Substance-Related Disorders Flashcards
What is alcohol use disorder?
a problematic pattern of alcohol use leading to clinically significant impairment or distress
What is alcohol intoxication?
- recent ingestion of alcohol
- clinically significant problematic behavioral or psychological changes (e.g. inappropriate sexual or aggressive behavior, mood lability, impaired judgement) that developed during, or shortly after, alcohol ingestion
- one (or more) of the following signs or symptoms developed during, or shortly after, alcohol use:
- slurred speech
- incoordination
- unsteady gait
- nystagmus
- impairment in attention or memory
- stupor or coma
What is alcohol withdrawal?
- cessation or (or reduction in) alcohol use that has been heavy and prolonged
- two (or more) of the following, developing within several hours to a few days after the cessation of (or reduction in) alcohol use:
- autonomic hyperactivity (e.g. sweating or pulse rate greater than 100 bpm)
- increased hand tremor
- insomnia
- nausea or vomiting
- transient visual, tactile, or auditory hallucinations or illusions
- psychomotor agitation
- anxiety
- generalized tonic-clonic seizures
What is the treatment of alcohol-related disorders?
- thiamine, magnesium, multivitamin, dextrose (particularly if chronic alcoholism)
- benzodiazepines (if withdrawal)
What are the addiction medications?
- disulfiram (Antabuse) - inhibits acetaldehyde dehydrogenase, aversive conditioning
- 500 mg once daily for 1-2 weeks then decrease to the maintenance dose (range 12-500 mg once daily)
- not for use in persons actively drinking alcohol; avoid alcohol in other products
- Oral Naltrexone - decreases desire
- 50 mg once daily
- cannot be given to patients taking opioids
- Extended - Release Naltrexone - decreases desire
- 300 mg IM every 4 weeks; administer in the gluteal area with 1.5 inch 20-gauge needle
- cannot be given to patients taking opioids
- Acamprosate - changes brain chemistry in a way that reduces anxiety, irritability, and restlessness associated with early sobriety
- 666 mg three times daily
- dose reduction required with renal impairment
- Topiramate - reduces drinking at least as well as naltrexone and acamprosate
- begin at 25 mg daily and increases up to 150 mg BID
- gabapentin- decreases desire
- begin at 300 mg once daily and increase up to 600 mg TID
What is the treatment of DT?
DT may be fetal and thus must be treated promptly with high-dose IV benzodiazepines, preferably in an ICU
What is cannabis use disorder?
- a problematic pattern of cannabis use leading to clinically significant impairment or distress, occurring within a 12-month period
- urine drug test: can detect cannabis for 4-6 days in occasional users and up to 50 days in chronic users
- chronic use of cannabis has the following complications: laryngitis, rhinitis, low testosterone, low sperm count, COPD
What are the symptoms of cannabis intoxication?
euphoria, anxiety, disinhibition, paranoid delusions, a perception of slowed time, conjunctival injection, impaired judgment, social withdrawal, increase appetite, dry mouth, hallucinations
What are the symptoms of cannabis withdrawal?
irritability, depression, insomnia, nausea, and anorexia
-most symptoms peak at 48 hours and last for 5-7 days
What is the treatment of cannabis use disorder?
no specific treatment is required
-symptomatic treatment only
What is the mechanism of PCP?
NMDA receptor antagonist - Ketamine is a similar drug
What is the intoxication of PCP?
belligerence, impulsiveness, fear, homicidality, psychosis, delirium, seizures, psychomotor agitation, vertical and horizontal nystagmus, tachycardia, ataxia
What is the tx of PCP?
Pharmacologic -antipsychotics (haloperidol) -benzodiazepines Further Management -low stimulus environment -restraints if needed to prevent the patient from hurting self/others
What is the withdrawal of PCP?
depression, anxiety, irritability, restlessness, anergia, disturbances of thought and sleep
-treatment: no specific treatment - symptomatic treatment only
What is the mechanism of LSD?
action at 5-HT receptor
What is the symptoms of LSD intoxication?
- visual hallucinations and synesthesias (e.g. seeing sound as color)
- marked anxiety or depression, delusions, pupillary dilation
- “bad trip” panic
What is the treatment of LSD?
Pharmacologic
- antipsychotics (e.g haloperidol)
- benzodiazepines
- talking down, supportive counseling
What are the symptoms of LSD withdrawal?
-largely no withdrawal because it does not affect dopamine
-flashbacks can occur years later
Treatment
-no specific treatment - symptomatic treatment only
What is inhalant-related disorders?
inhalation of certain gases found in paint, petroleum, toluene, glues, and nail polish produce the same effects of volatile anesthetic
-mechanism of action is unknown
What are the symptoms of intoxication from inhalant-related disorders?
depends on the dose of inhalant sniffed
- for mild to moderate dose: the following are noted: euphoria, slurring of speech, confused state, auditory and visual hallucinations
- physical exam: watery eyes, impaired vision, rhinorrhea, perinasal, and perioral rash, headache and nausea
- for high does: cardiopulmonary failure, liver problems, kidney problems, and bone marrow suppression
What are the symptoms of withdrawal form inhalant - related disorders?
not well characterized, no treatment
What is the treatment of inhalant-related disorders?
antipsychotics (haloperidol) if severe aggression
