Substance-Related Disorders Flashcards
What is the diagnostic criteria for substance use disorder?
significant impairment or distress PLUS ≥ 2 sxs in 12 months
* using more/longer than intended
* desire/failed efforts to cut down
* significant time spent obtaining/using/recovering from substance
* cravings
* failure to fulfill work/school/home obligations
* continued use despite social/interpersonal problems
* limiting social/occupational/recreational activities b/c of use
* use in dangerous situations (driving)
* continued use despite physical/psych problems, development of tolerance
* withdrawal
What screening tool can be used for alcohol use disorder?
CAGE
* Cut down
* Annoyed/criticized for drinking
* Guilty
* Eye opener
How is alcohol use disorder treated?
- 1st line: Naltrexone or Acamprosate
- 2nd line: disulfiram or topiramate
What is the diagnostic criteria for alcohol intoxication?
Recent alcohol ingestion w/ problematic behavioral/psych changes that developed during, or shortly after, ingestion PLUS ≥ 1 sxs
* Slurred speech, incoordination, unsteady gait, nystagmus, impairment in attention or memory, stupor or coma
How is alcohol intoxication treated?
IVF, vitamins, thiamine, electrolytes
What tool can be used to assess alcohol withdrawl severity?
CIWA-Ar score
* Minimal (<8)
* Mild (8-15)
* Moderate (16-20)
* Severe (>20)
What is the diagnostic criteria for alcohol withdrawl?
Cessation or ↓ of heavy/prolonged alcohol use PLUS ≥ 2 sxs within hrs-days after stopping
What symptoms can be expected after 6 hours of alcohol withdrawal and how are they treated?
- Sx: Trembling, irritability, anxiety, headache, tachycardia, insomnia
- Tx: IVF, thiamine then glucose, folate
What symptoms can be expected after 12-24 hours of alcohol withdrawal and how are they treated?
- Sx: visual or auditory hallucinations s/w a clean sensorium & normal vitals
- Tx: begin BZD taper to avoid seizures
What symptoms can be expected after 48 hours of alcohol withdrawal and how are they treated?
- Sx: tonic-clonic seizures
- Tx: BZD taper, head CT
What symptoms can be expected after 48-96 hours of alcohol withdrawal and how are they treated?
- Sx: Delirium tremens - autonomic instability, disorientation, hallucinations, agitation
- Tx: BZD taper
What is the general treatment recommendation for alcohol withdrawal?
BZDs (Chlordiazepoxide, lorazepam) + IVF, vitamins, thiamine, folic acid
* Replace thiamine before giving any glucose to prevent Wernicke encephalopathy & Korsakoff psychosis
* Hallucinations: Haldol
What is the diagnostic criteria for cannabis intoxication?
Recent cannabis use w/ problematic behavioral/psych changes during or shortly after use PLUS ≥ 2 sxs w/in 2 hrs
* Conjunctival injection, increased appetite, dry mouth, tachycardia
What is the diagnostic criteria for cannabis withdrawl?
Cessation or ↓ of heavy/prolonged cannabis use PLUS ≥ 3 sxs within 1 week of stopping
* Irritability or aggression, anxiety, sleep difficulty (insomnia, disturbing dreams), ↓ appetite/weight, restlessness, depressed mood
* ≥ 1: abdominal pain, shakiness/tremors, sweating, fever, chills, or headache
How is cannabis intoxication and withdrawal treated?
Supportive
* cannabis hyperemesis syndrome: zofran
What is PCP (phencyclidine)?
NMDA receptor antagonist
* hallucinogenic
* Withdrawal: depression, anxiety, irritability, restlessness, anergia, disturbance of thought & sleep
What is LSD?
5-HT (serotonin) receptor
* Intoxication: visual hallucination, seeing sound as color, anxiety/depression, delusions, pupillary dilation & “bad trip” panic.
* Withdrawal: none since it does not affect dopamine
What is the diagnostic criteria for PCP intoxication?
Recent use of PCP w/ problematic behavioral changes during or shortly after use PLUS ≥ 2 sxs w/in 1 hr
* vertical or horizontal nystagmus, HTN or tachycardia, numbness or diminished responsiveness to pain, ataxia, dysarthria, muscle rigidity, seizures or coma, hyperacusis
How is PCP intoxication treated?
ABCs, BZDs (Lorazepam), adjunct antipsychotics (Haloperidol)
What is the diagnostic criteria for inhalant intoxication?
Recent high-dose exposure to inhalants w/ problematic behavioral/psych changes during, or shortly after, exposure PLUS ≥ 2 sxs
* dizziness, nystagmus, incoordination, slurred speech, unsteady gait, lethargy, depressed reflexes, psychomotor retardation, tremor, muscle weakness, blurred vision or diplopia, stupor or coma, euphoria
How is inhalant intoxication treated?
Antipsychotics (Haloperidol) if severe aggression
What is the MOA of opioids?
mu receptor agonist (morphine, heroin, methadone)
What screening tools can be used for opioid use disorder?
- Opioid Risk Tool, Screener & Opioid Assessment for Patient w/ Pain (SOAPP-SF)
- Current Opioid Misuse Measure (COMM)
How is opioid addiction treated?
Methadone or Suboxone (buprenorphine + naloxone)
What is the diagnostic criteria for opioid intoxication?
Recent use of opioid w/ problematic behavioral changes during or shortly after use PLUS pupillary constriction & ≥ 1 sxs
* TRIAD: pupillary constriction, comatose state, respiratory depression
How is opioid intoxication treated?
Naloxone (Narcan)
What is the diagnostic criteria for opioid withdrawal?
Stop or ↓ in opioid use OR administration of an opioid antagonist after a period of opioid use PLUS ≥ 3 sxs w/in min-days
* dysphoric mood, N/V/D, muscle aches, lacrimation/rhinorrhea, pupillary dilation, piloerection, or sweating, yawning, fever, insomnia
How is opioid withdrawal treated?
Methadone, Clonidine for CV sxs, Zofran for N/V
* Buprenorphine + naloxone (suboxone): can precipitate withdrawal if given too soon
What are anxiolytic medications?
medications such as BZDs used for the tx of anxiety disorders.
* MOA: target GABAa channel to increased frequency of opening
What is the diagnostic criteria for sedative intoxication?
Recent use of a sedative, hypnotic, or anxiolytic w/ problematic behavioral changes during or shortly after use PLUS ≥ 1 sxs
* slurred speech, incoordination, unsteady gait, nystagmus, impairment in cognition (attention, memory), stupor or coma.
* Tx: supportive
What is the diagnostic criteria for sedative withdrawal?
Stop or ↓ in sedative, hypnotic, or anxiolytic use that has been prolonged PLUS ≥ 2 sxs w/in hrs-days
* autonomic hyperactivity, hand tremor, insomnia, N/V, hallucination, psychomotor agitation, anxiety, grand mal seizures.
How is sedative withdrawal treated?
long-acting benzo (clonazepam, diazepam) w/ appropriate taper
How is sedative overdose treated?
flumazenil (competitive GABA antagonist)
What is the MOA of stimulants?
block amine (dopamine, norepinephrine & 5HT) reuptake
What is kindling?
a phenomenon a/w chronic stimulant use, even a small dose of stimulant (ex. coffee) can cause hallucination & paranoia.
How is stimulant use disorder treated?
drug counseling & intensive outpatient therapy
What is the diagnostic criteria for stimulant intoxication?
Recent use of an amphetamine-type substance w/ problematic behavioral/psych changes PLUS ≥ 2 sxs
* pupillary dilation!!!
How is stimulant intoxication treated?
supportive, monitor in a quiet, safe environment
* BDZs for agitation, Haloperidol only if extreme paranoia or psychosis
* AVOID BETA BLOCKERS (coronary spasm)
What is the diagnostic criteria for stimulant withdrawl?
Stop or ↓ in amphetamine-type substance, cocaine, or other stimulant + dysphoric mood PLUS ≥ 2 sxs w/in hrs-days
* hypersomnia, ↑ appetite, constricted pupils
How is stimulant withdrawal treated?
bupropion, bromocriptine, SSRIs for depression
What is the diagnostic criteria for tobacco withdrawal?
Daily use of tobacco for several weeks w/ abrupt stopping or ↓ in use PLUS ≥ 4 sxs w/in 24 hrs
What are the treatment options for tobacco use disorder and withdrawal?
- 1st line: NRT (long acting patch + short acting gum/lozenge)
- Varenicline
- Bupropion
When should a patient stop smoking if taking Varenicline?
1 week after starting medication
When should a patient stop smoking if taking Bupropion?
1 week before starting treatment
