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Behavioral Health > Substance-Related Disorders and Treatment of Substance Abuse > Flashcards

Substance-Related Disorders and Treatment of Substance Abuse Flashcards

1
Q

Substance use

A

Sporadic consumption of ETOH or drugs w/o adverse consequences

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2
Q

Abuse

A

Frequency of use may vary

Adverse consequences are experienced

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3
Q

Physical Dependency

A

Adaptation state with drug-class specific withdrawal syndrome

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4
Q

Tolerance

A

Have to increase intake amount in order to achieve same effect

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5
Q

Physiologic dependence

A

Subjective need for psychoactive substance for either positive effect or to avoid negative effect

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6
Q

Addiction

A

Primary, chronic, neurobiologic disease with multiple factors influencing development and manifestations

Impaired control over drug use - compulsive use or continued use despite harm

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7
Q

CAGE

A

Cut down on drinking

Annoyed by criticism of drinking

Guilty feelings about drinking

Eye-opener to steady nerves or eliminate hangover

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8
Q

Alcohol abuse criteria

A

1 or more w/in 12 month period:

  • Fail to fulfill work, school, or social obligations
  • Recurrent substance use in physically hazardous situations
  • Recurrent legal problems related to substance abuse
  • Continued use despite alcohol-related social/interpersonal problems
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9
Q

Alcohol dependence definition

A

Maladaptive pattern of use - 3 or more w/in 12 months

  • Tolerance, withdrawal, larger quantity intake than intended
  • Persistent desire to cut down/control use
  • Time spent obtaining, using, or recovering from substance
  • Sacrifice social, occupational, recreational activities
  • Continued use despite physical and psychosocial problems
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10
Q

CRAFFT

A

For adolescents and college students - 2 or more indicates problem

Car while/with intoxicated driving

Relax by using substance

Alone use of substance

Forget things you did while using

Family/Friends tell you to cut down

Trouble while using

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11
Q

Alcohol Dehydrogenase (ADH)

Aldehyde Dehydrogenase (ALDH)

A

ADH catalyzes ETOH to acetaldehyde (toxic to liver)

ALDH catalyzes acetaldehyde to acetate

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12
Q

Wenicke-Korsakoff Syndrome

A

Heavy drinkers, usually >35 years old

Wernicke’s: acute gait ataxia, vestibular dysfunction, confusion, ocular abnormalities

-Treat w/ high dose thiamine

Korsakoff’s: chronic impaired recent memory and anterograde amnesia

-only 20% recover, Tx w/ PO thiamine

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13
Q

Withdrawal Symptoms

A

Mild symptoms - begin w/in 6 hours cessation, resolve in 24-48 hours

Seizures - w/in 48 hours, treat w/ benzodiazepine

Hallucinosis - w/in 12-24 hours, resolve in 24-48

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14
Q

Delirium Tremens

A

5% withdrawing patients - 5% die

Delirium, tachycardia, hypertension, agitation, fever, diaphoresis

Treat w/ phenobarbitol/propofol + Thiamine

Risk: sustained drinking, >30 yo, concurrent illness

Occurs 72 hours after last drink

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15
Q

Drugs to avoid with alcohol withdrawal

A

Ethanol

Antipsychotics

Anticonvulsants

Central acting alpha-2 agonists (Clonidine, Guanfacine, Methyldopa)

Baclofen (muscle relaxant)

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16
Q

Acamprosate (Campral)

A

Motivate not to drink - get sick

Relapse-prevention with counseling

SE: Diarrhea, low pulse, high/low BP, HA, impotence

CI: Kidney disease

17
Q

Disulfiram (Antabuse)

A

Most effective

Inhibits ALDH - get acetaldehyde buildup when drinking

Flushing, dyspnea, N/V, HA, blurred vision, vertigo, anxiety

SE: Hepatotoxic, depression/psychosis - monitor LFTs and depression

Also increases levels phenytoin, isoniazid, anticoagulants

18
Q

Methamphetamine

A

Displaces epi, NE, dopamine, and serotonin - inactivates reuptake

High energy, tachycardia, pupil dilation, HTN, agitation, psychosis

N/V, seizures, delirium

Protect airway, control BP and temp, sedate if agitated

Can result in cardiovascular collapse

19
Q

Cocaine

A

MOA: Blocks presynaptic reuptake pump - dopamine, NE, serotonin

CV effects: vasoconstriction, thrombus formation, tachycardia, HTN

CNS: agitation, seizures, HA, coma, intracranial hemorrhage

20
Q

Cannabis

A

THC crosses BBB and binds w/ endogenous cannabinoid (CB1) which activates mesolimbic dopamine system

Comorbid mood and anxiety disorders occur frequently w/ cannabis disorder

Tx: Buspirone (Buspar) for withdrawal

21
Q

Hallucinogens

A

Affect serotonin, dopamine, glutamate to alter sensory perception, mood, and thought patterns

Can cause serotonin syndrome

LSD

Dextromethorphan - codeine analog

Mescaline - peyote

Bromo

Phencyclidine (PCP)

22
Q

Phencyclidine (PCP)

A

Similar to ketamine

Bizarre, violent behavior, nystagmus

Catatonic stupor/coma at high doses

23
Q

Sudden sniffing death

A

Due to CV collapse

24
Q

Inhalants

A

CNS depression after initial bout of euphoria

CNS, GI effects

Hematologic effects w/ benzene - aplastic anemia and malignancy

25
Q

Nicotine

A

Agonist of nicotinic subtype - dopamine receptor reward system

Reaches brain in 15 seconds, 1/2 life 2 hours

Treat with Chantix (1st line), Buproprion, patches/lozenges/gum

26
Q

Varenicline (Chantix)

A

1st line

Partial nicotinic agonist - reduces withdrawals and blocks nicotine - no reward for smoking

BBW suicidality/depression - monitor closely

27
Q

Buproprion (Zyban)

A

For smoking cessation

Enhances CNS noradrenergic and dopamine function

CI: Seizure disorder, pregnancy

SE: insomnia, HA, seizure, dry mouth

28
Q

Naltrexone

A

For long-term treatment

After complete detox - prevents euphoric effects w/ drug use

Most effective in highly motivated

Under close supervision

29
Q

Methadone

A

Opioid agonists - long term treatment

Schedule 2 drug

>180 day maintenance, <180 day detox

SE: Constipation, drowsy, decreased libido, increased sweating, edema, prolonged QT

30
Q

Buprenorphine

A

Partial opioid agonist

Schedule 3 drug

Can be outpatient treatment from clinician

31
Q

Clonidine

A

For low-dose opioid use in order to decrease withdrawal

SE: Orthostatic HOTN, dry mouth, constipation

Clonidine + Methadone = euphoric - abuse potential

32
Q

Benzodiazepine withdrawal

A

Anxiolytics - highly addictive

Slow taper w/ mild/moderate

Severe: life-threatening; long-acting benzos +/- anticonvulsants

(Carbamazepine, Valproate)

33
Q

Cardiovascular collapse

A

Catecholamine toxicity caused by excessive catecholamines release in PNS

Narrowing and spasm of blood vessels, tachycardia, hypertension, heart muscle death

Treatment: Aggressive fluid resuscitation, correct metabolic acidosis, and give vasoactive amines (histamine)

Behavioral Health (15 decks)

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