Substance use Flashcards by Amy Collins

8 possible symptoms of PCP intoxication

-nystagmus
-HTN/tachycardia
-numbness/muted pain response
-ataxia
-dysarthria
-muscle rigidity
-seizures/coma
-hyperacusis

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how many symptoms must be present for PCP intoxication

2+ within 1 hour of ingestion

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universal substance use criteria

problematic pattern of use leading to significant impairment with at least 2 manifestations in the past 12 months

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3 universal possible manifestations of impaired control in substance use disorder

-larger amount or longer period than intended
-unsuccessful attempts to cut down
-a lot of time spent getting, using, recovering from substance
-cravings present

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universal severity specifiers for substance use disorders

-mild: 2-3 sx
-mod: 4-5 sx
severe: 6+ sx

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universal recovery specifiers

-in early remission
-in sustained remission
-in controlled environment
-on maintenance therapy

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4 possible manifestations of social impairment in substance use disorders

-failure to meet role obligations
-continued use despite problems caused/exacerbated by substance
-giving up important activities for substance use
-withdrawal from family/friends

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2 possible manifestations of risky use in substance abuse disorders

-use in physically unsafe situation
-continued use despite physical or psychological problems caused/exacerbated by use

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2 pharmacological criteria for substance use disorders

-tolerance develops
-withdrawal occurs

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what is true about the length of the withdrawal period in relation to severity of sx

longer the duration, less intense the symptoms. Withdrawal tends to be worse from short acting substances but withdrawal from long acting substances takes longer

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sedating drugs tend to cause what symptoms/disorders

depressive disorders with rebound anxiety on cessation

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what symptoms/disorders are associated with stimulant abuse

psychotic/anxiety features during intoxication and depression on withdrawal

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which lab tests for heavy alcohol use and what results are significant

-gamma-glutamyltransferase of >35 (modest elevation)
-carbohydrate deficient transferring >20

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which labs can be useful in monitoring abstinence of drinking and why

gamma-glutamyltransferase and carbohydrate deficient transferrin because these levels return to normal in a matter of days after drinking cessation

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how much alcohol can the body generally metabolize in 1 hour

1 beer

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8 possible manifestations of alcohol withdrawal and how many must be present for dx

at least 2:
-autonomic hyperactivity (increased HR, sweating, etc.)
-increased hand tremor
-insomnia
-N/V
-transient hallucinations/illusions
-psychomotor agitation
-anxiety
-seizures

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definition of “with perceptual disturbance”

hallucination w/ intact reality testing or illusions in the absence of delirium

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what is likely when alcohol withdrawal delirium presents

likely a clinically relevant medical condition (liver failure, GI bleed, hypoglycemia, etc.)

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typical length of alcohol withdrawal

4-5 days after extended periods of heavy drinking

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5 predictor of severe alcohol withdrawal

-development of delirium
-hx severe withdrawal
-low potassium
-decreased platelets
-systolic HTN

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how many sx must be present for dx caffeine intoxication

5+ shortly after ingestion

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5 sx of caffeine withdrawal and how many must be present for dx

at least 3 within 24 hours of cessation:
-HA
-marked fatigue/drowsiness
-dysphoric/depressed mood or irritability
-difficulty concentrating
-flu like sx

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what is the hallmark feature of caffeine withdrawal

headache

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development and course of caffeine withdrawal

sx start 12-24h after last dose, peak in 1-2 days and can last up to 9 days

how long can you continue to get headaches from caffeine withdrawal

up to 21 days

what is considered early onset for cannabis use disorder

before 15

4 possible manifestations of cannabis intoxication and how many must be present for dx

2+ within 2h or use" -conjunctival injection -increased appetite -dry mouth -tachycardia

7 possible manifestations of cannabis withdrawal and how many must be present for dx

3+ within 1 week of cessation: -irritability/anger/aggression -nervousness/anxiety -sleep difficulty -decreased appetite/weight loss -restlessness -depressed mood -at least 1 physical sx

physical sx associated with cannabis withdrawal

abdominal pain shakiness/tremors sweating fever chills headache

development and course of cannabis withdrawal

onset in 24-48 hours after cessation peak in 2-5 days resolves in 1-2 weeks

how long can PCP be detected in urine

8 days (maybe longer with high doses)

which hallucinogen has the highest risk of disorder development

ecstacy

8 possible manifestations of PCP intoxication and how many must be present for dx

2+ within 1h of use: -nystagmus -HTN/tachycardia -numbness/diminished pain response -ataxia -dysarthria -muscle rigidity -seizures/coma -hyperacusis

7 possible manifestations of other hallucinogen intoxication and how many must be present for dx

2+: -dialted pupils -tachycardia -sweating -palitations -blurry vision -tremors -incoordination

diagnostic criteria for hallucinogen persisting perception disorder

1+ perceptual disturbance experienced after cessation of substance that causes clinically significant distress/functional impairment that is not attributable to another substance or condition

which hallucinogen is most likely to cause hallucinogen persisting perception disorder

LSD

reality testing in hallucinogen persisting perception disorder

remains intact

what sz might be present in inhalant use disorder

peri-oral or peri-nasal rash

natural opioids

morphine codeine

semi-synthetic opioids with morphine-like action

heroine oxycodone hydrocodone hydromorphone oxymorphone

synthetic opioids with morphine-like action

methadone meperidine tramadol fentanyl carfentanil

what intoxicating substances are possible when there is lack of pupillary constriction or response to naloxone challenge test

benzodiazepines sedatives hypnotics anxiolytics alcohol

3 possible manifestations of opioid intoxication and how many must be present for dx

pupillary constriction with 1+: -drowsiness/coma -slurred speech -impairment in attention/memory

9 possible manifestations of opioid withdrawal and how many must be present for dx

3+ within minutes-days of cessation: -dysphoric mood -N/V -muscle aches -lacrimation or rhinorrhea -pupillary dilation, piloerection, or sweating -diarrhea -yawning -fever -insomnia

what 2 sx are associated with more severe opioid withdrawal

piloerection and fever

tolerance development with sedative, hypnotic, and anxiolytic disorders

tolerance develops slower in the brainstem than it does for the high so increased dosages may cause sudden respiratory depression and death without achieving the high

most common psych disorders comorbid with substance use disorders

antisocial personality disorder depression anxiety bipolar borderline personality disorder

6 possible manifestations of sedative/hypnotic/anxiolytic intoxication and how many must be present for dx

1+: -slurred speech -Incoordination -unsteady gait -nystagmus -cognitive impairment -stupor/coma

8 possible manifestations of withdrawal from sedative/hypnotics/anxiolytics and how many must be present for dx

2+ within a few hours-several days after cessastion: -autonomic hyperactivity -hand tremor -insomnia -N/V -transient hallucinations/illusions -psychomotor agitation -anxiety -grand mal seizures

development and course of withdrawal from fast acting sedatives/hypnotics/anxiolytics

sx in 6-8h peak on 2nd day improve by 4th-5th day

development and course of withdrawal from longer acting sedatives/hypnotics/anxiolytics (Diazepam)

sx may not develop for >1 week peek in week 2 sx decrease over 3-4 weeks

amphetamine v. cocaine

amphetamine is longer acting so it is used less frequently

how long can cocaine be detected in urine

7-12 days

how long can amphetamine be detected in urine

up to 4 days (up to 90 in hair samples)

9 possible manifestation of stimulant intoxication and how many must be present for dx

2+: -tachycardia/bradycardia -pupillary dilation -elevated/lowered BP -perspiration/chills -N/V -weight loss -psychomotor agitation/retardation -muscular weakness, respiratory depression, chest pain, or arrhythmias -confusion, seizures, dyskinesia, dystonia, coma

5 possible manifestations of stimulant withdrawal and how many must be present for dx

2+ within a few hours-days after cessation: -fatigue -vivid nightmares -insomnia/hypersomnia -increased appetite -psychomotor agitation/retardation

7 possible manifestation of tobacco withdrawal and how many must be present for dx

4+ within 24 hours after cessation: -irritability/frustration/anger -anxiety -difficulty concentrating -increased appetite -restlessnes -depressed mood -insomnia

development and course of nicotine withdrawal

begins within 24 hours, peaks in 2-3 days, and lasts 2-3 weeks