Substance Use Disorder Flashcards
What is the “Substance Abuse Triad”?
1) Psychological dependence or craving (Mental)
2) Physiologic dependence (Physical)
3) Tolerance
How many deaths per year are directly attributable to alcohol use?
85,000
___ in ___ deaths in working age adults results from excessive drinking?
1 in 10
What is the 3rd leading preventable cause of death in the United States?
Alcohol Use Disorder
What is the NIAAA?
National Institute of Alcohol Abuse and Alcoholism
What are the estimated consumption amounts of alcohol that would increase health risks for a man?
1) More than 14 drinks/week
2) More than 4 drinks on ANY day
What are the estimated consumption amounts of alcohol that would increase health risks for a woman?
1) More than 7 drinks/week
2) More than 3 drinks on ANY day
What is a “standard drink” of wine?
5 oz
What is a “standard drink” of beer?
12 oz beer
What are the criteria used to diagnose an alcohol use disorder?
LW-STACK-SHOT
1) Drinking in LARGER amounts for longer periods than intended
2) Evidence of alcohol WITHDRAWAL or use of alcohol for relief or avoidance of withdrawal
3) Persistent desire or unsuccessful attempts to STOP or reduce drinking
4) Great deal of TIME spent obtaining, using, or recovering from alcohol
5) Important ACTIVITIES given up or reduced because of drinking
6) Alcohol CRAVING
7) Continued drinking despite KNOWLEDGE of problems caused
8) Continued drinking despite alcohol-related SOCIAL or interpersonal problems
9) Recurrent drinking in HAZARDOUS situations
10) Recurrent drinking resulting in failure to fulfill role OBLIGATIONS
11) Evidence of TOLERANCE
What are the Medical Complications of alcohol use?
1) HTN
2) Cardiovascular disease
3) Liver disease
4) Pancreatitis
5) Gastritis
6) Esophagitis
7) Neuropathy
What are physical exam findings of withdrawal?
Tremors and Agitation
What are the features of liver disease from alcohol abuse?
1) Hepatic/splenic enlargement
2) Icterus/jaundice
3) Spider angiomata
4) Palmar erythema
What are the CAGE questions?
1) Have you ever felt you should CUT down on your drinking?
2) Have people ANNOYED you by criticizing your drinking?
3) Have you ever felt bad or GUILTY about your drinking?
4) Have you ever taken a drink first thing in the morning (EYE OPENER) to steady your nerves or get rid of a hangover?
Wernicke Korsakoff syndrome is a complication of what?
Alcohol Use Disorder
If you were dealing with a patient that has an Alcohol Abuse disorder, What is a possible complication if you noticed Nystagmus, wide/short steps and Disorientation during your physical exam?
Wernicke Encephalopathy
Direct damage to the brain caused by thiamine deficiency
Wernicke Korsakoff Syndrome is caused by a deficiency in what?
Due to a deficiency of Thiamine (Vitamin B1)
A deficiency of Thiamine (Vitamin B1) is caused by what?
Alcohol Abuse
What is the triad for Wernicke encephalopathy?
1) Encephalopathy (Confused)
2) Oculomotor dysfunction (Nystagmus)
3) Gait ataxia (Wide short gait)
MILD Withdrawal Symptoms generally begin within ___ to ___hours of last drink and last __ to __ days.
6-24 hours
1-2 days
Alcohol Hallucinosis begins within ___ - ___ hours and last ___ - ___ days
12-24 hours
1-2 days
Seizures due to alcohol withdrawal occur within ___ - ___ hours.
6-48 hours
True or False:
Risk of seizures increases with repeated Alcohol Withdrawals.
True
Its called “Kindling effect”
What is the leading preventable cause of mortality worldwide?
Tobacco Use Disorder
What are the stages of quitting tobacco?
1) Pre-contemplation
2) Contemplation
3) Preparation
4) Action
5) Maintenance
What is the most important risk factor for COPD?
Smoking
When does nicotine withdrawal peak?
First three days
When does nicotine withdrawl subside?
1 month
What is an example of a long acting nicotine replacement therapy?
Nicotine Patch
What is an example of short acting nicotine replacement therapy?
Nicotine gun or lozenges
What medications can be used for tobacco cessation?
1) Buproprion (Wellbutrin)
2) Varenicline (Chantix)
What is the Mechanism of Action for Buproprion?
It is a Dopamine and Norepinephrine reuptake inhibitor
What is the treatment of choice for a patient that is suffering from seizures due to alcohol withdrawal?
Diazepam
How long can THC be detected in the urine for a long term and short term user?
Short term = 4 - 6 days
Long term= 20 - 50 days
What is a negative effect of marijuana usage?
You go to heck
What is the most widely used treatment for cannabis dependence?
Cognitive behavioral therapy
Where are 55% of abused opioids obtained from?
Friends and Family
What are the effects of opioid abuse on a patients vitals?
+/- Heart Rate
Hypo-tension
Bradycardia
Hypothermia
What physical exam findings would be present in a patient that has abused opioids?
Hypo-active bowel sounds (That’s why you get constipated)
Neurological Sedation or Seizures
Miosis (Constricted pupils)
What should be ruled out when suspecting a patient has abused opiods?
Hypoglycemia
What is the treatment of choice for acute opioid intoxication?
Naloxone
You should also pay attention to airway management
What are the physical findings in an acute stimulant intoxication patient?
1) Sweating
2) Tachycardia
3) Elevated blood pressure
4) Mydriasis (dilated pupils)
5) Hyperactivity
6) Acute brain syndrome with confusion and disorientation.
What should be a clinical concern for patients presenting with unexplained nasal bleeding, headaches, fatigue, insomnia, anxiety, depression, and chronic hoarseness?
Cocaine use
Bipolar disorder is a mood disorder that is characterized by what three mood states?
1) Mania *
2) Hypomania
3) Major Depression *
What is defined as a distinct period of abnormally or persistently elevated, expansive, or irritable mood and persistently increased activity or energy, lasting at least one week.
Mania
What are the symptoms that need to be present for a person to be considered Manic?
(3+ symptoms must be present)
DIG FAST
D - Distractibility I - Indiscretions G - Grandiosity F - Flight of ideas A - Activity increase S - Sleeplessness T – Talkativeness
What are the symptoms that need for be present for a person to be considered to have “Major Depression”?
(5+ symptoms must be present)
* SIG-E-CAPS*
S- Suicide
I- Loss of intersts
G- Guilt (for unknown reasons)
E- Energy decreased
C- Concentration loss
A- Appetite (Increased or decreased)
P- Psychomotor Retardation
S- Sleep disturbances
How does an IDC manage a patient with Bipolar disorder?
1) Immediately refer and manage acute symptoms while awaiting referral
2) Haloperidol and MEDEVAC if for an acute manic episode
What is the maintenance therapy for bipolar disorder?
(Prescribed by a psychiatrist)
a) Lithium
b) Valproic acid
c) Lamotrigine (Lamictal)
d) Quetiapine (Seroquel)
