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Behavioral Med: Test 4 > Substance Abuse Disorders > Flashcards

Substance Abuse Disorders Flashcards

1
Q

Substance Abuse: DSM V definition and criteria

A

Substance Abuse: a pattern of maladaptive substance use that is associated with recurrent and significant adverse consequences characterized by at least 3 of the 7 symptoms:

  • Tolerance (a state in which a person no longer responds to a drug; a higher dose is required to achieve the same effect)
  • Withdrawal
  • Increased consumption
  • A lack of desire or ability to stop
  • Large amounts of time devoted to procuring substance
  • Abandonment of typical activities because of need to use substance
  • Continued use despite knowledge of damaging effects
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2
Q

What is substance dependence?

A

Compulsive pattern of use characterized by a loss of control over substance use and continued use despite the significant substance related problems

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3
Q

What is dependence? (more info)

A
  1. A state in which a person functions normally only in the presence of a drug
  2. Dependence develops when the neurons adapt to the repeated drug exposure and only function normally in the presence of the drug
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4
Q

Emerging Trends in the U.S. - Substance abuse disorders

A
  1. In New York, among persons aged 12 or older with alcohol abuse or dependence, about 66,000 persons (5.7%) per year in 2008 - 2012 received treatment for their alcohol use.
  2. In New York, among persons aged 12 or older with illicit drug dependence of abuse, about 58,000 persons (11.9%) per year in 2008 – 2012 received treatment for their illicit drug use. (NOT MANY PEOPLE GETTING CARE)
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5
Q

Recognizing Impairment: Feeling of wellbeing

A
  1. Up to 0.05

2. Talkative, relaxed, confident, happy, cheerful

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6
Q

Getting Risky

A
  1. 0.05 to 0.08

2. Impaired judgement, lack of attention, reduced inhibitions

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7
Q

Dangerous

A
  1. 0.08 to 0.15

2. speech slurred, visual impairment, nausea, and vomiting, slowed reflexes, balance affected

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8
Q

Stupor

A
  1. 0.15 to 0.40

2. Labored breathing, loss of bladder control, sleepy, passing out, unable to walk unaided

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9
Q

Death

A
  1. Over .40

2. Coma, Shock, Death

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10
Q

BAC Level and Hours until 0

A 
0.016 - 1 hr
.05 - 3.75
.08 (legal limit) - 5 hrs
.10 - 6.25
.16 (2x legal) - 10 hrs
.24 (3x legal) - 15 hrs
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11
Q

What is the pneumonic Must Help?

A

M - mental confusion
U - Unresponsive
S - Snoring/Gasping for air
T - Throwing up

H - hypothermia
E - Erratic breathing
L - Loss of consciousness
P - Paleness/Blueness of skin

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12
Q

With alcoholics what should you be worried about if admitted during the 1st 24 hrs?

A

Risk of Seizures

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13
Q

Minor Symptoms of withdrawal? (start)

A 
Anxiety
Insomnia
GI upset
HA
Palpitations
Anorexia
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14
Q

Alcoholic Hallucinations withdrawal sxs? (@ 1 day)

A

Most commonly visual, also auditory or tactile

usually resolves within 48 hrs

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15
Q

Withdrawal seizures sxs? (@ 1.5-2 days)

A

Generalized tonic- clonic convulsions

may occur as early as 2 hrs after alcohol cessation

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16
Q

Delirium Tremens sxs? (Day 2.5-3)

A 
Agitation
Hallucinations
Disorientation
Tachy
HTN
Fever
Diaphoresis
(Peak at 5 days, lasts up to 7 days)
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17
Q

CNS depressants- benzodiazepines

A
  1. Symptoms of abuse: fatigue/tiredness, irritability, drowsiness, loss of coordination, emotional numbing, mania, hostility, rage, aggressiveness and impulsivity, hallucinations.
  2. Withdrawal: drowsiness, impaired judgment, impaired motor skills, CNS respiratory depression, paradoxical excitement, restlessness, delirium and cardiovascular collapse.
  3. Requires medically supervised detoxification.
18
Q

CNS depressants- Inhalants

A

AKA “HUFFING” – which can take the form of sniffing or snorting fumes from a container, spraying aerosols directly into nose or mouth, placing an inhalant soaked rag in the mouth, inhale fumes from a balloon or plastic bag that contains the inhalant

Sxs: Drunk or disoriented appearance, Slurred speech, Nausea or loss of appetite, in-attentionness, lack of coordination, irritability, and depression

19
Q

CNS Stimulants

A

cocaine, amphetamines, nicotine, caffeine

20
Q

Stimulant Sxs: Cocaine/Crack

A 
Dilated pupils
Nosebleeds
Nasal congestion
Sniffing
Impaired movement
seizures
elevated BP, respirations, temp
Hallucinations
Agitation, anxiety, WL
21
Q

Common effects: Amphetamines

A

Euphoria
Increased energy
Mental alertness
Rapid speech

22
Q

Sxs: Nicotine

A 
Increased clotting tendency
Bronchospasm
Muscular Tremor
Muscular Pain
Dry mouth
Nausea
Dyspepsia
Diarrhea
Heartburn
Joint pain
Lightheadedness
HA
Sleep disturbances
Abnormal dreams
Irritability
Dizziness
Increased or decreased heart rate
Increased BP
Tachy
More or less arthymias
Coronary Artery constriction
Hyperinsulinemia
Insulin resistance
23
Q

Caffeine OD Sxs

A 
Irritability
Anxiety
Restlessness
confusion
delirium
HA
Insomnia
Seizures
Trembling
Twitching
Overextension
Rapid breathing
Freq urination
Dehydration
Fever
Abd pain
N/V 
Rapid HR/irreg rhythm
increased sen. to touch
ringing in ears
Seeing flashes
24
Q

Psychoactive Bath Salts (PABS)

A
  1. CNS stimulant with hallucinogenic properties that inhibit the norepinephrine-dopamine reuptake system
  2. Most common ingredients: MDPV (methylenedioxypyrovalerone), mephedrone and pyrovalerone.
  3. Structurally similar to cathinone, an alkaloid found in the khat plant and methamphetamine.
  4. Produces a “high” similar to methamphetamine
  5. Snorted, smoked, ingested, used rectally and injected
  6. Effects occur with doses as small as 3 – 5 mg/ average dose is 5 – 20 mg.
  7. High risk for overdose because most packages contain up to 500mg.
  8. Oral ingestion produces peak “rush” at 1.5 hours, effect lasting 3-4 hours and then a hard “crash”.
  9. Total bath salts “experience” may last up to 8 hours.
25
Q

Bath Salt Sxs

A 
Anxious & Jittery Behavior
Violence
Self mutilation
Hyperthermia
Delirium
Insomnia
Lack of appetite
Severe paranoia
26
Q

Sxs of opioid intoxication

A 
Activation or rush (low dosage)
Sedation/Apathy (high dosage)
Euphoria or dysphoria
Feelings of warmth, facial flushing, itching
Impaired judgement, attention, or memory
Analgesia
Constipation
Pupilary constriction
Drowsiness
Resp. depression, hypotension
Tachy
27
Q

Sxs of opioid withdrawal

A 
Decreased mood and anxiety, dysphoria
Piloerection, lacrimation or rhinorrhea
Frequently high attention
Hyperalgesia, joint, & muscle pain
Diarrhea & GI cramping, N/V
Insomnia
Autonomic hyperactivity
Yawning
28
Q

Screening tools

A
  1. AUDIT – alcohol screening questionnaire with 10 questions
  2. DAST - drug abuse screening test with 10 questions
  3. ASSIST - alcohol, smoking and substance involvement screening test with 8 questions; also has feedback card for patients
  4. CRAFFT – targets alcohol and drug use in adolescents; has 6 questions
  5. TWEAK – (Tolerance, Worried, Eye-opener, Amnesia and K/Cut down) 5 item scale to screen for risk of drinking during pregnancy
  6. 5 P’s - (parents, peers, partner, past, present) 8 questions for pregnant women and those of child bearing age.
29
Q

Pharmacological Interventions : ANTIDIPSOTROPICS

A
  1. Best known medication in this category is disulfiram (anatabuse)
  2. When taken with alcohol, negative physical reactions can range from nausea and headaches to unconsciusness or death
  3. Not a cure for alcohol dependency, but can be used on a long-term basis as part of a complete treatment program
30
Q

Pharmacological Interventions: Naltrexone (ReVia):

A

opioid receptor antagonist but also useful to help with cravings (available p.o. and IM)

31
Q

Pharmacological Interventions: Acamprosate (Campral)

A

calcium-acetyl homotaurine/ works on GABA and glutamate. Helps with cravings and post-acute withdrawal syndrome

32
Q

Pharmacological Interventions: OPIATE REPLACEMENT THERAPY

A
  1. Used to help stop use of heroin, morphine, OxyContin, Dilaudid, Vicodin through substitution; prevents withdrawal symptoms but doesn’t provide a strong euphoria; usually a long-term treatment that lasts for years
    - Methadone – synthetic opioid; acyclic analog of heroin and morphine; acts on same receptor sites.
33
Q

Pharmacological Interventions: Suboxone (Buprenorphine)

A

semi-synthetic opioid used to treat opioid addiction in higher doses; can only be prescribed by DEA qualified physicians; less tightly controlled than methadone (patients can have their medications at home)

34
Q

Pharmacological Interventions: NICOTINE ADDICTION MEDICATIONS

A
  1. NICOTROL: delivers nicotine without smoking; includes inhalants, lozenges and patches
  2. BUPROPION(Zyban, Wellbutrin): an anti-depressant that can be used to stop smoking…usually prescribed for up to 6 months
  3. VARENICLINE (Chantix): blocks nicotine receptors and is generally prescribed for 12 – 24 weeks
35
Q

Why do you have to be careful when prescribing Chantix for nicotine addiction?

A

It can worsen depression

36
Q

What is Motivational Interviewing ?

A
  1. A clinical approach that helps people with mental health, substance use disorders and other chronic conditions such as diabetes, cardiovascular conditions and asthma make positive behavioral changes to support better health.
  2. The approach uphold 4 principles: expressing empathy and avoid arguing, developing discrepancy, rolling with resistance and supporting self-efficacy.
37
Q

Best Practice Techniques

A
  1. SCREENING: a healthcare professional assesses a patient for risky substance use behaviors using standardized screening tools. Screening can occur in any healthcare setting.
  2. BRIEF INTERVENTION: a healthcare professional engages a patient showing risky substance use behaviors in a short conversation, providing feedback and advice.
  3. REFERRAL TO TREATMENT: a healthcare professional provides referral to brief therapy or additional treatment to patients who screen in need of additional services.
38
Q

SE of Oxycodone

A 
Hallucination
Confusion
Fainting
Dizziness
Swelling of mouth, tongue, or lips
Hives, rash
Difficultly breathing, slowed
Swelling of hands, feet, ankles, or lower legs
Swelling of eyes
Hoarseness of voice
Difficulty Swallowing
Fast or slow heartbeat
Seizures
39
Q

Long Term effects of Oxycontin

A
  1. Central
    - Addiction
    - Tolerance
    - Dependence
  2. Circulatory
    - Collapsed veins
  3. Heart
    - Infection of heart, lining & valves
  4. Respiratory
    - Pneumonia
  5. Liver
    - Decreased Function
40
Q

Sxs of Hallucinogens/PCP

A
  1. Possible Signs of use
    - Heighted senses
    - Loss of control
    - Loss of identity
    - Illusions & hallucinations
    - Altered perception of time & distance
  2. Extreme Reactions
    - Increased body temperature (MDMA)
    - Electrolyte imbalance
    - Cardiac arrest
    - A nightmare like trip (LSD)
    - Unable to direct movement, feel pain to remember

Behavioral Med: Test 4 (5 decks)

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