Substance Abuse Flashcards
What is substance use disorder?
cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance related problems
What is an important characteristic of substance use disorders
the underlying change in brain circuits that may persist beyond detoxification
What may be experienced when individuals are exposed to drug related stimuli?
brain changes may be exhibited in repeated relapses and intense drug craving
How many substances contribute to substance use disorder?
11
Mild
2-3
Moderate
4-5
Severe
> 6
What is impaired control?
substance taken in larger amounts, persistent desire, time spent obtaining the substance, craving
What is social impairment?
recurrent substance use that results in failure to fulfill major roles, and also causes the person to give up or reduce activites
What is risky use?
recurrent substance use in situations in which it is physically hazardous and continued use despite knowing its risk
What is tolerance?
requiring markedly increased dose of the substance to achieve the desired effect
What is withdrawal?
a syndrome occurring when blood or tissue concentrations of a substance decline
Screening for adolescent alcohol use?
annually at age 11 yo
What is the screening tool for adolescent alcohol use?
CRAFT screen
What makes a adolescent screening positive?
> 2 positive answers
Who recommends questions normalizing use?
US National Institute on Alcohol Abuse and Alcoholism (NIAAA)
C
Have you ever ridden in a CAR driven by someone who was high, drunk, or had been using drugs?
R
Have you ever used drugs or alcohol to RELAX?
A
Do you ever use ALONE?
F
Do you ever FORGET things that you did while using?
F
Do FAMILY or FRIENDS tel you to cut down?
T
Have you ever gotten into TROUBLE when using?
What does CRAFFT stand for?
CAR, RELAX, ALONE, FORGET, FAMILY & FRIENDS, TROUBLE
When is substance abuse often found?
Incidentally or when investigating worsening health
What two screenings are used for alcohol screening in adults?
AUDIT-C or CAGE
What screening is used for detecting opioid?
Rapid Opioid Dependence Screen
What are the 3 questions in the Audit-C questionnaire?
1) How often did you have a drink containing alcohol in the past year?
2) How many drinks containing alcohol did you have on a typical day when you were drinking in the past year?
3) How often did you have six or more drinks on one occasion in the past year?
What 4 questions are apart of CAGE?
1) Have you ever felt you should CUT down on your drinking?
2) Have people ANNOYED you by criticizing your drinking?
3) Have you ever felt bad or GUILTY about your drinking?
4) Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (EYE-OPENER)
Medical detoxification for substance use disorder?
Alcohol and Benzodiazpines
Often used long acting benzo?
Librium & clonazepam
What is required during a medical detoxification for alcohol and benzo’s?
tapering w/ benzodiazepine
Why must benzodiazepine be used for tapering?
to avoid dangerous withdrawals
What can be used to treat all substances for detox?
Fluid rehydration
Vitamins and nutrition
What is substance induced disorder?
overall category of intoxication, withdrawal, and other substance/medication-induced mental disorders
Psychosis or anxiety is an example of?
Substance induced disorder
a 6 pack of beer equal to ?? wine and ?? liquor
1 wine and 6 “shots” liquor
a 12 pack of beer equal to ?? wine and ?? liquor
2 wine and pint of liquor
a 18 pack of beer equal to ?? wine and ?? liquor
3 wine and a 1/5 (750 cc) liquor
a case of 24 pack of beer equal ?? wine and ?? liquor
4 wine and liter liquor
Having a “buzz” and experiencing euphoria and mild deficits in coordination, attention, and cognition
BAC 0.01- 0.10
decreased attention, ataxia, impaired judgment, slurred speech, and mood variability
BAC 0.10 and 0.20
severe alcohol intoxication: lack of coordination, incoherent thoughts, confusion, and nausea and vomiting
BAC 0.20- 0.30
stupor and loss of consciousness, coma, respiratory depression, and death is possible
BAC > 0.30
At what rate is alcohol cleared?
20mg/dL per hour
What happens to receptors during alcohol withdrawal?
induced GABA insensitivity and glutamate receptor upregulation
Minor withdrawals occur when?
<6hrs of cessation or with relatively low blood alcohol
What are 7 minor withdrawals?
insomnia tremulousness mild anxiety gastrointestinal upset, anorexia headache diaphoresis Palpitations
When does moderate to severe withdrawals occur?
up to 96hrs of last drink
What are 3 moderate to severe alcohol withdrawal symptoms?
hallucinations-usual visual
seizures
delirium tremens
untreated severe alcohol withdrawals can lead to
DEATH
What makes up delirium tremens?
hallucinations, disorientation, tachycardia, hypertension, hyperthermia, agitation, and diaphoresis
What is the treatment for alcohol withdrawal?
Thiamine IV
Benzodiazepines
What are some non-traditional meds for acute withdrawal
Haldol Propofol (anesthetize)
What is the mainstay and you need alot of it for alcohol treatment?
Benzodiazepines (Lorazepam, Diazepam, Chlordiazepoxide)
Librium
Chlordiazepoxide
Valium
Diazepam
Ativan
Lorazepam
What are considered stimulants?
Amphetamines
Cocaine
Synthetics (Bath Salts, Molly)
What are 3 symptoms seen in stimulant intoxication?
pupillary dilation, tachycardia, weight loss w/ chronic use
What are 6 symptoms seen in stimulant withdrawal?
Fatigue, Dysphoric mood, Vivid, unpleasant dreams, hypersomnia, increased appetite, psychomotor retardation or agitation
What is the treatment for stimulant withdrawal?
IV fluids
Nutrition
Time
What is considered opiates?
herion, morphine, oxycodone
What is the most commonly abused opioid?
Heroin
What are some nicknames for heroin?
Smack, H, sugar brown, junk, horse, dope, china white, and black tar
What is the most potent route of administration for heroin?
intravenous use “shooting up/mainlining” (3-5x more potent)
What are 6 symptoms of opiate intoxication?
pinpoint pupils sleepiness- unresponsive shallow- infrequent respirations snoring breathing sounds bradycardia cyanosis
What is the treatment for opiate intoxication?
Naloxone IV or IM
How should opiate be administrated?
1st strap the pt down,30 min duration if given IV, keep dosing or start IV drip
What are symptoms of opiate withdrawal?
piloerection, muscle aches, yawning, insomnia
What is a short term txt for opiate withdrawal?
Clonidine
What is a long term txt for opiate withdrawal?
Buprenorphine
What removes the danger and safety of needles, can be used for once daily dosing in txt opiate withdrawal?
Methadone
Dosing for Buprenorphine
3x week dosing
How does Cannabis qualify as a substance use disorder?
based on # of criteria experienced by patient
What is Cannabis hyperemesis syndrome?
abdominal pain, vomiting, or nausea that is typically relieved by hot showers
How is cannabis hyperemesis treated?
IV fluid hydration, antiemetics (dilaudid) and benzo
What are two alternatives txt for cannabis?
Haldol or capsaicin cream on stomach
What is another name for Cannabis?
Marijuana Syndrome
