substance abuse/dependence Flashcards
definition of abuse
pattern of substance use that causes impairment or distress for at least 12 months (one failure at least)
How long is utox screen positive for cocaine after use? for amphetamines? PCP?
cocaine: 2-4 days
amphetamines 1-3 days
PCP 3-8 days (CPK and AST often high too)
How long are short acting and long-actig barbiturates positive in the urine?
short (phenobarbital): 24 hrs
long (phenobarbital): 3 wks
How long are short and long acting benzos positive in the urine?
lorazepam/ativan: 3 days
dizepam: 30 days
What should I know about urine tox screen for opiods?
drug test positive 2-3 days
methadone and oxycodone will be negative on a general screen
At what BAL do most adults show signs of intoxication?
> 100 for some signs; >150 will cause obvious signs of intoxication
What is the progression of alcohol intoxication in terms of BAL?
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
What is the progression of alcohol withdrawal sx? When do seizures occur?
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
Delirium tremens
48 to 72 hrs is typical, but may occur as late as 7 days
high mortality rate if untreated
What is considered at risk or heavy drinking?
Men: >4 drinks/day or >14 drinks/week
Women: >3 drinks/day or >7 drinks/wk
What are the contraindications to disulfram?
severe cardiac disease, pregnancy, psychosis
How does naltrexone work? For whom is it most effective?
reduces desire/craving for alcohol. most effective for pts w/family hx of alcoholism. careful in pts who are opioid dependent- will precipitate withdrawal
Purpose of acamprosate, advantages, contraindications
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.
3 features of wernicke’s encephalopathy?
ataxic gait, confusion, and ocular abnormalities like nystagmus and gaze palsies
How does cocaine work?
blocks DA reuptake at the synaptic cleft
What are the dangerous sequelae of cocaine abuse? How long does withdrawal from cocaine last?
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
How do amphetamines work?
block reuptake AND facilitate DA and NE release
What are the side effects of chronic amphetamine use? What are the dangers/effects of substituted amphetamines?
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
What are the effects of ketamine?
tachycardia, tachypnea, hallucinations, and amnesia. sometimes used as a “date rape” drug
What is the mechanism of PCP?
dissociative, hallucinogenic drug that antagonizes NMDA receptors and activates DA neurons. can be a stimulant or a depressant, depending on dose.
Which drugs cause tactile and visual hallucinations? How can you tell the difference?
both PCP and cocaine cause tactile and visual hallucinations, but only pcp causes rotary nystagmus
