Substance Abuse (Williams) - 10/18/16

Question 1

Substance Use Disorder

Need to meet 2 or more criteria in the last 12 months

Answer 1

Pharmacological

• Withdrawal
• Tolerance

Impaired Control

• Desire or unsuccessful efforts to cut down
• Craving; strong urges to use

Risky Use

• Use despite physical or psychological problems
• Use when it is hazardous

Social impairment

• Use despite problems in relationships
• Failure to fulfill roles (work, school, home)
• Reduced occupational and recreational activity

Question 2

Substance Use Disorder

• Mild
• Moderate
• Severe

Answer 2

• Mild (2-3 symptoms)
• Moderate (4-5 symptoms)
• Severe (6 or more)

Question 3

Controlled Substances Act

Schedule I-V

Answer 3

Schedule I: High potential for abuse; no medical use

• MDMA
• Heroin
• Marijuana
• LSD

Schedule II: High potential for abuse; medical use

• Cocaine
• Morphine
• PCP
• Methylphenidate (ritalin)
• Methamphetamine

Schedule III: Less potential for abuse

• Ketamine
• Codeine

Schedule IV: Low potential for abuse

• Benzodiazepines
• Zolpidem

Schedule V:

• Codeine cough medicines

Question 4

Screening Tests for Alcohol

Answer 4

• CAGE
  
  • C: have you ever felt you should cut down on your drinking?
  • A: have people annoyed you by criticizing your drinking?
  • G: Have you ever felt guilty about your drinking
  • E: eye opener: have you ever had a drink first thing in the morning to stedy your nerves or get rid of a hangover? (withdrawal)
  • TWO POSITIVE RESPONSES - POSITIVE TEST
• MAST (michigan alcohol screening test) /DAST
• AUDIT

Question 5

How many grams of pure alcohol are contained in a “drink?”

Answer 5

14 g

Question 6

Healthy Liver vs. Fatty Liver

Answer 6

Almost all heavy drinkers

Usually asymptomatic

Reversible

Question 7

Alcoholic Cirrhosis

Answer 7

• Portal HTN
  
  • ​Hepatosplenomegaly (splenic vein)
  • Caput medusae (umbilical vein)
  • Esophageal varices (esophageal veins)
  • Hemorrhoids (internal hemorrhoidal veins)
• Detoxifying function
  
  • Dec. androgens
    
    • Gynecomastia
    • Testicular atrophy
    • Spider angioma (vascular changes in skin)
    • Decreased axillary or pubic hair
  • Ammonia
    
    • Asterixis (flapping hand tremor)
    • Delirium
    • Encephalopathy
• Synthesizing function
  
  • Glucose
  • Albumin (ascites- abdominal swelling, edema)
  • Coagulation factors (ecchymoses)
  • Bilirubin (jaundice, scleral icterus)
• Storage function
  
  • Thiamine (B1)
  • Folate
    
    • Macrocytic anemia- pallor
  • Pyridoxine (B6)
    
    • Pallor - anemia

Question 8

Blood Alcohol Level

Answer 8

Explanation of BAC levels :

.020 - Light to moderate drinkers begin to feel some effects
.040 - Most people begin to feel relaxed
.060 - Judgment is somewhat impaired
.080 - Definite impairment of muscle coordination and driving skills. This is the legal intoxication level in most states..100 - Clear deterioration of reaction time and control. This is legally drunk in all states.
.120 - Vomiting usually occurs
.150 - Balance and movement are impaired. Here the equivalent of a 1/2 pint of whiskey is circulating in the blood stream.
.200 - Most people begin to experience blackouts
.300 - Many people lose consciousness
.400 - Most people lose consciousness and some die
.450 - Breathing stops. This is a fatal dose for most people.

Question 9

Alcohol Intoxication

One (or more) of the following symptoms

Answer 9

• Slurred speech
• Incoordination
• Unsteady gauit
• Memory or attention impairement
• Stupor or coma
• Nystagmus

Question 10

What’s in a standard urine drug screen?

Answer 10

Question 11

Liver Function Tests for alcohol

Answer 11

• GGT
  
  • Best for specificity for alcohol
  • >35
  • Good marker for heavy drinking
  • Normalizes ~5 weeks of abstinence
• AST and ALT
  
  • AST:ALT ratio > 2 suggestive of alcohol
  • Less sesnsitive than GGT

Question 12

Wernicke Encephalopathy

Cause:

Source:

Triad:

Answer 12

• Cause:
  
  • Acute dec. thiamine (B1)
• Source:
  
  • Dietary depletion
• Triad (usually reversible):
  
  • Confusion
  • Ataxia (incoordination)
  • Ophthalmoplegia (eye muscle paralysis)
    
    • Usually affects lateral rectus

Question 13

Korsakoff’s Syndrome

Answer 13

Cause: chronic thiamine (B1); not reversible

Bilateral involvement of mammillary bodies

• Impaired memory in alert, responsive patient
• Confabulation–makes up stories
• Retrograde and anterograde memory loss

Question 14

Alcohol Treatment:

1-3 steps

Answer 14

1. Intervention
2. Detoxification
3. Rehabilitation

Question 15

Alcohol’s Effects on Inhibitory Neurotransmission

During usage vs. during withdrawal

Answer 15

During Usage:

• Dec. GABA receptor sensitivity –> tolerance
• NMDA receptor antagonist

During Withdrawal:

• Dec. GABA receptor function –> excitation

Question 16

Course of alcohol withdrawal

Stage I-IV

Answer 16

Stage I (12-48 hrs)

• Peak severity at 36 hrs
• 90% of AW seizures

Stage II (48-72 hrs)

• Inc. Stage I symptoms

Stage III (72-105 hrs)

• “Delirium Tremens”
  
  • Medical emergency b/c autonomic instability (going into shock)

IV (>7 days)

• Protracted withdrawal

Question 17

Treatment of alcohol withdrawal

Answer 17

• Benzodiazepine taper (4-6 days)
  
  • All are effective
  • Increased GABA_AR function
  • Decreased seizures
• Carbemazapine, phenobarbital
• Thiamine and MVI
• Fluid/electrolytes (Magnesium and K)
• Frequent vitals