Substance Use Disorders Flashcards
Deadliness
Die 20 years early
Must treat as a medical disorder`
Substance use disorder diagnostic
<2 items in 12 months
Fialure to fulfill responsibilities Use in hazardous situations Craving Social.interpersonal probs Use larger amounts or longer Cannot cut down increase time spent to get Give up or decrease other parts of life Ongoing use despite probs Toleracne Withdraswl
Mild 2-3
Mod 4-5
Severe 6+
Tolerance and withdrawl
Tol = need for increased amounts to achieve previous affect…diminished effect with ontinued use of the same amount of substance
W/d - characteristic withdrawl syndrome when not taken
Physical dep key points `
NOT required for diagnosis but must know if physicially dependent because w/d can be life threatening
Substance induced intoxication
Reversible substance specific syndrome due to recent substance ingestion
Effects lead to maladaptive behavioral or psych changes due to effect on CNS
Substance induced w/d
Substance specific syndrome due to cessation of substance use
CS distress
Substance induced mental disorders
Screen everyone for these because it is common
General rules for substance induced mood disorders
Chronic CNS dep - depressive moods
CNS stimulants - mixed/manic moods and psychosis
SUD etiology
50% genetic and 50% enviorment
Alcohol intoxication
CNS dep and metabolism in liver
Decreased BP and HR
Dec temp (because vasodilator…why homeless die in winter)
Dec RR
Eventual coma and death
Alcohol withdrawl mild
Within hours of last drink
Resolvesin 48 hours
Tremor, nauseua, irritability, insomnia, tachycardia, HTN, diaphoresis
TX is supportive
Alcohol related med problems
CNS PNS - peripheral neuropathy) cardiac - cardiomyopathy Bllod - thinning of blood of macrocytic anemia GI
Alcohol withdrawl seizure
12-48 hours after last drink…this is important
Tonic-clonic type
Tx with benzos
Delirium tremens
72-96 hours after last drink
Resolves in 3-5 days
Mortalitiy high
Tx with benzos and autonomic instability/fluid/electrolyre probs
Wernicke’s encephalopathy
Severe thiamine edficiency
Triad of delirium, opthalmoplegia (nystagmus), and ataxia
Tx with thiamine replacement BEFORE glucose b/c thimaine needed to metabolize glucose
Korsakoff’s syndrome
AMnestic syndrome caused by thiamine def…preced by wernickes
Anterograde and retregrade amenia with cofabulation
Tx is daily thiamine
Brain - lesionjs in mammillary bodies and meidal dorsal nucles of the thalamus
Alcohol dep tx
Disulfiram - inhibits acetaldehyde dehydrogenase…build up acetaldehyde after alcohol consume
Naltrexone - blocks mu receptor so decrease reward…best if fam hx
Acamprosate - unclear…decreased craving
Education
Males - 2 or less recommended
Females - 1
Drunking 3 or more drinks per days increases of binge drinking (5 or more) increased
1 std drink - .6 fluid ounces or 14 grams of pure alcohol
Brief intervention for those without AUD
Make recommendations
Drunk 2 or less a day
Cannabis intox
Impaired motor coordination Conjunctival injection Increased appetite Dry mouth Tachycardia and BP increases
Increased psychosis risk
Cannbis withdrlawl
Usually after daily/near daily nuse for months with 3 of following
Irritable, angry aggressive Nervous/ancious Sleep probs Decrease appetite or weight loss Restlessness Depressed mood
Caffeine induced anxiety DO
Seen in med students and interns
Trial of caffeine abstinence may help diagnose
Cocaine intox
Mydriasis
N/V
Stimulant med probs
CV
CNS
Pulm
Cocaine w/d
Sleep probs Dysphoric mood Hallucinations Dreams Increased appetite
Methamphetamine
Immediate release of dopamine and looks similar to cocaine
MDMA
Primary effect is on serotonin
Tkane to enhance attachment and feeling
Psychomotor agitation
Disco dump
MDMA severe effects
Rhabdomyolysis, ARF
Hyponatremia
Hallucinogens
Mostly causes an illusion, NOT hallucination
Preserves consciousness
PCP
Dissociative anesthetics - at NMDA receptor
PCP intox
Belligerence, assaultiveness
Vertical nystagmus
Diminished pain response
Ketamine intox
Similar to PCP but without the aggressiveness Increased BPO and HR Ataxia Dissociative expereicne N/V
