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Psychiatry Rotation > Substance-Related Disorders > Flashcards

Substance-Related Disorders Flashcards

1
Q

WILD

A

Needed criteria to determine substance ABUSE

Work, school or home role obligation failure
Interpersonal or social consequence
Legal problems
Dangerous Use

More common in males
17% in america have substance abuse

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2
Q

Dependence

A

impairment or distress manifested by (at least 3):
Tolerance
Withdrawal
Using substance more than originally intended
Persistent desire or unsuccessful attmepts to cut down
Significant time spent in getting, using or recovering from substance use
Decreased occupational or recreational activities
Continued use despite severe physical or psychological problems

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3
Q

WIthdrawal

A

Develpopment of a substance specific syndrome due to the cessation of substance used that has been heavy and prolonged.

Symptoms of withdrawal are often the opposite of what the effects of drug use are

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4
Q

Tolerance

A

The need for greater amounts of substance to achieve the desired effects

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5
Q

Basics of treatment for Substance abuse or Dependence

A

Behavioral Conseling
Psychosocial Treatment
Twelve Step Groups
Pharmacotherapy (if appropriate)

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6
Q

Phencyclidine

A

+ for 3-8 days. Creatine Phosphokinase and Aspartate Aminotranseferase are often elevated

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7
Q

Barbituates

A

In urine and blood for up to 3 weeks if long acting

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8
Q

Benzodiazepines

A

Short acting : 3 days

Long Acting: 30 days

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9
Q

Marijuana

A

Up to 4 weeks in urine

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10
Q

Alcohol mechanism of action and Metabolism

A

Activation of GABA and serotonin receptors in the CNS. Inhibits Glutamate …potent depressant.

Alcohol –> Acetaldehyde (Alcohol dehydrogenase)

Acetaldehyde – > Acetic Acid ( Aldehyde dehydrogenase.)

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11
Q

Tx of acute intoxication

A

Monitor basics
Give thiamine and folate (Wernickes Encephalopathy)
Naloxone (Narcaine) if opiods taken concurrently
CT if thought of head trauma

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12
Q

ALcohol: 20 -50 mg/dl

A

decreased fine motor control

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13
Q

ALcohol - 50-100 mg/dl

A

Impaired judgement and coordination

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14
Q

alcohol 100-150 mg/dl

A

Ataxic gait and poor balance

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15
Q

Alcohol 150-200 mg/dl

A

Lethargy, can’t sit upright, difficulty with memory

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16
Q

alcohol 300 mg/dl

A

Coma

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17
Q

Alcohol 400 mg/dl

A

Resp depression possible death

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18
Q

Dangers of Alcohol withdrawal ?DOC for acute alcohol withdrawal ?

A

Seizures, HTN and Arrythmias .

Librium (Chlordiazepoxide)

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19
Q

Symptoms of alcohol withdrawal

A

Insomina, anxiety, hand tremor (asterixis), irritability, anorexia, nausea, vomiting, autonomic hyperactivity (diaphoresis, tachycardia, HTN), Psychomotor agitation, fever, seizures, hallucination, delirium.

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20
Q

Seizures in alcohol withdrawal ?

A

occur between 6 and 48 hrs after cessation of drinking and peak around 13-24 hrs.

(Watch for hypomangnesemia, can predispose)

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21
Q

Tx of Seizures due to Alcohol withdrawal ?

A

Benzodiazepines in short term. Anti-convulsants in short term

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22
Q

Delirium Tremens

A

May occur 48-72 hours after last drink
15-25% mortality rate . 5% of hospitalized patients with withdrawal develop DT’s.
Symptoms: Delirium, Hallucinations (often visual), gross tremor, autonomic instability,

TX:
Benzodiazepines are first line
Antipsychotics for severe agitation
Thiamine, Folic acid and nutritional IV (Wernicke Encephalopathy)

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23
Q

Confabulations

A

False memories, often a sign of Korsakoffs Psychosis and patients are unaware they are making these up.

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24
Q

CAGE Questionairs

A

Have you ever/wanted to CUTDOWN on drinking ?
Have you felt ANNOYED by people critical of your drinking ?
Have you ever felt GUILTY about drinking ?
Have you ever taken a drink as an EYE OPENER . To prevent shakes.

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25
Q

Common biomarkers for Alcohol

A 
Blood Alcohol Level
Liver Function Tests (AST, ALT)
Gamma Glutamyl Transpeptidase
Carbohydrate deficient Transferrin
Mean Corpuscular Volume
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26
Q

Disulfuram

A

Disulfuram (antabuse) : Blocks Aldehyde Dehydrogenase leading to build up of Acetaldehyde thus sick feelings when drinking alcohol
Cannot use in severe cardiac disease, pregnancy, psychosis.
Monitor LFT’s

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27
Q

Naltrexone

A

Oral anti-opiod (opiod receptor blocker)

Decreases desired effects of alcohol

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28
Q

Acomprosate

A

Similar to GABA
Started post detoxification
Can be used in patients with liver disease
Contradicted in severe renal disease

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29
Q

Topiramate

A

Anticonvulsant that potentiates GABA and inhibits glutamate receptors
Reduces cravings for alcohol

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30
Q

Wernickes Encephalopathy

A

Due to a thiamine deficiency (poor nutrition in alcoholics)
Acute and can be reversed with thiamine therapy

Sx: ATaxia, confusion, occular abnormalities,

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31
Q

Korsakoff Syndrome

A

Chronic manifestation of untreated Wernickes Encephalopathy

Chronic amnesitic syndrome
Reversible in only about 20% of patients
Sx: Impaired recent memory, anterograde amnesia, compensatory confabulation.

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32
Q

Mechanism of Action for Cocaine

A

Blocks dopamine reuptake from the synaptic cleft (DA reuptake inhibitor –> potentiated DA activity).Plays a large role in reward pathway.

33
Q

Cocaine Intoxication

A

Euphoria, heightened self-esteem, Variable blood pressures (often HTN), Dilated pupils, weight loss, chills, sweating.

Dangerous effects: respiratory depression, seizures, arrythmias , paranoia with hallucination (tactile)

Deadly: Myocardial Infarction

34
Q

Tx of Intoxication

A

Minor Agitation: Reassurance and Benzo

Severe: Antipsychotics (like Haldol)

35
Q

Tx of cocaine dependence

A

No FDA approved pharm for treatment. Mostly supportive.

36
Q

Cocaine Withdrawal

A

Abrupt abstinence is not dangerous

Postintoxication depression: malaise, fatigue, depression, hunger, constricted pupils, vivid dreams, psychomotor retardation.

Tx is supportive (may have psychotic symptoms)

37
Q

MOA for Amphetamines

A

Block DA and NE reuptake in the synaptic cleft

Designer amphetamines –> release of DA, NE and Serotonin from terminal endings. (MDMA etc). May cause serotonin syndrome

38
Q

Amphetamine Intoxication

A

Similar to Cocaine
MDMA may lead to feelings of closeness to others.
Overdose –> Hyperthermia, HTN, Dehydration and thus rhabdomyloysis –> Renal Failure

39
Q

Amphetamine Withdrawal

A

Prolonged depression
Psychosis

Tx is supportive and symptomatic.

40
Q

Phencyclidine (PCP) MoA

A

Hallucinogenic drug that antagonizes NMDA glutamate receptors and activates Dopaminergic Neurons ( Leading to psychotic/hallucinogenic feelings)

Note: Ketamine is similar the PCP

41
Q

Phencyclidine Intoxication

A

Agitation, depersonalization, hallucination (tactile and visual), synesthesia, memory impairment, aggression, nystagmus (rototory nystagmus is pathognomnic), ataxia, dysarthria

42
Q

RED DANES

A

For PCP intoxication

Rage
Erythema
Dilated Pupils

Delusions
Amnesia
Nystagmus
Excitation
Skin Dryness
43
Q

Tx of PCP intox

A

Monitor basics
Benzos for agitation
Antipsychotics for psychotic symptoms

44
Q

PCP WIthdrawal

A

Does not really exist but can have “Flashbacks” where drug is released from lipid stores leading to symptoms of intoxication

45
Q

Types of Sedative Hypnotics

A

Benzos, Barbs, zolpidem, zalepon, GHB, meprobamate,

46
Q

MoA for Benzodiazepines

A

Potentiates GABA effects by increasing the opening of Cl- Channels

47
Q

MoA for Barbituates

A

Potentiate the effects of GABA by increasing the open time of Cl- channels

Typically lower margin of safety than Benzos (esp in high doses)

48
Q

Tx of Benzodiazepine intoxication

A

Flumazenil (a short acting BDZ antagonist).. may cause seizure in some cases.

49
Q

Sedative/Hypnotic Intoxication

A

drowsiness, confusion, HYPOTENSION, slurred speech, ataxia, mood lability, coma and death in OD.

50
Q

Sedative/Hypnotic WIthdrawal

A

Abrupt abstinence after chronic use can be LIFE THREATENING.

Dependence more likely with SHORT ACTING AGENTS

Sx of Withdrawal: Same as Alchohol dependence withdrawal (since both worth through GABA). Tonic-Clonic Seizure is serious complication.

51
Q

Tx of Barbituate Intoxication:

A

Alkalize urine with Sodium Bicarb to promote renal excretions

52
Q

Tx of Benzodiazepine withdrawal

A

Taper BNZ

Valproic Acid or Carbamezepine for Seizure prophylaxis.

53
Q

MoA for Opiod drugs

A

Bind to opiod receptors (Mu, Kappa, Delta) and mediate a analgesia, sedation and dependence. Also, have an effect on Dopaminergic system, mediating the reward/pleasure system–> addictive nature.

Codeine, OxyContin, Morphine, Dextromethorphan, methadone and meperidine.

Prescription opiods are most commonly abused.

54
Q

Opiod Intoxication

A

Drowsiness, Nausea, Vomiting, constipation, CONSTRICTED PUPILS (except meperidine), seizure and respiratory depression.

55
Q

Complication of meperidine or MAOi’s taken with opiods ?

A

Serotonin Syndrome

56
Q

Tx of Opiod Intoxication

A

Ensure the Airway is open (ABC’s)
If OD, give Naloxone (Narcaine) or Naltrexone. Can improve respiratory depression but can lead to severe withdrawal.
Ventilation if needed

57
Q

Opiod Withdrawal

A

Not life threatening

Dysphroria, insomnia, lacrimation, rhinorrhea, yawning, weakness, sweating, piloerection, NVD,

58
Q

Tx of Opiod Withdrawal/Dependence

A

Moderate: Clonidine , NSAIDSs and Dicyclomine for abd. cramps
Severe: Detox with buprenorphine or methadone

59
Q

Methadone

A

LONG acting opiod receptor agonist.
Give once daily,
Gold standard in pregs

Can cause QT interval prolongation, need ECG

60
Q

Buprenorphine

A

Partial opiod receptor agonist (can act as antagonist then)

Sublingual prep is safer than methadone (Suboxone = buprenorphine + naloxone).

61
Q

Naltrexone

A

Competitive Opiod antagonist, precipitates withdrawal
Good for highly motivated individuals
Compliance is on the low end

62
Q

Hallucinogens

A

LSD, psilocybin, mescaline.

Act by various mechanisms.

63
Q

Hallucinogen intoxication

A

Perceptual changes such as illusions, hallucinations, body image distortions and synesthesia), Dilated pupils, tachycardia, HTN, Hyperthermia,

64
Q

Tx for Hallucinogen intoxication

A

Usually maintenance
Benzos for anxiety
Antipsychotics for dangerous ideations

65
Q

MoA of Cannabis

A

Binds cannabinoid receptors in the brain which inhibit Adenylate Cyclase.

66
Q

Sx of Cannabis intoxication

A

euphoria or anxiety, impaired motor coordination, perceptual disturbances, mild tachycardia, conjunctival injection, dry mouth and Increased appetite.

Can cause induced psychotic disorders with paranoia, hallucinations or delusions. NO OVERDOSE

Dependence in 5% of users.

67
Q

Cannabis Withdrawal

A

irritability, anxiety, restlessness, aggression, strange dreams, depression, headaches, sweating, insomnia, nausea, cravings and dec. appetite.

68
Q

Inhalants MoA

A

Typically a CNS depressant but with various mechanisms.
Often inhaled or absorbed through skin
Seen in adolescents

69
Q

Inhalant Intoxication

A

Perceptual disturbances, psychosis, lethargy, dizziness, nausea, vomiting, headache, slurred speech etc.

70
Q

Inhalant Overdose

A

Death via respiratory depression is common. CNS damage with long term use,

71
Q

Inhaland overdose Tx

A

Chelation therapy if substance can be identified.

72
Q

MoA for Caffeine

A

Adenosine antagonist, leading to increased cAMP (how ?) and stimulant effect due to Dopaminergic activation

73
Q

Caffeine overdose

A

250 mg (2-3 cups) –> Anxiety, insomnia, muscle twitching, rambling speech, GI disturbances, tachycardia

> 1g : Tinnitus, severe agitation, visual light flashes, cardiac arrhythmias.

> 10 g : Death may occur secondary to seizure

74
Q

Caffeine Withdrawal

A

headache, fatigue, irritability, nausea, vomiting, drowsiness, anxiety, muscle pain, mild depression.

Typically resolves in one week

75
Q

Nicotine MoA

A

Stimulates Nicotinic Receptors at the autonomic ganglia (both sympathetic and parasympathetic)

Affects the dopaminergic system, mediating the reward center.

76
Q

Nicotine withdrawal

A

Intense craving, dysphoria, anxiety, poor concentration, insomnia

77
Q

Chantix

A

Vareniclene : a4b2 cholinergic receptor partial agonist. Mimics nicotine and limits withdrawal

78
Q

Bupropion (wellbutrin, Zyban)

A

Antidepressant and partial agonist at nAChR. Inhibits DA reuptake also –> decreased withdrawal symptoms

Psychiatry Rotation (15 decks)

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