Substance Use *** Flashcards
RF
More EtOH than recommended
>4 joints a week
Any illicit drug use
Hx of personal or family addiction
Age <40
Active mental health disorder
DSM-V criteria for SUD
CHEW THAT COP
Cut down - unsuccessful
Health/ harm - continued use despite impact on health
Excessive use
Withdrawal
Time - spending lots procuring/ using/ recovering
Hazardous use
Activities - decreased participation
Tolerance - increases
Craving
Obligations - not met
Personal problems
DSM-V criteria for addiction - 4Cs
4Cs
Loss of Control
Use despite Consequences
Compulsion to use
Craving
Sx that should prompt screening
Warning signs in teens e.g. failing school
Resistant medical conditions such as increased triglycerides or poor asthma control
Absenteeism, depression, anxiety
Accidents
Unexplained GI S+S
Sexual dysfunction
Sleep dysfunction
Tremor
Screening for AUD
- AUDIT-C
Ix for SUD
HIV, Hep A/B/C, ALT, AST, bili, TB, STIs
General management
Support for pt + family
- CBT, family therapy
Vaccines (HPV, hepatitis)
Assess for comorbidity (STI, mental health)
Tx barriers
Harm reduction
Referral - mutual help meetings, supervised withdrawal, treatment programs, supervised consumption
Symptom management
Pain
Diarrhea
Sneezing/ tearing
N+V
Tachycardia/ HTN
Anxiety/ insomnia
Pain - OTC analgesia, NSAIDs
Diarrhea - immodium, Lomotil
Sneezing/ tearing - H1 antihistamine
N+V - ondansetron, promethazine
Tachycardia/ HTN - clonidine
Anxiety/ insomnia - benzo
Motivational interviewing fundamentals
PEARL
- pt’s motivation
- empower
- affirm
- reflect
- listen
Screen for comorbidities
Poverty
Crime
STIs
MH
Long term complications like cirrhosis
DV
ADHD
HIV/ hepatitis
Sympathomimetic causes + sx of intoxication
Causes: epinephrine, cocaine, amphetamines
Tachycardia, hypertensive, dyspnea, febrile, dilated pupils, increased BS, diaphoretic, N/V, hallucinations, increased reflexes
Anticholinergic causes + sx of intoxication
Causes: APs, TCAs, oxybutynin, ipratropium
Tachycardia, hypertensive, febrile, dilated pupils, reduced BS, dry
Cholinergic causes + sx of intoxication
Causes: ACh receptor antagonist
Pinpoint pupils, increased BS, diaphoretic
Toxins that cause sedation + sx of intoxication
Causes: benzos, antihistamines
Bradycardia, hypotension, reduced RR, afebrile, reduced BS, dry, nystagmus, ataxia
Opioid sx of intoxication
Bradycardia, hypotension, reduced RR, afebrile, reduced BS, dry, nystagmus, ataxia, pinpoint pupils
Toxins that cause Bradycardia
BB, opioids, antiarrhythmias, CCB, clonidine, digoxin
Toxins that cause Tachycardia
cocaIne, APs, amphetamines, alcohol withdrawal, TCA
Toxins that cause Hypothermia
CO, opioids, hypoglycemics, insulin, alcohol, sedatives