substance abuse/dependence

Question 1

definition of abuse

Answer 1

pattern of substance use that causes impairment or distress for at least 12 months (one failure at least)

Question 2

How long is utox screen positive for cocaine after use? for amphetamines? PCP?

Answer 2

cocaine: 2-4 days
amphetamines 1-3 days
PCP 3-8 days (CPK and AST often high too)

Question 3

How long are short acting and long-actig barbiturates positive in the urine?

Answer 3

short (phenobarbital): 24 hrs

long (phenobarbital): 3 wks

Question 4

How long are short and long acting benzos positive in the urine?

Answer 4

lorazepam/ativan: 3 days

dizepam: 30 days

Question 5

What should I know about urine tox screen for opiods?

Answer 5

drug test positive 2-3 days

methadone and oxycodone will be negative on a general screen

Question 6

At what BAL do most adults show signs of intoxication?

Answer 6

> 100 for some signs; >150 will cause obvious signs of intoxication

Question 7

What is the progression of alcohol intoxication in terms of BAL?

Answer 7

20-50: decr. fine motor control
50-100- impaired judgment/cooridination
100-150: ataxia, poor balance
150-250: memory problems, trouble sitting upright
>300: coma in novice drinker
>400: death

Question 8

What is the progression of alcohol withdrawal sx? When do seizures occur?

Answer 8

begin within 6-24 hrs; last 2-7 days
Seizures between 6-48 hrs; peak at 13-24 hrs
1/3 of pts who seize then develop DTs

Question 9

Delirium tremens

Answer 9

48 to 72 hrs is typical, but may occur as late as 7 days

high mortality rate if untreated

Question 10

What is considered at risk or heavy drinking?

Answer 10

Men: >4 drinks/day or >14 drinks/week
Women: >3 drinks/day or >7 drinks/wk

Question 11

What are the contraindications to disulfram?

Answer 11

severe cardiac disease, pregnancy, psychosis

Question 12

How does naltrexone work? For whom is it most effective?

Answer 12

reduces desire/craving for alcohol. most effective for pts w/family hx of alcoholism. careful in pts who are opioid dependent- will precipitate withdrawal

Question 13

Purpose of acamprosate, advantages, contraindications

Answer 13

stared after detox in pts who have stopped drinking to prevent relapse. Can be used in pts with liver disease, but contraindicated in pts with severe renal disease.

Question 14

3 features of wernicke’s encephalopathy?

Answer 14

ataxic gait, confusion, and ocular abnormalities like nystagmus and gaze palsies

Question 15

How does cocaine work?

Answer 15

blocks DA reuptake at the synaptic cleft

Question 16

What are the dangerous sequelae of cocaine abuse? How long does withdrawal from cocaine last?

Answer 16

can casue vasoconstrictive effect and lead to MI or stroke.
can also cause seizures, arrhythmias, paranoia, and tactile hallucinations.
withdrawal lasts about 18 hrs for most ppl, but can last days-wks in heavy users

Question 17

How do amphetamines work?

Answer 17

block reuptake AND facilitate DA and NE release

Question 18

What are the side effects of chronic amphetamine use? What are the dangers/effects of substituted amphetamines?

Answer 18

chronic use can casue acne and tooth decay (meth mouth)
substituted amphetamines like NDMA/ecstasy and MDEA/eve are both stimulating and hallucinogenic
serotonin syndrome is possible if designer amphetamines are combined with SSRIs. Overdose can also cause hyperthermia, dehydration, and rhabdomyolysis

Question 19

What are the effects of ketamine?

Answer 19

tachycardia, tachypnea, hallucinations, and amnesia. sometimes used as a “date rape” drug

Question 20

What is the mechanism of PCP?

Answer 20

dissociative, hallucinogenic drug that antagonizes NMDA receptors and activates DA neurons. can be a stimulant or a depressant, depending on dose.

Question 21

Which drugs cause tactile and visual hallucinations? How can you tell the difference?

Answer 21

both PCP and cocaine cause tactile and visual hallucinations, but only pcp causes rotary nystagmus