Substance Related Disorders Flashcards
Impairment or distress for at least 12 months with one or more of the following manifestations:
- Failure to fulfill obligations at work, school, or home
- Use in dangerous situations
- Recurrent substance related legal problems
- Continued use despite social or interpersonal problems due to the substance use
Abuse
Impairement or distress manifested by at least three of the following within a 12 month period:
- Tolerance
- Withdrawl
- use of substance more then originally intended
- Persistent desire or unsuccessful efforts to cut down on use
- Significant time spent in getting, using, or recovering from substance
- decreased social, occupational or recreational activities because of substance use
- Continued use despite subsequent physical or psychological problems
Dependence
True or false:
Mood symptoms are common among persons with substance abuse disorders
True (psychotic sx may occur w some substances)
Alcohol is sedating but alcohol withdrawl can lead to what?
Brain excitation and seizures
Alcohol stays in the system for how long?
only a few hours
Cocaine is positive in the urine drug screen for how long?
2-4 days
Amphetamines are in urine drug screen for how long?
1-3 days
Phencyclidine (PCP) in urine drug screen for how long?
3-8 days
Marijuana in urine drug screen for how long?
heavy users-4 weeks
one time user - about 3 days
Alcohol activates what neurotransmitter receptors?
GABA and serotonin (inhibitory effect that is why alcohol is a depressant)
Alcohol inhibits what neurotransmitters receptor and channel?
Glutamate and voltage gated calcium channels
Treatment for alcohol intoxication
Monitor: airway, breathing, circulation, glucose, electrolytes and acid base status
Give thiamine and folate and might need naloxone
Ethanol, methanol and ethylene glycol cause what kind of acid base status?
metabolic acidosis with increased anion gap
insomnia, anxiety, hand tremor, irritablility, anorexia, nausea, vomiting, autonomic hyperactivity (diaphoresis, tachycardia, hypertension), psychomotor agitation, fever, seizures, hallucinations, and delirium are signs and sx of what withdrawl?
Alcohol (treat with benzos and taper slowly)
what decreased element may predispose a pt with alcohol withdrawl to a seizure?
hypomagnesemia
Delirium Tremens (the most serious form of alcohol withdrawl) usually begins how long after the last drink?
48-72 hours (2-3 days) may occur later but 90% of cases within 7 days
Which gender develops DTs more often?
Men four to five times as often as women
Tx for DTs?
Dilantin (phenytoin) and Benzos (chlordiazepoxide, diazepam or lorazepam) should be given in sufficient doses then tapered down slowly Banana bags ( thiamine, and folate and multivitamin)
AST:ALT ratio of what? and an elevation of which biochemical marker suggest excessive alcohol use?
AST:ALT greater then or equal to 2:1 and elevated Gama-glutamy transpeptidase (GGT)
Alcohol can increase which function tests and what volume?
Liver function tests and macrocytosis (INCREASED MCV)
Medication for alcohol dependance that is anteabuse? who is it contraindicated in?
Disulfiram and it is contraindicated in severe cardiac disease, pregnancy and psychosis
Medication for alcohol dependance that decreases the desire or craving for alcohol?
naltrexone (revia, or IM- Vivitrol) it is an opioid receptor blocker.
medication that should be started postdetoxification for relapse prevention in patients who have stopped drinking
Acamprosate
what is the major advantage of acmprosate
it can be used in patients with liver disease
Anticonvulsant that potentiates GABA and inhibits glutamate receptors reducing the cravings for alcohol?
Topiramate (topamax)
Ataxia (broad based), confusion and ocular abnormalities (nystagmus, and gaze palsies)
Wernicke’s encephalopathy
All patients with altered mental status should be given thiamine and glucose in what order to prevent Wernicke- Korsakoff syndrome
Thiamine before glucose
blocks doapmine reuptake from the synaptic cleft, causing a stimulant effect
cocaine
Cocaine intoxication general sx?
Euphoria, heightened self esteem, increased or decreased blood pressure, tachy or bradycardia, nausea, DILATED pupils, weight loss, psychomotor agitation, depression or chills and sweating
What are dangerous sx of cocaine intoxication?
Respiratory depression, seizures, arrhythmias, paranoia, and hallucinations
Deadly sx of cocaine intoxication?
vasoconstrictive effect may result in MI.
Management of cocaine intoxication?
benzo’s for moderate to mild agitations and axiety
Antipsychotics (haloperidol) for severe
if a temp over 102 then aggressive temperature control with ice baths, cooling blanket, etc
dilated pupils, increased libido, perspiration, respiratory depression and chest pain are sx of what abuse?
amphetamine
block reuptake and facilitate release of dopamine and norepi from nerve endings, causing a stimulant effect?
amphetamine
amphetamines are used to treat which conditions?
Narcolepsy, ADHD, depressive disorders
What makes substituted amphetamines different?
they release dopamine, norepi AND SEROTONIN from nerve endings (examples are MDMA “ecstasy” and MDME “eve”)
chronic amphetamine use leads to?
acne and tooth decay (‘meth mouth”)
overdose of amphetamine can lead to ?
hyperthermia, dehydration and rhabdomylolysis which can lead to renal failure
amphetamine withdrawl can lead to
prolonged depression
amphetamine intoxication treatment
rehydration, electrolyte balance correction, and treat hyperthermia
PCP intoxication symptoms
Rage, Erythema (redness of skin), Dilated Pupils, Delusions, Amnesia, Nystagmus, Excitation, Skin dryness (RED DANES)
Drug sometimes used as date rap drug because it is tasteless and odorless
ketamine (special K)
Ketamine can produce what effects
tachycardia, tachypnea, hallucinations, and amnesia
PCP intoxication clinical presentation
Depersonalization, SYNESTHESIA, ROTATORY nystagmus, agitation, hallucination, HIGH TOLERANCE TO PAIN, ataxia, dysarthria, hypertension, muscle rigidity, tachycardia, MEMORY IMPAIRMENT, ASSAULTIVNESS
Treatment for PCP intoxication
monitor vitals, temp, and electrolyte and minimize SENSORY STIMULATION
use benzo to treat muscle rigidity, agitation, anxiety and seizures, use antipsychotics for severe agitation or psychotic sx
Rotatory nystagmus is pathognomonic for what intoxication?
PCP
Tactile and visual hallucinations are found in both?
cocaine and PCP abuse
more than with other drugs intoxication with PCP results in?
violence
overdose of PCP can cause?
coma, seizures and even death
dose specific CNS depressant that produces memory loss, respiratory distress and coma and is commonly used as date rape drug
Gamma-hydroxybutyrate (GHB)
Potentiate the effects of GABA by increasing the frequency of chloride channels opening
Benzodiazepines
potentiates the effects of GABA by increasing the duration of chloride channel opening
Barbiturates
Benzo’s are commonly used to treat?
anxiety disorders
Barbiturates are commonly used to treat?
epilepsy and as anesthetic
Withdrawl from what drug class has the highest mortality rate?
Barbiturates
Treatment strategy for barbiturate overdose only
Alkalinize urine with sodium bicarb to promote renal excretion
Treatment stragety for benzo overdose
Flumazenil
Tx of choice for opiate overdose?
Naloxone
in general withdrawl from what drugs is life threatening?
sedatives
opioid exception to producing miosis (constricted pupils)
Meperidine (“demerol dilates pupils”)
opioid intoxication causes:
nausea, vomiting, sedation, decreased pain perception, decreased GI motility, pupil constriction (except meperidine), and respiratory depression (which is what can kill)
What should you be careful taking with Meperidine and why?
MAO-I’s because they can cause serotonin syndrome ( hyperthermia, confusion, muscle rigidity and hyper or hypotension)
classic triad of opioid overdose
Respiratory depression, Altered Mental Status, Miosis (Rebels admire morphine)
Eating what can result in a positive urine drug screen for opioids?
poppey seed bagels or muffins
anxiety, insomnia, anorexia, fever, RHINORRHEA, PILOERECTION,
Opioid withdrawl sx. not life threatening
Gold Standard tx for opioid dependent pregnant women?
Methadone
precipitates withdrawl if used within 7 days of heroin use
Naltrexone
Marijuana has been used for what therapeutic effects?
Treat nausea in chemo pts, increase appetite in AIDS pts, and decrease intraocular pressure, muscle spasms, and tremor
chronic marijuana use may have side effects on which hormones?
reproductive hormones
which substances user is typically a preadolescent or adolescent
inhalants
increases cAMP and has a stimulant effect via the dopaminergic system
caffeine
effects of greater then 1 g of caffeine consumption
tinnitus, severe agitation, visual light flashes and cariac arrhythmias
effects of greater then 10 g of caffeine consumption
death may occur secondary to seizures and respiratory failure
nicotine is highly addictive through its effects on what?
the dopaminergic system
effects of nicotine
restlessness, insomnia, anxiety and increased GI motility
Tx of Nicotine dependence
Varenicline, bupropion
Name 7 opioids
Heroin, oxycodone, codeine, dextromethorphan, morphine, methadone, and meperidine (Demerol)
