Substance-related and addictive disorders Flashcards
Criteria for substance use disorder
Problematic pattern of substance use that leads to impairment or distress, manifested by at least two of:
- Using more than intended
- Persistent desire/inability to cut down
- Significant time spent in obtaining, using, or recovering from substance
- Failure to fulfill obligations (work, school, etc)
- Continued use despite social/personal probs
- Decreased social/occupational/recreational activities
- Use in dangerous situations (e.g. driving)
- Continued use despite subsequent physical or psychological problem (e.g. liver disease)
- Tolerance
- Withdrawal
How can you distinguish between substance-induced vs. primary mood symptoms/disorders?
Primary mood symptoms persist during periods of abstinence
Substance use can commonly present with what psychiatric symptoms?
Mood symptoms and mood disorders
Psychotic symptoms
Personality disorders
Anxiety disorders
Define withdrawal
The development of a substance-specific syndrome due to cessation/reduction of substance use
Define tolerance
The need for increasing amounts of the substance to achieve the desired effect
How long is alcohol detectable in a patient’s system and how do you test for it?
Only for a few hours
Breathalyzer in the field/police
Blood testing more accurate
How long is cocaine detectable in a patient’s system and how do you test for it?
UDS stays positive for 2-4 days
How long are amphetamines detectable in a patient’s system and how do you test for it?
UDS positive for 1-3 days
Most assays are not adequate sensitivity/specificity
How long is phencyclidine detectable in a patient’s system and how do you test for it?
UDS positive 4-7days
CPK and AST are often elevated
How long are benzos detectable in a patient’s system and how do you test for it?
Short-acting (lorazepam) for up to 5 days in blood or urine
Long-acting (diazepam) for up to 30 days in blood or urine
How long are barbiturates detectable in a patient’s system and how do you test for it?
Short acting (pentobarbital) 24 hours in urine or blood Long-acting (phenobarbital) 3 weeks in urine or blood
How long are opioids detectable in a patient’s system and how do you test for it?
UDS positive for 1-3 days (depending on drug)
Methadone comes up negative on a general screen
How long is marijuana/THC detectable in a patient’s system and how do you test for it?
3 days after a single use. Up to 4 weeks in heavy users, because THC is released from adipose stores
Alcohol activates what neurotransmitters/receptors in the CNS? Which does it inhibit?
Activates: GABA, Dopamine, Serotonin
Inhibits: Glutamate, voltage-gated calcium channels
Describe the metabolism of alcohol
Alcohol –> acetaldehyde (by alcohol dehydrogenase)
Acetaldehyde –> acetic acid (by acetaldehyde dehydrogenase (inhibited by disulfiram))
Presentation of alcohol intoxication
In order of increasing BALs: Loss of fine motor control Impaired judgment and coordination Ataxic gait and poor balance Lethargy, difficulty sitting upright, memory problems, nausea/vomiting Coma (in novice drinker) Respiratory depression and risk of death
Treatment of alcohol intoxication
Monitor: ABCs, glucose, lytes, acid-base status
Thiamine and folate
Naloxone (if opioid co-ingestion)
CT head if trauma
Liver will take care of the rest
If severely intoxicated, may need mechanical ventilation with monitoring of above variables
GI evacuation NOT indicated UNLESS significant ingestion within the last hour
Clinical presentation of alcohol withdrawal
Alcohol withdrawal syndrome: insomnia, anxiety, hand tremor, irritability, anorexia, nausea, vomiting, autonomic hyperactivity, psychomotor agitation, fever, seizures, hallucinations, delirium
When do the earliest symptoms of ethanol withdrawal appear?
6-24 hours after the patient’s last drink
When do seizures occur in alcohol withdrawal?
12-48 hours after last drink, with peak around 12-24hrs
What should be corrected promptly in alcohol-withdrawal patients to help prevent seizures?
Hypomagnesemia
When does delirium tremens usually begin?
48-96 hours after last drink, but may be later
What factors increase a patient’s risk for DTs?
Age >30, prior DTs, physical illness
Symptoms of DTs
Delirium, hallucinations (visual), agitation, gross tremor, autonomic instability, fluctuating psychomotor activity
