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Behavioral Health > Substance Disorders & Treatment > Flashcards

Substance Disorders & Treatment Flashcards

1
Q

Define Substance Use

A

Sporadic consumption of alcohol/drugs with no adverse consequences

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2
Q

Define Abuse

A

Frequency of alcohol/drug use may vary, there are adverse consequences experienced by the user
Increase in the frequency to eventually all day

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3
Q

Define Physical Dependence

A

State of adaptation that is manifested by a drug class-specific withdrawal syndrome

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4
Q

Define Psychological Dependence

A

Subjective need for a specific psychoactive substance, either for its positive effect or to avoid negative effects of its abstinence
Positive: euphoric
Negative: withdrawal

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5
Q

Define Addiction

A

Primary, chronic, neurobiology disease, with genetic, psychosocial, & environmental factors

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6
Q

What is addiction characterized by?

A

Behaviors that include impaired control over drug use, compulsive use, continued use despite harm & craving

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7
Q

Define Tolerance

A

Must increase dose of the substance to get the high associated with the substance

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8
Q

Special Populations with Increase Risk of Substance Abuse

A 
Adolescents
Anyone with a psychiatric comorbidity
Those who smoke or who abuse alcohol
Elderly
Health care workers
Pregnant women
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9
Q

What questions to ask for each substance the patient uses?

A 
Quantity
Amount $ daily/weekly/monthly
Frequency of use & time of last use
Route of administration
Prior detox or addiction treatment & abstinence periods
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10
Q

Physical Changes in Substance Abuse

A 
Impotence
Weight loss
Sleep disturbance
Localized or systemic infections
Enlarged/shrunken liver
Respiratory or nasal problems
Track marks
STI's
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11
Q

CAGE Questionnaire

A

C: cut down on drinking
A: annoyed by criticism of your drinking
G: guilty about drinking
E: eye-opener (morning)

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12
Q

Define risky or hazardness drinking

A

Men 14 drinks/week

Women 7 drinks/week

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13
Q

Define Unhealthy Alcohol Use

A

Uses that can result in health consequences

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14
Q

Alcohol abuse is associated with one or more of the following occurring in a 12-month period

A

Failure to fulfill work, school or social obligations
Recurrent substance use in physically hazardous situations
Recurrent legal problems related to substance use
Continued use despite alcohol-related social or interpersonal problems

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15
Q

Alcohol dependece is a maladaptive patterns of use associated with 3 or more of the following, occurring at any time in the same 12-month period

A

Tolerance
Withdrawal
Substance taken in larger quantity than intended
Persistent desire to cut down or control use
Time spent obtaining, using, or recovering from the substance
Social, occupational or recreational tasks are sacrificed
Use continues despite physical & psychosocial problems

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16
Q

Medical Morbidity with Alcohol Abuse

A

HTN, cardiomyopathy
Hepatitis, cirrhosis, pancreatitis
TB, pneumonia
Anxiety, depression & eating disorders
CA of the stomach, mouth, larynx, breast, & esophagus

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17
Q

Screening Tools for Alcohol Use/Abuse

A

Alcohol Use Disorders Identification Test (AUDIT)

CAGE questions

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18
Q

Which patients are essential for screening for alcohol use/abuse?

A

+ family history
Smoke
Frequent ER visits
On meds that interact with ETOH

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19
Q

Screening Tool for Adolescents & College Students

A

CRAFFT

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20
Q

What does CRAFFT stand for?

A

ridden in Car driven by someone
alcohol or drugs to Relax, feel better about yourself, or fit in
alcohol or drugs while Alone
Forget things while on alcohol/drugs
family/Friends tell you to cut down on drinking/drug use
Trouble while using alcohol/drugs

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21
Q

Define Moderate Drinking

A

Men:

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22
Q

Define Heavy Drinking

A

Men: >14 drinks/week or >4 drinks/occasion

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23
Q

Define Binge Drinking

A

Men: 5+ drinks in a row
Women: 4+ drinks in a row

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24
Q

Define drink of 80-proof liquor

A

1.5 fluid ounces

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25
Q

Define drink of wine

A

5 fluid ounces

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26
Q

Define drink of beer or wine cooler

A

12 fluid ounces

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27
Q

Etiology of Alcohol-Related Disorders

A

Psychosocial factors
Genetic factors
Behavioral factors

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28
Q

How does genetics play a factor in alcohol-related issues?

A

3-4 x higher for ETOH problems in first degree relatives with ETOH problems
Problems increase with # of alcoholic relatives & severity

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29
Q

What does pylorospasm result in?

A

Vomiting

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30
Q

What 2 enzymes metabolize alcohol?

A 
Alcohol dehydrogenase (ADH)
Aldehyde dehydrogenase (ALDH)
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31
Q

Effects of Alcohol on the Brain

A

CNS depression

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32
Q

Effects of Alcohol on the Brain with Relatively Mild Levels

A

Thought, judgement, & restraint are loosened

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33
Q

Effects of Alcohol on the Brain with Increasing Levels

A

Voluntary muscle dysfunction & entire motor area of the brain depressed (walking, stupor)

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34
Q

Effects of Alcohol on the Brain with “Yet Increasing Levels”

A

Confusion, stupor, coma and primitive centers that control breathing & HR are affected & can result in death due to secondary to direct respiratory depression or aspiration of vomitus

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35
Q

Effects of Alcohol on the Liver

A

Metabolism leads to chemical attack on the liver

Processes that damage liver cells may continue for weeks to months

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36
Q

What are the 3 patterns of hepatocellular injury?

A

Fatty liver
Alcoholic hepatitis
Cirrhosis

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37
Q

What is caused by thiamine deficiency due to poor nutrition/malabsorption?

A

Wenicke-Korsakoff Syndrome

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38
Q

Define Wernicke’s Encephalopathy

A

Acute symptoms which are reversible when treated with high dose thiamine

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39
Q

What is Wernicke’s Encephalopathy characterized by?

A 
Gait ataxia
Vestibular dysfunction
Confusion
Ocular abnormalities
Nystagmus
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40
Q

Define Korsakoff’s Syndrome

A

Chronic condition
20% recover
PO thiamine

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41
Q

Korsakoff’s Syndrome Characterized by

A

Impaired recent memory
Anterograde amnesia
Brain injury

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42
Q

Short Term Goals for Treating Alcohol Dependence

A

ID & initiate treatment for pets. at risk for withdrawal
Promote attendance at AA & support groups
Early intervention

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43
Q

Long Term Goals for Treating Alcohol Dependence

A

Extended management over time

Determine efficacy of treatment

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44
Q

Mild Symptoms of Alcohol Withdrawal

A 
Insomnia
Tremulousness
Mild anxiety
GI upset/anorexia
Headache
Diaphoresis
Palpitations
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45
Q

Alcohol Withdrawal Seizures

A

Occur within 48 hours after last drink
Tonic-clonic
3% of chronic alcoholics
Treat with benzodiazepines

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46
Q

Alcoholic Hallucinosis

A

12-24 hours of last drink
Resolves 24-48 hours
Not delirium tremens
Usual visual

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47
Q

Agents that should NOT be used Routinely

A 
Ethanol
Antipsychotics
Anticonvulsants
Central acting alpha-2 agonists
Beta-blockers
Baclofen
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48
Q

Symptoms/Signs of Delirium Tremens

A 
Hallucinations
Disorientation
Tachycardia
HTN
Low grade fever
Agitation
Diaphoresis
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49
Q

Delirium Tremens

A

48-96 hours after last drink

Last 1-5 days

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50
Q

Risk Factors for Delirium Tremens (DT)

A 
Hx of sustained drinking
Hx of previous DTs
Age >30
Concurrent illness
Mortality rate: 5%
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51
Q

Treatment of Minimal Delirium Tremens

A

Thiamin

Supportive care

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52
Q

Treatment of Mild Delirium Tremens

A

Thiamin
Supportive care
Medications to reduce symptoms & monitoring

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53
Q

Treatment of Moderate & Severe Delirium Tremens

A

Thiamin
Supportive care
Hourly monitoring
Benzodiazepines

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54
Q

Which benzodiazepines are used?

A

Diazepam (Valium)
Chlordiazepoxide (Librium)
Lorazepam

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55
Q

Scheduled Targeted Treatment of Delirium Tremens

A

4-6 hours on the clock

Fairly sedated

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56
Q

Symptom Targeted Treatment of Delirium Tremens

A

Treat symptoms

More alert

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57
Q

Treatment of Refractory Delirium Tremens

A

Add phenobarbitol or propofol

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58
Q

Outpatient Therapy of Alcoholism

A

Acomprosate (Campral)

Disulfiram (Antabuse)

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59
Q

SE of Acomprosate (Campral)

A 
Diarrhea
Low pulse
High or low BP
Headaches
Impotence
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60
Q

Contraindication of Acomprosate (Campral)

A

Kidney disease

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61
Q

MOA of Disulfiram (Antabuse)

A

Inhibits the activity of acetaldehyde dehydrenase (ALDH)

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62
Q

What does disulfiram (Antabuse) lead to if the patient drinks?

A 
Flushing
Dyspnea
N/V
Headache
Blurred vision
Vertigo
Anxiety
63
Q

Disulfiram (Antabuse) SE

A

Hepatotoxic
Depression
Psychosis

64
Q

What do you need to monitor with Disulfiram (Antabuse)

A

LFTs

Psychologically

65
Q

Examples of Stimulants

A

Methamphetamine

Cocaine

66
Q

MOA of Methamphetamine

A

Displaces epinephrine, norepinephrine, dopamine, & serotonin into synaptic cleft

67
Q

Signs/Symptoms of Methamphetamine

A 
High energy
Tachycardia
Pupil dilation
Increased BP
Psychosis
Agitation
68
Q

How is methamphetamine absorbed?

A 
Oral
Pulmonary
Nasal
IM
IV
Rectal
Vaginal routes
Body stuffing
69
Q

General Appearance of Methamphetamine Intoxicated Patient

A

Malnourished, agitated, disheveled
Severe intoxication has changes in behavior & become violent
“Meth mouth”

70
Q

Vital Signs in a Methamphetamine Intoxicated Patient

A

Tachycardic
HTN
Hyperthermic

71
Q

Signs/Symptoms of Methamphetamine Intoxication

A

N/V
Seizures
Delirium
Psychosis

72
Q

Differential Diagnosis of Methamphetamine Intoxication

A 
Cocaine & PCP
Theophylline & aspirin overdoses
MAOI, seretonin syndrome, anticholinergic poisoning
Heat stroke
Thyrotoxicosis
Pheochromocytoma
73
Q

Treatment for Methamphetamine Intoxication

A

Sedation for agitation
Protect airway
Control BP & temp

74
Q

Risk of Methamphetamine Intoxication Treatment

A

CV collapse

75
Q

MOA of Cocaine

A

Blocks presynaptic reuptake pumps for dopamine, norepinephrine, & serotonin
Blocks voltage-gated membrane sodium ion channels

76
Q

Methods of Cocaine Ingestion

A

“Crack, freebase”: smoked
Salt: injected or snorted
ETOH forms: cocaethylene

77
Q

Intended Effects of Cocaine Intoxication

A

Increased energy, alertness, sociability
Elation or euphoria
Decreased fatigue, need for sleep, & appetite
“Total body orgasm”

78
Q

Adverse Effects of Cocaine Intoxication

A 
Anxiety
Irritability
Panic attacks
Paranoia
Grandiosity
Impairment in judgment
Psychotic symptoms
79
Q

Physiological Effects of Cocaine Intoxication

A

Tachycardia
Pupil dilation
Diaphoresis
Nausea

80
Q

CV Effects of Cocaine Intoxication

A

Arterial vasoconstriction
Enhanced thrombus formation
Tachycardia
HTN

81
Q

CNS Effects of Cocaine Intoxication

A 
Agitation
Seizures
Headache
Coma
Intracranial
hemorrhage
82
Q

Lung Effects of Cocaine Intoxication

A

Smoked: angioedema & pharyngeal burns

Passive exposure: can present with toxicity

83
Q

Stimulant Intoxication Management Initial Labs

A

Fingerstick glucose
Acetaminophen & salicylate levels
EKG
Pregnancy test

84
Q

Specific Management for Stimulant Intoxication

A

Toward patient’s condition

Toward symptomatic problems

85
Q

Three Drug Products of Cannibis (Marijuana)

A

Herbal cannabis: dry leaves/flowers
Hashish: pressed, dry resin or secretion
Hash oil: oil

86
Q

Who uses cannabis more?

A

Men > Women

Blacks > Whites & hispanics

87
Q

What is cannabis use associated with?

A

Alcohol dependence

Another illicit drugs

88
Q

Co-morbid Mental Illnesses with Cannabis Use

A

Mood disorders

Anxiety disorders

89
Q

What does cannabis do for a persons psychosocially?

A

Relieve tension & cope with stress
Young adults feel it’s harmless
Leads to school dropout, use other illicit drugs, interpersonal problems, crime & unemployment

90
Q

Cannabis Effects on Mood, Perception, & Thought Content

A 
Euphoria, decreases anxiety, & tension
Time perception distorted
Increased self consciousness
Transient grandiosity
Paranoia
Psychosis
91
Q

Cannabis Effects on Cognition & Psychomotor Function

A

Decreases reaction time
Impairs attention, concentration, short term memory, & risk assessment
Impairs motor coordination & ability to do complex tasts

92
Q

Cannabis Physiologic Signs

A 
Tachycardia
Increased BP
Increased RR
Conjunctival injection
Dry mouth
Increased appetite
93
Q

Marijuana Withdrawal Symptoms

A 
Craving for marijuana
Irritability
Restlessness
Depression
Anxiety
Decreased quantity & quality of sleep
Vivid/strange dreams
Decreased food intake with associated weight loss
Increased aggression
Physical tension
Sweating
Runny nose
Stomach pain
Nausea
94
Q

Treatment for Marijuana Addiction

A 
Buspirone (Buspar): withdrawal symptoms
Inpatient advised
Change setting/routine
Oral THC
Treat underlying co-morbid psychiatric disease
95
Q

Define Hallucinogens

A

Describes substances whose primary effects include the alteration of sensory perception, mood, & thought

96
Q

Define “Bad Trip”

A

Acute intoxication with dysphoria, fear, agitation or other unwanted effects predominate

97
Q

Define “Flashback”

A

Recurrence of symptoms associated with hallucinogen after the effects of the acute intoxication have worn off
May occur months or years later

98
Q

Effects of Hallucinogens

A

Synesthesia

Feel like their entire body is alive

99
Q

Specific Hallucinogens

A 
LSD
Dextromethorphan (DXM)
Mescaline
"Bromo"- gentler LSD
"Blue Mystic"
Phencyclidine (PCP)
100
Q

Adverse Issues with Dextromethorphan (DXM)

A

Anticholinergic delirium

Acetaminophen toxicity

101
Q

What precedes the onset of psychedelic effects of Mescaline?

A

N/V

102
Q

Distinguishing Features of PCP Intoxication

A

Bizarre violent behavior
Nystagmus
Catatonic stupor & coma

103
Q

What is PCP commonly added to for smoking?

A

Cigarettes
Marijuana
Other herbs

104
Q

Treating Patients on Hallucinogens

A

Quiet, calm environment
Supportive care
Careful, mild sedation if agitated

105
Q

Why is inhalant abuse a common problem in adolescents?

A

Readily accessible
Inexpensive & legal to buy/possess
Perceived risk of use is low

106
Q

What do Inhalants act as?

A

CNS depressants

107
Q

What do nitrites in inhalants cause?

A

Intense vasodilation producing a sensation of heat & warmth
Prolong penile erection

108
Q

3 Techniques of Inhaling

A

Sniffing
Huffing
Bagging

109
Q

Define Sniffing

A

Spray directly on heated surface to vaporize

110
Q

Define Huffing

A

Saturate a cloth & hold near nose or mouth

111
Q

Define Bagging

A

Put substance in a bag that is placed over nose, mouth, or head

112
Q

Inhalant CNS Effects

A

Immediate: slurred speech, ataxia, disorientation, headache, hallucinations, violent behavior, seizure
Long term: neurocognitive impairment, cerebellar dysfunction & peripheral neuropathy

113
Q

Inhalant GI Effects

A

N/V
Anorexia & weight loss
Hepatotoxic (some substances)

114
Q

Inhalant Hematologic Effects

A

Aplastic anemia

Malignancy

115
Q

Define “Sudden Sniffing Death”

A

Cardiovascular collapse

116
Q

Presentation of Inhalant Intoxication

A

Extreme behavior problems
Neuropsychiatric problems
Altered mental status

117
Q

Labs for Inhalant Intoxication

A 
CBC
CMP
UA
ABGs
Pulse oximetry
EKG monitor
118
Q

Treatment of Inhalant Intoxication

A

Supportive

119
Q

Nicotine is and Etiology of what

A 
Lung CA
COPD
CV disease
URI- second hand
SIDS- second hand
120
Q

What does nicotine activate in the brain?

A

Dopamine reward system

121
Q

Mortality of Nicotine Abuse

A

CVD
Lung CA
COPD

122
Q

Nicotine Withdrawal Symptoms

A 
Loss of euphoric effects
Dysphoric or depressed mood
Insomnia
Irritability, frustration, anger, anxiety
Difficulty concentrating
Restlessness
Decreased HR
Increased appetite/weight gain
123
Q

Stages of Change in Behavioral Approaches of Nicotine Treatment

A 
Precontemplation
Contemplation
Determination
Action
Maintenance
124
Q

Smoking Cessation Treatment Strategies

A

Social support
Pharmacological therapy
Skills training or problem solving techniques

125
Q

What to discuss in smoking cessation counseling?

A

Congratulate on quitting
Encourage continued abstinence
Discuss problems that have arisen as a result of smoking cessation
Extend/increase pharmacotherapy if withdrawal symptoms persist

126
Q

MOA of Varenicline (Chantex)

A

Partial agonist of nicotinic acetylcholine receptors
Reduces withdrawal symptoms
Blocks nicotine from tobacco

127
Q

SE of Varenicline (Chantex)

A

Nausea
Insomnia
Abnormal dreams
Depression & suicidality

128
Q

MOA of Bupropion (Zyban)

A

Enhances CNS noradrenergic & dopaminergic function

129
Q

SE of Buproprion (Zyban)

A 
Dry mouth
Insomnia
Headache
Seizures
Monitor for neuropsychiatric symptoms
130
Q

Contraindications of Bupropion (Zyban)

A

Seizure disorders & pregnancy

131
Q

Treatment for Nicotine Cessation

A

Gum or lozenge
Gum use: chew & park
Withdrawal symptoms not totally prevented
Transdermal patches

132
Q

Opiods include

A

Heroin
Opium
Prescription opiates

133
Q

Which Prescription Drugs are Abused?

A 
Fentanyl
Percocet (oxycodone/acetominophen)
Vicodin (hydrocodone/acetominophen)
134
Q

MOA of Opioids

A

Activation of CNS mu receptors results in euphoria, respiratory depression, analgesia, & miosis

135
Q

Classic Signs of Opioid Toxicity

A

Depressed mental status
Decreased RR
Decreased TV
Miotic pupils

136
Q

VS Changes in Opioid Toxicity

A

Low HR
Mild hypotension
Hypothermia

137
Q

Why do we use naloxone in opioid toxicity?

A

Increase respirations to 12 or greater

138
Q

Withdrawal symptoms of Opiods within 3-4 hours of last dose

A

Drug craving
Anxiety
Fear of withdrawal

139
Q

Withdrawal Symptoms of Opioids between 8-14 hours of last dose

A

Anxiety, restlessness, insomnia, & yawning
Rhinorrhea, lacrimation, & diaphoresis
Stomach cramps & mydriasis

140
Q

Withdrawal Symptoms of Opioids between 1-3 days of last dose

A 
Tremor, muscle spasm
Vomiting
Diarrhea
HTN
Tachycardia
Fever, chills
Piloerection
141
Q

Symptoms Management for Acute Withdrawal

A 
Muscle relaxants
NSAIDs
Antiemetics
Antidiarrheal agents
Sleeping agent with low abuse potential
142
Q

Long-term Opioid Addiction Treatment

A

Abstinence based treatment
Naltrexone
Opioid agonists: methadone, buprenorphine

143
Q

Which patients is naltrexone most effective?

A

Highly motivated patients

144
Q

Naltrexone

A

Administered after patient completely detoxed

145
Q

Methadone

A

Long term opioid treatment
Single daily dose in controlled setting
>180 days = maintenance

146
Q

SE of Methadone

A 
Constipation
Drowsiness
Reduced libido
Excess sweating
Peripheral edema
Prolonged QT
147
Q

Buprenorphine

A

Partial opioid agonist
Sublingual
Combine with naloxone
Schedule III drug

148
Q

Clonidine

A

May decrease withdrawal symptoms in patients using low doses of opioids

149
Q

SE of Clonidine

A

Orthostatis hypotension
Dry mouth
Constipation

150
Q

Benzodiazepine Withdrawal

A 
Increased body temperature
Elevated BP
Increased pulse & RR
Aroused level of consciousness/ delirium
Tremulousness
Increased DTRs/seizures
Disorientation
Psychotic behavior/ hallucinations
151
Q

Treatment of Mild to Moderate Benzodiazepine Withdrawal

A

Slow taper of drug they were on for several months

Determining drug tolerance may be difficult

152
Q

Treatment of Severe Benzodiazepine Withdrawal

A

Life-threatening

Watch for respiratory depression

153
Q

Treatment of Severe/Serious Benzodiazepine Withdrawal

A

Carbamazepine
Valproate
Symptom rebound: insomnia & anxiety
ICU for abnormal vitals

Behavioral Health (25 decks)

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