Anxiety
Insomnia
Tremor
Delirium tremens
Withdrawal can be life threatening
Acute cognitive change Nightmares Agitation Disorientation Visual/auditory hallucinations Fever Htn Diaphoresis
Sx: 2-3 d after stop etOH
-something crawling on them
If severe:
Seizures
Extreme autonomic hyperactivity
-tachycardia, tachypnea, htn
scenario – elective surgery -> post op seizure
Tx: benzos, alcohol
Wernicke encephalopathy
Acute
Confusion Nystagmus Ophthalmoplegia Ataxic gait Sluggish pupillary reflexes Encephalopathy Oculomotor dysfxn Stupor Hypotension Hypothermia
Coma and death if untreated
Korsakoff syndrome
Long term consequences
Anterograde amnesia – inability to form new memories
Retrograde amnesia- loss of existing memories
Confabulation – false perceptions or memories – fill in memory gaps
Hallucinations
Personality changes
Apathy
Tx of Wernicke-Korsakoff
Thiamine BEFORE glucose
Thiamine active form major cofactor in metabolism of glucose
If glucose first, sx worsen
Prevention of relapse in recovering alcoholics
AA – CBT Naltrexone Disulfam Topiramate – glutamate receptors Acamprosate (campral) – glutamate receptors
Eye changes in substance abuse
Marijuana – red eye LSD – mydriasis, flash backs PCP – verticle/horizontal nystagmus Cocaine – mydriasis Amphetamines – mydriasis Organophosphates – miosis, sweating, drooling Opioids – miosis, CNS depressant
