Substance and Addictive Disorders Flashcards
Consumption exceeds 14 standard drinks per week or 4 drinks/day for men and 7 drinks per week or 3 drinks/day for women.
Alcohol use disorder
Screening and early intervention for substance use disorders; if positive, screen with CAGE, Alcohol Use Disorders Identification Test (AUDIT), or other screening tool and motivational interviewing techniques.
Screening, Brief Intervention, and Referral to Treatment (SBIRT)
Lab values may include: elevated AST/ALT (above 35 IU/L), gamma-glutamyl transferase (GGT) levels above 48 U/L, elevated carbohydrate-deficient transferrin (CDT) which can detect drinking of 4-5 drinks/day over 2 weeks.
Alcohol use disorder
Signs and symptoms include tremors, htn, tachycardia, hyperthermia or body temp irregularities, nausea and vomiting, hallucinations, and seizures can occur 7 to 48 hours following cessation. Seizure risk can be managed using benzodiazepines as well as carbamazepine.
Alcohol withdrawal
Onset 48 to 72 hours following cessation, peaks on 4th day, can last for 2 weeks. Characterized by autonomic hyperactivity, confusion, disorientation, and usually requires hospitalization.
Delirium tremens
Recommended for early withdrawal monitoring. Scoring: 15 = immediate need for medication intervention, 8-14 = consider starting medications for symptoms management, 0-8 = need for supportive treatment and continued monitoring without medications.
Clinical Institute Withdrawal Assessment of Alcohol (CIWA-AR)
Neurological symptoms of confusion, ataxia, vision changes caused by biochemical lesions of the CNS following thiamine deficiency. If suspected or patient at risk, start prophylactic parenteral treatment using 250mg thiamine once daily for 3-5 days; if no improvement increase to 500mg for 3-5 days, then 250mg for 3-5 days.
Wernicke’s encephalopathy (WE)
Symptoms may occur minutes to days following cessation and may include dysphoric mood, insomnia, lacrimation or rhinorrhea, dilated pupils, N/V/D, yawning, piloerection, increased sweating, fever, poss. tachy, sneezing, abdominal cramps, or myalgia. Typically do not see cognitive disturbances.
Opiate withdrawal
Scale measuring withdrawal and indicating use of clonidine 0.1 to 0.2 mg every 6 hours. Scoring: 5-12 = mild, 13-24 = moderate, 25-36 = moderately severe, more than 36 = severe; 0-14 indicate start of care with clonidine; 15 or more increased clonidine use and potentially add other meds including methadone replacement. Scale used for measuring buprenorphine induction.
Clinical Opiate Withdrawal Scale (COWS)
Symptoms following heavy or prolonged use which develop within 1 week following cessation may include irritability, anxiety/nervousness, sleep disturbance, decreased appetite or weight loss, restlessness, depression, and symptoms of physical discomfort including abdominal pain, tremors, sweating, fever, chills, or headache. Or patients may have minimal or no symptoms at all.
Cannabis withdrawal
Symptoms may include increased energy, alertness, concentration, sexual stimulation, empathy, palpitations, bruxism, diaphoresis, decreased appetite or weight loss, mood enhancement, probable acute agitation, combative violence with toxicity, possible paranoia and hallucinations, anxiety, panic, and increased suicidality or destructive behaviors.
Stimulant use disorder/stimulant abuse
Symptoms may be similar to those of acute intoxication but these patients are at risk for dangerous and combative behaviors due to psychosis and altered cognitive function.
Stimulant withdrawal
