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EOR: Behavioral Health > Substance Related Disorders > Flashcards

Substance Related Disorders Flashcards

1
Q

what do you think when you see a pt w. anxiety, tremors, sadness, and hematemesis

A

alcohol use disorder

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2
Q

definition of alcohol use disorder

A

problematic pattern of etoh use leadint to clinically significant impairment or distress

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3
Q

alcohol intoxication includes one or more of what symptoms (6)

A

slurred speech
incoordination
unsteady gait
nystagmus
impairment in attention or memory
stupor or coma

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4
Q

criteria for etoh withdrawal

A

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

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5
Q

tx for etoh withdrawal (5)

A

thiamine
Mg
MV
dextrose
benzos

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6
Q

addiction medications (5)

A

disulfram (antabuse)
naltrexone
acamprosate
topiramate
gabapentin

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7
Q

tx for delirium tremens

A

high dose benzos asap (preferably in ICU)

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8
Q

which addiction med inhibits acetaldehyde dehydrogenase and leads to aversive conditioning

A

disulfram (antabuse)

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9
Q

which addiction medication is contraindicated in a pt who is still drinking

A

disulfram (antabuse)

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10
Q

which 2 addiction medications decrease desire

A

oral naltrexone
gabapentin

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11
Q

contraindication for oral naltrexone

A

opioids

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12
Q

which addiction med changes brain chemistry in a way that reduces anxiety, irritability, and restlessness associated w. early sobriety

A

acamprosate

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13
Q

caution w. acamprosate

A

renal impairment -> dose reduction required

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14
Q

which addiction med reduces drinking at least as well as naltrexone and acamprosate

A

topiramate

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15
Q

timeline for etoh withdrawal sx

A

6 hr: minor sx
12-24 hr: hallucinations
48 hr: sz
delirium tremens: 48-96 hr

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16
Q

minor etoh withdrawal sx (6)

A

trembling
irritability
anxiety
HA
tachycardia
insomnia

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17
Q

sx of delirium tremens (4)

A

autononmic instability
disorientation
hallucinations
agitation

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18
Q

management of minor etoh withdrawal (5)

A

thiamine
folate
MV
dex
IVF

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19
Q

what sx of etoh withdrawal indiacates initiation of benzos

A

hallucinations

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20
Q

tx for etoh withdrawal hallucinations

A

benzos
+/- haldol

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21
Q

management of etoh withdrawal sz (2)

A

benzos
head CT

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22
Q

what drug is useful to reduce noradrenergic sx of etoh withdrawal

A

clonidine

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23
Q

t/f: barbituates can be used for etoh withdrawal

A

t - sometimes used as anticonvulsant

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24
Q

mainstay of etoh withdrawal therapy

A

long acting benzo taper:
diazepam, chlordiazepoxide, and clorazepate

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25
Q

definition of etoh withdrawal syndrome

A

syndrome of drug-specific withdrawal signs and symptoms follows the reduction or cessation of drug use

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26
Q

moa for psychoactive constituent of cannabis

A

delta-9-tetrahydro-cannabinol (THC) binds to CB1/CB2 receptors

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27
Q

3 PE finding suggestive of cannabis-related disorders

A

conjunctival injection
xerostomia
tachycardia

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28
Q

what do you think when you see a pt w. increased appetite, lack of motivation, slowed speech, and paranoia

A

cannaboid use disorder

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29
Q

criteria for cannabis use disorder

A

-problematic pattern of cannabis use leading to clinically significant impairment/distress
-occurs w.in 12 mo period

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30
Q

UA can detect cannabis for _ days in occasional users
and up to _ days in chronic users

A

occasional: 4-6 days
chronic: 50 days

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31
Q

complications of chronic cannabis use (5)

A

laryngitis
rhinitis
low testosterone
low sperm count
COPD

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32
Q

sx of cannabis intoxication (the snozzberries taste like snozzberries!)

A

euphoria
anxiety
disinhibition
paranoid delusions
perception of slowed time
conjunctival injection
impaired judgment
social withdrawal
increased appetite
dry mouth
hallucinations

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33
Q

withdrawal from cannabis sx (5)

A

irritability
dpn
insomnia
nausea
anorexia

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34
Q

cannabis withdrawal sx peak at _ hr
and last for _ days

A

48 hr
5-7 days

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35
Q

tx for cannabis intoxication/withdrawal

A

symptomatic only

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36
Q

when you see conjunctival injection on the exam, your answer should be

A

marijuana intoxication

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37
Q

what do you think when you see a pt who is extremely aggressive and becomes enraged when sudden movements or loud sounds are made

A

PCP (phencyclidine)

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38
Q

6 PE findings of PCP intoxication

A

nystagmus (horizontal and vertical)
htn
tachycardia
ataxia
dysarthria
muscle rigidity

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39
Q

moa of of PCP

A

NMDA receptor antagonist

similar to ketamine

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40
Q

sx of pcp intoxication

A

belligerenve
impulsiveness
fear
homicidality
psychosis
delirium
sz
coma
psychomotor agitation

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41
Q

management of pcp intoxication (4)

A

haloperidol
benzos
low stimulus environment
+/- restraints

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42
Q

withdrawal sx of pcp intoxication (6)

A

dpn
anxiety
irritability
restlessness
anergia
disturbance of thoughts and sleep

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43
Q

tx for pcp intoxication/withdrawal

A

symptomatic only

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44
Q

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

A

LSD

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45
Q

3 PE findings of LSD intoxication

A

abnormal gait
diffuse tremors
dilated pupils

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46
Q

moa for LSD intoxication

A

5-HT receptor agonist

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47
Q

sx of lsd intoxication (5)

A

visual hallucinations and synesthesias
anxiety
dpn
delusions
“bad trip” panic

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48
Q

what is synesthesia

A

seeing sound as color

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49
Q

tx for lsd intoxication (3)

A

haldol
benzos
supportive counseling

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50
Q

t/f: lsd is not associated w. withdrawal

A

t!
it does not affect dopamine

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51
Q

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

A

inhalant-related d.o

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52
Q

5 commonly inhaled substances

A

paint
petroleum
toluene
glues
nail polish

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53
Q

4 hallmarks of inhalant intoxication

A

euphoria
slurred speech
confused state
auditory/visual hallucinations

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54
Q

6 PE findings of inhalant intoxication

A

watery eyes
impaired vision
rhinorrhea
perinasal/perioral rash
HA
nausea

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55
Q

4 complications of inhalant abuse

A

cardiopulmonary failure
liver failure
renal failure
bone marrow suppression

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56
Q

moa of opioid intoxication

A

mu receptor agonist

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57
Q

sx of opioid intoxication

A

constipation
respiratory dpn
pupillry constriction
sz

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58
Q

which sx of opioid intoxication is not associated w. tolerance

A

constipation

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59
Q

sx of opioid withdrawal

A

anxiety
insomnia
anorexia
sweating
mydriasis
piloerection
flu like sx
yawning

60
Q

tx of opioid overdose

A

naloxone
symptomatic

61
Q

moa of naloxone

A

opioid receptor antagonist

62
Q

tx for opioid withdrawal (4)

A

clonidine
methadone
buprenorphine + naloxone (suboxone)
zofran

63
Q

which drug used for opioid withdrawal decreases NE and sympathetic output making autonomic sx less intense

A

clonidine

64
Q

what happens if you use naloxone for opioid withdrawal

A

opioid receptor antagonist -> makes symptoms worse

65
Q

which drug used for opioid withdrawal is long acting

A

methadone

66
Q

which drug used for opioid withdrawal can precipitate withdrawal if given too soon

A

buprenorphine + naloxone

67
Q

tx for opioid addiction

A

methadone
suboxone

68
Q

2 indications for methadone

A

heroine detox
long-term maintenance

69
Q

routes of administration for methadone

A

PO
IV

70
Q

suboxone is a combo of (2)

A

buprenorphine
naloxone

71
Q

benefit of suboxone over methadone

A

fewer withdrawal sx

72
Q

moa for suboxone

A

partial opioid agonist

73
Q

t/f: naloxone is ineffective when taken orally

A

t!

74
Q

what class of drug are benzos

A

anxiolytics

75
Q

moa for benzos

A

increased frequency of opening of GABA channel

76
Q

common history finding for pt who presents w. benzo intoxication

A

panic disorder

77
Q

PE findings of benzo intoxication (7)

A

respiratory depression
hypotn
amnesia
ataxia
stupor/somnolence
coma
death

78
Q

HEENT findings for benzo intoxication

A

normal

79
Q

t/f: benzos are associated w. withdrawal

A

t!

80
Q

sx of benzo withdrawal (3)

A

rebound anxiety
sz
tremor

81
Q

which type of benzo is withdrawal mc associated w.

A

short acting -> alprazolam

82
Q

tx for benzo overdose

A

supportive

flumazenil only if very severe w. airway compromise

83
Q

moa for flumazenil

A

GABA antagonist

84
Q

why should flumazenil generally be avoided in management of benzo overdose

A

it can precipitate withdrawal and sz

85
Q

tx for benzo withdrawal

A

long acting benzo taper -> clonazepam

86
Q

moa for barbituates

A

increased duration of opening of GABA channel

87
Q

PE findings of barbituate intoxication

A

extreme drowsiness
poor concentration
impaired memory
minimally responsive
respiratory depression
CNS depression

88
Q

t/f: barbituates do not have a depression ceiling

A

t!

more dangerous than benzos

89
Q

do barbs and benzos cause pupil dilation

A

no

90
Q

sx of barbituate withdrawal (4)

A

anxiety
sz
delirium
cardiovascular collapse

91
Q

tx for barbituate intoxication

A

symptomatic
respiration
intubation
bemegride

92
Q

moa for bemegride

A

GABA antagonist

93
Q

tx for barbituate withdrawal

A

long acting benzo taper

94
Q

what do you think when you see a pt w. dilated pupils, tachycardia, aggression, diaphoresis, prolonged wakefulnessm, and sympathetic activation

A

cocaine

95
Q

moa for cocaine

A

blocks biogenic amine (DA/NE) and serotonin reuptake (5HT/5-hydroxytryptamine)

96
Q

sx of cocaine intoxication (5)

A

euphoria
psychomotor agitation
grandiosity
hallucinations (tactile)
paranoid ideations

97
Q

PE findings of cocaine intoxication

A

sympathetic activation:
tachycardia
pupil dilation
htn
angina
stereotyped behavior - repetitive motions

98
Q

complications of cocaine abuse

A

-severe vasospasm -> MI
-placental vasospasm/infarction
-kiesselbach plexus spasm -> nasal septum perforation
-CVA

99
Q

sx of cocaine withdrawal (6)

A

severe dpn and suicidality
hyperphagia
hypersomnolence
fatigue
malaise
severe cravings

100
Q

tx for cocaine intoxication

A

haldol
benzos
anti HTN (alpha 1 blockers)
vitamin C

101
Q

moa of vitamin C in cocaine intoxication

A

promotes excretion

102
Q

what should you never do in management of cocaine intoxication

A

never restrain -> can lead to rhabdo

103
Q

tx for cocaine withdrawal

A

bupropion
bromocriptine
SSRI’s

104
Q

name 3 amphetamines

A

methamphetamine
dextroamphetamine (dexedrine)
methylphenidate (concerta)

105
Q

moa for amphetamines

A

-stimulates biogenic amine (DA/NE) and serotonin (5 hydroxytryptamine/5HT)
-high dose: promote release AND decrease uptake

106
Q

sx of amphetamine intoxication (5)

A

euphoria
impaired judgment
delusions
hallucinations
prolonged wakefullness/attentiveness

107
Q

PE findings of amphetamine intoxication

A

sympathetic activation:
psychomotor agitation
pupillary dilation
HTN
tachy
fever
cardiac arrhythmias

108
Q

tx for amphetamine intoxication

A

haldol
benzos
vitamin C
alpha 1 blockers
propranolol

109
Q

moa for MDMA/ecstasy

A

-similar to amphetamine but affect 5HT more than DA
-may damage serotonergic neurons

110
Q

sx of MDMA intoxication

A

hyperthermia
social closeness
hyponatremia

111
Q

sx of MDMA withdrawal

A

mood offset for several weeks

112
Q

tx for mdma intoxication/withdrawal

A

symptomatic

113
Q

leading cause of preventable death in US

A

cigarette smoking

114
Q

t/f: smoking causes more deaths each year than HIV, illegal drugs, etoh, MVA, and firearms combined

A

t!

115
Q

sx of tobacco intoxication (4)

A

restlessness
insomnia
anxiety
arrhythmias

116
Q

sx of tobacco withdrawal (5)

A

irritability
HA
anxiety
wt gain
cravings

117
Q

tx for tobacco cessation

A

bupropion
varenicline (chantix)
NRT

118
Q

moa for varenicline (chantix)

A

partial nicotinic acetylcholine receptor (a4-b2) agonist -> mediates partial reward of nicotine AND blocks reward of nicotine

119
Q

most successful nicotine cessation drug

A

varenicline (chantix)

*esp when used w. NRT

120
Q

contraindication for varenicline (chantix)

A

banned from use by pilots and air traffic controllers

121
Q

s.e of varenicline (chantix)

A

n/v
insonmnia
HA
neuropsych disorders: suicide, dpn, homicidal ideation

122
Q

tx for lithium od

A

dialysis

123
Q

longterm tx for etoh wd

A

librium

124
Q

tx for benzo od PLUS HTN

A

labetalol

125
Q

antidote for pyrexia

A

dantrolene

126
Q

ccb antidote

A

calcium chloride

127
Q

benzo antidote

A

flumazenil

128
Q

TCA antidote

A

sodium bicarbonate

129
Q

digoxin antidote

A

digoxin immune fab (Digibind)

130
Q

amphetamine antidote

A

benzos

131
Q

warfarin antidote

A

vitamin K
fresh frozen plasma

132
Q

heparin antidote

A

protamine sulfate

133
Q

APAP antidote

A

n-acetylcysteine

134
Q

opiate antidote

A

naloxone

135
Q

bb antidote

A

glucagon

136
Q

cocaine antidote

A

benzos

137
Q

tx for psychosis related to drug od

A

haldol

138
Q

tx for acute sz

A

benzos

139
Q

taking these drugs causes constricted pupils

A

-opiates

140
Q

taking these drugs causes dilated pupils

A

stimulants
etoh
hallucinogens
antidepressants

141
Q

loss of control over urges to take a drug even tho the consequences are unknown

A

addiction

142
Q

using a substance to maintain normal functioning

A

dependence

143
Q

amnesia, ataxia, stupor, somnolence

A

benzo and etoh intoxication

144
Q

miosis, drowsiness, constipation

A

opioid intoxication

145
Q

hyperphagia, hypersomnolence, and fatigue

A

cocaine wd

146
Q

restlessness, diuresis, muscle twitching, cardiac arrhythmias

A

caffeine intoxication

EOR: Behavioral Health (13 decks)

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