Substance Abuse/Dependence Flashcards
Definition of Abuse
Impairment or distress for AT LEAST 12 months + 1 or more of these:
- can’t fulfill obligations at work/school/home
- use in dangerous sit. (driving)
- recurrent legal problems a/w drug use
- cont. use despite soc/interpersonal problems caused by the use of the drug
Definition of Dependence
AT LEAST 3 OF THESE:
- Tolerance
- Withdrawl
- persistent desire or unsucc. efforts to cut downn
- dec. social, occupation, or recreational activities b/c of sub. abuse
- continued use despite subsequent phys or psych problems (drinking despite liver problems)
Cocaine in system
2-4 days
Amphetamines in system
1-3days
PCP in system
urine drug screen + for 3-8days
CPK and AST are elevated
Sedative-hypnotics in system
- Barbituates
long acting (phenobarb) - 3 weeks short acting (pentobarb) - 24 hours
Sedative-hypnotics in system
- BZD
long-acting (diazepam) - 30 days short acting (lorazepam) - 3 days
Opioids in system
urine test positive for 2-3 days
Methadone and oxycodone are NEGATIVE on GENERAL screen
Weed in system
urine test - up to 4weeks in heavy user (thc in fat)
after single use - 3days
EtOH BAL effects
- 20-50mg/dL
- 50-100mg/dL
- 100-150mg/dL
- 150-250mg/dL
- 300mg/dL
- 400mg/dL
- 20-50mg/dL ==> dec fine motor
- 50-100mg/dL ==> impaired judjge/coord
- 100-150mg/dL ==> ataxic gait/poor balance
- 150-250mg/dL ==> lethargy, diff. sitting up, difficulty w/ memory
- 300mg/dL ==> coma in novice drinker
- 400mg/dL ==> resp. dep./death
EtOH W/D sx
sx w/in 6-24 hrs and last 2-7days
Mild –> irritable, tremor, insomnia
Mod –> diaphoresis, hypertension, tachy, fever, disorient
Severe –> tonic clonic/DT/hallucinations
Opiod OD tx
Naloxone
EtOH poisoning
gastric lavage, induction of emesis, and charcol is NOT INDICATED unles….large volume was ingested in the last 30min-1hr
Seizures in EtOH W/d
occur 6-48hrs after lasrt drink (peak is 13-24hrs)
- generalized tonic clonic
- 30% –> DT M:F = 5:1
- inc seizures w/ hypoMg
- tx w/ BZD
- —-can use carbamazepine or valproic acid taper
Meds for EtOH dependence
Disulfiram
- blocks Ald. DH in liver –> cases bad rxn to alcohol
- ^^^contraindicated in cardiac dx, pregnancy and psychosis
Naltraxone (Revia, IM-Vivitrol)
- opioid receptor blocker
- dec the desire/craving and high a/w Etoh
- better in pt who have FHx of etoh abuse
- if pt has phys opioid dependence it WILL precipitate withdrawal
Acamprosate (Campral)
- started post-detox FOR RELAPSE PREVENTION
- CAN be used in liver dx patients = main adv
—> CANNOT be used in SEVERE kidney dx
-
Tactile Hallucinations seen in
EtOH Withdrawl
Some Drug Abuse
Heroin Withdrawal Sx
Diarrhea Runny Nose lots of yawning anxious and restless vomitting HTN muscle twitch/myalgias BLOWN pupils Untx the sx resolve in 7-10 days
Long Acting Opiate withdrawal
w/d sx delayed 1-3 days after last dose
- seen with methadone withdrawal
Cog deficits in Fetal Alc Sx
Delayed dev hyperactive attn deficits learning or IQ d/o seizures
Severe Opiate Intox
Seizures (grand mal) pinpoint/constricted pupils stupor/coma resp depression \+/- pulm edema
Less Severe opiate intox
slurred speech drowsy impaired attn/memory early on pupils are constricted but they dilaot if pt becomes ANOXIC from resp depression BP is low
Meperidine intox
if in chronic user, the NOr-meperidine is a toxic metabolite that causes cerebral irritant properties
steps in opiate intox tx
FIRST –> ventilation/airway (INTUBATE and ASPIRATE secretions)
THEN —> give naloxone
in what drug intox is forced diuresis good
salicylates and acetominophen
