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Substance Abuse and Tx Flashcards

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1
Q

Define each of the following:

  • substance use
  • substance abuse
  • physical dependence
  • psychological dependence
  • tolerance
  • addiction
A

Substance use: sporadic consumption of alcohol/drugs with no adverse consequences

Abuse: frequency of alcohol/drug use may vary, adverse consequences experienced by the user.

Physical dependence: state of adaptation that is manifested by a drug class-specific withdrawal syndrome

psychological dependence: subjective need for a specific psychoactive substance either for its positive effect or avoid negative effects of its abstinence.

Tolerance: increase dose of substance to achieve the same level of high once achieved before at that same dose.

Addiction: primary, chronic, neurobiologic dz, w/ genetic, psychosocial, and enviornmental factors influencing its development and manifestations
(impaired control of over drug use, compulsive use, continued use despite harm, craving, and adverse consequences in the abusers life)

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2
Q

What are the main things you want to ask if you suspect substance abuse?

A
  • quantity
  • amount of money spent daily/weekly/monthly
  • frequency of use and time of last use
  • route of administration
  • if hx of use ask about prior detox or addiction tx and abstinence periods
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3
Q

When is CAGE questionnaire used? What does it stand for? what is a positive result?

A

Used in medical setting, proven to be sensitive and specific tool for detecting a drinking problem primarily in men.

Positive result is 2 or more positive answers; likely dx of alcohol dependence.

C: Have you ever felt the need to CUT down on your drinking?

A: Have you even felt ANNOYED by criticism of your drinking.

G: Have you ever had GUILTY feelings about your drinking?

E: Do you ever take a morning EYE-OPENER? (drink first thing in the AM to steady your nerves or get rid of a hangover.)

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4
Q

WHat are some physical signs in patients with alcohol dependency?

What labs might be abnormal?

A

Cachexia/malnourished, jaundice, tremor, ascities.

CBC: macrocytic anemia (B12 or folate)

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5
Q

How many drinks per week is considered risky or hazardous drinking in men and women?

A

Men less than 65YO: greater than 14drinks/week

Women less than 65YO: greater than 7 drinks per week

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6
Q

Alcohol abuse is associated with one or more of the following sx within a 12mo period…

A
  • failure to fulfill work, school, or social obligations
  • recurrent substance use in physically hazardous situations
  • recurrent legal problems related to substance use
  • continued use despite alcohol related social or interpersonal problems.
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7
Q

Alcohol dependence is associated with 3 or more of the following sx occurring at any time in the same 12mo period…

A
  • tolerance
  • withdrawal
  • substance taken in larger quantity than intended
  • persistent desire to cut down or control use
  • time spent obtaining, using, or recovering from the substance
  • social, occupational, or recreational tasks are sacrificed
  • use continued despite physical and psychological problems.
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8
Q

What screening tool is used in suspected alcohol abuse in adolescents and college students? What is considered a positive result?

A

CRAFFT. 2+ is considered positive.

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9
Q 
How many drinks is considered: 
-moderate drinking
-heavy drinking
-binge drinking 
...in men and women
A

Moderate:
Men: 2or less
Women: 1 or less

Heavy:
Men: greater than 14/wk or 4/occasion
Women: greater than 7drinks/wk or 3/occasion

Binge:
Men: 5+ drinks in a row
Women: 4+ drinks in a row

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10
Q

How many oz are considered a drink ?

  • liquor
  • wine
  • beer
A

Liquor: 1.5fl oz

Wine: 5fl oz

Beer: 12fl oz

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11
Q

Alcohol metabolism

A
  • 90% metabolized in the liver via alcohol dehydrogenase(ADH) and aldehyde dehydrogenase(ALDH)
    alcohol. ..AHD….acetaldehyde…ALDH…acetate.
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12
Q

Effects of alcohol on the brain

A

CNS depression:
mild levels: thought, judgement, and restraint are loosened.

increasing levels voluntary muscle dysfunction and entire motor area of the brain depressed

Yet increasing levels there is confusion, stupor, coma, cessation of breathing resulting in death.

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13
Q

What are the 3 stages of hepatocellular injury?

A

Fatty liver
Alcoholic hepatitis
Cirrhosis

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14
Q

Wernicke-Korsakoff Syndrome:

  • occurs in who?
  • cause
  • what is this?
  • sx
A

occurs in persons who have been drinking heavily for many years

Cause; thiamin deficiency d/t poor nutrition/malabsorption

What:
Wernickes: ACUTE sx which are completely reversible when tx with high dose of thiamine.
-Sx: gait ataxia, vestibular dysfunction, ocular abnormalities

Korsakoff: CHRONIC condition, only 20% recover. Treated PO w/ thiamine.
-Sx: impaired recent memory and anterograde amnesia.

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15
Q

How many drinks per day may be cardioprotective in men and women?

A

1-2drinks/day in women

2-4drinks/day in men

greater intake leads to INCREASED Almortality

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16
Q

Alcohol Withdrawal: Mild sx

  • how soon after cessation do these sx occur?
  • how long before they resolve?
A

Insomnia, tremulousness, mild anxiety, GI upset/anorexia, HA, diaphoresis, palpitations

Begin within 6hrs of cessation of drinking

Resolve within 24-48hrs

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17
Q

Alcohol WIthdrawal Seizures;

  • MC occur when?
  • what type of seizure?
  • tx
A

MC occur within 48hrs of last drink

Tonic clonic seizure

Treat with benzodiazapines

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18
Q

Alcoholic Hallucinosis:

  • develops within how many hours of last drink?
  • resolves in how many hours?
  • types
A

Develops within 12-24hrs of last drink

Resolves 24-48hrs

Types: usually visual, can be auditory or tactile.

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19
Q

Delirium Tremens

  • what is this?
  • signs and sx
  • begin when?
  • how long do they last?
  • risk factors
A

Rapid onset of confusion, hallucinations, shaking.

Signs and Sx:

  • hallucinations
  • disorientatino
  • tachycardia
  • hypertension
  • low grade fever
  • agitation
  • diaphoresis

This is life threatening.

Begin 48-96hrs after last drink

May last 1-5days

Risk factors:

  • hx of sustained drinking
  • hx of previous DTs
  • Age greater than 30
  • presence of concurrent illness
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20
Q

DT Withdrawal dx

A

-dx of exclusion

21
Q

Tx of Alcohol Withdrawal

  • minimal
  • moderate
  • severe
  • refractory
A
  • may require mechanical restraint
  • treat dehydration and hypokalemia with IV fluids and KCl
  • Thiamine 100mg IV or IM BEFORE glucose.

Minimal-Moderate: thiamine & supportive care

Severe: thiamine and supportive care + benzodiazepines (Diazepam/Valium, Chlordiazepoxide/Librium, and lorazepam/ativan)

Refractory:
-refractory DT add phenobarbitol or propofol

22
Q

outpatient therapy of alcoholism

  • acomprosate/campral
  • -SE
  • -CI
  • Disulfiram/antabuse
  • -MOA
  • -Sx
  • -SE
A

Acomprosate (Campral):
-SE: diarrhea, low pulse, high or low BP, HA, impotence

-CI: kidney dz

Disulfiram (Antabuse):
-MOA: inhibits activity of ALDH leading to increased levels of acetaldehyde levels after alcohol ingestion

  • Sx:flushing, dyspnea, N/V, HA, blurred vision, vertigo, anxiety
  • SE: hepatotoxic, depression, psychosis
23
Q

Methamphetamine:

  • MOA
  • signs and sx
  • routes of administration
  • general appearance of an addict
A

MOA: displaces E, NE, dopamine, and serotonin into the synaptic cleft. Also inactivates NT reuptake systems.
*results in surge of adrenergic stimulation

Signs and Sx:
-tachycardia, diaphoresis, high energy, pupil dilation, increased BP, agitation, psychosis, hyperthermic

RouteS:
-PO, pulmonary, nasal, IM, IV, rectal, vaginal, body stufffing

Appearance:

  • malnourished, agitated, disheveled
  • may become violent
  • meth mouth
24
Q

Methamphetamine Intoxication

-Tx

A
  • Sedation for agitation
  • protect airway
  • control BP andd temp
  • cardiovascular collapse:
  • -vasoactive amines
  • -correct metabolic acidosis
  • -fluid resuscitation
25
Q

Cocaine:

  • MOA
  • routes of administration
  • sx
  • Adverse effects
A

MOA: blocks presynaptic reuptake pumps for dopamine, NE, and serotonin

Routes:
-smoked, injected, snorted

Sx:
-increased energy, alterness sociability, elation, euphoria, tachycardia, pupil dilation, diaphoresis, nausea. “Total body orgasm”

Adverse Effects:
-anxiety, irritability, panic attacks, paranoia, gradiosity, impaired judgement, psychotic sx

26
Q

Acute Cocaine intoxication:

  • effects on the CV, CNS, and lungs
  • tx
A

CV: arterial vasoconstriction and enhanced thrombus formation, tachycardia, HTN

CNS: agitation, seizures, HA, coma, intracranial hemorrhage

Lungs: angioedem and pharyngeal burns if smoked

Tx: symptomatic

27
Q

Cannibis:

  • what is the main component of this drug?
  • processed into what forms?
  • MOA
  • sx
  • signs
A

Main component: THC

Processed into:

  • dry leaves and flowers
  • pressed, dry resin or secretion (hashish)
  • oil (hash oil)

MOA:
-crosses the BBB and bind to endogenous canabinoid receptors

Sx:

  • euphoria, decreases anxiety and tension, time perception is distorted (faster), may even have paranoia and psychosis
  • decreases rxn time & impairs attention, concentration, short term memory, and risk assessment
  • impairs motor coordination and the ability to do complex tasks

Signs:

  • tachycardia
  • increased BP and RR
  • conjunctival injection
  • dry mouth
  • increased appetite
28
Q

Cannibis:

  • what kind of drug is this? (depressant/stimulant?)
  • withdrawal sx
  • tx
A

Depressant!!!

withdrawal sx:
-craving, irritability, restlessness, depression, anxiety, decreased sleep strange dreams, sweating, runny nose, stomach pain, nausea

Tx:
-Buspar (buspirone) (for withdrawal sx)

29
Q

Hallucinogens:

  • what is a trip? flashback?
  • MOA
  • Types
A

Trip: effects experienced from acute intoxication, may have “bad trip”

Flackback: recurrence of sx associated with hallucinogen after the effects of acute intoxication have worn off, may occur months to years after last use of drug.

MOA:
-binds 5-HT2A receptors, involves NT serotonin, dopamine, and glutamate.

Types:

  • LSD
  • Dextromethorphan (DXM)
  • Mescaline (peyote cactus)
  • 4-bromo-2,5-dimethoxypheethylamine (Bromo/2CB)
  • 2,5-dimethox-4-(N)-propylthiphenethylamine (Blue Mystic/2CT-7)
  • Phenycyclidine (PCP)
30
Q

Tx of pts on Hallucinogens

A
  • quiet, calm environment
  • supportive care
  • careful mild sedation if agitated
31
Q

Inhalants

  • what type of drug is this? (stimulant/depressant)
  • sx
  • techniques
  • MC used inhalants
  • tx
A

CNS depressant

Sx: euphoria followed by lethargy.
-intense vasodilation producing sensation of heat and warmth, prolong penile erection.

Techniques:

  • sniffing = spray on heated surface to vaporize
  • huffing = saturate cloth and hold near nose or mouth
  • bagging = put substance in a bag that is placed over nose, mouth, or head.

MC used:
-glue, shoe polish and toluene

Tx: supportive

32
Q

Inhalant effects on:

  • CNS
  • GI
  • Hematologic
  • CV
A

CNS: slurred speech, ataxia, disorientation, HA, hallucinations, violent behavior, seizures, peripheral neuropathy*

GI: n/v, anorexia and weight loss, hepatotoxicity

Hematologic: benzene can cause aplastic anemia and malignancy

CV: sudden death d/t cardiovascular collapse

33
Q 
Nicotine: 
-commonly causes what other dzs? 
-MOA
-T/F, more addictive than opioids?
-mean onset of age? 
-
A

Dzs:

  • lung cancer, COPD, cardiovascular dz
  • DEATH!

MOA:
-reaches brain in 15 seconds, activates dopamine reward center, increases circulation of NE and E.

TRUE! it is more addictive than opioids.

mean onset of age is 16YO

34
Q

Nicotine Withdrawal Sx

A

Loss of Euphoric effects

Depressed mood

Insomnia

irritability, frustration, anger, anxiety***

difficulty concentrating

restlessness

decreased HR

Weight gain

35
Q

What are the stages of change?

A

precontemplation

contemplation

determination

action

maintenance

36
Q

What are the 3 successful smoking cessation tx strategies?

A

social support

Pharmacological therapy

Skills training or problem solving techniques.

37
Q

Venicline (Chantex)

  • MOA
  • SE
A

MOA: agonist of nicotinic acetylcholine receptors
(reduces withdrawal sx)
*1st line agent!!!

SE:

  • nausea
  • insomnia
  • weird dreams
  • depression
  • suicidality**
38
Q

Buproprion (zyban)

  • MOA
  • SE
  • CI
A

MOA: enhances CNS noradrenergic and dopaminergic function

SE: dry mouth, insomnia, HA, seizures, monitor for neuropsych sx

CI: seizure disorders and pregnancy

aka: wellbutrin

39
Q

Nicotine Polacrilex:

  • types
  • which type has higher rate of abstinence at one year?
A

Types:

  • Gum (nicorette)**
  • lozenge

Lozenge has higher rates of abstinence at one year.

40
Q

Nicotine Transdermal Patch

-use

A

can wear 24hrs a day,, may only wear during the day if causes sleep disturbances and vivid dreams.

41
Q

Opioids:

  • drug names
  • MOA
A

Heroin (dope, horse, smack, tar)

Opium

Fentanyl- patch

percocet (oxycodone/acetminophen)

Vicodin (hydrocodone/acetminophen)

MOA:
-activate transmembrane NT receptors (mu) that couple G proteins, activation of CNS mu receptors results in euphoria, respiratory depression, analgesia, miosis (constriction)

42
Q

Opioid Toxicity

  • signs
  • tx
A

Signs:

  • depressed mental status
  • decreased resp rate*
  • decreased tidal volume
  • miotic (constricted) pupils
  • lower HR
  • mild hypotension
  • hypothermia

Tx:

  • mainstay is ABCs
  • naloxone/narcan (opiod antagonist) give until resp 12 or greater NOT to attain normal level of conciousness
43
Q

Opiod Withdrawal

A

within 3-4hrs last dose;

  • drug craving and anxiety
  • fear of withdrawal

8-14hrs of last dose:

  • anxiety, restlessness, insomnia and yawning
  • rhinorrhea, lacrimation, and diaphoresis
  • stomach cramps and mydriasis (dilation)

1-3days last dose:

  • tremor, muscle spasm
  • vomiting and diarrhea
  • HTN and tachycardia
  • Fever, chills, and piloerection
44
Q

Sx management for acute opioid withdrawal

A
  • muscles relaxants
  • NSAIDS
  • antiemetics
  • antiemetics
  • antidiarrheal
  • sleep agent with low abuse potential (melatonin, benadryl)
45
Q

Long term addiction Tx of opiod dependence

A
  • abstinence based treatment programs
  • naltrexone (opioid antagonists)
  • opioid agonists:
  • -methadone
  • -buprenophine
46
Q

Naltrexone:

  • administration routes
  • MOA
A

admin routes:
-oral or monthly depot preparation

MOA: antagonists prevents the pt from experiencing any euphoric effects with subsequent opioid use

47
Q

Methadone:

  • how long do you use this for maintenance and detoxification?
  • SE
A

Maintenance: use greater than 180days

Detoxification: less than 180 days

SE: same as opioid but without the eurphoria

  • constipation, drowsiness
  • reduced libido, excess sweating
  • peripheral edema
  • prolonged QT
48
Q

Clonidine:

  • MOA
  • use
  • SE
A

MOA alpha-2-adrenergic receptor agonist

Use: decreases withdrawal sx in pts using low dose opioids

SE:

  • orthostatic hypotension
  • dry mouth
  • constipation

*can combine clonidine and methadone to get euphoric effects.

49
Q

Anxiolytic Disorders
-tx

Benzodiazepine withdrawal sx

Benzodiazepine tx of

  • mild to moderate
  • severe
  • severe/serious
A

Tx: benzodiazepines

Benzo Sx:

  • hyperthermia
  • elevated BP
  • increased pulse and RR
  • delirium
  • tremulousness
  • increased DTRs/Seizures
  • disorientation
  • psychotic behavior/hallucinations

Benzo withdrawal tx:
-Mild/mod: slow taper off the drug over several months.

  • Severe: long acting benzos watching for respiratory depression.
  • severe/serious: anticonvulsants may be used: carbamazepine, valproate (valproic acid)

Psych (13 decks)

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