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Behavioral Health > Substance-Related Disorders 1 > Flashcards

Substance-Related Disorders 1 Flashcards

1
Q

What is the most important modifiable
risk factor in the US for health prevention?

A

Smoking

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2
Q

What does nicotine withdrawal present as?

A

-Restlessness
-Anxiety
-Irritability
-Sleep abnormalities
- HA
-Depression
-Increased appetite
-Weight gain
-Chest tightness
-Nicotine craving

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3
Q

_____ after nicotine abstinence is common

A

Relapse

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4
Q

What are the three main treatment options for smoking cessation?

A
  1. Nicotine tapering therapy
  2. Bupropion
  3. Varenicline
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5
Q

What options are available for nicotine tapering therapy?

A

-Gum
-Nasal sprays
-Transdermal patches
-Inhaler
-Lozanges

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6
Q

What is the MOA of Bupropion?

A

Dopamine and norepinephrine reuptake inhibitor

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7
Q

What is the MOA of Varenicline?

A

Blocks nicotine receptors, reducing nicotine activity, mimic effects thereby reducing the reward effect and preventing withdrawal

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8
Q

What is the timeline of Varenicline administration?

A

Begin one week prior to quit date an dcontinue four months after quit date

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9
Q

What are the AEs of Varenicline?

A

Suicidality
-HA
-Nausea
-Insomnia
-Neuropsychiatric conditions

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10
Q

What are the opioids?

A
  1. Heroin
  2. Hydrocodone
  3. Codeine
  4. Morphine
  5. Dextromethorphan
  6. Meperidine
  7. Methadone
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11
Q

How does opioid intoxication present?

A

Euphoria and sedation

(drowsiness, impaired social functioning, impaired memory, slow or slurred speech)

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12
Q

Opioid intoxication may progress to ____

A

N/V, seizures and coma

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13
Q

What are the hallmarks of opioid intoxication on physical exam?

A

-Pupillary constriction
-AMS
-Respiratory depression
-Bradycardia
-Hypotension

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14
Q

Opioid withdrawal may cause ___ breathing

A

Biot’s (groups of quick, shallow breaths followed by regular or irregular periods of apnea)

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15
Q

What is the classic GI effect of long term opioids?

A

Constipation

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16
Q

What are the symptoms of opioid withdrawal?

A

-Piloerections
-Pupil dilations
-Flu-like symptoms
-Rhinorrhea
-HTN
-Lacrimation
-Priritis
-Tachycardia
-N/V/D

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17
Q

Is opioid withdrawal life threatening?

A

No

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18
Q

How do you treat opioid intoxication/overdose?

A

Naloxone

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19
Q

What is naloxone?

A

Opioid antagonist

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20
Q

What is the onset of action of naloxone?

A

2 minutes IV (5 minutes IM)

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21
Q

How long does naloxone work?

A

30-60 minutes

22
Q

How is opioid withdrawal managed?

A

Symptomatic withdrawal

23
Q

What is the main medication used in opioid withdrawal?

A

Clonidine (decreases sympathetic symptoms)

24
Q

Opioid withdrawal use _______ for diarrhea

A

Loperamide

25
Q

Opioid withdrawal use _______ for abdominal cramps

A

Dicyclomine

26
Q

Opioid withdrawal use _______ for joint and muscle pain/cramps

A

NSAIDs

27
Q

Opioid withdrawal use _______ for mild withdrawal

A

Benzos

28
Q

Opioid withdrawal use _______ for severe symptoms

A

Detox with methadone or Buprenorphine + Naloxone

29
Q

What are the three options for longterm management of opioid dependence?

A
  1. Methadone
  2. Suboxone
  3. Naltrexone
30
Q

What is the MOA of methadone?

A

Long-acting opioid agonist to control withdrawal

31
Q

____ can be used in pregnant opioid dependent women

A

methadone

32
Q

What is the adverse effect of methadone?

A

Can cause QT prolongation

33
Q

What is the MOA of buprenorphine?

A

Partial opioid agonist

34
Q

What is suboxone?

A

Buprenorphine + Naloxone

35
Q

Why is Naloxone in Suboxone?

A

Prevents intoxication from IV injection

36
Q

What is naltrexone?

A

Competitive opioid antagonist

37
Q

What is the main concern with naltrexone?

A

Precipitates withdrawal if used within seven days of heroin use

38
Q

How is naltrexone administered?

A

oral or monthly injections

39
Q

When does alcohol withdrawal onset?

A

6-36 hours after last drink

40
Q

What is the main category of alcohol w/d symptoms?

A

Increased CNS activity (tremors, anxiety, irritability, diaphoresis, palpitations, HTN, insomnia and GI

41
Q

What is “uncomplicated” withdrawal?

A

No seizures, hallucinations or delirium tremens

42
Q

When do alcohol withdrawal seizures usually start?

A

6-48 hours after last drink

43
Q

What type of seizures usually occur during alcohol withdrawal?

A

Tonic-clonic

44
Q

When do alcoholic hallucinosis usually start in alcohol withdrawal?

A

12-48 hours after last drink

45
Q

What does alcoholic hallucinosis present as?

A

-Visual or tactile hallucinations
-Clear sensorium
-Normal vital signs

46
Q

When do delirium tremens usually onset?

A

2-5 days after last drink

47
Q

How does delirium tremens usually present?

A

-Delirium (altered sensorium)
-Hallucinations
-Agitation
-Abnormal vital signs
-Diaphoresis

48
Q

Can alcohol withdrawal be fatal?

A

Yes

49
Q

How is alcohol withdrawal treated?

A

-IV benzos
-IV fluids
-IV thiamine (B1)
-Magnesium
-Multivitamins (including B12 and folate)
-Electrolyte repletion

50
Q

What is the MOA of benzos in alcohol withdrawal?

A

Potentiates GABA-mediated CNS inhibition (because alcohol mimics GABA and withdrawal causes excessive CNS activity)

51
Q

What benzos are preferred in alcohol withdrawal for patients with cirrhosis or alcoholic hepatitis?

A

Lorazepam or Axazepam

Behavioral Health (19 decks)

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