Substance Abuse, Psychoactive Drugs

Question 1

Maladaptive pattern of substance abuse defined as 3 or more of the following signs in 1 year:

1. Tolerance - need more to achieve the same effect
2. Withdrawal
3. Persistent desire or unsuccessful attempts to cut down
4. Significant energy spent obtaining, using or recovering from substance
5. Important social, occupational, or recreational activities reduced because of substance abuse
6. Continued use in spite of knowing problems it causes

Answer 1

Substance dependence

Question 2

Maladaptive pattern leading to clinically significant impairment or distress:

• Recurrent use resulting in failure to fulfill major obligations at work, school, or home
• Recurrent use in physically hazardous situation
• Recurrent substance-related legal problems
• Continued use in spite of persistent problems caused by use

Answer 2

Substance abuse

Question 3

Stages of change in overcoming substance addiction - not yet acknowledging that there is a problem

Answer 3

1. Precontemplation

Question 4

Stages of change in overcoming substance addiction - acknowledging that there is a problem, but not yet ready or willing to make a change

Answer 4

2. Contemplation

Question 5

Stages of change in overcoming substance addiction - getting ready to change behavior

Answer 5

3. Preparation/determination

Question 6

Stages of change in overcoming substance addiction - changing behaviors

Answer 6

4. Action/willpower

Question 7

Stages of change in overcoming substance addiction - maintaining behavior change

Answer 7

5. Maintenance

Question 8

Stages of change in overcoming substance addiction - returning back to old behaviors and abandoning new changes

Answer 8

6. Relapse

Question 9

Emotional lability, slurred speech, ataxia, coma, blackouts

Answer 9

Alcohol intoxication

Question 10

Serum GGT is a sensitive indicator of

Answer 10

Alcohol use

Question 11

Lab AST is twice ALT

Answer 11

Alcohol use

Question 12

Autonomic hyperactivity and delirum tremens

Answer 12

Severe Alcohol Withdrawal (use benzos for DT)

Question 13

Euphoria, respiratory and CNS depression, decreased gag reflex, pupillary constriction (pinpoint pupils), seizures (OD).

Answer 13

Opioid intoxication

Treatment: Naloxone, Naltrexone

Question 14

Sweating, dilated pupils, piloerection (“cold turkey”), fever, rhinorrhea, yawning, nausea, stomach cramps, diarrhea (“flu-like symptoms”)

Answer 14

Opioid withdrawal

Treatment: Methadone, Buprenorphine (partial agonist)

Question 15

Low safety margin, marked respiratory depression

Answer 15

Barbiturate intoxication

Treatment: Assist respiration, BP

Question 16

Delirium, life-threatening CVD collapse

Answer 16

Barbiturate Withdrawal

Question 17

Greater safety margin. Ataxia, minor respiratory depression.

Answer 17

Benzodiazepine intoxication

Treatment: Flumazenil

Question 18

Sleep disturbance, depression, rebound anxiety, seizure (severe).

Answer 18

Benzo withdrawal

Question 19

Euphoria, grandiosity, pupillary dilation, prolonged wakefulness and attention, hypertension, tachycardia, anorexia, paranoia, fever. Severe: cardiac arrest and seizure

Answer 19

Amphetamine intoxication

Treat overdose with ammonium chloride to acidify urine (amphetamine is a weak base)

Question 20

Anhedonia, increased appetite, hypersomnolence, existential criss

Answer 20

Amphetamine withdrawal

Question 21

Impaired judgment, pupillary dilation, hallucinations (including tactile), paranoid ideations, angina, sudden cardiac death

Answer 21

Cocaine intoxication

Treatment: Benzodiazepines

Question 22

Hypersomnolence, malaise, severe psychological craving, depression/suicidality

Answer 22

Cocaine withdrawal

Question 23

Retlessness, increased diuresis, muscle twitching

Answer 23

Caffeine intoxication

Question 24

Lack of concentration, headache

Answer 24

Caffeine withdrawal

Question 25

Restlessness

Answer 25

Nicotine intoxication

Question 26

Irritability, anxiety, craving.

Answer 26

Nicotine withdrawal
Treatment: Nicotine patch, gum, or lozenges.

Buproprion/Varenicline (partial nicotinic agonist)

Question 27

Belligerence, impulsiveness, fever, psychomotor agitation, analgesia, vertical and horizontal nystagmus, tachycardia, homicidality, psychosis, delirium, seizures

Answer 27

PCP intoxication

Treatment: Benzos, rapid-acting antipsychotic

Question 28

Depression, anxiety, irritability, restlessness, anergia, disturbances of thought and sleep

Answer 28

PCP withdrawal

Question 29

Perceptual distortion (visual, auditory), depersonalization, anxiety, paranoia, psychosis, possible flashbacks

Answer 29

LSD

Question 30

Euphoria, anxiety, paranoid delusions, perception of slowed time, impaired judgment, social withdrawal, increased appetite, dry mouth, conjunctival injection, hallucinations.

Answer 30

Marijuania/cannabinoid intoxication

Prescription form is Dronabinol - used as anti-emetic (chemo) and appetite stimulant (AIDS)

Question 31

Irritability, depression, insomnia, nausea, anorexia. Most symptoms peak in 48 hours and last for 5-7 days. Generally detectable in urine for 4-10 days.

Answer 31

Marijuana/cannabinoid withdrawal

Question 32

Heroin addiction treatment

Answer 32

1. Methadone - long acting oral opiate, used for heroin detoxification or long-term maintenance
2. Naloxone (antagonist) + Buprenorphine (partial agonist) –> naloxone is not active when taken orally, but if injected, it will cause severe withdrawal symptoms, making it have a lower abuse potential

Question 33

Life-threatening alcohol withdrawal syndrome that peaks 2-5 days after last drink. Symptoms in order of appearance: autonomic system hyperactivity (tachy, tremors, anxiety, seizures), psychotic symptoms (hallucinations, delusions), confusion

Answer 33

DTs

Treatment: Benzos