Substance Use Disorders

Question 1

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

Answer 1

intoxication
withdrawal
mental disorders

Question 2

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

Answer 2

Delirium
Dementia 
Amnesia 
Psychosis
Mood Disorders
Anxiety 
Sexual Dysfunction
Sleep Disorders

Question 3

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

Answer 3

Frequency
Quantity
Duration

Question 4

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

Answer 4

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

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

Question 5

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

Answer 5

GGT

Question 6

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

Answer 6

AST:ALT 2:1

Question 7

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

Answer 7

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

Question 8

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

Answer 8

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

Question 9

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

Answer 9

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

Question 10

Why does fatty liver / hypertriglyceridemia result in liver damage?

Answer 10

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

Question 11

Why does ascites develop?

Answer 11

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

Question 12

Why do we see scleral icterus in liver failure?

Answer 12

Hyperbillirubinemia

Question 13

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

Answer 13

Thiamine (B1)
Folic Acid
Pyridoxine (B6)

Question 14

What are the 3 miscellaneous signs in alcoholic cirrhosis?

Answer 14

Palmer Erythema
Parotid Gland enlargement
Leukonuchia (white nail beds)

Question 15

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

Answer 15

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.

Question 16

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

Answer 16

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

Question 17

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

Answer 17

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

Question 18

What are the signs of substance use disorder?

Answer 18

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

Question 19

What are the signs of alcohol intoxication?

Answer 19

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

Question 20

What 4 disorders can you see nystagmus in?

Answer 20

Alcohol intoxication
Benzo intoxication
Inhalant intoxication
PCP intoxication

Question 21

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

Answer 21

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

Question 22

What are the 3 types of complicated withdrawal from alcohol?

Answer 22

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

Question 23

What scale can you use to assess alcohol withdrawal?

Answer 23

CIWA

Question 24

What is the protocol for treating alcohol intoxication?

Answer 24

Sleep it off

Question 25

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

Answer 25

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

Question 26

What is the protocol for treating alcohol withdrawal?

Answer 26

Benzodiazepine as standard taper, front loading, or CIWA symptom based scale. Haloperidol can also be used in delirium. This lowers seizure thresholds though.

Question 27

What are the 3 treatment options for maintaining sobriety?

Answer 27

Disulfram - makes you sick Naltrexone - binds mu opioid receptor and cuts down craving of both alcohol and opioids Acamprosate - similar to naltrexone

Question 28

What are 3 stimulants that can cause disorders?

Answer 28

Cocaine Methamphetamine Herbal Khat

Question 29

Stimulant INTOXICATION most resembles...

Answer 29

Panic

Question 30

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

Answer 30

``` Perspiration / chills Pupil dilation Tachy or Brady Elevated or low BP Evidence of weight loss ```

Question 31

What is the treatment protocol for stimulant INTOXICATION?

Answer 31

Supportive Measures O2, telemetry, observe for chest pain. Avoid B-blockers - unopposed alpha action = hypertensive crisis

Question 32

Nasal septum erosion can be a sign for what?

Answer 32

Cocaine intoxication

Question 33

Stimulant WITHDRAWAL most resembles ...

Answer 33

Depression

Question 34

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

Answer 34

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

Question 35

What is the treatment protocol for stimulant withdrawal?

Answer 35

Supportive Measures

Question 36

What are the signs of opioid intoxication?

Answer 36

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

Question 37

What is the treatment protocol for opoid intoxication?

Answer 37

Supportive care

Question 38

Opioid withdrawal most resembles ...

Answer 38

Flu

Question 39

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

Answer 39

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

Question 40

What is L-Alpha-acetylmethadol?

Answer 40

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.

Question 41

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

Answer 41

buprenorphine (combined with naloxone)

Question 42

What is clonidine used for and why?

Answer 42

It is symptomatic relief for opioid withdrawl. (Not a substitute) It is an alpha agonist. Should be given with anti-emetic.

Question 43

What are the signs of inhalant intoxication?

Answer 43

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

Question 44

What is the treatment for inhalant withdrawal?

Answer 44

Supportive care