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EOR Exam - Behavioral Medicine > Substance Use Disorders > Flashcards

Substance Use Disorders Flashcards

1
Q

What are the three most commonly abused drugs?

A

Alcohol, nicotine, caffiene

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2
Q

Give a general definition of substance use disorder.

A

Inappropriate use of a substance with 2 or more maladaptive behaviors that result in impairment.

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3
Q

Describe the maladaptive behaviors associated with substance use disorder.

A

Use to prevent/avoid difficult circumstances, anxiety, anger, withdrawal, self-harm, continued use despite awareness of adverse effects, cravings, etc.

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4
Q

Define tolerance and withdrawal.

A

Tol: Decreased affect over time with same amount of substance.
With: Symptoms related to sudden cessation of substance use.

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5
Q

What S/S are associated with chronic AUD?

A

acne, rosacea, palmar erythema, hepatomegaly, dupuytren contracture, testicular atrophy, gynecomastia

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6
Q

What is dupuytren contracture?

A

An abnormal thickening of the skin in the palm of your hand at the base of your fingers which can cause one or more fingers to curl over time.

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7
Q

What serum lab changes are associated with AUD?

A

elevated –> GGT (early), AST, ALT, LDH, MCV

decreased –> BUN, LDL, red cell volume

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8
Q

Describe the progression of severe alcohol withdrawal over a 4 day period.

A

12-24h: irritable, diaphoretic, tachycardia, insomnia, tremor, autonomic hyperreactivity
24-48h: seizure risk
48-96h: DTs, disorientation, agitation, hyperthermia

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9
Q

What are S/S of delirium tremens?

A

Fever, tachycardia, HTN, anxiety, irritability, tremors, decreased seizure threshold, AVH.

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10
Q

What is the treatment for DTs?

A

Emergent: BZDs, anti-psychotics

Supplement PRN: glucose, thiamine, fluids

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11
Q

What is the treatment for AUD?

A

Non-pharm: education, coping skills, family therapy, psychotherapy, AA
Pharm: disulfiram (antabuse), naltrexone

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12
Q

What is the concern with use of disulfiram?

A

Any intake of alcohol while on the medication causes severe nausea and illness.

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13
Q

What is the MOA of cannabis products?

A

Delta-9-Tetrahydrocannabinol (THC) is a partial agonist at cannabinoid 1 & 2 receptors. C-1 receptors are found in the brain’s dopamine reward system.

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14
Q

What determines the potency of a cannabis product?

A

Ratio of THC to cannabidiol in the substance. Cannabidiol inhibits the effects of THC.

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15
Q

What are the S/S associated with cannabis intoxication?

A

disconnected speech, recent memory impairment, emotional lability, confusion, tachycardia, decreased body temp, depersonalization.

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16
Q

Define emotionally labile.

A

Emotions easy to arouse and that tend to alter quickly and spontaneously –> emotionally unstable

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17
Q

Define depersonzalization.

A

The feeling of observing oneself from outside the body.

18
Q

Describe adverse effects from cannabis use disorder.

A

Panic, psychosis, depression (rare), amotivational syndrome. Psychosis is more common at higher potency (eastern cultures)

19
Q

Describe withdrawal syndrome associated with cannabis use disorder.

A

Medication typically not required. S/S include malaise, irritability, insomnia, diaphoresis, night sweats, GI disturbance. Anxiolytics may be used to manage S/S.

20
Q

How long after use is THC detectable in urine?

A

1 month

21
Q

List some examples of hallucinogenic substances.

A

Psilocybin, mescaline (peyote), LSD, PCP

22
Q

What is the classic presentation of PCP intoxication?

A

Violent or bizarre behavior, horizontal and vertical nystagmus, disorientation, auditory hallucinations.

23
Q

What is the first line treatment for severe PCP intoxication?

A

BZDs

24
Q

What medications should be avoided in management of hallucinogenic intoxication?

A

Anti-psychotics –> adverse Ach reaction from hallucinogenic + antipsychotic

25
Q

T/F: Addiction risk is high with abuse of inhalants.

A

False: addiction is possible but unlikely

26
Q

What is the cardinal S/S associated with inhalation of a solvent and what is it caused by?

A

Erythematous rash around the mouth –> contact dermatitis.

27
Q

What are the long term effects of inhalant use?

A

Damage to kidney, liver, nerve fibers, and brain cells.

28
Q

What are the S/S of opioid intoxication?

A

Respiratory depression, CNS depression, miosis

29
Q

What are the S/S of opioid withdrawal?

A

Severe discomfort but not life threatening –> tachypnea, tachycardia, HTN, N/V/D, mydriasis, lacrimation.

30
Q

What is used in treatment of opioid withdrawal?

A

Clonidine

31
Q

What medications are used for ongoing maintenance in the management of opioid use disorder?

A

Methadone, naltrexone, buprenorphine, suboxone (buprenorphine + naloxone)

32
Q

What medication is used in the management of opioid overdose?

A

Naloxone

33
Q

What are the S/S BZD intoxication and overdose?

A

Intox: mimic alcohol intoxication
OD: coma, respiratory depression, hypotension

34
Q

What is used in the management of BZD overdose?

A

Flumazenil if no risk of seizure

Gastric lavage if within 12 hours since ingestion, alkalinize urine, respiratory and vasopressor support.

35
Q

What are the S/S of BZD withdrawal and what is the risk?

A

Risk of seizures and death.

S/S: agitation, anxiety, anorexia, N/V, tachycardia, hypotension, hypereflexia, tremor, seizures, delirium.

36
Q

What is the treatment of BZD overdose?

A

Long acting BZD with slow taper –> may take several weeks

37
Q

What are the S/S of acute stimulant intoxication?

A

agitation, impaired judgement, euphoria, HTN, psychosis, tachycardia, mydriasis, hallucinations.

38
Q

What are the S/S of stimulant withdrawal?

A

fatigue, depression, HA, dysphoria, diaphoresis, muscle cramps, hunger.

39
Q

What is the management of stimulant intoxication/overdose?

A

BZDs, anti-psychotics

40
Q

What medications should NOT be used to treat stimulant intoxication/overdose and why?

A

BBs –> unopposed alpha stimulation can lead to cardiovascular collapse.

41
Q

List and describe the medications used for smoking cessation.

A

NRT: gum, patch, lozenge –> avoids cravings and prevents withdrawal.
Bupropion: blocks reuptake of DA and norepi –> dec seizure threshold, C/I in seizure history.
Varenciline (Chantix): partial agonist to nicotine receptors –> inc risk of SI and cardiovascular events

42
Q

What circumstances are known to decrease the success of smoking cessation programs.

A

Concomitant AUD or other SUD, family history of smoking.

EOR Exam - Behavioral Medicine (6 decks)

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