Substance Abuse - Week 5 Flashcards
Risk of developing ETOH overuse in women
10%
Risk of developing ETOH overuse in men
20%
What number of drinks increase risk for multiple diseases?
> 3
How much does someone decrease their lifespan with ETOH abuse?
decade of life
What drug is responsible for the most overdoses than any other substance?
ETOH
What is too many drinks a day for men?
4+
What are too man drinks a day for women?
3+
What is too many drinks a week for men?
14+
What are too many drinks a week for women?
7+
How many underage deaths a year?
4300
What causes the feel goodness of ETOH?
increase gaba (decrease anxiety. increase muscle relaxation)
increase DA
release beta endorphins
loss of inhibition
What are issues with ETOH abuse?
Impaired decision making Driving under influence Reckless behavior Exposure to STIs Legal trouble Work impairment Work injuries Impaired relationships / divorce
Disturbed sleep patterns with reduced REM time resulting a lack of restful and restorative sleep
blackouts
What are the effects of a hangover?
thirst, nausea, vomiting, fatigue
What are the neuro effects of ETOH abuse?
peripheral neuropathy
cerebellar atrophy
reduced vitamins –> wernicke’s encephalopathy and korsakoff syndrom
impaired congitive and memory impairment
What are the sxs in wernicke’s
opthalmoparesis, ataxia, encephalopathy
What are the sxs in korsakoff’s?
anterograde and retrograde amnesia
What are some co existing disorders with ETOH abuse?
Anxiety or panic disorder Depression Schizophrenia Bi-polar disorder Other substance abuse
What are GI issues in ETOH abuse?
GI bleeding Mallory-Weiss tears Boerhaave’s Rupture Acute pancreatitis Hepatitis Cirrhosis of the
What are the CA associated with ETOH?
breast, oral, esophageal, rectal
What are the heme issues with ETOH?
increase MCV. sideroblastic, thrombocytopenia
What are the cardiac effects of ETOH?
HTN, ^ LDL, CHF, paroxysmal atrial tachycardia
What is the USPSTF screening recommendation for ETOH in adults age 18 and older?
B
What is the USPSTF recommendation for screening kids for ETOH?
I
What are the screeners for ETOH?
AUDIT-C
CAGE
When are opportunities for ETOH intervention?
Routine physical examinations D.O.T. physical examinations Pre-college examinations Treatment for alcohol-related disease Evaluation of depression or mental health issue Treatment for alcohol-related injury After DUI arrest Prenatal visits
1-2 statements
Express concern about patient’s drinking
Advise they are over recommended limits and recommend stopping.
basic intervention
Two appointments separated by 4 weeks to discuss alcohol abuse and ramifications using motivational interviewing
Call patient half-way between appointments to reinforce change.
intermediate intervention
Perform brief or intermediate intervention + referral for treatment by an addiction specialist
advanced intervention
What are drug prices of heroin and oxycontin?
15 and 30
What is danger of heroin?
more powerful
unsure purity
cut with substances
What are the opioids?
oxycodone, hydrocodone, heroin morphine, merperidine, fentanyl
What are the clinical clues for heroin addict?
skin popping tracks disheveled less baths slurred speech pinpoint eyes
What are the effects of opioid use on society?
Increased cost to health care systems
Transmission of disease for drug users, such as HIV and Hepatitis C
Rise in crime such as shoplifting, burglary
Distress to family members (stealing from family members)
Risk to others (accidents)
What receptors do opioid influence?
mu, kappa, delta
What primary effect causes addiction in opioid?
mu due to mesolimbic reward pathway –> ventral tegmental to nucleus accumbens (dopaaminergic pthwya)
dopamine = reward
What is the timeline of heroin?
cross BB in 15-20 s
half life 30 min
duration 4-5 hr
What is dope sick and the sxs?
withdrawal from heroin, N/V/D, cramps. HTN, tachycardia, anxiety, irritability, insomnia
How do you tx heroin pt?
IMMEDIATE DRUG REHAB
Who is the typical cocaine user?
15-35 urban male
What drug causes highest rate of ED visits?
cocaine
What can cocaine cause?
MI
Prepared with sodium bicarbonate
Can be smoked - “crack” noise
Less commonly injected as it is insoluble in water
cocaine base aka crack or freebase
snorted
Melting occurs and destruction of molecule at temps needed to smoke
cocaine salt
What is the timeline for the two ways to use cocaine?
smoke - seconds
nose - 20-30 min
What are the effects of cocaine?
Energy Alertness of mind Sociability Euphoria Decreased appetite and sleep
What are the psychiatric effects of cocaine?
Anxiety Irritability Panic Suspicion Paranoia Delusions Hallucinations
What are the bad things cocaine can cause?
MI, increase temp, arrhythmias, szs, stroke, crack dancers
What happens when combine cocaine and ETOH?
additive effects of both
What are the long term effects of cocaine?
paranoid hallucinations nasal septum hep C due to nasal respiratory failure LVH, CMP sex dysfunction
How can you take meth?
snort, smoke, inject, oral
What does meth do?
block reuptake of DA, NE, serotonin
What is the half life of meth?
9-13 hrs
What can meth cause in the brain?
neurotoxicity
What are the effects of meth?
Increased energy, euphoria, alertness Increased talking, sweating, hypersexuality Bruxism Insomnia Decreased appetitie N/V/D Sympathetic cardiovascular effects
What are other drugs that are abused?
weed. benzo, tramadol, ketamine, MDMA, ADD/ADHD meds
What is the USPSTF screen for kids w/o substance use disorder?
I
What is the screening for kids, adults, and preg women for illicit drug use?
I
What is the best screen for illicit drug use?
“How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasons?”
Whats the real screener?
DAST 10
What are the consequences of bringing up illicit drug use and doing tox screen?
cost. distrust built, disclosure to insurance, refusal of tx
