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Substance Abuse Disorders Flashcards

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1
Q

Criteria for Substance Use Disorder dignosis

A

maladaptive patterns of substance use that impair work, physical, social functioning

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2
Q

Substance induced disorder

A

induced disorder: intoxication and withdrawal

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3
Q

What drugs fall under stimulant use disorders?

A

amphetamines

cocaine

***dilated pupils

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4
Q

What drugs fall under sedatives/hypnotics/anxiolytic use disorders?

A

benzos

barbiturates

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5
Q

What drugs fall under hallucinogen use disorders?

A

LSD

PCP

Synthetics (K2, bath salts, molly/ecstasy)

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6
Q

What drugs fall under opioid use disorders?

A

morphine

heroin

codeine

methadone

***constricted pupils

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7
Q

Define at risk drinking

A

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

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8
Q

Define moderate drinking

A

men: 2 drinks or fewer per day

females and over 65: 1 or fewer per day

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9
Q

List childhood factors that can lead to alcohol abuse

A

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

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10
Q

Describe social/culture factors that can lead to alcohol abuse

A

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

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11
Q

When can you diagnose alcohol abuse?

A

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
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12
Q

Describe tolerance

A

need for increased amounts to achieve desired effect

diminished effect with continued use of same amount

sign of dependence

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13
Q

Describe sx of alcohol withdrawal

A 
autonomic hyperactivity
increased hand tremor
insomnia
N/V
hallucinations
psychomotor agitation
seizures
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14
Q

What are 3 things that can be fatal with sudden withdrawal?

A

3 Bs

booze
benzos
barbiturates

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15
Q

Clinical presentation of alcohol abuse

A

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

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16
Q

What questions to ask alcoholic

A

CAGE

cut down, annoyed, guilty, early-morning to get through day or eliminate shakes

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17
Q

List some alcohol induced disorders

A 
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)
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18
Q

Medical complications of alcohol abuse

A

decreased REM, awaken form sleep

fatty liver, cirrhosis, alcoholic hepatitis

GI varices, ulcers, pancreatitis

MI, cardiomyopathy, stroke

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19
Q

Blood levels of alcohol

A 
.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)

20
Q

Signs of alcohol intoxication

A 
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

21
Q

Signs of alcohol withdrawal

A

delirium tremens—> 30% MORTALITY if not treated

  • -> tremulousness
  • -> delusions
  • -> hallucinations
  • -> seizures

around day 3, up to 2 weeks

22
Q

Treatment of alcohol withdrawal

A 
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

23
Q

What drug is used to maintain abstinence in alcoholics following withdrawal?

A

acamprosate

reduces voluntary ingestion of alcohol via inhibition of GABA, also antagonizes receptor

doesn’t treat withdrawal or prevent intoxication

24
Q

What drug is used to reduce alcohol cravings?

A

Naltrexone (opioid antagonist)

improves abstinence

can be injected monthly

25
Q

What is disulfram?

A

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

26
Q

Signs of stimulant intoxication

A

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

27
Q

Signs of stimulant withdrawal

A 
increased sleep
nightmares
increased appetite
depression
suicide attempts
craving for drug

won’t die–> just sleep and eat

28
Q

Treatment for stimulant withdrawal

A

antidepressants, hospitalization

phentolamine for hypertension and hyperthermia

Halperidol (Haldol) for psychotic sx

29
Q

Sx of sedatives/hypnotics/anxiolytic intoxication

A

AKA benzos and barbiturates

euphoria

increased seizure threshold

sedation, coma

RESPIRATORY DEPRESSION

depressed reflexes

hypotension

hypoxemia

hypothermia

30
Q

Treatment of sedative intoxication

A

protect airway
oxygen
ventilation
prevent loss of body heat

forced diuresis with alkalinization of urine

hemodialysis

31
Q

Sx of sedative withdrawal

A

FATAL****

anxiety/agitation
orthostatic hypotension
weakness/tremulousness
hyperreflexia
diaphoresis
delirium
seizures
32
Q

Tmt of sedative withdrawal

A

phenobarbital

weans pt off sedatives

33
Q

Signs of hallucinogen intoxication

A

AKA LSD and PCP

DILATED pupils
increased heart rate, BP
paranoia
anxiety
hallucinations

PCP–> violent behavior, hyperactivity, nystagmus, muscular rigidity, seizures

34
Q

Tmt of hallucinogen intoxication

A

diazepam

sedation with Haldol/haloperidol if violent

35
Q

Sx of hallucinogen withdrawal

A

flashbacks of hallucinogenic state

–> several days to weeks

36
Q

Tmt of hallucinogen withdrawal

A

reassurance

benzo

37
Q

Sx of opioid intoxication

A

AKA morphine, heroin, codeine, methadone

analgesia /t LOC
apathy/lethargy
euphoria
itching
CONSTRICTED pupils
constipation
flushed, warm skin

RESP Depression

hypotension and depressed reflexes

38
Q

Tmt of opioid intoxiation

A

supportive care

NARCAN (naloxone)

  • -> reverse coma and apnea
  • –> causes vomiting
  • -> intranasal
39
Q

Sx of opioid withdrawal

A

lacrimation, rhinorrhea, coryza

sweating

restlessness/sleepiness

gooseflesh

DILATED pupils

irritability

violent yawning

craving

NOT FATAL

40
Q

Tmt of opioid withdrawal

A

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

41
Q

Advantages/Disadvantages of Buprenorphine

A

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

42
Q

Advantages/Disadvantages of methadone

A

+:
-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
43
Q

What meds to stop while pt is in hospital (recovering opioid addict)?

A

buprenorphine/naloxone (restart on discharge)

continue methadone and treat pain

44
Q

What is K2?

A

synthetic cannabis

–> really bad

45
Q

What is molly?

A

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

46
Q

What is wet?

A

cocktail of PCP mixed with formaldehyde and dipped into cigarettes

47
Q

Tmt for molly intoxication

A

hypertonic saline solution (slow)

hyperthermia ice bath for rapid cooling

benzo for psychomotor agitation and shivering

cyproheptadine for signs of serotonin syndrome

Psych (12 decks)

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