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Substance Related Disorders Flashcards

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1
Q

Impairment or distress for at least 12 months with one or more of the following manifestations:

  1. Failure to fulfill obligations at work, school, or home
  2. Use in dangerous situations
  3. Recurrent substance related legal problems
  4. Continued use despite social or interpersonal problems due to the substance use
A

Abuse

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2
Q

Impairement or distress manifested by at least three of the following within a 12 month period:

  1. Tolerance
  2. Withdrawl
  3. use of substance more then originally intended
  4. Persistent desire or unsuccessful efforts to cut down on use
  5. Significant time spent in getting, using, or recovering from substance
  6. decreased social, occupational or recreational activities because of substance use
  7. Continued use despite subsequent physical or psychological problems
A

Dependence

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3
Q

True or false:

Mood symptoms are common among persons with substance abuse disorders

A

True (psychotic sx may occur w some substances)

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4
Q

Alcohol is sedating but alcohol withdrawl can lead to what?

A

Brain excitation and seizures

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5
Q

Alcohol stays in the system for how long?

A

only a few hours

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6
Q

Cocaine is positive in the urine drug screen for how long?

A

2-4 days

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7
Q

Amphetamines are in urine drug screen for how long?

A

1-3 days

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8
Q

Phencyclidine (PCP) in urine drug screen for how long?

A

3-8 days

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9
Q

Marijuana in urine drug screen for how long?

A

heavy users-4 weeks

one time user - about 3 days

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10
Q

Alcohol activates what neurotransmitter receptors?

A

GABA and serotonin (inhibitory effect that is why alcohol is a depressant)

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11
Q

Alcohol inhibits what neurotransmitters receptor and channel?

A

Glutamate and voltage gated calcium channels

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12
Q

Treatment for alcohol intoxication

A

Monitor: airway, breathing, circulation, glucose, electrolytes and acid base status
Give thiamine and folate and might need naloxone

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13
Q

Ethanol, methanol and ethylene glycol cause what kind of acid base status?

A

metabolic acidosis with increased anion gap

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14
Q

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?

A

Alcohol (treat with benzos and taper slowly)

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15
Q

what decreased element may predispose a pt with alcohol withdrawl to a seizure?

A

hypomagnesemia

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16
Q

Delirium Tremens (the most serious form of alcohol withdrawl) usually begins how long after the last drink?

A

48-72 hours (2-3 days) may occur later but 90% of cases within 7 days

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17
Q

Which gender develops DTs more often?

A

Men four to five times as often as women

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18
Q

Tx for DTs?

A 
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)
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19
Q

AST:ALT ratio of what? and an elevation of which biochemical marker suggest excessive alcohol use?

A

AST:ALT greater then or equal to 2:1 and elevated Gama-glutamy transpeptidase (GGT)

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20
Q

Alcohol can increase which function tests and what volume?

A

Liver function tests and macrocytosis (INCREASED MCV)

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21
Q

Medication for alcohol dependance that is anteabuse? who is it contraindicated in?

A

Disulfiram and it is contraindicated in severe cardiac disease, pregnancy and psychosis

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22
Q

Medication for alcohol dependance that decreases the desire or craving for alcohol?

A

naltrexone (revia, or IM- Vivitrol) it is an opioid receptor blocker.

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23
Q

medication that should be started postdetoxification for relapse prevention in patients who have stopped drinking

A

Acamprosate

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24
Q

what is the major advantage of acmprosate

A

it can be used in patients with liver disease

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25
Q

Anticonvulsant that potentiates GABA and inhibits glutamate receptors reducing the cravings for alcohol?

A

Topiramate (topamax)

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26
Q

Ataxia (broad based), confusion and ocular abnormalities (nystagmus, and gaze palsies)

A

Wernicke’s encephalopathy

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27
Q

All patients with altered mental status should be given thiamine and glucose in what order to prevent Wernicke- Korsakoff syndrome

A

Thiamine before glucose

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28
Q

blocks doapmine reuptake from the synaptic cleft, causing a stimulant effect

A

cocaine

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29
Q

Cocaine intoxication general sx?

A

Euphoria, heightened self esteem, increased or decreased blood pressure, tachy or bradycardia, nausea, DILATED pupils, weight loss, psychomotor agitation, depression or chills and sweating

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30
Q

What are dangerous sx of cocaine intoxication?

A

Respiratory depression, seizures, arrhythmias, paranoia, and hallucinations

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31
Q

Deadly sx of cocaine intoxication?

A

vasoconstrictive effect may result in MI.

32
Q

Management of cocaine intoxication?

A

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

33
Q

dilated pupils, increased libido, perspiration, respiratory depression and chest pain are sx of what abuse?

A

amphetamine

34
Q

block reuptake and facilitate release of dopamine and norepi from nerve endings, causing a stimulant effect?

A

amphetamine

35
Q

amphetamines are used to treat which conditions?

A

Narcolepsy, ADHD, depressive disorders

36
Q

What makes substituted amphetamines different?

A

they release dopamine, norepi AND SEROTONIN from nerve endings (examples are MDMA “ecstasy” and MDME “eve”)

37
Q

chronic amphetamine use leads to?

A

acne and tooth decay (‘meth mouth”)

38
Q

overdose of amphetamine can lead to ?

A

hyperthermia, dehydration and rhabdomylolysis which can lead to renal failure

39
Q

amphetamine withdrawl can lead to

A

prolonged depression

40
Q

amphetamine intoxication treatment

A

rehydration, electrolyte balance correction, and treat hyperthermia

41
Q

PCP intoxication symptoms

A

Rage, Erythema (redness of skin), Dilated Pupils, Delusions, Amnesia, Nystagmus, Excitation, Skin dryness (RED DANES)

42
Q

Drug sometimes used as date rap drug because it is tasteless and odorless

A

ketamine (special K)

43
Q

Ketamine can produce what effects

A

tachycardia, tachypnea, hallucinations, and amnesia

44
Q

PCP intoxication clinical presentation

A

Depersonalization, SYNESTHESIA, ROTATORY nystagmus, agitation, hallucination, HIGH TOLERANCE TO PAIN, ataxia, dysarthria, hypertension, muscle rigidity, tachycardia, MEMORY IMPAIRMENT, ASSAULTIVNESS

45
Q

Treatment for PCP intoxication

A

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

46
Q

Rotatory nystagmus is pathognomonic for what intoxication?

A

PCP

47
Q

Tactile and visual hallucinations are found in both?

A

cocaine and PCP abuse

48
Q

more than with other drugs intoxication with PCP results in?

A

violence

49
Q

overdose of PCP can cause?

A

coma, seizures and even death

50
Q

dose specific CNS depressant that produces memory loss, respiratory distress and coma and is commonly used as date rape drug

A

Gamma-hydroxybutyrate (GHB)

51
Q

Potentiate the effects of GABA by increasing the frequency of chloride channels opening

A

Benzodiazepines

52
Q

potentiates the effects of GABA by increasing the duration of chloride channel opening

A

Barbiturates

53
Q

Benzo’s are commonly used to treat?

A

anxiety disorders

54
Q

Barbiturates are commonly used to treat?

A

epilepsy and as anesthetic

55
Q

Withdrawl from what drug class has the highest mortality rate?

A

Barbiturates

56
Q

Treatment strategy for barbiturate overdose only

A

Alkalinize urine with sodium bicarb to promote renal excretion

57
Q

Treatment stragety for benzo overdose

A

Flumazenil

58
Q

Tx of choice for opiate overdose?

A

Naloxone

59
Q

in general withdrawl from what drugs is life threatening?

A

sedatives

60
Q

opioid exception to producing miosis (constricted pupils)

A

Meperidine (“demerol dilates pupils”)

61
Q

opioid intoxication causes:

A

nausea, vomiting, sedation, decreased pain perception, decreased GI motility, pupil constriction (except meperidine), and respiratory depression (which is what can kill)

62
Q

What should you be careful taking with Meperidine and why?

A

MAO-I’s because they can cause serotonin syndrome ( hyperthermia, confusion, muscle rigidity and hyper or hypotension)

63
Q

classic triad of opioid overdose

A

Respiratory depression, Altered Mental Status, Miosis (Rebels admire morphine)

64
Q

Eating what can result in a positive urine drug screen for opioids?

A

poppey seed bagels or muffins

65
Q

anxiety, insomnia, anorexia, fever, RHINORRHEA, PILOERECTION,

A

Opioid withdrawl sx. not life threatening

66
Q

Gold Standard tx for opioid dependent pregnant women?

A

Methadone

67
Q

precipitates withdrawl if used within 7 days of heroin use

A

Naltrexone

68
Q

Marijuana has been used for what therapeutic effects?

A

Treat nausea in chemo pts, increase appetite in AIDS pts, and decrease intraocular pressure, muscle spasms, and tremor

69
Q

chronic marijuana use may have side effects on which hormones?

A

reproductive hormones

70
Q

which substances user is typically a preadolescent or adolescent

A

inhalants

71
Q

increases cAMP and has a stimulant effect via the dopaminergic system

A

caffeine

72
Q

effects of greater then 1 g of caffeine consumption

A

tinnitus, severe agitation, visual light flashes and cariac arrhythmias

73
Q

effects of greater then 10 g of caffeine consumption

A

death may occur secondary to seizures and respiratory failure

74
Q

nicotine is highly addictive through its effects on what?

A

the dopaminergic system

75
Q

effects of nicotine

A

restlessness, insomnia, anxiety and increased GI motility

76
Q

Tx of Nicotine dependence

A

Varenicline, bupropion

77
Q

Name 7 opioids

A

Heroin, oxycodone, codeine, dextromethorphan, morphine, methadone, and meperidine (Demerol)

Psych Shelf (18 decks)

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