Substance Use / Addictive Flashcards
substance use disorder DSM
problematic pattern of substance use leads to impairment or distress by 2+ within a 12 month period
- using more than originally intended
- desire/unsuccessful efforts to cut down
- signif time spent on obtaining, using or recovering
- craving to use
- failure to fulfill obligations at work, school or home
- continued us despite social/interpersonal problems
- decreased social/occupational/recreational activities because of use
- continued use despite physical or psych problems
- use in dangerous situations (driving)
- tolerance 11. withdrawal
withdrawal
development of substance-specific syndrome due to cessation or reduction of substance that has been heavily and prolonged use
opposite of intox (EtOH withdrawal - excitation and seizures)
tolerance
need for inc amounts of substance to achieve desired effect
EtOH intox
loss of motor control, impaired coordination, ataxic gait and poor balance, lethargy, n/v, coma, resp depression and death
treatment: ABCs, thiamine, folate, CT to r/o SDH, attention to acid/base/lytes,
GI evacuation only if 30-60 mins
EtOH withdrawal
irritability, tremor, insomnia –> diaphoresis, HTN, tachy, fever, disorientation –> seizures, DTs, hallucination
sz begin 12-48 hrs no drink
DTs 48-96 days, treat with BZDs
carbamazepine or valproate if mid intox
thiamine, banana bag, lytes and fluids, CIWA scale
check for liver impairment
EtOH use disorder
AUDIT-C: how often do you drink, how many drinks a day, how often > 6 drinks.
risk: > 4 drinks a day (3 women), and >14 week (7 )
labs: BAL, LFTs (AST/ALT 2:1), Inc MCV
tx: Naltrexone (vivitrol), acamprosate (can be used in liver dz), Disultram/antabuse blocks EtOH DeOH and causes n/v/SOB/HA, Topamax dec craving,
long term complications of EtOH
Wernicke encephalopathy: due to thiamine deficiency, acute and can be reversed with thiamine. ataxia, confusion, nystagmus gaze palsies
leads to Korsakoff syndrome: chronic amnesia, only reversible in 20%, impaired memory, anterograde amnesia, compensatory confabulation
cocaine
blocks re-uptake of NE, DA, and Epi –> flight or fight
intox: general euphoria, heightened self esteem, bp changes, tachy or brady, nausea, dilated pupils, wt loss, chills, sweating
dangerous: resp depression, sz, arrhythmia, hyperthermia, paranoia, hallucinations
deadly: vasoconstriction, MI, intracranial hemorrhage, stroke
withdrawal: crashing, malaise, fatigue, hyper-somnolence, depression, anhedonia, hunger, constricted pupils, dreams, suicide, bzd for tx prn
amphetamines
stimulants, block DA and NE reuptake
heavy use can cause schizophrenic-like psychosis
sx of abuse: euphoria, dilated pupils, inc libido, tachy, sweats, chest pain, also similar to cocaine
OD –> hyperthermia, dehydration, rhabdo, renal failure
withdrawal = prolonged depression
tx: rehydrate, correct lytes, treat hyperthermia
PCP and Ketamine
angel dust, dissociative, hallucinogenics
antagonize NMDA, stimulate glutamate release, activates DA
intox: agitation, depersonalization, hallucinations, synesthesia, impaired judgement, memory impairment, assaultiveness, rotatry nystagmus, ataxia, HTN, tachy, muscle rigidity
OD = sz, delirium, coma, death
tx: monitor vitals and lytes, BZD and haldol
PCP intox sx
RED DANES Rage Erythema Dilated pupils Delusions Amnesia Nystagmus Excitation Skin dryness
sedative-hypnotics (BZDs and Barbiturates)
include BZDs, barbiturates, sleep drugs, GHBs - highly abused drugs
BZDs: potentiate GABA, as well as Barbiturates
GHB: CNS depressant, causes confusion, dizzy, drowsy, memory loss, resp distress, coma, date-rape
intox: drowsy, confusion, HoTN, slurred speech, in-coordination, ataxia, mood lability, impaired judgement, nystagmus, resp depression, coma or death if OD
barbiturate OD: alkalize urine with sodium bicarb to inc renal excretion
flumazenil in BZD OD ONLY
abrupt abstinence/withdrawal is DEATHLY, sim to DTs, can get seizure and die
opioids
stimulate opioid receptors –> analgesia, sedation, dependence
intox: drowsy, n/v/c, constricted pupils, sz, resp dep–> coma and death
meperidine can cause 5HT syndrome, and dilates pupils
tx: ABCs, narcan, clonidine for withdrawal, NSAIDs, dicyclomine for abd cramps
withdrawal: dysphoria, insomnia, lacrimation, rhinorrhea, yawning, weakness, sweating, piloerection, n/v, fever, dilated pupils, abd cramps, arthralgias/myalgias, HTN, tachy, craving
tx of opioid use:
methadone = agonist, bup = partial, naltrexone = agonist
hallucinogens (LSD and shrooms)
intox: illusions, hallucinations, synesthesia, labile affect, dilated pupils, tacky, HTN, hyperthermia, tremors, in-coordination, sweating, palps
bad trip = anxiety, panic, psychosis
tx: BZD or antipsychotics PRN
MJ
proven helpful for n/v with chemo, inc appetite in cachexia, chronic pain, dec IOP in glaucoma
intox: euphoria, anxiety, dec motor coordination, slowed, tachy, anxiety, red eyes, dry mouth, munchies
withdrawal: irritable, anxious, restless, aggressive, depression, HA, sweats, chills, insomnia, dec appetite
