Substance Abuse Disorders Flashcards
Criteria for Substance Use Disorder dignosis
maladaptive patterns of substance use that impair work, physical, social functioning
Substance induced disorder
induced disorder: intoxication and withdrawal
What drugs fall under stimulant use disorders?
amphetamines
cocaine
***dilated pupils
What drugs fall under sedatives/hypnotics/anxiolytic use disorders?
benzos
barbiturates
What drugs fall under hallucinogen use disorders?
LSD
PCP
Synthetics (K2, bath salts, molly/ecstasy)
What drugs fall under opioid use disorders?
morphine
heroin
codeine
methadone
***constricted pupils
Define at risk drinking
men: more than 14 drinks per week or more than 4 per occasion
female: more than 7 drinks per week or more than 3 per occasion
Define moderate drinking
men: 2 drinks or fewer per day
females and over 65: 1 or fewer per day
List childhood factors that can lead to alcohol abuse
environmental stressors: abuse, around alcohol so started drinking or saw alcoholic parents
ADHD
conduct or antisocial personality disorders: under 18, act inappropriate in public with rage, start fires, kill animals
—> AKA psychopaths and sociopaths
Describe social/culture factors that can lead to alcohol abuse
Native Americans have highest rates of abuse
More frequent in non-African American races
—> HOWEVER, AA more likely to need tmt but don’t get it
Low rates in Asians
When can you diagnose alcohol abuse?
clinically significant impairment or distress of 2+ in a 12 month period:
- alcohol in large amounts over longer period of time than was intended
- persistent desire or ineffective efforts to cut down
- excessive amount of time trying to get alcohol or recover
- cravings
- recurrent use despite failures to meet obligations
Describe tolerance
need for increased amounts to achieve desired effect
diminished effect with continued use of same amount
sign of dependence
Describe sx of alcohol withdrawal
autonomic hyperactivity increased hand tremor insomnia N/V hallucinations psychomotor agitation seizures
What are 3 things that can be fatal with sudden withdrawal?
3 Bs
booze
benzos
barbiturates
Clinical presentation of alcohol abuse
solitary drinking with rationalization about their need to drink
daily or frequent drinking to function
loss of control over drinking, defensive, hostile
neglect food intake, physical appearance, hygiene
N/V, shaking in the morning, confusion
What questions to ask alcoholic
CAGE
cut down, annoyed, guilty, early-morning to get through day or eliminate shakes
List some alcohol induced disorders
intoxication, withdrawal delirium (wernicke/korsakoff) dementia amnesic disorder psychotic disorder mood disorder sexual dysfunction d/t neuropathy sleep disorder (alcohol pass out but doesn't keep you asleep)
Medical complications of alcohol abuse
decreased REM, awaken form sleep
fatty liver, cirrhosis, alcoholic hepatitis
GI varices, ulcers, pancreatitis
MI, cardiomyopathy, stroke
Blood levels of alcohol
.05 judgement and restraint impaired .08 legally intoxicated .30 stupor .4-.5 coma over .5 death
with chronic drinkers, can be way higher without meeting these criteria (can have .4 and be walking/talking)
Signs of alcohol intoxication
slurred speech loss of coordination unsteady gait nystagmus ------------> above checked by police impaired attention or memory stupor or coma
mild: overconfidence, mood swings, increased pain threshold, N/V
severe: hypothermia, tachy, dilated pupils, slow respirations, increased ICP
Signs of alcohol withdrawal
delirium tremens—> 30% MORTALITY if not treated
- -> tremulousness
- -> delusions
- -> hallucinations
- -> seizures
around day 3, up to 2 weeks
Treatment of alcohol withdrawal
benzos antipsychotics only when necessary (if delirium tremens) fluids (help mag, potassium) vitamins (thiamine, folic acid) restraints if needed
if conscious, wait it out with IV thiamine/fluids
What drug is used to maintain abstinence in alcoholics following withdrawal?
acamprosate
reduces voluntary ingestion of alcohol via inhibition of GABA, also antagonizes receptor
doesn’t treat withdrawal or prevent intoxication
What drug is used to reduce alcohol cravings?
Naltrexone (opioid antagonist)
improves abstinence
can be injected monthly
What is disulfram?
antabuse drug–> alcohol intake is deterrent
produces adverse effects if drinks alcohol: flushing, tachy, SOB, N/V, throbbing headache, visual shit
some don’t have sx or have sx that can be tolerated–> decreased abstinence effectiveness
Signs of stimulant intoxication
AKA meth, cocaine, Adderall
hypervigilance anxiety/irritable insomnia, exhaustion hyperthermia loss of appetite and weight hallucinations DILATED pupils elevated BP and pulse seizures
pick at skin–> lesions
necrotic teeth
Signs of stimulant withdrawal
increased sleep nightmares increased appetite depression suicide attempts craving for drug
won’t die–> just sleep and eat
Treatment for stimulant withdrawal
antidepressants, hospitalization
phentolamine for hypertension and hyperthermia
Halperidol (Haldol) for psychotic sx
Sx of sedatives/hypnotics/anxiolytic intoxication
AKA benzos and barbiturates
euphoria
increased seizure threshold
sedation, coma
RESPIRATORY DEPRESSION
depressed reflexes
hypotension
hypoxemia
hypothermia
Treatment of sedative intoxication
protect airway
oxygen
ventilation
prevent loss of body heat
forced diuresis with alkalinization of urine
hemodialysis
Sx of sedative withdrawal
FATAL****
anxiety/agitation orthostatic hypotension weakness/tremulousness hyperreflexia diaphoresis delirium seizures
Tmt of sedative withdrawal
phenobarbital
weans pt off sedatives
Signs of hallucinogen intoxication
AKA LSD and PCP
DILATED pupils increased heart rate, BP paranoia anxiety hallucinations
PCP–> violent behavior, hyperactivity, nystagmus, muscular rigidity, seizures
Tmt of hallucinogen intoxication
diazepam
sedation with Haldol/haloperidol if violent
Sx of hallucinogen withdrawal
flashbacks of hallucinogenic state
–> several days to weeks
Tmt of hallucinogen withdrawal
reassurance
benzo
Sx of opioid intoxication
AKA morphine, heroin, codeine, methadone
analgesia /t LOC apathy/lethargy euphoria itching CONSTRICTED pupils constipation flushed, warm skin
RESP Depression
hypotension and depressed reflexes
Tmt of opioid intoxiation
supportive care
NARCAN (naloxone)
- -> reverse coma and apnea
- –> causes vomiting
- -> intranasal
Sx of opioid withdrawal
lacrimation, rhinorrhea, coryza
sweating
restlessness/sleepiness
gooseflesh
DILATED pupils
irritability
violent yawning
craving
NOT FATAL
Tmt of opioid withdrawal
buprenorphine or methadone
buprenorphine and naloxone
- -> suboxone
- -> requires specialized training and DEA number
clonidine for elevated BP
diphenhydramine for itching and rhinorrhea
imodium for diarrhea
Advantages/Disadvantages of Buprenorphine
with or without naloxone
+:
-not an opioid (partial ag/antag @ opioid receptor, minimal chance of overdose)
- prescribed by physician with special training
- not long term
- helps with mild-moderate pain
-:
-cost
-finding legitimate
licensed providers
Advantages/Disadvantages of methadone
+:
-available through licensed clinics without prescription
-long half life (if missed dose, won’t withdraw)
- :
- not closely monitored
- have to go to clinic daily
- doses are high–> prolonged QT/cardiac issues
- pt remain opioid dependent
What meds to stop while pt is in hospital (recovering opioid addict)?
buprenorphine/naloxone (restart on discharge)
continue methadone and treat pain
What is K2?
synthetic cannabis
–> really bad
What is molly?
MDMA/ecstasy
hyperthermia, jaw clenching and teeth grinding
nystagmus, dilated pupils
tremors
tachy, increased BP
psychogenic polydipsia
hyponatremia, CEREBRAL EDEMA
sensation of chills
auditory hallucinations
orthostatic issues
What is wet?
cocktail of PCP mixed with formaldehyde and dipped into cigarettes
Tmt for molly intoxication
hypertonic saline solution (slow)
hyperthermia ice bath for rapid cooling
benzo for psychomotor agitation and shivering
cyproheptadine for signs of serotonin syndrome
