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Psych EOR > Substance-Related Disorders > Flashcards

Substance-Related Disorders Flashcards

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1
Q

What is the diagnostic criteria for substance use disorder?

A

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

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2
Q

What screening tool can be used for alcohol use disorder?

A

CAGE
* Cut down
* Annoyed/criticized for drinking
* Guilty
* Eye opener

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3
Q

How is alcohol use disorder treated?

A
  • 1st line: Naltrexone or Acamprosate
  • 2nd line: disulfiram or topiramate
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4
Q

What is the diagnostic criteria for alcohol intoxication?

A

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

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5
Q

How is alcohol intoxication treated?

A

IVF, vitamins, thiamine, electrolytes

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6
Q

What tool can be used to assess alcohol withdrawl severity?

A

CIWA-Ar score
* Minimal (<8)
* Mild (8-15)
* Moderate (16-20)
* Severe (>20)

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7
Q

What is the diagnostic criteria for alcohol withdrawl?

A

Cessation or ↓ of heavy/prolonged alcohol use PLUS ≥ 2 sxs within hrs-days after stopping

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8
Q

What symptoms can be expected after 6 hours of alcohol withdrawal and how are they treated?

A
  • Sx: Trembling, irritability, anxiety, headache, tachycardia, insomnia
  • Tx: IVF, thiamine then glucose, folate
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9
Q

What symptoms can be expected after 12-24 hours of alcohol withdrawal and how are they treated?

A
  • Sx: visual or auditory hallucinations s/w a clean sensorium & normal vitals
  • Tx: begin BZD taper to avoid seizures
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10
Q

What symptoms can be expected after 48 hours of alcohol withdrawal and how are they treated?

A
  • Sx: tonic-clonic seizures
  • Tx: BZD taper, head CT
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11
Q

What symptoms can be expected after 48-96 hours of alcohol withdrawal and how are they treated?

A
  • Sx: Delirium tremens - autonomic instability, disorientation, hallucinations, agitation
  • Tx: BZD taper
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12
Q

What is the general treatment recommendation for alcohol withdrawal?

A

BZDs (Chlordiazepoxide, lorazepam) + IVF, vitamins, thiamine, folic acid
* Replace thiamine before giving any glucose to prevent Wernicke encephalopathy & Korsakoff psychosis
* Hallucinations: Haldol

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13
Q

What is the diagnostic criteria for cannabis intoxication?

A

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

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14
Q

What is the diagnostic criteria for cannabis withdrawl?

A

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

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15
Q

How is cannabis intoxication and withdrawal treated?

A

Supportive
* cannabis hyperemesis syndrome: zofran

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16
Q

What is PCP (phencyclidine)?

A

NMDA receptor antagonist
* hallucinogenic
* Withdrawal: depression, anxiety, irritability, restlessness, anergia, disturbance of thought & sleep

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17
Q

What is LSD?

A

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

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18
Q

What is the diagnostic criteria for PCP intoxication?

A

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

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19
Q

How is PCP intoxication treated?

A

ABCs, BZDs (Lorazepam), adjunct antipsychotics (Haloperidol)

20
Q

What is the diagnostic criteria for inhalant intoxication?

A

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

21
Q

How is inhalant intoxication treated?

A

Antipsychotics (Haloperidol) if severe aggression

22
Q

What is the MOA of opioids?

A

mu receptor agonist (morphine, heroin, methadone)

23
Q

What screening tools can be used for opioid use disorder?

A
  • Opioid Risk Tool, Screener & Opioid Assessment for Patient w/ Pain (SOAPP-SF)
  • Current Opioid Misuse Measure (COMM)
24
Q

How is opioid addiction treated?

A

Methadone or Suboxone (buprenorphine + naloxone)

25
Q

What is the diagnostic criteria for opioid intoxication?

A

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

26
Q

How is opioid intoxication treated?

A

Naloxone (Narcan)

27
Q

What is the diagnostic criteria for opioid withdrawal?

A

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

28
Q

How is opioid withdrawal treated?

A

Methadone, Clonidine for CV sxs, Zofran for N/V
* Buprenorphine + naloxone (suboxone): can precipitate withdrawal if given too soon

29
Q

What are anxiolytic medications?

A

medications such as BZDs used for the tx of anxiety disorders.
* MOA: target GABAa channel to increased frequency of opening

30
Q

What is the diagnostic criteria for sedative intoxication?

A

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

31
Q

What is the diagnostic criteria for sedative withdrawal?

A

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.

32
Q

How is sedative withdrawal treated?

A

long-acting benzo (clonazepam, diazepam) w/ appropriate taper

33
Q

How is sedative overdose treated?

A

flumazenil (competitive GABA antagonist)

34
Q

What is the MOA of stimulants?

A

block amine (dopamine, norepinephrine & 5HT) reuptake

35
Q

What is kindling?

A

a phenomenon a/w chronic stimulant use, even a small dose of stimulant (ex. coffee) can cause hallucination & paranoia.

36
Q

How is stimulant use disorder treated?

A

drug counseling & intensive outpatient therapy

37
Q

What is the diagnostic criteria for stimulant intoxication?

A

Recent use of an amphetamine-type substance w/ problematic behavioral/psych changes PLUS ≥ 2 sxs
* pupillary dilation!!!

38
Q

How is stimulant intoxication treated?

A

supportive, monitor in a quiet, safe environment
* BDZs for agitation, Haloperidol only if extreme paranoia or psychosis
* AVOID BETA BLOCKERS (coronary spasm)

39
Q

What is the diagnostic criteria for stimulant withdrawl?

A

Stop or ↓ in amphetamine-type substance, cocaine, or other stimulant + dysphoric mood PLUS ≥ 2 sxs w/in hrs-days
* hypersomnia, ↑ appetite, constricted pupils

40
Q

How is stimulant withdrawal treated?

A

bupropion, bromocriptine, SSRIs for depression

41
Q

What is the diagnostic criteria for tobacco withdrawal?

A

Daily use of tobacco for several weeks w/ abrupt stopping or ↓ in use PLUS ≥ 4 sxs w/in 24 hrs

42
Q

What are the treatment options for tobacco use disorder and withdrawal?

A
  • 1st line: NRT (long acting patch + short acting gum/lozenge)
  • Varenicline
  • Bupropion
43
Q
A
44
Q

When should a patient stop smoking if taking Varenicline?

A

1 week after starting medication

45
Q

When should a patient stop smoking if taking Bupropion?

A

1 week before starting treatment

Psych EOR (9 decks)

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