Substance Related Disorders Flashcards
what do you think when you see a pt w. anxiety, tremors, sadness, and hematemesis
alcohol use disorder
definition of alcohol use disorder
problematic pattern of etoh use leadint to clinically significant impairment or distress
alcohol intoxication includes one or more of what symptoms (6)
slurred speech
incoordination
unsteady gait
nystagmus
impairment in attention or memory
stupor or coma
criteria for etoh withdrawal
2 or more of the following developwing w.in several hours to a few days after cessation or reduction of etoh:
-autonomic hyperactivity (sweating, tachy, etc)
-increased hand tremor
-insomnia
-n/v
-visual, tactile, or auditory hallucinations or illusions
-psychomotor agitation
-anxiety
-generalized tonic clonic sz
tx for etoh withdrawal (5)
thiamine
Mg
MV
dextrose
benzos
addiction medications (5)
disulfram (antabuse)
naltrexone
acamprosate
topiramate
gabapentin
tx for delirium tremens
high dose benzos asap (preferably in ICU)
which addiction med inhibits acetaldehyde dehydrogenase and leads to aversive conditioning
disulfram (antabuse)
which addiction medication is contraindicated in a pt who is still drinking
disulfram (antabuse)
which 2 addiction medications decrease desire
oral naltrexone
gabapentin
contraindication for oral naltrexone
opioids
which addiction med changes brain chemistry in a way that reduces anxiety, irritability, and restlessness associated w. early sobriety
acamprosate
caution w. acamprosate
renal impairment -> dose reduction required
which addiction med reduces drinking at least as well as naltrexone and acamprosate
topiramate
timeline for etoh withdrawal sx
6 hr: minor sx
12-24 hr: hallucinations
48 hr: sz
delirium tremens: 48-96 hr
minor etoh withdrawal sx (6)
trembling
irritability
anxiety
HA
tachycardia
insomnia
sx of delirium tremens (4)
autononmic instability
disorientation
hallucinations
agitation
management of minor etoh withdrawal (5)
thiamine
folate
MV
dex
IVF
what sx of etoh withdrawal indiacates initiation of benzos
hallucinations
tx for etoh withdrawal hallucinations
benzos
+/- haldol
management of etoh withdrawal sz (2)
benzos
head CT
what drug is useful to reduce noradrenergic sx of etoh withdrawal
clonidine
t/f: barbituates can be used for etoh withdrawal
t - sometimes used as anticonvulsant
mainstay of etoh withdrawal therapy
long acting benzo taper:
diazepam, chlordiazepoxide, and clorazepate
definition of etoh withdrawal syndrome
syndrome of drug-specific withdrawal signs and symptoms follows the reduction or cessation of drug use
moa for psychoactive constituent of cannabis
delta-9-tetrahydro-cannabinol (THC) binds to CB1/CB2 receptors
3 PE finding suggestive of cannabis-related disorders
conjunctival injection
xerostomia
tachycardia
what do you think when you see a pt w. increased appetite, lack of motivation, slowed speech, and paranoia
cannaboid use disorder
criteria for cannabis use disorder
-problematic pattern of cannabis use leading to clinically significant impairment/distress
-occurs w.in 12 mo period
UA can detect cannabis for _ days in occasional users
and up to _ days in chronic users
occasional: 4-6 days
chronic: 50 days
complications of chronic cannabis use (5)
laryngitis
rhinitis
low testosterone
low sperm count
COPD
sx of cannabis intoxication (the snozzberries taste like snozzberries!)
euphoria
anxiety
disinhibition
paranoid delusions
perception of slowed time
conjunctival injection
impaired judgment
social withdrawal
increased appetite
dry mouth
hallucinations
withdrawal from cannabis sx (5)
irritability
dpn
insomnia
nausea
anorexia
cannabis withdrawal sx peak at _ hr
and last for _ days
48 hr
5-7 days
tx for cannabis intoxication/withdrawal
symptomatic only
when you see conjunctival injection on the exam, your answer should be
marijuana intoxication
what do you think when you see a pt who is extremely aggressive and becomes enraged when sudden movements or loud sounds are made
PCP (phencyclidine)
6 PE findings of PCP intoxication
nystagmus (horizontal and vertical)
htn
tachycardia
ataxia
dysarthria
muscle rigidity
moa of of PCP
NMDA receptor antagonist
similar to ketamine
sx of pcp intoxication
belligerenve
impulsiveness
fear
homicidality
psychosis
delirium
sz
coma
psychomotor agitation
management of pcp intoxication (4)
haloperidol
benzos
low stimulus environment
+/- restraints
withdrawal sx of pcp intoxication (6)
dpn
anxiety
irritability
restlessness
anergia
disturbance of thoughts and sleep
tx for pcp intoxication/withdrawal
symptomatic only
what do you think when you see a pt who wants to hurt himself and has been freaking out and seeing things that are not there
maybe he even tried to ride a bike off of his roof
LSD
3 PE findings of LSD intoxication
abnormal gait
diffuse tremors
dilated pupils
moa for LSD intoxication
5-HT receptor agonist
sx of lsd intoxication (5)
visual hallucinations and synesthesias
anxiety
dpn
delusions
“bad trip” panic
what is synesthesia
seeing sound as color
tx for lsd intoxication (3)
haldol
benzos
supportive counseling
t/f: lsd is not associated w. withdrawal
t!
it does not affect dopamine
what do you think when you see a pt from low socioeconomic background that arrives in ED w. HA, loss of appetite, rhinorrhea, injected sclera, dizziness, photopobia, and a cough
inhalant-related d.o
5 commonly inhaled substances
paint
petroleum
toluene
glues
nail polish
4 hallmarks of inhalant intoxication
euphoria
slurred speech
confused state
auditory/visual hallucinations
6 PE findings of inhalant intoxication
watery eyes
impaired vision
rhinorrhea
perinasal/perioral rash
HA
nausea
4 complications of inhalant abuse
cardiopulmonary failure
liver failure
renal failure
bone marrow suppression
moa of opioid intoxication
mu receptor agonist
sx of opioid intoxication
constipation
respiratory dpn
pupillry constriction
sz
which sx of opioid intoxication is not associated w. tolerance
constipation
sx of opioid withdrawal
anxiety
insomnia
anorexia
sweating
mydriasis
piloerection
flu like sx
yawning
tx of opioid overdose
naloxone
symptomatic
moa of naloxone
opioid receptor antagonist
tx for opioid withdrawal (4)
clonidine
methadone
buprenorphine + naloxone (suboxone)
zofran
which drug used for opioid withdrawal decreases NE and sympathetic output making autonomic sx less intense
clonidine
what happens if you use naloxone for opioid withdrawal
opioid receptor antagonist -> makes symptoms worse
which drug used for opioid withdrawal is long acting
methadone
which drug used for opioid withdrawal can precipitate withdrawal if given too soon
buprenorphine + naloxone
tx for opioid addiction
methadone
suboxone
2 indications for methadone
heroine detox
long-term maintenance
routes of administration for methadone
PO
IV
suboxone is a combo of (2)
buprenorphine
naloxone
benefit of suboxone over methadone
fewer withdrawal sx
moa for suboxone
partial opioid agonist
t/f: naloxone is ineffective when taken orally
t!
what class of drug are benzos
anxiolytics
moa for benzos
increased frequency of opening of GABA channel
common history finding for pt who presents w. benzo intoxication
panic disorder
PE findings of benzo intoxication (7)
respiratory depression
hypotn
amnesia
ataxia
stupor/somnolence
coma
death
HEENT findings for benzo intoxication
normal
t/f: benzos are associated w. withdrawal
t!
sx of benzo withdrawal (3)
rebound anxiety
sz
tremor
which type of benzo is withdrawal mc associated w.
short acting -> alprazolam
tx for benzo overdose
supportive
flumazenil only if very severe w. airway compromise
moa for flumazenil
GABA antagonist
why should flumazenil generally be avoided in management of benzo overdose
it can precipitate withdrawal and sz
tx for benzo withdrawal
long acting benzo taper -> clonazepam
moa for barbituates
increased duration of opening of GABA channel
PE findings of barbituate intoxication
extreme drowsiness
poor concentration
impaired memory
minimally responsive
respiratory depression
CNS depression
t/f: barbituates do not have a depression ceiling
t!
more dangerous than benzos
do barbs and benzos cause pupil dilation
no
sx of barbituate withdrawal (4)
anxiety
sz
delirium
cardiovascular collapse
tx for barbituate intoxication
symptomatic
respiration
intubation
bemegride
moa for bemegride
GABA antagonist
tx for barbituate withdrawal
long acting benzo taper
what do you think when you see a pt w. dilated pupils, tachycardia, aggression, diaphoresis, prolonged wakefulnessm, and sympathetic activation
cocaine
moa for cocaine
blocks biogenic amine (DA/NE) and serotonin reuptake (5HT/5-hydroxytryptamine)
sx of cocaine intoxication (5)
euphoria
psychomotor agitation
grandiosity
hallucinations (tactile)
paranoid ideations
PE findings of cocaine intoxication
sympathetic activation:
tachycardia
pupil dilation
htn
angina
stereotyped behavior - repetitive motions
complications of cocaine abuse
-severe vasospasm -> MI
-placental vasospasm/infarction
-kiesselbach plexus spasm -> nasal septum perforation
-CVA
sx of cocaine withdrawal (6)
severe dpn and suicidality
hyperphagia
hypersomnolence
fatigue
malaise
severe cravings
tx for cocaine intoxication
haldol
benzos
anti HTN (alpha 1 blockers)
vitamin C
moa of vitamin C in cocaine intoxication
promotes excretion
what should you never do in management of cocaine intoxication
never restrain -> can lead to rhabdo
tx for cocaine withdrawal
bupropion
bromocriptine
SSRI’s
name 3 amphetamines
methamphetamine
dextroamphetamine (dexedrine)
methylphenidate (concerta)
moa for amphetamines
-stimulates biogenic amine (DA/NE) and serotonin (5 hydroxytryptamine/5HT)
-high dose: promote release AND decrease uptake
sx of amphetamine intoxication (5)
euphoria
impaired judgment
delusions
hallucinations
prolonged wakefullness/attentiveness
PE findings of amphetamine intoxication
sympathetic activation:
psychomotor agitation
pupillary dilation
HTN
tachy
fever
cardiac arrhythmias
tx for amphetamine intoxication
haldol
benzos
vitamin C
alpha 1 blockers
propranolol
moa for MDMA/ecstasy
-similar to amphetamine but affect 5HT more than DA
-may damage serotonergic neurons
sx of MDMA intoxication
hyperthermia
social closeness
hyponatremia
sx of MDMA withdrawal
mood offset for several weeks
tx for mdma intoxication/withdrawal
symptomatic
leading cause of preventable death in US
cigarette smoking
t/f: smoking causes more deaths each year than HIV, illegal drugs, etoh, MVA, and firearms combined
t!
sx of tobacco intoxication (4)
restlessness
insomnia
anxiety
arrhythmias
sx of tobacco withdrawal (5)
irritability
HA
anxiety
wt gain
cravings
tx for tobacco cessation
bupropion
varenicline (chantix)
NRT
moa for varenicline (chantix)
partial nicotinic acetylcholine receptor (a4-b2) agonist -> mediates partial reward of nicotine AND blocks reward of nicotine
most successful nicotine cessation drug
varenicline (chantix)
*esp when used w. NRT
contraindication for varenicline (chantix)
banned from use by pilots and air traffic controllers
s.e of varenicline (chantix)
n/v
insonmnia
HA
neuropsych disorders: suicide, dpn, homicidal ideation
tx for lithium od
dialysis
longterm tx for etoh wd
librium
tx for benzo od PLUS HTN
labetalol
antidote for pyrexia
dantrolene
ccb antidote
calcium chloride
benzo antidote
flumazenil
TCA antidote
sodium bicarbonate
digoxin antidote
digoxin immune fab (Digibind)
amphetamine antidote
benzos
warfarin antidote
vitamin K
fresh frozen plasma
heparin antidote
protamine sulfate
APAP antidote
n-acetylcysteine
opiate antidote
naloxone
bb antidote
glucagon
cocaine antidote
benzos
tx for psychosis related to drug od
haldol
tx for acute sz
benzos
taking these drugs causes constricted pupils
-opiates
taking these drugs causes dilated pupils
stimulants
etoh
hallucinogens
antidepressants
loss of control over urges to take a drug even tho the consequences are unknown
addiction
using a substance to maintain normal functioning
dependence
amnesia, ataxia, stupor, somnolence
benzo and etoh intoxication
miosis, drowsiness, constipation
opioid intoxication
hyperphagia, hypersomnolence, and fatigue
cocaine wd
restlessness, diuresis, muscle twitching, cardiac arrhythmias
caffeine intoxication
