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Substance Use Disorders Flashcards

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1
Q

What are the types of substance-induced disorders? (3)

A

intoxication
withdrawal
mental disorders

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2
Q

What are the different types of mental disorders that could be induced by substance abuse? (8)

A 
Delirium
Dementia 
Amnesia 
Psychosis
Mood Disorders
Anxiety 
Sexual Dysfunction
Sleep Disorders
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3
Q

When you are asking a patient about substance abuse, what 3 parameters are you asking for?

A

Frequency
Quantity
Duration

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4
Q

What is the criteria for alcohol use disorder in men and women, respectively?

A

Men: 14 drinks / wk || 4 drinks / episode

Women: 7 drinks / wk || 3 drinks / episode

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5
Q

What lab value would you look at to accurately assess abstinence from alcohol?

A

GGT

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6
Q

What would AST and ALT values look like with alcoholic hepatitis?

A

AST:ALT 2:1

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7
Q

Portal HTN can cause the back up of systemic veins leading to their engorgement. What are the 4 veins affected?

A

Splenic Vein - Hepatosplenomegaly
Umbilical Vein - Caput Medusae
Esophageal Vein - Esophageal varices
Internal hemorrhoidal Veins - hemorrhoids

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8
Q

What 3 signs do you see with elevated ammonia levels in liver failure due to alcohol?

A

Asterixis = Flapping Tremor
Fetor Hepaticas = Distinct bad breath
Delirium / encephalopathy

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9
Q

Loss of the ability to detoxify androstenedione leads to what 4 signs?

A

Testicular atrophy
Gynacomastia
Decreased axillary / pubic hair
spider angioma (decreased estrogen)

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10
Q

Why does fatty liver / hypertriglyceridemia result in liver damage?

A

Impaired gluconeogenesis leads to fatty acid utilization in the liver for energy

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11
Q

Why does ascites develop?

A

Failure to synthesize albumin leads to osmotic movement of capillary fluids out into the peritoneum and interstitial space.

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12
Q

Why do we see scleral icterus in liver failure?

A

Hyperbillirubinemia

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13
Q

What are the 3 vitamins that are affected in storage in the liver?

A

Thiamine (B1)
Folic Acid
Pyridoxine (B6)

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14
Q

What are the 3 miscellaneous signs in alcoholic cirrhosis?

A

Palmer Erythema
Parotid Gland enlargement
Leukonuchia (white nail beds)

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15
Q

Why would you administer thiamine before D50/D10 in patients with alcohol intoxication?

A

If you gave D50 without thiamine you would push them into a state of delirium. Without thiamine you cannot go through the kreb’s cycle.

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16
Q

What does the acronym COAT mean for Wernicke’s encephalopathy?

A 
C = Confusion
O = Opthalmoplegia
A = Ataxia
T = Thiamine to treat
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17
Q

What does the acronym RACK mean for Korsakoff’s psychosis?

A 
R = Retrograde amnesia
A = Anterograde amnesia
C = Confabulation
K = Korsakoff psychosis
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18
Q

What are the signs of substance use disorder?

A

Taken in larger amounts of over longer periods
unsuccessful cut down
spend time to obtain substance
cravings
failure to fulfill roles / obligations
continued use despite interpersonal problems
tolerance / withdrawl

19
Q

What are the signs of alcohol intoxication?

A

Slurred speech, incoordination, unsteady gait, memory impairment, stupor or coma, nystagmus

20
Q

What 4 disorders can you see nystagmus in?

A

Alcohol intoxication
Benzo intoxication
Inhalant intoxication
PCP intoxication

21
Q

Alcohol withdrawal criteria requires 2 or more of the following signs:

A

N/V, tremor, anxiety, psychomotor agitation, sweating, insomnia

22
Q

What are the 3 types of complicated withdrawal from alcohol?

A

Alcoholic hallucinosis
Alcohol withdrawal delirium (DT)
Alcohol withdrawal seizures (Tonic-clonic)

23
Q

What scale can you use to assess alcohol withdrawal?

A

CIWA

24
Q

What is the protocol for treating alcohol intoxication?

A

Sleep it off

25
Q

What is the protocol for treating suspected mental disorders in alcoholics?

A

6 mos. sobriety required before re-assessing for mental disorder.

26
Q

What is the protocol for treating alcohol withdrawal?

A

Benzodiazepine as standard taper, front loading, or CIWA symptom based scale.

Haloperidol can also be used in delirium. This lowers seizure thresholds though.

27
Q

What are the 3 treatment options for maintaining sobriety?

A

Disulfram - makes you sick

Naltrexone - binds mu opioid receptor and cuts down craving of both alcohol and opioids

Acamprosate - similar to naltrexone

28
Q

What are 3 stimulants that can cause disorders?

A

Cocaine
Methamphetamine
Herbal Khat

29
Q

Stimulant INTOXICATION most resembles…

A

Panic

30
Q

Stimulant INTOXICATION signs are (2 of the following needed for diagnosis)

A 
Perspiration / chills 
Pupil dilation
Tachy or Brady
Elevated or low BP
Evidence of weight loss
31
Q

What is the treatment protocol for stimulant INTOXICATION?

A

Supportive Measures
O2, telemetry, observe for chest pain.

Avoid B-blockers - unopposed alpha action = hypertensive crisis

32
Q

Nasal septum erosion can be a sign for what?

A

Cocaine intoxication

33
Q

Stimulant WITHDRAWAL most resembles …

A

Depression

34
Q

Mephadrone (bath salts) are a synthetic stimulant. What are its unintended effects?

A

Poor concentration, pupil dilation, hallucinations, delusions, etc.

35
Q

What is the treatment protocol for stimulant withdrawal?

A

Supportive Measures

36
Q

What are the signs of opioid intoxication?

A

Pinpoint pupils (miosis)
Coma or drowsiness
Impairment in attention/memory
Slurred speech

37
Q

What is the treatment protocol for opoid intoxication?

A

Supportive care

38
Q

Opioid withdrawal most resembles …

A

Flu

39
Q

What drug can be given for opioid withdrawal? How does it work?

A

Methadone.

It is a pure mu receptor agonist. It’s longer lasting than opoid

40
Q

What is L-Alpha-acetylmethadol?

A

This is another drug that can be used in opioid withdrawal. It has a longer half-life than methadone.

Pulled from market due to risk of Torsaddes.

41
Q

What is the partial agonist of the mu receptor that can be given for opioid withdrawal treatment?

A

buprenorphine (combined with naloxone)

42
Q

What is clonidine used for and why?

A

It is symptomatic relief for opioid withdrawl. (Not a substitute)

It is an alpha agonist. Should be given with anti-emetic.

43
Q

What are the signs of inhalant intoxication?

A

Muscle weakness
Euphoria
slurred speech, incoordination, unsteady gait, stupor, coma, nystagmus etc.

44
Q

What is the treatment for inhalant withdrawal?

A

Supportive care

Psych Disorders (6 decks)

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