Substance Use Disorder Flashcards
goals of substance use treatment X4
recognition of acute toxicity
facilitation of withdrawal
dx and tx of complications
education/counseling/therapy
CNS Depressants X3
alcohol
barbiturates
benzos
Opiates X9
oxycodone fentanyl heorin meperidine morphine codeine methadone hydromorphone opium
CNS Stimulants X3
cocaine/crack
amphetamines
methamphetamines
Club drugs X4
ectasy
GBH
ketamine
rohypnol
Hallucinogens X2
PCP
LSD
abuse
habitual use of a substance which falls outside of medical necessity or societal acceptance
addiction
chronic, relapsing disease characterized by compulsive substance seeking behaviors
psychological risk factors
low frustration levels poor impulse control lack of meaningful relationships childhood trauma low self-esteem propensity for risk taking behaviors
societal considerations
peer influences
family acceptance
gender influences on substance use
men at greater risk
genetic
member of family in which SUD prevalent
brain reward system
reinforcement of behaviors and production of memories/limbic system
neurobiology and neurotransmitters
substances of abuse affect neurotransmitters - varies by specific drug
genetic risk for substance disorder
increased risk associated with genetic links
Acute MOA of Alcohol
binding with GABA receptor and glutamate receptors - activates the reward circuit
how does alcohol act as a diuretic
inhibits the release of ADH
heavy or at risk alcohol use in men
> 4 drinks on one day or more than 14 in one week
heavy or at risk alcohol use in women
> 3 drinks on one day or more than 7 in one week
breast feeding moms and alcohol
bBAC of mom is the same as in breast mil
high BAL with few symptoms =
high tolerance
early signs of alcohol withdrawal
sweating
tremors
elevated BP
peaks within 24 to 48 hours
when does alcohol withdrawal go away
rapidly and dramatically disappears unless it progresses to delirum
when are grand mal seizures possible in alcohol withdrawal
7-48 hours after cessatoin
withdrawal delirium
medical emergency d/t possible fatality
autonomic hyperactivity perceptual disturbances fluctuation LOC paranoid delusions fever
when does alcohol withdrawal delirium peak
2-3 days after cessation and reduction`
sedatives used in alcohol withdrawal
benzos
diazepam
chlordiazepoxide
meds used for seizure control in alcohol withdrawal
carbamazepine
magnesium sulfate
thiamine
alleviation of ANS symptoms in alcohol withdrawal
betablockers
clonidine
CIWA-AR
max of 67
lower than 10 do not require treatment
wernicke’s encephalopathy
d/t chronic alcohol use
inflammatory henorrhagic degenerative condition of the brain caused by thamine deficiency from poor diet
how is wernicke’s encephalopathy treated
thiamine
if untreated, wernicke’s encephalopathy leads to
korsakoff’s psychosis
korsakoff’s psycosis
irreversible form of amnesia characterized by:
short-term memory loss/long term memory gaps
inability to learn
drugs used to maintain alcohol sobriety X4
naltrexone
acamprosate
disulfiram
gabapentin
how does naltrexone stop alcoholism
blocks feel good results
how does acamprostate stop alcoholism
blocks s/s of withdrawal
how does disulfram stop alchoolism
makes you sick when drinking
benzo toxicity
severe confusion drowsiness lack of coordination/balance lighteheadedness muscle weakness fainting memory loss
what does a benzo OD usually occur with
usually occurs with cross use of
alcohol
opiates
TCAs
CNS depressants
benzo withdrawal
body pain, muscle tension, cramping, vomiting, sweating, seizures
benzo reversal agent
flumazenil
opioid intoxication
constricte dpupils decreased RR sedation hypotension intially euphoric - progresses to dysphoria
opioid toxicity
triad symptoms
leads to death d/t shock, seizures, cardiac arrest
withdrawal opioids
yawning, insomnia, irritabilty, rhinorrhea, panic, increased BP and HR
BONE PAIN
what are triad symptoms
pinpoint puils
decreased RR
coma
opioid toxicity treatement
AIRWAY
oxygenation
naloxone - short acting - multiple doses
nalmefene - longer acting
why is heroin so addictive
high lipid solubility - crosses BBB easily to convert to active form (morphine)
how fast does heroin take place
IV 7-8 seconds
smoked/snorted - 10-15 minurwa
Oxycodone OD risk
if no tolerance has been developed - OD risk is higher
meperidine use
effective when taken orally
no obvious signs of IV drug use
meperidine pupil response
less pupillary constriction than other opioids
meperidine effects on smooth muscle
minimal effects on smooth muscle
less constipation and urinary retention
treatment for opioid sobriety X3 meds
methodone
buprenorphine
naltrexone
methodone interventions opioids
daily clinic visits
decreasing doses
buprenorphine maintenance opioids dose route
SL tabs or film used once daily
naltrexone is used for
maintenance after opioid detox
cocaine intoxication
euphoria dilated pupils elevated BP and HR grandiosity altered judgment
cocaine use in preganncy
preemie small head decreased BW LBW ADD/ADHD memory/language development
methamphetamine intoxication
delusions of increased strength and mental capacity
littel need for sleep/food
talkative
meth withdrawal
strong cravings, dysphoria, depression lasting for months
meth overdose
cerebral and systemic vasculitis
what does meth induced psychosis mimic
paranoid schizophrenia
meds for meth treatment
none FDA approved
bupropion and modafinil used
ibudilast is in clinical trials
matrix model meth tx
CBT/group therapy
family edu
drug testing
non-drug related activities
Ecstasy intoxication
muscle cramping
involuntary teeth clenching
feelings of trust and love
ecstasy AE
hyperthermia
memory impairment
CV stimulation - HTN
ketamine intoxication
dreamlike state
hallucinations
sedation
ketamine long term effects
bladder pain/ulcers kidney problems stomach pain depression poor memory
bath salts intoxication
extreme agitation and violent behavior
increased HR and BP
X2 date rape drugs
GHB
flunitrazepam
LSD intoxication
pupil dilation
synesthesi
LSD OD
psychosis CVA Resp arrest sz HTN crisis
LSD tx
acidify urine to hasten excretion
diazepam/haloperidol
PCP intoxication
hallucinations bizzare behavior violence sz elevated vitals muscle rigidity
PCP toxicity
hallucinations HTN coma Seizures depressed respirations
X2 inhalents
nitrous oxide and ether
