Substance Abuse/Dependence

Question 1

Definition of Abuse

Answer 1

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

Question 2

Definition of Dependence

Answer 2

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)

Question 3

Cocaine in system

Answer 3

2-4 days

Question 4

Amphetamines in system

Answer 4

1-3days

Question 5

PCP in system

Answer 5

urine drug screen + for 3-8days

CPK and AST are elevated

Question 6

Sedative-hypnotics in system

- Barbituates

Answer 6

long acting (phenobarb) - 3 weeks
short acting (pentobarb) - 24 hours

Question 7

Sedative-hypnotics in system

- BZD

Answer 7

long-acting (diazepam) - 30 days
short acting (lorazepam) - 3 days

Question 8

Opioids in system

Answer 8

urine test positive for 2-3 days

Methadone and oxycodone are NEGATIVE on GENERAL screen

Question 9

Weed in system

Answer 9

urine test - up to 4weeks in heavy user (thc in fat)

after single use - 3days

Question 10

EtOH BAL effects

• 20-50mg/dL
• 50-100mg/dL
• 100-150mg/dL
• 150-250mg/dL
• 300mg/dL
• 400mg/dL

Answer 10

• 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

Question 11

EtOH W/D sx

Answer 11

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

Question 12

Opiod OD tx

Answer 12

Naloxone

Question 13

EtOH poisoning

Answer 13

gastric lavage, induction of emesis, and charcol is NOT INDICATED unles….large volume was ingested in the last 30min-1hr

Question 14

Seizures in EtOH W/d

Answer 14

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

Question 15

Meds for EtOH dependence

Answer 15

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
-

Question 16

Tactile Hallucinations seen in

Answer 16

EtOH Withdrawl

Some Drug Abuse

Question 17

Heroin Withdrawal Sx

Answer 17

Diarrhea
Runny Nose
lots of yawning
anxious and restless
vomitting
HTN
muscle twitch/myalgias
BLOWN pupils
Untx the sx resolve in 7-10 days

Question 18

Long Acting Opiate withdrawal

Answer 18

w/d sx delayed 1-3 days after last dose

- seen with methadone withdrawal

Question 19

Cog deficits in Fetal Alc Sx

Answer 19

Delayed dev
hyperactive
attn deficits
learning or IQ d/o
seizures

Question 20

Severe Opiate Intox

Answer 20

Seizures (grand mal)
pinpoint/constricted pupils
stupor/coma
resp depression
\+/- pulm edema

Question 21

Less Severe opiate intox

Answer 21

slurred speech
drowsy
impaired attn/memory
early on pupils are constricted but they dilaot if pt becomes ANOXIC from resp depression
BP is low

Question 22

Meperidine intox

Answer 22

if in chronic user, the NOr-meperidine is a toxic metabolite that causes cerebral irritant properties

Question 23

steps in opiate intox tx

Answer 23

FIRST –> ventilation/airway (INTUBATE and ASPIRATE secretions)
THEN —> give naloxone

Question 24

in what drug intox is forced diuresis good

Answer 24

salicylates and acetominophen

Question 25

Hallucinogen intox duration

Answer 25

usually 8-12 hrs

but the psychosis (esp in PCP) can last weeks

Question 26

length of Marijuanna in sys

Answer 26

3days to 4weeks depending on use

Question 27

lenght of PCP in sys

Answer 27

8days

Question 28

length of BZD in sys

Answer 28

3days (longer if long acting or chronic use)

Question 29

EtOH w/d timeline

Answer 29

8 hrs after last drink is when sx start
* if chronic user*
PEAK at 2-3rd day
diminished by 5Th day

Question 30

Wernicke’s

Answer 30

in severe prolong alc abuse
due to thiamine def ==> ENCEPHALOPATHY
C.O.At (confusion, optahlmoplegia, and ataxia)

• hallucinations in wernicke’s start shortlty after drink and are AUDITORY and vivid
• also these are assoc with ANS instability

Question 31

4 nutrients given in etoh w/d

Answer 31

Folic Acid
Thiamine
Glucose
Mag Sulfate (if seizure ppx)
(+ BZD)

Question 32

if naloxone/naltrexone not available what can you give for some of the CV effects of Opiate withdrawal

Answer 32

give clonidine 3-4x/ day
GOOD FOR ANS instability sx
NOT good for cravings, insomnia and muscle aches that coming from w/d
- good for methadone detox

Question 33

in PCP intox

Answer 33

look for ANS and Neuro excitation

• ranges seizures to nystagmus
• rage

Question 34

why not to give to anti=psychotic in acute etoh w/d

Answer 34

will LOWER the seizure threshold

Question 35

EtoH W/D delerium

Answer 35

20%  can die,
result of PNA, Heaptic dx, or heart fx
sx of EtOH W/D Delerium =
- ANS hyperactive
- hallucinations
- Fluctuating activity levels (acute agitation to lethargy)

Question 36

amphetamine vs cocaine MOA

Answer 36

Amphet - > incR release of DA and NE into synaptic cleft

Cocaine -> inhib reuptake of NE, etc