SUBSTANCE-RELATED DISORDERS Flashcards
what is the difference between dependence and addiction
dependence manifests a withdrawal syndrome. addiction is characterized by craving and impulse control.
What is considered “at risk drinking” for men, women, and elderly?
what are the demographics for alcohol dependence
- Male
- white/native american
- single
- younger (<30)
- low income
what is the CAGE questionnare
- cut down
- annoyed at people criticizing your drinking
- guilty about your drinking
- need an eye opener
what are screening tools that can be used after a positive CAGE questionnare
- Alcohol use disorders identification test (AUDIT)
- Drug abuse screening test (DAST-10)
- NIDA quick screening tool
what is teh MOA of alcohol
- increases dopamine
- stimulates GABA
- affects glutamate (NMDA) and seratonin
what is the triad of wenickes encephalopathy
confusion, ataxia, ophthalmoplegia
ophthalmoplegia = weakness of eye muscles
what is the difference between wernickes encephalopathy and korsakoff psychosis
wernickes encephalopathy is often completely reversibel, whereas korsakof presents with more severe symptoms and is only reversible about 20% of the time
what is the treatment of both wernickes encephalopathy and korsakoff syndrome
thiamine and other B vitamins
what will liver enzymes look like in a patient with chronic alcohol use?
AST:ALT >2:1
what is the timeline of the symptoms of alcohol withdrawal
8-12 hours: tremors, NV, insomnia, diaphoresis
12-48 hours: add hallucinations, seizures
48-96+: delirium tremens
what are the s/s of delirium tremens
hallucinations, disorientation, tachycardia, hypertension, fever, and diaphoresis.
48+ hours after last drink
what is the treatmen of acute alcohol withdrawal
- benzos
- BB for tachycardia or anxiety
- thiamine 1st then glucose
what is used to evaluate the severity of alcohol withdrawal
CIWA scoring
what medication is reccomended 1st line for alcohol dependence while the patient is still drinking
naltrexone
what is the MOA of naltrexone
blocks release of dopamine in the brain (takes away the reward)
antagonizes mu receptor
what is the CI for naltrexone
cant be given if the patient uses opioids
also causes liver problems, so pre-existing liver issues is probs a no
what medication is reccomended 1st line for alcohol dependence if the patient has stopped drinking
acamprosate
what is the MOA of acamprosate
- restores normal glutamate action
- stops glutamate excitation that causes withdrawal
what is the CI for acamprosate
severe renal impairement
which alcohol abuse treatment causes a bad reaction to alcohol
disulfuram (antabuse)
what is the CI for antabuse
severe heart disease
what is the MOA of nicotine in the body
- stimulates nicotinic cholinergic receptors in the brain
- triggers dopamine and epinephrine release
causes tolerance and upregulation of nicotinic (acetylcholine) receptors
what are the s/s of nicotine withdrawal
- irritability
- insomnia
- increased appetite
- weight gain
what are the nicotine metabolites
- continine (16 hours in serum, several weeks in urine)
- anabasine (present in tobacco/vapes but not in nicotine replacement or second hand smoke)
what is the MOA of bupropion
- blocks dopamine and NE reuptake
- antagonizes nicotinic cholinergic receptors
what are the SE of bupropion
insomnia
agitation
dry mouth
headache
seizure
what is the MOA of chantix (varenicline)
- partial agonist of nicotinic cholinergic receptors
- AKA decreases withdrawal and blocks “reward” from nicotine
what are the 5 A’s
- Ask: Identify and document the behavior being targeted
- Advise: Provide clear, personalized guidance on the risks and benefits of changing the behavior
- Assess: Evaluate the individual’s readiness to change
- Assist: Provide resources and support to help the individual change their behavior
- Arrange: Schedule a follow-up contact to check in on progress
what is the MOA of opioids in the body
acts on mu, kappa, and delta opioid receptors in the brain, digestive tract and spinal cord
what are some of the s/s of severe opioid intoxication
- respiratory depression
- peripheral vasodilation
- pinpoint pupils
- pulmonary edema
- death
what is the treatment for acute opioid overdose
naloxone (narcan)
what is the MOA of naloxone
short-acting opioid antagonist
what is the treatment of opioid withdrawal
- methadone or suboxone (buprenorphine)
- clonidine or lofexidine for HTN, tacycardia, anxiety, ect.
- Naltrexone
what is the risk of using natrexone for opioid abusers
if they resume opioid use while on medication it can stimulate overdose
what is the MOA of methamphetamine
cause release and block reuptake of domaine, NE, and seratonin
what are s/s of acute amphetamine intoxication
- euphoria
- psychosis
- pupillary dilation
- tachycardia/HTN
what is the s/s of severe amphetamine intoxication
- hyperkalemia
- hypertensive crisis
- hyperthermia
- metabolic acidosis
- rhabdomyolysis
What is the treatment for amphetamine intoxication
Symptomatic treatment
* benzos
* antihypertensives
what are the s/s of amphetamine withdrawal
honestly every symptom ever
what is the treatment regimen for amphetamine withdrawal
“no clear cut treatment”
* bupropion + naltrexone used firstline per UTD
what is the MOA of benzodiazepines
enhances GABA
what is the presentation of benzo overdose
CNS depression with NORMAL vital signs
what is the treatment for acute BZD overdose
flumazenil (can cause seizures!!)
what is the presentation for BZD withdrawal
- Neuro - tremors, seizures, perceptual disturbances
- Psych - anxiety, psychosis, dysphoria
- very dangerous!
what is the treatment of BZD withdrawal
long-acting BZD titrated down over months
what is the MOA of cocaine
blocks dopamine reuptake
what are s/s of cocaine use
- nosebleeds
- arrhythmias/MI
- HTN, tachycardia, fever
- insomnia
- mydriasis (pupillary dilation)
- rhabdomyolysis
what are the s/s of cocaine withdrawal
- craving
- sleep disturbance
- hunger
- severe fatigue and depression
with is the treatment for cocaine acute withdrawal
bromocriptine and symptomatic tx
what is the treatment for cocaine dependence long term
topiramate (1st line)
what is the MOA of marijuana
mimics anandamide and increases dopamine levels
what is the s/s of acute marijuana intoxication
- euphoria
- hunger
- conjunctival injection
can have hallucinations/delusions/delerium in high doses
what are the s/s of marijuana withdrawal
- fatigue
- yawning
- hypersomnia
- anorexia
- depression/anxiety
what is the treatment of cannabis withdrawal
mild: no tx
symptoms affecting work/school: dronabinol or gabapentin
symptoms causing sleep disurbance: zolpidem
describe the presentation of cannabis hyperemesis syndrome
- NVD abdominal pain
- relieved by hot showers/baths
tx: abstinence
just glance at whatever the heck this is
