Substance Use Disorders Flashcards
What symptoms are associated with an opioid overdose?
- Hypoventilation or respiratory depression
- CNS depression
- Miosis
- Bradycardia
- Hypoactive reflexes (hyporeflexia)
- Decreased bowel sounds
Modafinil has been used to treat dependency to which substance?
What is a severe side effect associated with Modafinil?
Methanphatamines
Steven-Johnson Syndrome
What are the indications of methamphetamines?
What are some common side effects?
- ADHD
- Exogenous Obesity
- Narcolepsy (off-label)
HTN, palpitations, tachycardia, alopecia, dizziness, HA, dysphoria, itch
Which over-the-counter decongestant can be used in the production of methamphetamine?
Pseudophedrine
What medications are first-line pharmacologic treatment for tobacco use disorder other than bupropion?
When should bupropion be avoided?
Nicotine replacement therapy and varenicline
Use of MOAI’s, seizure disorders, and eating disorders
A 46-year-old man presents for evaluation. He has a medical history of opioid use disorder and is currently on buprenorphine therapy. What is the mechanism of action of buprenorphine?
What are the adverse effects of buprenorphine?
Mu-opioid receptor partial agonist
Prolonged QT
What complication of methadone use in the management of opioid use disorder is more prevalent than that of buprenorphine or naltrexone use?
Respiratory Depression
Which pharmacologic treatment for smoking cessation is contraindicated in a patient with seizures?
Buproprion
Which pharmacologic intervention for smoking cessation has the fastest onset of action?
Nicotine gum or losanges but may need to be taken every hour to prevent withdrawal symptoms
What class of medications is recommended as first-line therapy in the treatment of moderate to severe alcohol withdrawal?
Benzo’s (e.g., diazepam, lorazepam, chlordiazepoxide)
What treatment is recommended for patients with delirium tremens refractory to high-dose benzodiazepines?
Phenobarbitol or Propofol
A 27-year-old male patient underwent pre-employment urine drug testing after being hired for a full-time hospital position. The patient admits to using recreational drugs in the past, but he claims he has not used anything for at least 2 weeks. The urine test returns positive.
Question
What substance is this patient most likely using?
A. Cannabinoids
B. Nicotine
C. Amphetamine
D. Cocaine
E. Opiates
Cannabinoids, the only drug listed that would be detectable after 2 weeks since last use.
Moderate-to-severe daily use of cannabis will be detected in the urine between 10-32 days
How long is nicotine detectable in urine after use?
About 12 hours
How long after use are amphetamines detectable in the urine?
What about opioids?
2-3 days
Variable but does not exceed 3 days
What symptoms are associated with chronic marijuana use?
- Sweet smell on clothes
- Lack of motivation (amotivation)
- Conjunctival injection
- Increased appetitie
- Social withdrawal
- Hallucinations
- Dry mouth
What conditions are associated with long-term chronic cannabis use?
- COPD
- Laryngitis
- Rhinitis
- Low testosterone
- Low sperm count
What physical symptoms are associated with phencyclidine (PCP) overdose?
What are the most common hallucinagens people abuse?
- Vertical or Horizontal Nystagmus
- Dilated pupils
- Ataxia or muscle rigidity
- Tachycardia
- Dizziness
- Prolonged glare or blank stare
Phencyclidine (PCP, or “angel dust”) or LSD
Phencyclidine is an antagonist to what receptor?
NMDA
Are there withdrawal symptoms associated with LCD?
No, LCD acts on 5-HT and therefore because it does not affect dopamine no withdrawal symptoms take place
What are the signs of an LSD intoxication?
visual hallucination, seeing sound as color, marked anxiety or depression, delusions, pupillary dilation and “bad trip” panic.
What is the pharmacologic treatment for a hallucinagenic intoxication?
- Antipsychotics (Haldol)
- Benzo’s
A 19-year-old male is brought to the emergency department by police after being arrested for petty theft. The patient complains of severe muscle aches and spasms. Upon questioning, he says he regularly uses heroin but has not had access to the drug for 15 hours. Which of the following is characteristic of heroin withdrawal?
A. Miosis, constipation
B. Mydriasis, diaphoresis, rhinorrhea
C. Delirium, cardiovascular collapse
D. Stomach cramps, hypersomnolence
E. Belligerence, impulsiveness
Mydriasis, diaphoresis, rhinorrhea
Miosis and constipation are seen in opioid intoxication
What is the difference between mydriasis and miosis?
Mydriasis is when the pupils are dilated, or enlarged
Drugs, such as amphetamines, cocaine, and LSD, can cause mydriasis
Miosis is when the pupils are constricted, or narrowed.
Opioids such as heroin, morphine, and fentanyl can cause miosis
What are the withdrawal symptoms associated with opioids?
What is the MOA of opioids?
- Anxiety, insomnia, anorexia, sweating, dilated pupils (mydriasis), piloerection (“cold turkey”),
- Fever, rhinorrhea, nausea, stomach cramps, diarrhea (“flulike” symptoms)
- Yawning
- Unpleasant but not life-threatening
MU receptor agonist
A 55-year-old female was admitted to the hospital after a motor vehicle accident. A family member mentioned to the nursing staff that the patient had been chronically taking a medication for her anxiety. If by the third day of her hospitalization, the patient has not been restarted on her home medication regimen, what clinical manifestations could be experienced by her?
A. Excessive somnolence, low heart rate, and low blood pressure
B. Fever, tachycardia, HTN, tremor, elevated CPK, “lead pipe” rigidity
C. Dry mouth, blurred vision, urinary retention.
D. Restlessness, confusion, tremulousness, psychosis, and generalized seizure
E. Darting and writhing of face, tongue, or head
Restlessness, confusion, tremulousness, psychosis, and generalized seizure are common symptoms of withdrawal from benzo’s
In a patient with unexplained nose bleeding and septal perforation you should suspect abuse of what substance?
Cocaine
What vitamin can be given in stimulent intoxication to promote excretion?
Vitamin C
What should be given in stimulent withdrawal?
What is the first line treatment for stimulent abuse disorder?
- Buproprion
- Bromocriptine
- SSRI’s for depression
Intensive outpatient therapy (IOT)
What symptom is classic of a salicylate acid overdose?
What type of acid-base disturbance will be seen?
Tinnitus
A high anion-gap metabolic acidosis m/c (especially in kiddos)
Respiratory alkolosis
What substance will cause the patient to believe there are bugs crawling all over them?
This is a form of what type of hallucination?
Cocaine
Tactile Hallucination
What is the MOA of methadone?
Long-acting opioid agonist
What are some common side effects of cocaine?
- Anxiety
- Irritablity
- Fatigue
Other common side effects that are seen in stimulants are increased appetite, cravings, and depression
A 30-year-old male presents to the emergency department with agitation, dilated pupils, diaphoresis, and tremors. He reports intense cravings for alcohol and a history of binge drinking. His vital signs are within normal limits. What is the most appropriate initial management for this patient?
A) Immediate administration of lorazepam
B) Discharge with outpatient follow-up
C) Admission for inpatient detoxification
D) Prescribing naltrexone for craving control
Admission for inpatient detoxification
Given history, patient is suffering from alcohol use disorder and the first line treatment is always detoxification.
A 35-year-old female with a history of cocaine use disorder presents to the clinic requesting help to quit using cocaine. She has tried multiple times to stop using but always relapses. She has no medical comorbidities and denies any other substance use. Which medication is FDA-approved for the treatment of cocaine use disorder?
A) Bupropion
B) Naltrexone
C) Disulfiram
D) Topiramate
Topiramate
A 28-year-old female presents with a history of intravenous heroin use. She reports using heroin daily for the past five years. She expresses a desire to quit but is afraid of withdrawal symptoms. Which medication is commonly used for opioid withdrawal management in outpatient settings?
A) Methadone
B) Naltrexone
C) Clonidine
D) Buprenorphine-naloxone
Buprenorphine-naloxone
Buprenorphine-naloxone is a preferred medication for opioid withdrawal management in outpatient settings. It helps alleviate withdrawal symptoms and cravings, making it easier for individuals to taper off opioids and engage in ongoing treatment.
