Substance Use Disorder Flashcards
What is the characterized triad of substance abuse?
- Psychological dependence or craving
- Physiologic dependence
- Tolerance
What are commonly encountered abused substances?
- Alcohol
- Tobacco
- Prescription medication
Opioids
Benzodiazepines - Other illegal substances
What is the 3rd leading preventable cause of death in the United States?
Alcohol Use Disorder
What is “Risky Alcohol Use”
- refers to consumption of alcohol that puts patient at risk for health consequences
- Use is not so severe as to meet criteria for alcohol use disorder
Risky alcohol use may develop into
alcohol use disorder
According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), estimates how much alcohol increases health risks for men and women?
-Men under age of 65
More than 14 standard drinks per week on average
Standard drink: 5 oz of wine, 12 oz beer
More than 4 drinks on any day
- Women and adults 65 years and older
More than 7 standard drinks per week on average
More than 3 drinks on any day
Criteria for Alcohol Use disorder
Diagnosed as mild, moderate, or severe on the basis of the number of the following present (at least 2-3 required for mild):
- Recurrent drinking resulting in failure to fulfill role obligations
- Recurrent drinking in hazardous situations
- Continued drinking despite alcohol-related social or interpersonal problems
- Evidence of tolerance
- Evidence of alcohol withdrawal or use of alcohol for relief or avoidance of withdrawal
- Drinking in larger amounts for longer periods than intended
- Persistent desire or unsuccessful attempts to stop or reduce drinking
- Great deal of time spent obtaining, using, or recovering from alcohol
- Important activities given up or reduced because of drinking
- Continued drinking despite knowledge of problems caused
- Alcohol craving
The following are co-morbidities for what kind of substance abuse?
- HTN
- Cardiovascular disease
- Liver disease
- Pancreatitis
- Gastritis
- Esophagitis
- Neuropathy
Alcohol use
Alcohol use has a strong association to what psychiatric disorders?
- Depression
- Anxiety
- PTSD
- Eating disorders
- Other substance use disorders
- Sleep disturbances
- Suicidal ideation and attempt
PE findings:
- May be signs of withdrawal
Tremor, agitation
- Peripheral neuropathy
Problems with sensation, diminished DTRs, parasthesias, etc.
-Features of liver disease
Hepatic/splenic enlargement
Icterus/jaundice
Spider angiomata
Palmar erythema
Alcohol use disorder
CAGE questions
- Have you ever felt you should Cut down on your drinking?
- Have people Annoyed you by criticizing your drinking?
- Have you ever felt bad or Guilty about your drinking?
- Have you ever taken a drink first thing in the morning (Eye opener) to steady your nerves or get rid of a hangover?
What is Wernicke-Korsakoff Syndrome
- Known complication of Thiamine (B1) deficiency
- Two separate syndromes:
Wernicke encephalopathy (WE): acute syndrome
Korsakoff syndrome: chronic neuro condition
What is Wernicke’s encephalopathy?
- Direct damage to the brain caused by thiamine deficiency
Demyelination, atrophy, hemorrhages, vascular congestion
The following are signs and sx of:
- Triad
Encephalopathy
Disorientation, inattentiveness
Oculomotor dysfunction
Nystagmus most common finding
- Gait ataxia
Wide based gait
Slow, short spaced steps
- Most will not have triad
- Most common symptom: Confusion
Wernicke’s Encephalopathy
What is korsakoff syndrome
- Late neuropsychiatric manifestation of Wernicke encephalopathy
- Striking disorder of anterograde and retrograde amnesia
Long term memory and cognitive skill impairment less common
What kind of Alcohol Withdrawl is life threatening?
Cold Turkey
Approximately how many patients experience some form of withdrawl?
Half
What percentage of patients experience severe sx of alcohol withdrawl?
20%
What kind of withdrawal does the following describe
Symptoms generally begin within 6 to 24 hours of last drink
Anxiety
Minor agitation
Restlessness
Insomnia
Tremor
Diaphoresis
Palpitations
Headache
Alcohol craving
- Tachycardia, hypertension, tremor
Mild Withdrawal
How long does mild withdrawal sx take to resolve?
1-2 days
When do hallucinations occur during alcohol withdrawal?
12-24 hours and resolves after 1-2 days
What are more severe sx of alcohol withdrawal
- Hallucinations
- Delirium
- Seizures
What are hallucinations caused by alcohol withdrawal called?
Alcohol hallucincosis
What kind of seizures occur with alcohol withdrawal
Tonic clonic
When do seizures occur during alcohol withdrawal
6-48 hours of last drink
What is the “kindling effect”
Risk of seizures increases with repeated withdrawals
What is the leading preventable cause of mortality worldwide
Tobacco Use Disorder
What mortalities does tobacco use cause
- Cardiovascular disease
- Pulmonary disease
- Cancer
What is the most important risk factor for COPD
Tobacco use
What is the role of the clinician for tobacco cessation
- Ask about tobacco use
- Advise quitting
Clear evidence that less than 5 minutes of advice at each encounter can increase rates of quitting - Assess readiness to quit
- Assist those who are ready to quit
- Follow up
What are the stages for someone is considering quitting?
- Pre-contemplation: not ready to quit
Less time should be spent with these people
Let them know that you are there for them to help if they decide they want to quit
Consider asking them how quitting would personally benefit them - Contemplation: considering a quit attempt
- Preparation: actively planning a quit attempt
- Action: actively involved in a quit attempt
- Maintenance: achieved smoking cessation
What are common triggers for smoking
Morning coffee, drinking alcohol, around meal time
What are the effects of nicotine withdrawal?
- Peaks in first 3 days and subsides over 3-4 weeks
- Increased appetite, weight gain, depression, insomnia, irritability, anxiety, restlessness
What are Long acting and short acting nicotine replacement
Long acting: nicotine patch
Short acting: gum or lozenge
What antidepressant is used for smoking cessation?
Buproprion (Wellbutrin)
How does Varenicline (Chantix) assist with smoking cessation
- Partial nicotine agonist
- Stimulates dopamine activity but to a much smaller degree than nicotine
- Reduces cravings and withdrawal symptoms
Joint on average contain how much marijuana?
0.3g or approx 20mg of THC
How long can cannabis be detected in most urine tests?
4-6 days in short term users and 20-50 days in long term users.
How long does the effect of cannabis last
Effects occur in 10-20 minutes and last 23 hours
Clinical findings:
- Produces: mild euphoria followed by sleepiness. Altered time perception, less inhibited emotions, psychomotor problems, impaired immediate memory, and conjunctival injection
- High doses produce psychotomimetic effects.
- Frequently aggravates mental illness and adversely affects motor performance.
- Withdrawal can cause insomnia, nausea, myalgia, and irritability.
- Long term use can lead to respiratory problems.
- Men: decrease testosterone levels and reduce sperm counts.
- Women: abnormal menstruation and failure to ovulate.
Cannabis use
Signs and sx:
- VSS change
- GI: decreased bowel sounds
- Neuro: sedation
- Ophthalmologic: Miosis
Opioid use disorder
What percentage of abused opioids are obtained form friends or family?
55%
What lab should be done for opioid intoxication
Serum glucose
Why should liver enzymes be checked for patients who use opioids
Many opioids formulated as a mix of narcotic and acetaminophen
An opioid abuse patient found down should have what condition be considered
Rhabdomyolisis
What is the treatment of choice for acute opioid intoxication
Nalaxone
