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Clin Med III - Psych, Genetics > Substance Use Disorders > Flashcards

Substance Use Disorders Flashcards

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1
Q

Define substance related disorder

A
  • Progressive disease
  • Use of psychoactive substances to the point of impaired functioning in health, occupation, psychosocial
  • Sometimes fatal
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2
Q

Approximately how many over the age of 12 have used alcohol?

A

Over 51%

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3
Q

Approximately how much of the US population has used illicit substances?

A

40%

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4
Q

Epidemiology of substance abuse disorders

A
  • Males, whites (55%)

- Co-morbid psych conditions (60-75%)

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5
Q

Alcohol use in the US?

A

On the decline in recent years

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6
Q

How many people who use alcohol become dependent for some period of time?

A

1 in 5

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7
Q

Cocaine use in the US?

A

Has remained fairly steady since its peak in the 1980s and early 1990s

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8
Q

What substance is on the rise in rural communities?

A

Crystal meth

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9
Q

Base ingredient of methamphetamine?

A

Pseudoephedrine

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10
Q

Effect of alcohol in low doses?

A
  • Depress inhibitory centers

- Disinhibition leading to out of character activities

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11
Q

Effect of alcohol in higher doses?

A

Inhibition of excitatory centers

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12
Q

What type of alcohol is most consumed in US?

A

Beer (57%)

Liquor (30%)

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13
Q

What does 12 grams of alcohol equal?

A
  • 12 oz can of beer
  • 5 oz glass of wine
  • 1.5 oz hard liquor
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14
Q

How much alcohol can a chronic alcoholic consume in a day?

A

Over a liter per day of hard liquor

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15
Q

Recommended alcohol use per day in men and women?

A

3 drinks/day for men

2 drinks/day for women

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16
Q

What is considered excessive alcohol use per day for men and women?

A

Over 4 drinks/day for men

Over 3 drinks/day for women

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17
Q

CAGE screening?

A

Used for any drug/addiction

  • Cut down
  • Annoyed
  • Guilty
  • Eye opener
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18
Q

Define anterograde amnesia

A
  • “Black outs”
  • Can’t remember what happened during or after drinking
  • 64-90% of alcoholics experience black outs
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19
Q

Risk factors for anterograde amnesia

A
  • Drinking on empty stomach

- Lack of sleep

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20
Q

What is the CIWA protocol?

A
  • Clinical Institute Withdrawal Assessment

- Started on any pt admitted to hospital w/potential symptoms of alcohol withdrawal

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21
Q

Sample CIWA protocol

A
  • Record BAC by breathalyzer on admission
  • Vital signs
  • Obtain serum glucose, HFP, CMP, CBC w/diff, urine for drug screen
  • Give thiamine
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22
Q

During CIWA protocol, when should physician be called?

A
  • Abnormal vitals (HR over 110, DBP over 120, SBP over 180)

- If pt requires over 6 mg of Lorazepam in 3 hours

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23
Q

Pharm treatment of alcohol use disorder

A
  • Disulfiram
  • Naltrexone
  • Acamprosate
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24
Q

Describe Disulfiram

A
  • Inhibits aldehyde dehydrogenase
  • Use only temporarily to help establish sobriety
  • Do NOT use if patient is intoxicated
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25
Q

Side effects of Disulfiram

A

When used with ETOH:

  • Flushing
  • HA
  • Tachy, SOB, hypotension
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26
Q

Naltrexone MOA

A

Blocks endogenous opioid release which decreases ETOH craving

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27
Q

Describe Acamprosate

A
  • Reduces craving for alcohol
  • May involve both inhibitory and excitatory neuronal activity
  • For abstinent pts only
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28
Q

Treatment programs for alcohol use disorder

A
  • Detox (inpatient or outpatient)
  • Rehab (inpatient)
  • AA
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29
Q

Define abuse

A

Use of any drug outside of social precepts

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30
Q

Define misuse

A

Like abuse, but referring to prescribed meds

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31
Q

Define psychological dependence

A

Subjective sense for the need of a mind alerting substance for its positive effects OR to avoid negative effects

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32
Q

Define intoxication

A

Reversible condition due to a psychoactive substance affecting various mental functions

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33
Q

Define tolerance

A

Drug no longer produces same effect of original lower dose after repeated doses

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34
Q

Define behavioral tolerance

A

Ability to perform tasks under the influence of higher doses of psychoactive drugs

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35
Q

Describe addiction

A
  • No longer officially used

- Replaced by “dependence”

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36
Q

Define dependence

A
  • Repeated use of a drug with or w/o physical dependence

- Can escalate to physical dependence (resulting in tolerance/withdrawal symptoms)

37
Q

Describe physical dependence that results in addiction

A

Abnormal response to physical dependence that results in:

  • History of prior drug use
  • Out of control use
  • Sacrificing responsibilities
  • Inability to hold a job
  • Encounters w/law enforcement
38
Q

Describe physical dependence that does NOT result in addiction

A
  • Pseudo-addiction

- Can be physically dependent without a change in behavior

39
Q

Factors to consider with substance disorders

A
  1. Addicting agent’s characteristics
  2. Host variables (the user)
  3. Environment
40
Q

What is important to evaluate regarding the addicting agent’s characteristics in substance disorder?

A
  • Degree of euphoria
  • Reinforcement property (higher capacity to create desire = higher addiction risk)
  • Rapidity of onset (based on specific drug AND route)
41
Q

What is important to evaluate regarding the user in a substance disorder?

A
  • Genetics (fam hx?)

- Underlying psych disease (greater addiction risk)

42
Q

What is important to evaluate regarding the environment of someone with a substance disorder?

A
  • Societal norms
  • Peer pressure
  • Rebellious against authority
  • Income, education
43
Q

Describe phencyclidine

A
  • PCP, angel dust
  • Anesthetic w/hallucinatory effects
  • Can be smoked, injected, inhaled, eaten
44
Q

Neuropsych effects of PCP

A
  • Hallucinations
  • No regard for their body (can easily hurt themselves/others)
  • HTN
45
Q

Treatment of acute PCP intoxication

A
  • Seclude in quiet area
  • Restrain to protect pt and others
  • Use BZD for acute agitation
  • Use Haldol if agitated AND psychotic
  • Evaluate for co-existing diseases
46
Q

Recovery from acute PCP intoxication?

A

Usually self limited and rapid

47
Q

Opioids are deadly when taken with:

A

Alcohol

48
Q

What are opioids?

A

Synthetic opiates

49
Q

Types of opioids

A
  • Natural (morphine, codeine)
  • Semi synthetic (heroin)
  • Synthetic (dilaudid, methadone, oxycodone)
50
Q

What is dextromethophan?

A
  • Opioid
  • Cough suppressant
  • Used by pre-teens and teens
  • Hallucinations, resp depression, coma, rhabdo
51
Q

Describe heroin use

A
  • Males, 30-40s

- Routes: injected (IV/SC), inhaled, combined with cocaine IV (speedball)

52
Q

Neuropsych effects of heroin

A
  • CNS depression
  • NV
  • Miosis
  • Euphoria
53
Q

Life threatening effects of heroin

A
  • Resp depression
  • Decreased mental status (obtundation)
  • Decreased tidal wave
  • Hypoglycemia
  • Pupillary miosis
54
Q

Opioid OD treatment

A
  • IV Naloxone
  • IV hydration
  • ICU admission
55
Q

What is one of the most addictive drugs?

A

Cocaine because of intense exuberant euphoria lasting days (w/repeated use)

56
Q

Clinical presentation of cocaine intoxication

A
  • Can look like bipolar cycling

- Crashes are followed by profound fatigue, depression

57
Q

What is the highest risk of cocaine addiction?

A

Freebasing (injecting/smoking)

58
Q

Epidemiology of cocaine abuse

A
  • Males
  • 18-25 yo
  • No difference in SES/race
59
Q

Most prominent sign of cocaine withdrawal?

A

Intense cocaine craving

60
Q

How should Haldol be given?

A

At lowest therapeutic doses (it can lower seizure threshold)

61
Q

What is the MC abused illicit drug?

A

Marijuana

62
Q

Who MC overuses marijuana?

A

Whites

63
Q

Consequences of very high doses of marijuana

A
  • Mild delirium w/panic symptoms

- Can see prolonged cannabis psychosis up to 6 wks

64
Q

Chronic use of marijuana can lead to:

A

Apathetic amotivational syndrome

65
Q

Treatment of marijuana overdose

A
  • Anxiolytics for anxiety

- Antipsychotics for psychosis

66
Q

Describe depressants

A
  • Downers, barbs, benzos

- Diazepam, alprazolam

67
Q

Treatment of depressant overdose

A 
ABCs
Flumazenil IV (antidote)
68
Q

Describe ketamine

A
  • Animal tranquilizer
  • Depressant
  • Anesthetic like effects
  • Anterograde amnesia
69
Q

Describe K-hole

A

With abuse of ketamine

  • Near death experience
  • Depersonalization
  • Paralysis
70
Q

How do amphetamines work?

A
  • Releases DA into cortex via reward pathway (mesolimbic)
  • Produces psychotic like symptoms when taken in high doses
  • Effects similar to cocaine
71
Q

Which route of amphetamines is less addictive?

A

PO - less euphoria too

72
Q

Treatment for acute intoxication of amphetamines

A

Short acting BZDs for agitation

73
Q

What are bath salts?

A
  • Amphetamine like stimulant

- Synthetic cathinone

74
Q

Treatment of acute intoxication of bath salts

A
  • IV Lorazepam or Diazepam every 3 mins until calm
  • Restraints
  • NO antipsychotics (increased QT, hyperthermia, seizures)
75
Q

What shouldn’t be given in acute intoxication of bath salts and why?

A

NO antipsychotics (increased QT, hyperthermia, seizures)

76
Q

Effects of inhalants

A

One inhalation can cause immediate death

  • Anesthesia
  • Unconsciousness
  • Heart failure
  • Suffocation (hypoxia)
  • Coma and death
77
Q

Treatment of inhalant overdose

A

ABCs

Anti-arrhythmics

78
Q

What are the common prescription drugs of abuse?

A

Narcotics
Stimulants
Sedatives

79
Q

Components of ED evaluation for substance abuse disorders

A
  1. Assess need for treatment
  2. Placement into appropriate treatment
  3. Determination of physical suitability for treatment (medical clearance)
80
Q

Which drug often causes fear of intimacy and inhibitions?

A

Alcohol

81
Q

Which drug often causes low self-esteem?

A

Cocaine

82
Q

Which drug often causes uncontrolled anger?

A

Heroin and opiates

83
Q

Single positive response to CAGE?

A

Suggestive of an alcohol problem

84
Q

2 or more positive responses to CAGE?

A

Presence of alcohol problem (90% sensitivity/specificity)

85
Q

Should alcohol intake be quantified before or after CAGE questions?

A

Ask quantity of alcohol intake AFTER CAGE

86
Q

CAGE score is less accurate in which patients?

A

White females

87
Q

What alcohol screening tool is recommended for white females?

A 
TWEAK
Tolerance
Worried
Eye openers
Amnesia
K (cut down)
88
Q

Most popular drug screen test?

A

Urine

  • Yields detectable concentration for most drugs than other sample sites (blood)
  • Does not measure impairment
89
Q

What do all chronic alcoholics in the ED get?

A

“Banana bag”

  • Thiamine 200 mg
  • Folate 1 mg
  • MVI

Clin Med III - Psych, Genetics (9 decks)

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