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Substance Use *** Flashcards

1
Q

RF

A

More EtOH than recommended
>4 joints a week
Any illicit drug use
Hx of personal or family addiction
Age <40
Active mental health disorder

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2
Q

DSM-V criteria for SUD

A

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

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3
Q

DSM-V criteria for addiction - 4Cs

A

4Cs
Loss of Control
Use despite Consequences
Compulsion to use
Craving

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4
Q

Sx that should prompt screening

A

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

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5
Q

Screening for AUD

A
  • AUDIT-C
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6
Q

Ix for SUD

A

HIV, Hep A/B/C, ALT, AST, bili, TB, STIs

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7
Q

General management

A

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

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8
Q

Symptom management
Pain
Diarrhea
Sneezing/ tearing
N+V
Tachycardia/ HTN
Anxiety/ insomnia

A

Pain - OTC analgesia, NSAIDs
Diarrhea - immodium, Lomotil
Sneezing/ tearing - H1 antihistamine
N+V - ondansetron, promethazine
Tachycardia/ HTN - clonidine
Anxiety/ insomnia - benzo

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9
Q

Motivational interviewing fundamentals

A

PEARL
- pt’s motivation
- empower
- affirm
- reflect
- listen

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10
Q

Screen for comorbidities

A

Poverty
Crime
STIs
MH
Long term complications like cirrhosis
DV
ADHD
HIV/ hepatitis

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11
Q

Sympathomimetic causes + sx of intoxication

A

Causes: epinephrine, cocaine, amphetamines
Tachycardia, hypertensive, dyspnea, febrile, dilated pupils, increased BS, diaphoretic, N/V, hallucinations, increased reflexes

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12
Q

Anticholinergic causes + sx of intoxication

A

Causes: APs, TCAs, oxybutynin, ipratropium
Tachycardia, hypertensive, febrile, dilated pupils, reduced BS, dry

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13
Q

Cholinergic causes + sx of intoxication

A

Causes: ACh receptor antagonist
Pinpoint pupils, increased BS, diaphoretic

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14
Q

Toxins that cause sedation + sx of intoxication

A

Causes: benzos, antihistamines
Bradycardia, hypotension, reduced RR, afebrile, reduced BS, dry, nystagmus, ataxia

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15
Q

Opioid sx of intoxication

A

Bradycardia, hypotension, reduced RR, afebrile, reduced BS, dry, nystagmus, ataxia, pinpoint pupils

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16
Q

Toxins that cause Bradycardia

A

BB, opioids, antiarrhythmias, CCB, clonidine, digoxin

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17
Q

Toxins that cause Tachycardia

A

cocaIne, APs, amphetamines, alcohol withdrawal, TCA

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18
Q

Toxins that cause Hypothermia

A

CO, opioids, hypoglycemics, insulin, alcohol, sedatives

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19
Q

Toxins that cause Hyperthermia

A

NMS, nicotine, alcohol withdrawal, salicylates, serotonin syndrome, anticholinergics, antidepressants

20
Q

Toxins that cause Hypotension

A

clonidine, CCB, antidepressants, antihypertensives, sedatives, opioids

21
Q

Toxins that cause Hypertensive

A

cocaine, caffeine, anticholinergics, amphetamines, nicotine

22
Q

Cannabis Problematic use

A

daily use, anxiety, unsuccessful attempts to quit, family concern, financial implications

23
Q

Strategies to minimise use

A

Record on calendar
Purchase smaller amounts
Prepare smaller joints
Certain number of days without
Avoid high risk situations
Coping mechanisms

24
Q

PCP sx

A

muscle rigidity, sz, rhabdomyolysis

25
Amphetamines (ecstasy) complications + withdrawal
Complications: coma, serotonin syndrome Withdrawal: depression, increased appetite, diarrhea, HA, abdo pain
26
Cocaine complications + withdrawal
Complications: MI, stroke, pulmonary edema, rhabdomyolysis, sz, arrhythmias Withdrawal: increased sleep, fatigue, irritability
27
Alcohol At risk
consuming more than amounts recommended but does not meet criteria for AUD
28
CAGE alcohol questions
Have you ever felt you should CUT down on your drinking? Have people ANNOYED you by criticizing your drinking? Have you ever felt bad or GUILTY about your drinking? Have you ever had a drink first thing in the morning (EYE-OPENER) to steady your nerves or to get rid of a hangover?
29
AUD definition
Larger amount or longer periods than intended Persistent desire, unable to cut down ++ time spent obtaining alcohol Cravings Recurrent use despite failure to fulfil obligations Continued use despite social or interpersonal problems Responsibilities given up d/t alcohol Physically hazardous Continued use despite harm Increasing tolerance Withdrawal sx
30
Recommended amounts of alcohol
<2/d <9/wk for women and <14/wk men
31
Complications of AUD
CNS: wernicke’s encephalopathy (nystagmus, ataxia, confusion), Korsakoff’s psychosis, dementia CVS: HTN, cardiomyopathy, AF GI: cirrhosis, PUD, gastritis, pancreatitis, carcinoma Psych: depression, anxiety
32
Sx of alcohol withdrawal
Irritability, Anxiety, Tremors, Sweating, Nausea, Vomiting, Headaches, Fatigue, Insomnia, Confusion, Racing heart, Hallucinations
33
Sx of B12 deficiency
Ataxia (sub-acute combined degeneration of the cord), Paresthesia, Cognitive impairment, Numbness, Personality changes, Gait changes, Dementia, Psychosis, Forgetfulness, Visual disturbances, Weakness/paraplegia/incontinence, Lhermitte sign, Extrapyramidal signs (dystonia, dysarthria, rigidity)
34
Motivational interviewing for AUD
Goal of amount/d and amount/wk, non-drinking days Record drinks on calendar Switch to less preferred alcoholic drink Pace 1 drink/ hr Alternate w/ non-alcoholic drink Avoid triggers Reduce stress Support - AA or friends
35
Withdrawal management
PAWSS (prediction of alcohol withdrawal severity scale) >4 = inpatient Diazepam 5-10mg QID x 1 day, then decrease by 5mg/day Consider carbamazipine 200mg QID, clonidine 0.1-0.2mg BID or gabapentin 300mg TID for sx relief
36
Pharmacotherapy for AUD
Naltrexone 12.5mg BID x3d then increase to 50mg/d (CI in liver failure or ongoing opioid use), check LFTs 1, 3 + 6mo. Use for abstinence or reduction Acamprosate 666mg TID - use for abstinence Topiramate or gabapentin 300mg TID Disulfram 250mg/d - only use in pt preference
37
What lab results would you expect to see in alcohol abuse?
Elevated AST, Elevated ALT, AST/ALT Ratio (2:1), Elevated GGT, Elevated MCV Hemoglobin (anemia) Platelets (thrombocytopenia) INR (increased; decreased clotting capability) Albumin (hypoalbuminemia) Thiamine (reduced) Uric Acid (hyperuricemia)
38
Contraindications to outpt detox
<19 or >65 y/o Hx of sz during withdrawal Drinks non-beverage alcohol Uncontrolled medical condition Severe liver dz
39
Opioid use complications + withdrawal sx
Complications: pulmonary edema, resp failure, skin infections, endocarditis, HIV, hepatitis Withdrawal: peaks 48-72hrsm subsides after 1wk Tears, diarrhea, abdo pain, rhinorrhea
40
Acute opioid intoxication management
naloxone 0.4-0.8mg IV q3 min, up to 10mg
41
Norepinephrine dump rx
clonidine (start 17mcg/kg/d x several days then taper)
42
False positives for UDS: Amphetamines Opioids Cocaine Benzos
Amphetamines – ibuprofen, cough + cold, ranitidine Opioids – codeine Cocaine – usually true positive Benzos – clonazepam doesn’t show up as a positive
43
Benzo withdrawal sx + rx for withdrawal
Withdrawal: grand mal sz, agitation, restless, insomnia, tremors, febrile Rx for withdrawal: benzo taper
44
What tool to use to screen for AUD?
M-SASQ - how many times have you had >8 (men) or >6 (women) drinks in a single sitting?
45
SE of OAT
constipation, amenorrhea, low testosterone

CCFP 3 (67 decks)

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