Substance-Related Disorders Flashcards
In order for something to be classified as substance abuse, what time frame and characteristics must be presents?
12 months of WILD (one or more of the following)
- work, school, home obligation failures
- interpersonal/social consequences
- legal issues
- dangerous use
What is the definition of substance dependence?
12 months of 3 of the following:
- tolerance
- withdraw
- trying to cut down but cannot
- using more than intended
- significant time devoted to obtaining, using, recovering
- reduced job, social, recreational activities
- continued use despite physical/psych harm
What is withdrawal?
substance-specific syndrome due to the cessation of the substance,
(symptoms are the opposite of intoxication effects)
What is tolerance?
needing to increase the amount of substance used to achieve the desired effect
How long after use will a UDS for cocaine be positive?
2-4 days
How long after use will a UDS for amphetamines be positive?
1-3 days
How long will a UDS for PCP be positive?
What other things will be elevated with PCP use?
UDS will be positive for 3-8 days
CPK and AST will be elevated
How long will pentobarbital be in the urine/blood?
Phenobarbital?
Pento - 24 hours
Pheno- 3 wks
How long will short acting benzos be in the urine and blood? Long acting benzos?
Short acting = 3 days
Long acting = 30 days
Which opioids will come up negative on a general UDS and need a separate panel?
methadone, oxycodone
How long can cannabis be detected in urine in heavy users? After single use?
Heavy user = 4 weeks bc it is stored in adipose
One use= 3 days
What receptors are activated by alcohol?
Inhibited?
Activated:
- GABA
- 5HT
Inhibited:
- glutamate
- voltage gated Ca channels
What is treatment for alcohol intoxication?
- monitor: airway, breathing, circulation, glucose, electrolytes, acid-base
- give thiamine to prevent Wernicke enceph
- give folate
- naloxone of co-ingested opioid
- CT of head
What BAL would cause:
- impaired judgement and coordination
- memory difficulty/lethargy
- coma in a novice drinker
- respiratory depression/death
- 50-100mg/dl
- 150-250
- 300
- 400
When do the earliest signs of alcohol withdrawal occur?
How long do the withdrawal symptoms last?
6-24 hours after the last drink depending on amount and duration of EtOH consumption
Symptoms last 2-7days
When would generalized tonic-clonic seizures occur after drinking?
6-48 hours after cessation with peak at 13-24 hours
What electrolyte imbalance in people with alcohol withdrawal predispose to seizures?
hypomagnesemia
What is the mortality rate for DTs?
When after the last drink does delerium tremens tend to occur?
What does it look like?
15-25% die.
It occurs 2-3days after the last drink
- delirium
- hallucinations (visual)
- seizures/autonomic instability
- gross tremor
What is the treatment for alcohol withdrawal?
- benzo taper [chlordiazepoxide, diazepam, lorazepam] and then tapered down slowly OR carbamazepine, valproic, phenytoin {dilantin}
- antipsychotics if they are severely agitated
- thiamine, folate, multiV
- electrolyte/fluid repletion
What is used to monitor alcohol withdrawal symptoms?
CIWA -clinical institute withdrawal assessment scale
What is used to screen for alcohol abuse?
CAGE
- Cut down attempts?
- Annoyed with criticism of drinking?
- Guilty about drinking
- Eye opener? [to prevent shakes]
What biomarkers will be elevated in chronic/prolonged drinking?
- BAL
- LFTs [AST to ALT ratio 2:1, GGT]
- carbohydrate-deficient transferrin
- elevated MCV [macrocytosis]
What is the mechanism of disulfiram (antabuse)?
What are the 3 main contraindications?
What needs to be monitored?
Blocks aldehyde dehydrogenase causing flushing, tachycardia/palpitations, N/V, headache, SOB
- cardiac disease
- pregnant
- psychotic
Monitor LFTs
