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Psych EOR (billie) > SUBSTANCE-RELATED DISORDERS > Flashcards

SUBSTANCE-RELATED DISORDERS Flashcards

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1
Q

what is the difference between dependence and addiction

A

dependence manifests a withdrawal syndrome. addiction is characterized by craving and impulse control.

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2
Q

What is considered “at risk drinking” for men, women, and elderly?

A
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3
Q

what are the demographics for alcohol dependence

A
  • Male
  • white/native american
  • single
  • younger (<30)
  • low income
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4
Q

what is the CAGE questionnare

A
  1. cut down
  2. annoyed at people criticizing your drinking
  3. guilty about your drinking
  4. need an eye opener
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5
Q

what are screening tools that can be used after a positive CAGE questionnare

A
  1. Alcohol use disorders identification test (AUDIT)
  2. Drug abuse screening test (DAST-10)
  3. NIDA quick screening tool
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6
Q

what is teh MOA of alcohol

A
  • increases dopamine
  • stimulates GABA
  • affects glutamate (NMDA) and seratonin
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7
Q

what is the triad of wenickes encephalopathy

A

confusion, ataxia, ophthalmoplegia

ophthalmoplegia = weakness of eye muscles

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8
Q

what is the difference between wernickes encephalopathy and korsakoff psychosis

A

wernickes encephalopathy is often completely reversibel, whereas korsakof presents with more severe symptoms and is only reversible about 20% of the time

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9
Q

what is the treatment of both wernickes encephalopathy and korsakoff syndrome

A

thiamine and other B vitamins

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10
Q

what will liver enzymes look like in a patient with chronic alcohol use?

A

AST:ALT >2:1

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11
Q

what is the timeline of the symptoms of alcohol withdrawal

A

8-12 hours: tremors, NV, insomnia, diaphoresis
12-48 hours: add hallucinations, seizures
48-96+: delirium tremens

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12
Q

what are the s/s of delirium tremens

A

hallucinations, disorientation, tachycardia, hypertension, fever, and diaphoresis.

48+ hours after last drink

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13
Q

what is the treatmen of acute alcohol withdrawal

A
  • benzos
  • BB for tachycardia or anxiety
  • thiamine 1st then glucose
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14
Q

what is used to evaluate the severity of alcohol withdrawal

A

CIWA scoring

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15
Q

what medication is reccomended 1st line for alcohol dependence while the patient is still drinking

A

naltrexone

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16
Q

what is the MOA of naltrexone

A

blocks release of dopamine in the brain (takes away the reward)

antagonizes mu receptor

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17
Q

what is the CI for naltrexone

A

cant be given if the patient uses opioids

also causes liver problems, so pre-existing liver issues is probs a no

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18
Q

what medication is reccomended 1st line for alcohol dependence if the patient has stopped drinking

A

acamprosate

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19
Q

what is the MOA of acamprosate

A
  • restores normal glutamate action
  • stops glutamate excitation that causes withdrawal
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20
Q

what is the CI for acamprosate

A

severe renal impairement

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21
Q

which alcohol abuse treatment causes a bad reaction to alcohol

A

disulfuram (antabuse)

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22
Q

what is the CI for antabuse

A

severe heart disease

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23
Q

what is the MOA of nicotine in the body

A
  • stimulates nicotinic cholinergic receptors in the brain
  • triggers dopamine and epinephrine release

causes tolerance and upregulation of nicotinic (acetylcholine) receptors

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24
Q

what are the s/s of nicotine withdrawal

A
  • irritability
  • insomnia
  • increased appetite
  • weight gain
25
Q

what are the nicotine metabolites

A
  • continine (16 hours in serum, several weeks in urine)
  • anabasine (present in tobacco/vapes but not in nicotine replacement or second hand smoke)
26
Q

what is the MOA of bupropion

A
  • blocks dopamine and NE reuptake
  • antagonizes nicotinic cholinergic receptors
27
Q

what are the SE of bupropion

A

insomnia
agitation
dry mouth
headache
seizure

28
Q

what is the MOA of chantix (varenicline)

A
  • partial agonist of nicotinic cholinergic receptors
  • AKA decreases withdrawal and blocks “reward” from nicotine
29
Q

what are the 5 A’s

A
  • 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
30
Q

what is the MOA of opioids in the body

A

acts on mu, kappa, and delta opioid receptors in the brain, digestive tract and spinal cord

31
Q

what are some of the s/s of severe opioid intoxication

A
  • respiratory depression
  • peripheral vasodilation
  • pinpoint pupils
  • pulmonary edema
  • death
32
Q

what is the treatment for acute opioid overdose

A

naloxone (narcan)

33
Q

what is the MOA of naloxone

A

short-acting opioid antagonist

34
Q

what is the treatment of opioid withdrawal

A
  • methadone or suboxone (buprenorphine)
  • clonidine or lofexidine for HTN, tacycardia, anxiety, ect.
  • Naltrexone
35
Q

what is the risk of using natrexone for opioid abusers

A

if they resume opioid use while on medication it can stimulate overdose

36
Q

what is the MOA of methamphetamine

A

cause release and block reuptake of domaine, NE, and seratonin

37
Q

what are s/s of acute amphetamine intoxication

A
  • euphoria
  • psychosis
  • pupillary dilation
  • tachycardia/HTN
38
Q

what is the s/s of severe amphetamine intoxication

A
  • hyperkalemia
  • hypertensive crisis
  • hyperthermia
  • metabolic acidosis
  • rhabdomyolysis
39
Q

What is the treatment for amphetamine intoxication

A

Symptomatic treatment
* benzos
* antihypertensives

40
Q

what are the s/s of amphetamine withdrawal

A

honestly every symptom ever

41
Q

what is the treatment regimen for amphetamine withdrawal

A

“no clear cut treatment”
* bupropion + naltrexone used firstline per UTD

42
Q

what is the MOA of benzodiazepines

A

enhances GABA

43
Q

what is the presentation of benzo overdose

A

CNS depression with NORMAL vital signs

44
Q

what is the treatment for acute BZD overdose

A

flumazenil (can cause seizures!!)

45
Q

what is the presentation for BZD withdrawal

A
  • Neuro - tremors, seizures, perceptual disturbances
  • Psych - anxiety, psychosis, dysphoria
  • very dangerous!
46
Q

what is the treatment of BZD withdrawal

A

long-acting BZD titrated down over months

47
Q

what is the MOA of cocaine

A

blocks dopamine reuptake

48
Q

what are s/s of cocaine use

A
  • nosebleeds
  • arrhythmias/MI
  • HTN, tachycardia, fever
  • insomnia
  • mydriasis (pupillary dilation)
  • rhabdomyolysis
49
Q

what are the s/s of cocaine withdrawal

A
  • craving
  • sleep disturbance
  • hunger
  • severe fatigue and depression
50
Q

with is the treatment for cocaine acute withdrawal

A

bromocriptine and symptomatic tx

51
Q

what is the treatment for cocaine dependence long term

A

topiramate (1st line)

52
Q

what is the MOA of marijuana

A

mimics anandamide and increases dopamine levels

53
Q

what is the s/s of acute marijuana intoxication

A
  • euphoria
  • hunger
  • conjunctival injection

can have hallucinations/delusions/delerium in high doses

54
Q

what are the s/s of marijuana withdrawal

A
  • fatigue
  • yawning
  • hypersomnia
  • anorexia
  • depression/anxiety
55
Q

what is the treatment of cannabis withdrawal

A

mild: no tx
symptoms affecting work/school: dronabinol or gabapentin
symptoms causing sleep disurbance: zolpidem

56
Q

describe the presentation of cannabis hyperemesis syndrome

A
  • NVD abdominal pain
  • relieved by hot showers/baths

tx: abstinence

57
Q

just glance at whatever the heck this is

A
58
Q
A

Psych EOR (billie) (10 decks)

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