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Substance Abuse Flashcards

1
Q

How many high school seniors have reported using an illicit drug at least once?

A

1/2

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2
Q

How many high school seniors report having been drunk within the past month?

A

1/3

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3
Q

What OTC drug are students abusing?

A

Dextromethorphan (cough medicine)

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4
Q

What type of drug are students using now with increased frequency?

A

Prescription (oxycodone)

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5
Q

True or False: Use of more than one drug is more common than single use drug in kids?

A

True

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6
Q

True or False: The earlier a child starts using a drug, the more likely it is that they will develop dependency

A

True

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7
Q

What is he most common substance of abuse by young people?

A

Alcohol

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8
Q

What is the most common illicit drug used by young people?

A

Marijuana

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9
Q

True or False: More ER visits are due to the ill effects of marijuana (and/or drugs that might be mixed with it) than for alcohol

A

True

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10
Q

Name 12 risk factors for drug abuse

A
  1. Low self esteem/poor coping skills
  2. Alienation from conventional norms
  3. Homosexuality
  4. Use of performance-enhancing drugs
  5. Parental use/abuse of drugs
  6. Child abuse
  7. Inconsistent parenting
  8. Drug use among close friends
  9. Early academic failure
  10. Disconnect from family/school/community
  11. Early behavior problems (ADHD/ODD/Moos and disruptive behavior disorders)
  12. Depression, conduct disorders, antisocial personality disorders
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11
Q

True or False: Studies show that the media plays a powerful role in influencing adolescent behaviors related to alcohol and tobacco

A

True

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12
Q

True or False: Parents should be encouraged to discuss and help their teenagers understand the circumstances under which they will be pressured to try drugs

A

True

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13
Q

How should a pediatrician approach talking about drug use?

A

Open-ended questions asked in confidence

Ask about attitude in general regarding drug/alcohol use

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14
Q

Why should casual use of drugs/alcohol not be dismissed?

A

The transition from casual use to dependence may occur more quickly in adolescents than adults

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15
Q

What is a red flag to substance abuse?

A

Declining school performance

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16
Q

What psychiatric comorbidity is common in kids who use drugs?

A

Conduct disorder

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17
Q

What happens with psychiatric disorders after drug use?

A

Usually worsens after onset of drug use (and often precedes use of drugs)

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18
Q

True or False: Kids with ADHD who are appropriately treated are less likely to abuse drugs that those who aren’t treated

A

True

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19
Q

True or False: Drug abuse can mimic and worsen psychiatric disorders

A

True

*Alcohol/cocaine can induce depression or depression can lead to substance abuse

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20
Q

True or False: Alcohol and drug use can cause psychosis or mimic anxiety disorders

A

True

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21
Q

There is a higher likelihood of what type of trauma in kids who are abusing drugs?

A

Physcial

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22
Q

What is one of the strongest predictors of substance use?

A

Hanging around peers who use substances

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23
Q

Do urine drug screens have high sensitivity or specificity?

A

Sensitivity

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24
Q

What time frame to urine drug screens reflect?

A

Substance use within the previous 48 hours

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25
Q

How long can marijuana be detected in a urine drug screen for?

A

Several weeks

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26
Q

What 2 things impact the validity of drug tests?

A
  1. Urine specific gravity

2. Creatinine concentration

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27
Q

What are positive urine tox screens confirmed by?

A

Gas chromatography and mass spectrometry

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28
Q

What other factors are important in identifying besides which drugs are being used by teens?

A
  1. How often

2. Context within which they are being used

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29
Q

True or False: Obtaining information from the school and/or law enforcement is considered appropriate when dealing with teen drug use

A

True

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30
Q

How should urine drug screen specimens be collected?

A

Under direct observation

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31
Q

What is one exception to strict confidentiality with regards to drug abuse?

A

If adolescent is at risk of harming themselves or others

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32
Q

Who is expected to track progress when an adolescent is placed into a drug treatment program?

A

The pediatrician

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33
Q

True or False: Random drug screening isn’t recommended

A

True- If parents are requesting and teen is refusing, you should do a good H&P to address risks and concerns

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34
Q

If parents are requesting a random drug test for their child, what might be something to ask when doing history?

A

Parents for their mental health and drug use history

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35
Q

What is important to remember for any overdose victim?

A

Consider multiple drugs or potential combination of drugs from what is reported to you

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36
Q

What is one of the most commonly used drugs by adolescents?

A

Inhalants

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37
Q

Name commonly used inhalants

A
  1. Volatile hydrocarbons: Paint thinner, gasoline, cleaning fluids, aerosols, lighter fluid, organic solvents, glue, spray paint
  2. Nitrite compounds: Nitrous oxide, amyl nitrate
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38
Q

How do you inhale an aerosol?

A

Spray into a bag and then inhale from the bag

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39
Q

How do you inhale a liquid?

A

Pour onto a rag, then place it against the nose/mouth

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40
Q

What are the immediate effects of inhalant abuse?

A

Decreased inhibition, short-lived drowsiness/lightheadedness leading to ataxia and disorientation

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41
Q

How long does it take to feel the effects of inhalants and how long to the effects last?

A

Effects noticed within seconds and last 5-15 minutes (makes drug testing very hard)

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42
Q

What are some exam findings in someone who abused inhalants?

A
  1. Sluggish pupillary responses
  2. Bradycardia
  3. “Glue-sniffer’s rash” around nose and mouth
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43
Q

What are findings with inhalant intoxication?

A

Generalized muscle weakness, confusion, hallucinations, ataxia, delirium, nystagmus, and/or lack of coordination

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44
Q

True or False: You can have a hangover from inhalant intoxication

A

True (similar to alcohol hangover)

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45
Q

Which groups is inhalant use more common in?

A

Lower SE groups, Hispanic, Native American

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46
Q

What can repeated use of inhalants lead to?

A

Psychosis, dementia, bone marrow suppression

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47
Q

Name 3 fatal effects of inhalants

A
  1. Asphyxia
  2. Cardiac arrhythmia
  3. Aspiration
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48
Q

What is the most common fatal complication of inhalant use?

A

Cardiac arrhythmia

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49
Q

How will an adolescent who is high from inhalant use present?

A

Mental status changes, but head CT and urine tox will be negative

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50
Q

What 2 substances might inhalant intoxication present similarly to?

A
  1. Alcohol (agitation/ataxia)

2. PCP

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51
Q

What are 2 potential clues for inhalant intoxication versus alcohol or PCP?

A
  1. Negative tox screen

2. Abnormal smell on their breath

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52
Q

What 3 things can long-term use of inhalants lead to?

A
  1. Liver/kidney damage
  2. Encephalopathy
  3. Hematologic aberrations`
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53
Q

What problem can gasoline sniffers develop?

A

Lead toxicity

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54
Q

How many high school seniors have reported using marijuana at some point?

A

Close to half

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55
Q

What % of high school seniors report using marijuana daily?

A

5%

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56
Q

What is the potency of marijuana today compared to in the past?

A

Much more potent

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57
Q

Name 5 psychological consequences from marijuana use

A
  1. Learning problems
  2. Deficits in problem-solving skills
  3. Memory impairment
  4. Symptoms from underlying personality disorders, depression, and anxiety can worsen
  5. Worse school performance
58
Q

How long can memory impairment from marijuana last?

A

Up to 1 month after last use

59
Q

Name 6 acute physiologic effects of marijuana

A
  1. Dry mouth
  2. Dilated pupils
  3. Drowsiness
  4. Distortion of time
  5. Tachycardia (up to 3 hours)
  6. Increased BP
60
Q

How do you monitor the discontinuation of marijuana use?

A

Serial measurements of urine THC:Creatinine ratio (should decrease as marijuana use is discontinued)

61
Q

Name 3 long-term physiological consequences of marijuana use

A
  1. Compromised immune function
  2. Decreased sperm count (reversible)
  3. Impaired coordination (regular use)
62
Q

What 2 systems does chronic marijuana use effect?

A
  1. Pulm- Carcinogens

2. CV- Tachycardia/poor stamina

63
Q

True or False: Gynecomastia is a consequence of chronic marijuana use

64
Q

Name 4 symptoms of marijuana withdrawal

A
  1. Irritability
  2. Insomnia
  3. Tremor
  4. Nystagmus
65
Q

When does marijuana withdrawal peak and how long can it last?

A

Peak: 4 days
Duration: 2 weeks

66
Q

When do the effects of marijuana use begin?

A

Seconds after inhalation, fall rapidly within 30 minutes

67
Q

Where is marijuana and its metabolites stored?

A

Lipid-soluble… stored in fatty tissue and released slowly

68
Q

How long can tests for marijuana remain positive?

69
Q

What is the most common substance of abuse by young people?

70
Q

What % of high school seniors report having used alcohol at some point in their lives?

71
Q

True or False: There may be a genetic association with alocoholism

72
Q

Describe some findings of acute alcohol toxicity

A
  1. Ataxia
  2. Slurred speech
  3. Visual disturbance
  4. Nausea
  5. Vomiting
  6. Sluggishly reactive pupils (but normal pupil size)
  7. Excessive sweating
  8. Flushed skin
  9. Hypoglycemia
  10. Irritability
  11. Stupor
  12. Coma
73
Q

What system do the medical effects of alcohol abuse typically hit?

A

GI- Esophagitis, gastritis, peptic ulcer disease

74
Q

True or False: Teens with alcohol abuse may have liver cirrhosis

A

False- Teens haven’t used long enough to have these effects

75
Q

What are the 2 primary consequences of alcohol use/abuse in teens?

A
  1. Physical trauma

2. Overdose

76
Q

True or False: The majority of adolescents who binge drink aren’t at risk for becoming alcoholics as adults

77
Q

What are adolescents who binge drink at risk for having?

A

Pre-existing depression

78
Q

What category of drugs are amphetamines?

A

Stimulants

79
Q

What are the primary effects of amphetamines?

A

Sympathomimetic

80
Q

What are some short-term physiologic signs of amphetamine toxicity?

A

Adrenergic: Tachycardia, high BP, sweating, agitation, fever, hyperthermia, dilated pupils with slow reaction to light, fatal arrhythmias

81
Q

Feels like insects are crawling on one’s skin… drug abused?

A

Amphetamines

82
Q

True or False: Nystagmus is a common finding in amphetamine use

83
Q

What is treatment for amphetamine overdose

A
  1. Symptomatic
  2. Decontamination: Gastric lavage/activated charcoal
  3. ABC’s
84
Q

What should you always monitor for in amphetamine overdose?

A

Arrhythmias

85
Q

What can be used for high BP and agitation in patients with amphetamine overdose?

86
Q

What can be used for psychosis seen in amphetamine overdose?

A

Haloperidol

87
Q

What is needed for hyperthermia in amphetamine overdose?

A

Cooling blanked

88
Q

What may be required in amphetamine overdose if other measures fail?

A

Hemodialysis

89
Q

What type of drug is cocaine?

90
Q

Name toxic effects of cocaine at lower doses

A
  1. Euphoria
  2. Overconfidence
  3. Irritability
  4. Insomnia
  5. Tremors
  6. Tachycardia
  7. HTN
  8. Hyperreflexia
  9. Diaphoresis
  10. Dilated pupils
  11. Flushing
91
Q

Name toxic effects of cocaine at higher doses

A
  1. Aggressive/violent behavior
  2. Hypertensive crises
  3. Dysrrhythmias
  4. Seizures
  5. Coma
  6. Myocardial infarction
  7. Stroke
  8. Cardiovascular collapse
  9. Renal complications
92
Q

In chronic abuse of cocaine, what can be seen on neuro exam?

A

Choreoathetotic movements (due to depletion of dopamine storage)

93
Q

True or False: Death secondary to cocaine ingestion isn’t dose dependent

94
Q

How long are stimulants detected in blood/urine?

A

48 hours after lase dose (rapid metabolism)

95
Q

How can cocaine be taken?

A

Pill, nasally, IV

Smokeable: Cocaine (crack), Meth (Ice)

96
Q

What kind of effect do smokeable forms of cocaine and meth have?

A

Instant, extreme, intense, short-lived euphoria or rush

97
Q

Typical presentation of opiate toxicity

A
  1. Comatose
  2. Responsive to painful stimuli
  3. Pinpoint, but reactive pupils
  4. Cyanosis
  5. Respiratory depression
  6. Decreased/shallow breaths
  7. Bradycardia
  8. Hypotension
  9. Low temps
98
Q

What is a miotic pupil?

A

Pinpoint (O is pinpOint)

99
Q

What is a mydriatic pupil?

A

Dilated (myDriatic is Dilated)

100
Q

Features that distinguish DKA from opiate toxicity in child with depressed level of consciousness

A
  • DKA is rapid deep breathing

- DKA no pupil constriction

101
Q

Features that distinguish organophosphate toxicity from opiate toxicity in a child with depressed level of consciousness

A
  • Both have constricted pupils

- Organophosphate has profuse sweating, tearing, abdominal pain, wheezing, respiratory distress

102
Q

Features that distinguish head trauma from opiate toxicity in a child with depressed level of consciousness

A

-Head trauma is often dilated, non-reactive pupils

103
Q

What is a narcotic analgesic which also presents with ventricular arrhythmias, seizures, and/or pulmonary edema?

A

Propoxyphene

104
Q

What is the treatment and diagnosis for opiate toxicity?

105
Q

What type of drugs are barbiturates?

106
Q

What are signs and symptoms of barbiturate overdose?

A
  1. Bradycardia
  2. Bradypnea
  3. Hypotension
  4. Hypothermia
  5. Hypoactive bowel sounds
  6. Hyporeactive pupillary reflex
107
Q

True or False: Pupil size in barbiturate overdose is normal

A

True (If miosis- think opiate, not barbiurate)

108
Q

What are the initial symptoms of barbiturate overdose and what could they be mistaken for?

A

Slurred speech, unsteady gait, impaired judgement, poor impulse control- Alcohol intoxication

109
Q

What is a big clue for barbiturate overdose?

110
Q

What are the 4 categories of effects from Hallucinogens?

A
  1. Sympathomimetic
  2. Cholinergic
  3. Cerebellar
  4. Psychological
111
Q

What are some sympathomimetic effects seen from hallucinogens?

A
  1. Tachycardia
  2. HTN
  3. Increased reflexes
112
Q

What are some cholinergic effects seen from hallucinogens?

A
  1. Miosis
  2. Flushing
  3. Diaphoresis
113
Q

What are some cerebellar effects seen from hallucinogens?

A
  1. Vertical/horizontal nustagmus
  2. Ataxia
  3. Lack of coordination
114
Q

What are some psychological effects seen from hallucinogens?

A
  1. Disinhibition
  2. Euphoria
  3. Psychosis (looks like schizophrenia)
115
Q

Name some examples of hallucinogens

A
  1. Mescaline (peyote cactus)
  2. Psilocybin (mushrooms)
  3. Jimsonweed
  4. LSD
  5. PCP
  6. Ecstasy
116
Q

How are hallucinogens taken?

117
Q

Name 5 presentations consistent with hallucinogen use

A
  1. Distortion of body image
  2. Paranoia
  3. Agitation
  4. Auditory and visual hallucinations
  5. Distortions of time
118
Q

Child who is mydriatic, violent, asymmetric pupils, anasarca… drug abused?

119
Q

How is hallucinogen toxicity treated?

A

Supportive: Calm environment, dim lighting, talk back to reality about familiar things in reassuring tone

120
Q

What can help alleviate risk for seizures, HTN, and hyperthermia in hallucinogen intoxication?

A

Cooling blanket

121
Q

What medications may be helpful in hallucinogen intoxication?

A
  1. Haloperidol
  2. Chlorpromazine
  3. Lorazepam
122
Q

What can the effects of hallucinogens be similar to?

A

Schizophrenia

123
Q

If you are questioning schizophrenia versus hallucinogen use, what should your do?

A

Re-evaluate after off drugs for 2-4 weeks

*Absence of family history of schizophrenia and absence of symptoms when patient is drug free points towards hallucinogens

124
Q

Which type of hallucinations are more common with hallucinogen ingestion?

125
Q

What type of hallucinations are more common with schizophrenia?

A

Auditory (in addition to completely disorganized and delusional thinking)

126
Q

What is the most potent hallucinogen?

127
Q

True or False: Ecstasy will not show up in most drug screens

A

True

*Unless high quantities ingested, then shows as amphentamines

128
Q

Name 6 drugs that can present with combativeness

A
  1. Cocaine
  2. Alcohol
  3. Inhalants
  4. Opiates
  5. Amphetamines
  6. PCP
129
Q

Name distinguishing features of cocaine intoxication

A
  1. Tachycardia
  2. Temulousness
  3. HTN
  4. Mydriasis
130
Q

Name distinguishing features of alcohol intoxication

A
  1. Combative behavior
  2. Agitation

*Tremulousness isn’t common in teens with this

131
Q

Name distinguishing features of inhalant intoxication

A
  1. Quick drunk
  2. Disinhibition
  3. Agitation
  4. Halluincations
  5. Generalized muscle weakness
  6. Nystagmus
132
Q

Name distinguishing features of opiate intoxication

A
  1. Agitation

* No tremulousness and tachycardia

133
Q

Name distinguishing features of amphetamine intoxication

A
  1. Combative
  2. Tachycardia
  3. Mydriasis

*No nystagmus

134
Q

Name distinguishing features of PCP intoxciation

A
  1. Combative

2. Vertical/horizontal nystagmus

135
Q

Name 5 short term physiologic effects of nicotine

A
  1. Increased alertness
  2. Muscle relaxation
  3. Enhanced memory and alertness
  4. Decreased appetite
  5. Decreased irritability
136
Q

What are some adverse effects of nicotine?

A
  1. PUD

2. Nausea and vomiting (initially, but wear off quickly)

137
Q

Why is smoking cessation difficult?

A

Discomfort caused by withdrawal (verses absence of pleasurable symptoms)

138
Q

What is one of the more important adverse effects of withdrawal?

A

Increased appetite

139
Q

What are the 5 A’s for brief intervention in smoking cessation?

A
  1. Ask about tobacco use: Every patient/every visit
  2. Advise to quit: Clear, strong, personalized manner
  3. Assess willingness to attempt quitting: Is now a good time
  4. Assist in quit attempt: Counseling, referral, pharmacotherapy
  5. Arrange follow-up: Preferably within first week of quit date
140
Q

True or False: Scare tactics about long term ill effects of smoking rarely work with adolescents

A

True: They view themselves as immortal

141
Q

What are 3 things that the nicotine in chewing or smokeless tobacco can cause?

A
  1. Early fatigue during sports
  2. Tachycardia
  3. Vasoconstriction

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