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Psychiatry > Substance Use > Flashcards

Substance Use Flashcards

1
Q

What is addiction? (DSM-4)

A
  • Substance use
  • Use/procurement despite problems
  • Return to use after period of abstinence
  • Inability to control use
  • Pre-ocupation
  • Cognitive changes (over-valuation, de-valuation, minimization/denial)
  • Enhanced cue responsiveness via conditioning/generalization
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2
Q

What are different aspects of recovery?

A
  • Clinical (absence of sx)
  • Social
  • Economic
  • Personal
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3
Q

What is dependence? (DSM-4)

A

Maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifest by 3+ of the followed w/in the same 12 months:

  • Tolerance
  • Withdrawal
  • Using more or for longer than intended
  • Inability to cut-down/control
  • Takes up your time (to get it or to recover)
  • Activities reduced
  • Continued use despite problems
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4
Q

What personality d/o has the highest incidence of substance use d/o?
- What 2 mood d/o’s come in 2nd and 3rd?

A
  1. Anti-social personality d/o
  2. BD
  3. Schizophrenia
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5
Q

How many ounces in 1 drink of liquor?
Beer?
Wine?

A

Liquor: 1 oz
Beer: 12 oz
Wine: 4oz

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6
Q

What % of 12th-graders have been drunk once in the last month?

A

26.8%
(14.7% 10th graders)
(5% 8th graders)

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7
Q

When is the first episode of etoh intoxication likely to occur?

  • When does are of onset of etoh DEPENDENCE peak?
A

Mid-teens

  • Peaks 18-25 y/o
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8
Q

What are the signs of etoh intoxication?

A
  • Slurred speech
  • Incoordination
  • Unsteady gait
  • Nystagmus
  • Impaired attn or memory
  • Stupor or coma
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9
Q

What are the possible somatic tx’s for acute intoxication w/etoh?

A
  • Reassurance
  • Maintenance in a safe/monitored environment
  • Decrease external stimulation
  • Provide orientation and reality testing
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10
Q

When does mild-mod etoh withdrawal start?

- What are some s/s?

A

W/in first several HRS s/p cessation/reduction of heavy drinking

  • N/V
  • Anxiety
  • Tachycardia
  • Irritability
  • HTN
  • Autonomic hyperactivity
  • Tremors
  • Insomnia
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11
Q

When do etoh withdrawal sx peak?

A

2nd day of abstinence

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12
Q

When do etoh withdrawal sx usually resolve?

A

4-5 days after withdrawal sx peak (~6-7 days total)

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13
Q

When does severe etoh withdrawal occur?

- What are some s/s?

A

W/in 1st several DAYS s/p cessation/reduction

  • Clouding of consciousness
  • Trouble sustaining attn
  • Disorientation
  • Grand mal seizures
  • Fever
  • Respiratory alkalosis
  • Hallucinations
  • Delirium
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14
Q

What are the two main goals of mod/severe etoh withdrawal tx?

A
  1. Reduce CNS irritability

2. Restore physiologic homeostasis

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15
Q

Which pts undergoing etoh withdrawal will likely require hospitalization?

A
  • H/o withdrawal seizure
  • H/o DTs
  • Documented h/o heavy etoh use and high tolerance
  • Concurrently abusing other substances
  • Severe co-morbid medical/psychiatric d/o
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16
Q

What is CIWA-Ar?

  • How many items are in it?
  • Why do we use it?
A

Etoh withdrawal protocol (rates severity and freq of sx)

  • 10-item (scored 0-7)
  • Guides drug use
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17
Q

What CIWA score indicates mild withdrawal?
Mod?
Severe?

A
  • Mild: = <10
  • Mod: 10-19
  • Severe: >20

(some ppl use different cutoffs)

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18
Q

What is the tx for mild etoh withdrawal?

A
  • Generalized support
  • Reassurance
  • Frequent monitoring
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19
Q

What is the tx for mod/severe etoh withdrawal? (3)

A
  • BZDs
  • Thiamine
  • Fluids
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20
Q

What is “kindling,” w/r/t etoh withdrawal?

A

Repeated episodes of withdrawal may lead to a worsening of future withdrawal episodes
(these pts require more aggressive tx)

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21
Q

When considering pharm tx for mod/severe etoh withdrawal, what factors should you consider?

A
  • Relieves sx
  • Prevents seizures/delirium
  • Benign side effects
  • Relatively safe in OD
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22
Q

What route of BZDs can you use in etoh withdrawal?

A
  • PO a/o IV
  • Do not use IM

(Definite info regarding which BZD is superior does not exist)

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23
Q

Compare and contrast the equivalent doses of alprazolam, chlordiazepoxide, clonazepam, chlorazepate, diazepam, lorazepam, and oxazepam.

A
  • Clonazepam: 0.5mg
  • Alprazolam: 1mg
  • Lorazepam: 2mg
  • Diazepam: 10mg
  • Chlorazapate: 15mg
  • Oxazepam: 15mg
  • Chlordiazepoxide: 20mg
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24
Q

Compare and contrast the onset speeds of alprazolam, chlordiazepoxide, clonazepam, chlorazepate, diazepam, lorazepam, and oxazepam.

A
  • Diazepam: very fast
  • Chlorazapate: fast
  • Clonazepam: intermediate
  • Alprazolam: intermediate
  • Lorazepam: intermediate
  • Chlordiazepoxide: intermediate
  • Oxazepam: slow
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25
Q

Compare and contrast the T1/2’s of alprazolam, chlordiazepoxide, clonazepam, chlorazepate, diazepam, lorazepam, and oxazepam.

A
  • Alprazolam: short
  • Lorazepam: short
  • Oxazepam: short
  • Clonazepam: long (18-50 hrs)
  • Chlordiazepoxide: long (30-200 hrs)
  • Chlorazapate: long (30-200 hrs)
  • Diazepam: long (30-200 hrs)
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26
Q

What is the tx for CIWA-Ar < 9?

A

No dosing required; monitor w/q4H CIWA

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27
Q

What is the BZD tx for CIWA-Ar 10-20?

A
  • Lorazepam 2mg
  • Diazepam 10mg
  • Chlordiazepoxide 50mg
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28
Q

What are the tx considerations for CIWA-Ar >20?

A

Consider tx in a more highly monitored setting (eg ICU)

- Consider more aggressive BZD dosing

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29
Q

In ETOH withdrawal, which BZDs are indicated for pts w/severe hepatic dz, elderly, or dementia?
(short or long-acting?)

A

Short-acting

  • Lorazepam
  • Oxazepam
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30
Q

*What are the features of DTs?

A
  • Autonomic hyperactivity (tachycardia, diaphoresis, fever, hypotension)
  • Insomnia
  • Perceptual disturbances
  • Hallucinations (visual, tactile)
  • Fluctuating level of psychomotor activity
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31
Q

Why are DT’s considered a medical emergency?

A
  • May be assaultive or suicidal
  • May act on hallucinations
  • Often preceded by seizures
  • May appear de novo
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32
Q

*What is the % mortality for ETOH withdrawal delirium?

A

1%

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33
Q

What is the tx for DTs during etoh withdrawal?

A
  • Best tx is prevention
  • BZDs to calm and raise seizure threshold
  • Consider seclusion
  • Fluids (PO if tolerated, or IV)
  • Skilled verbal support
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34
Q

What drugs can be used to reduce signs of autonomic hyperactivity during DTs?

A
  • BBs (eg propranolol) for tremor, tachycardia, HTN, and diaphoresis
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35
Q

Can alpha-agonists help in tx of DTs?

A
  • Yes, can reduce tremor, HR, and BP

eg clonidine

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36
Q

What anticonvulsants may be useful during DTs?

A
  • Carbamazepine (Tegretol)
  • Divalproex sodium (Depakote)
  • Benzos
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37
Q

What is the brand name for acamprosate?

A

Campral

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38
Q

What is the brand-name for extended release IM naltrexone?

A

Vivatrol

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39
Q

What is the brand-name for PO form of naltrexone?

A

Revia

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40
Q
  • What is the MoA of naltrexone?

- What is its role in ETOH use d/o tx?

A
  • Opioid antagonist
  • Prevents opioid-mediated euphoria and rewarding effects of etoh
  • Blunts subsequent craving for etoh
  • Better than PBO; reduces heavy drinking days; decreases rates of relapse
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41
Q

In etoh tx, naltrexone appears to work better when combined w/….

A

Psychosocial tx’s

  • Relapse prevention
  • CBT
  • Coping skills
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42
Q

What are the side effects of naltrexone (vivatrol, revia)

A
  • Hepatotoxicity
  • Ppt’s opioid withdrawal
  • HA
  • Fatigue
  • Dysphoria
  • N/V
  • Abd pain
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43
Q

When is hepatotoxicity more likely w/ naltrexone?

A

In morbidly obese or at high doses

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44
Q

What is the MoA of acamprosate (Campral) in etoh withdrawal/tx?

A
  • A GABA analogue
  • Presumed to work at glutamate receptor sites -
    Normalizes aberrant glutamate system that occurs in protracted withdrawal and cravings (decreases cravings)
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45
Q

When should acamprosate be started? (before or after stopping drinking)

What are the benefits pts see w/ use of acamprosate?

A

Start it once they’ve stopped drinking

  • Increased time prior to relapse
  • More abstinent days during year of tx
  • Can be used in liver disease (excreted renally)
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46
Q

What are adverse effects of acamprosate?

When is it contraindicated? (1)

A
  • Well-tolerated
  • Diarrhea

Contraindicated in renal disease.

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47
Q

Brand name for disulfiram?

A

Antabuse

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48
Q

What does disulfiram do?

- What is MoA of disulfiram?

A

Aversive therapy

- Inhibits aldehyde DH, increasing blood levels of acetaldehyde

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49
Q

What are the effects of disulfiram?

A
  • Heat in face/neck
  • HA
  • Flushing
  • N/V
  • Hypotension
  • Anxiety
  • Tachycardia
  • SOB
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50
Q

Who are the best candidates for disulfiram tx?

A
  • Intelligent
  • Motivated
  • Not impulsive
  • Drinking triggered by unanticipated internal ro external cues

(NEVER use w/o pts knowledge/consent)

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51
Q

What are the contraindications for disulfiram?

* What rxn can it cause?

A
  • Highly impulsive
  • Poor judgment
  • Severe co-existing psych illness
  • May cause “alcohol-antabuse” reaction 1-2 wks s/op last dose
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52
Q

__% of US population has tried cocaine w/ __% report using in last year.

A

10% tried

20% did in last yr

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53
Q

Lifetime rate of cocaine abuse or dependence?

A

2%

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54
Q

What % of cocaine users smoke crack?

A

33%

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55
Q

What age range has highest cocaine use?

A

18-25, 26-34

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56
Q

Sex differences b/w cocaine users?

A

M x2 > F

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57
Q

Which is most potent/addictive?

Routes of cocaine use?

A
  • Snorting (tooting)
  • SQ (“skin popping”
  • IV
  • # Smoking (freebasing/basing)
  • PO (rare)
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58
Q

T1/2 cocaine?

A

1 hr

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59
Q

Major metabolite of cocaine and when can it be detected?

A

Benzoyelcgonine

- 2-3 days s/p single use

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60
Q

Cocaine MoA?

A

Blocks pre-synaptic reuptake of NE and DA (excess at post-synaptic receptors)

61
Q

S/s of cocaine intoxication?

A
  • Tachycardia
  • HTN
  • Tachypnea
  • Hyperthermia
  • Agitation
  • Pupillary dilatation
  • Peripheral vasoconstriction
  • Seizures
  • Elation/euphoria
  • ^ self-esteem
  • Perceived improvement on mental/physical tasks
62
Q

What is the general tx for cocaine intox? (2)

A
  • Supportive

- Treat sx of autonomic hyperactivity

63
Q

What s/s can be seen at very high doses of cocaine intoxication?

A
  • Agitation
  • Irritability
  • Impaired judgment
  • Impulsive and potentially dangerous sexual behaviors
  • Aggression
64
Q

Most common causes of cocaine-related deaths?

A
  • Cardiac (arrhythmias; MI)

- CNS (hemorrhage, infarct, seizures)

65
Q

When does cocaine withdrawal start/end?

A

Few hrs - several days after cessation of use

66
Q

S/s of cocaine withdrawal?

A
  • Depression
  • Fatigue
  • Dysphoria
  • Sleep disturbance
  • Anxiety
  • Anhedonia
  • Appetite changes
67
Q

How long does the cocaine crash last usually? How long can it last?

A
  • 9-12 hrs, up to 9 days
68
Q

Cocaine withdrawal can mimic what mood d/o’s?

A

Unipolar or bipolar depression

69
Q

What CNS NT systems do opioids act on?

A
  • DA
  • GABA
  • Glutamate
70
Q

What are some clinical indications for opioid use?

A
  • Pain
  • Cough
  • Diarrhea
  • Opioid detox (specialized use)
71
Q

How does heroin differ from morphine in terms of potency, lipid solubility?

A

Heroin:

  • More potent than morphine
  • Liquid soluble
72
Q

How many current heroin users are there?

73
Q

Sex differences b/w heroin users?

74
Q

When does opioid dependence usually occur?

What about ppl w/current dependence?

A

Mid 20s - 30s

most ppl w/current dependence: 30s-40s

75
Q

What % of 12-graders have used oxycontin?

A
  1. 1%
    (4. 6% 10th graders)
    (2. 1% 8th graders)
76
Q

What % of 12-graders have used vicodin?

A
  1. 0%
    (7. 7% 10th graders)
    (2. 7% 8th graders)
77
Q

What are the 3 types of opioid receptors?

A
  • Mu
  • Kappa
  • Delta
78
Q

What do mu-opioid receptors mediate?

A
  • Analgesia
  • Respiratory depression
  • Constipation
  • Dependence
79
Q

What do kappa-opioid receptors mediate?

A
  • Analgesia
  • Diuresis
  • Sedation
80
Q

What do delta-opioid receptors mediate?

A

Possibly analgesia

81
Q

What are the routes of opioids?

A

All (PO, smoking, nasal, SQ, IM, IV)

82
Q

What are the s/s of opioid intoxication?

A
  • Altered mood
  • Psychomotor retardation
  • Drowsiness “nodding”
  • Slurred speech
  • Impaired memory/attn
  • Pupillary constriction
  • Feelings of warmth
  • Itchy face and extremities
  • Facial flushing
83
Q

What are the s/s of opoid OD?

A
  • Marked unresponsiveness
  • Coma
  • Slow respirations
  • Hypothermia
  • Hypotension
  • Bradycardia
84
Q

*What is the clinical triad of opioid OD?

A
  • Unresponsiveness/coma
  • Pinpoint pupils
  • Respiratory depression
85
Q

What is the tx for opioid OD?

A
  • Airway
  • Naloxone (0.4mg IV); may repeat 4-5x; sometimes given IM
  • Careful observation
86
Q

Brand name of naloxone?

*T1/2?

A

Narcan

  • 45 min
87
Q

What are opioid withdrawal s/s?

A
  • Muscle cramps
  • Diarrhea
  • Abdominal cramps
  • Dysphoric mood
  • N/V
  • Rhinorrhea
  • Piloerection
  • Yawning
  • *Flu-like sx
88
Q

When does heroin withdrawal start after last dose?

When does heroin withdrawal peak?

When does heroine withdrawal subside?

A

6-8 hrs

2nd or 3rd day

7-10 days after peaking

89
Q

What are the goals of heroin tx?

A
  • Abstinence from all illicit opioid use

- Substantial decrease in use (harm reduction)

90
Q

What are the different tx settings for heroin?

A
  • Inpt hospital
  • Outpt clinics/offices
  • Opioid tx programs
  • Self-help programs
  • Therapeutic communities
91
Q

What is the most common form of pham tx for opioid dependence?

A

Methadone Maintenance (opioid maintenance therapy - OMT)

92
Q

Methadone MoA?

A

Mu-opioid agonist

  • Orally active
  • Can be dosed once daily
  • Suppresses withdrawal
  • Blocks effect of other opioids
93
Q

What CYP enzyme metabolizes methadone?

Methadone T1/2?

A

3A4

T1/2: ~24 hrs

94
Q

When does methadone withdrawal typically begin?

When does it typically subside?

A

1-3 days s/p last dose

Subsides in 10-14 days

95
Q

Most common side effects of methadone?

A
  • Constipation
  • Sweating
  • Sedation
  • Sexual dysfcn
  • QTc prolongation
  • Low T
96
Q

Opioid maintenance therapy is effective in: (read)

A
  • Decreasing use
  • Decreasing psychosocial and medical morbidity
  • Improving overall health status
  • Decreasing mortality
  • Decreasing criminal activity
  • Improving social fcning
97
Q

Brand name of buprenorphine alone?

98
Q

What is the MoA of buprenorphine?

A

Mixed opioid partial agonist/antagonist

  • Produces partial agonist effect at mu receptor
  • Antagonizes kappa receptor
99
Q

What is Suboxone (how is it different from Subutex?

A

Buprenorphine + naloxone

Subutex is buprenorphine alone

100
Q

Buprenorphine:

  • Onset of effects?
  • Peak effects?
  • Duration?
  • T1/2?
A
  • Onset: 30-60 min
  • Peak: 1-4 hrs
  • Depends on dose, 8-72 hrs
  • 24-37 hrs
101
Q

Which CYP enzyme metabolizes buprenorphine?

102
Q

How severe physical opioid dependence should pts have to receive buprenorphine vs. methadone?

A
  • Buprenorphine: mild-mod

- Methadone: severe

103
Q

What’s are some adjunctive pharm tx’s used in opioid withdrawal? (read)

A
  • Clonidine (alpha2 agonist) for N/V/D, cramps, sweating
  • Anti-spasmotics (dicyclmine)
  • Anti-emetics (trimethobenzamide)
  • Anti-diarrheals (loperamide)
  • NSAIDs
  • BZDs
  • Diphenhydramine
  • Hydroxyzine
  • Sedating anti-depressants (doxepin, amitriptyline)
104
Q

What % of 12th graders have used marijuana?

A
  • 49%
    (40% 10th graders)
    (20.4% 8th graders)
105
Q

What questions should you ask during drug screening?

A
  • Types used
  • Age at 1st use
  • Period of heaviest lifetime use
  • Use past 3 months
  • Presence of tolerance or withdrawal
106
Q

Recall the CAGE screening questions.

A
  • Felt need to CUT down on drinking
  • Feel ANNOYED when asked about drinking
  • Feel GUILTY about drinking
  • Ever needed an EYEOPENER
107
Q

How do you interpret CAGE results?

A
  • 2+ positive = considered probably alcoholism
  • 1 positive = warrants further evaluation
  • Not recommended as a screening tool but…can be useful for quickly finding out if someone who screens positive on a single-item screening question has or has had a more severe problem (by answering two or more as “yes”)
108
Q

What does MAST stand for?

  • What is it used for?
  • How many questions is it?
A

Michigan Alcoholic Screening Test

  • Used to assess alcoholic potential
  • 25 items
109
Q

What are the reasons to do brief therapies for etoh intervention?

A
  • Enhance entrance into alcoholism tx
  • Education about substance abuse and dependence
  • Decrease etoh consumption for 12 mo
  • Cuts health care utilization
  • Reduces societal and health costs
110
Q

What is considered healthy alcohol use for men under 65?

Women?

A

14 drinks per week, 4 or less any day

7 drinks per week, 3 (2?) or less any day

111
Q

What is the overall prevalence of etoh use d/o?

112
Q

What is the overall prevalence of substance use d/o?

113
Q

What is the criteria for substance use d/o?

how many criteria to consider mild? Mod? Severe?

A

A problematic pattern of use leading to clinically significant impairment or distress is manifested by 2 or more of the following w/in 12-month period:

  • Using more than intended
  • Desire or failing to cut down
  • Times spent trying to obtain/use/recover
  • Recurrent use despite problems
  • Giving up activities that are important
  • Using in hazardous conditions
  • Tolerance
  • Withdrawal

(mild = 2-3, mod = 4-5, severe = 6+)

114
Q

What does SBIRT stand for?

A
  • Screening
  • Brief Intervention
  • Referral Tx
115
Q

Which adults should be screened for unhealthy etoh use?

A

All (those w/unhealthy use should receive brief counseling intervention)

116
Q

If someone is already known to have substance use problems, what should you do instead of screening?

A

Full assessment for substance use d/o’s

117
Q

Describe the 2 questions used in “Single Item Screening”

- When is it positive?

A

“Do you sometimes drink beer, wine or other alcoholic beverages?” IF YES:

  • How many times in the past year have you had 5 (4 for women) or more drinks in a day?
  • Test is is positive when response > 0 or when the patient states he/she is having difficulty coming up with the # (because it is therefore > 0)
118
Q

What does AUDIT stand for?

How many questions is it?

A

Alcohol use d/o identification test (review it online)

  • 10-item questionnaire (takes longer than single-item screening); score ranges 0-40
    > 8 = unhealthy use
    >/= 20 = dependence
119
Q

Give an eg of a single-item screening question for substance use.

A

“How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasons?”

  • Response > 0 is + test
120
Q

What is DAST?

  • Score ≥ __ w/ 10 yes/no items suggests drug use w/ adverse consequences
  • When may it be useful?
A

“Drug Abuse Screening Test”

  • Score ≥ 3 w/ 10 yes/no items suggests drug use w/ adverse consequences
  • May have some utility for assessing severity
121
Q

What does SoDU stand for?

A

Screening of Drug Use (d/o)

122
Q

What can serum/urine drug panels typically detect?

A
  • Opiates
  • Cocaine
  • Marijuana
  • Benzodiazepines
  • Barbiturates
  • Acetaminophen
  • Alcohol
  • Aspirin

(Possibly false positives may require confirmation with gas chromatography-mass spectrometry)

123
Q

If a pt screens positive for etoh use, what questions should you ask next?

A

Ask about consumption:
• On average, how many days per week do you drink alcohol?
• On a typical day when you drink, how many drinks do you have?
• What is the maximum number of drinks you had on any given occasion during the last month?

124
Q

Read about some major medical consequences of drug/etoh abuse.

A
  • Cocaine: CV, pulm
  • Drug-induced myopathies
  • Drug-induced neutropenia and agranulocytosis
  • Leukoencephalopathy due to heroin inhalation
  • Injection drug use: Hepatitis C, HIV
125
Q

What are the goals of brief intervention in mild substance abuse d/o?

A
  • Abstinence or reduced use
126
Q

What are the goals of brief intervention in mod-severe substance abuse d/o?

A

Pt to enter and participate in SUD specialty care

*if at-risk for withdrawal, must first undergo detox

127
Q

What are endorphins?

A

Subclass of opioids consisting of endogenous peptides that cause pain relief, including:

  • enkephalins
  • dynorphins
  • beta-endorphins
128
Q

Fentanyl and methadone are a subclass of opioids called ____________ opioids.

129
Q

Oxycodone and hydrocodone are a subclass of opioids called ____________ opioids.

A

Semisynthetic

130
Q

What are some health consequences of opioid use disorder?

A
  • Increased mortality
  • Overdose
  • Infections
  • Endocarditis
  • Narcotic bowel syndrome
  • Accident-related injuries (increased rate vs general pop)
131
Q

Urine drug tests can detect metabolites of heroin and morphine within __ days of last use.

132
Q

What are some things that can cause false-positives on UDS?

A
  • Rifampin
  • Quinolones
  • Poppy seeds
133
Q

In early opioid remission: After full criteria were previously met, none of the criteria for OUD have been met (with the exception of craving) for at least __ months but < __ months.

134
Q

In sustained opioid remission: After full criteria were previously met, none of the criteria for OUD have been met (with the exception of craving) during a period of ≥ __ months

135
Q

When should naloxone be provided?

A
  • Any illicit opioid use (including those receiving/discontinuing tx for OUD)
  • Suspected opioid use d/o
  • Receiving Rx’d opioids +… (50 morphine +, BZDs/other sedating drugs, h/o substance use d/o, h/o opioid OD)
  • Risk of witnessing opioid OD
136
Q

When should opioids be Rx’d?

A
  • Other alternative therapies have not provided sufficient pain relief and:
  • Pain is adversely affecting a pt’s fcn and/or QoL and
  • When the potential benefits of opioid therapy outweigh potential harms
137
Q

What are the S.M.A.R.T. goals to use w/opioid prescribing?

A 
Specific
Measurable
Attainable
Relevant
Time-limited
138
Q

What should you always remind pt about goals w/opioid therapy?

A

They do not include being completely pain-free!

139
Q

What a good tapering strategy when discontinuing opioids?

A

25% dose reduction per week

140
Q

Which benzos are best to use in liver disease?

A

LOT

  • Lorazepam
  • Oxazepam
  • Temazepam
141
Q

Provide the brand names for the following:

  • Clonazepam
  • Alprazolam
  • Lorazepam
  • Diazepam
  • Chlorazapate
  • Oxazepam
  • Chlordiazepoxide
A
  • Clonazepam: Klonopin
  • Alprazolam: Xanax
  • Lorazepam: Ativan
  • Diazepam: Valium
  • Chlorazapate: Tranxene
  • Oxazepam: Serax
  • Chlordiazepoxide: Librium
142
Q

Name the different stages of alcohol withdrawal.

A
  1. Mild withdrawal
  2. Seizures
  3. Alcoholic halucinosis
  4. DTs
143
Q

When do “mild” alcohol withdrawal sx start?

What are the sx?

A

6-24 hrs s/p last drink

Anxiety, insomnia, tremors, diaphoresis, palpitations, GI upset, (intact orientation)

144
Q

When do alcoholic withdrawal seizures typically start/end?

A

12-48 hrs s/p last drink

145
Q

When does alcoholic hallucinosis typically start/end?

A

12-48 hrs s/p last drink

sensorium intact, stable vitals

146
Q

When do DTs typically start?

A

48-96 hrs s/p last drink

147
Q

What is the hallmark of DTs?

What are the other sx of DTs?

A

Disorientation + global confusion

Agitation, fever, tachycardia, HTN, diaphoresis, hallucinations

148
Q

Is alcoholic hallucinosis a type of DTs?

A

No, DTs are more severe and separate (*DTs potentially life-threatening)

149
Q

What labs should you definitely get in substance use d/o, besides the usual?

A
  • U-tox
  • HIV
  • Hep A, B, C
    (vaccinations for hep A and B to those w/negative serologies)

Psychiatry (16 decks)

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