Substance Use Disorders Flashcards
Define Substance-Related Disorders according to the DSM 5
- includes the name of specific substance
- consists of maladaptive patterns of substance use leading to impairment in occupational, physical, and social functioning
- specify as mild, moderate or severe
What is the definition of Substance-Induced Disorders?
Includes intoxication and withdrawal
Define Addiction
An overwhelming involvement with seeking and using drugs or ETOH and a high tendency toward relapse after substance withdrawal
What is considered At-Risk drinking for men and women?
Men: >14 drinks per week or >4 per occasion
Women: >7 drinks per week or >3 drinks per occasion
Define Alcohol Tolerance
Need for increased amounts to achieve desired effect
Diminished effect with continued use and the same amount
What are the symptoms of Alcohol Withdrawal?
Autonomic hyperactivity
Increased hand tremor
Insomnia
N/V
Hallucinations
Psychomotor agitation
Seizures
What is the clinical presentation of a patient with Alcohol dependcy?
Daily or frequent drinking to function
Violence associated with drinking
Neglect of food intake, physical appearance and hygiene
N/V, shaking in morning, confusion
What is the CAGE screening for alcohol/drug abuse?
Cut Down-have you ever felt like you should?
Annoyed-when critised about drinking?
Guilty-about drinking
Early morning-drink to get going?
What are the s/s of intoxication based on ABV?
- 05:
- 08:
- 30:
- 40-0.50:
>0.50:
Judgement/restraint impaired
Legally intoxicated
Stupor/Stupid
Coma
Death
What are some mild signs of alcohol intoxication?
slurred speech, loss of coordination, unsteady gait
mood swings, increased pain threshold, N/V
What are some severe signs of alcohol intoxication?
Stupor, coma
Hypothermia
Tachycardia
Dilated pupuls
Slow respiration
Increased ICP
What is a serious outcome of Alcohol Withdrawal?
Delirium Tremens-30% mortality if not treated
- Tremulousness
- Delusions
- Hallucinations
- Seizures
How is Delirium Tremens prevented?
Detox order set including
Benzos
Antipsychotics
Fluids
Vitamins (thiamin and folate)
Restraints if needed
Why should IV Thiamine be given?
Deficiency in alcoholics can result in Wenicke’s Encephalopathy leading to Korsafoff’s Syndrome which is permanent damage to mammillary bodies
What is Acamprosate?
used to maintain absitence in alcoholics
inhibits GABA in CNS and antagonizes receptor similar to ETOH
Does not prevent intoxication or lessen effects of ETOh
What is Naltrexone
opioid antagonist, cuts cravings
improves abstinence in alcohol dependence
May be synergistic when used with acamprosate
What is Disulfram?
Used to control ETOH intake as a deterrant
Produced unpleasant adverse effects if pt’s drinks alcohol
(makes them really sick)
What are some signs and symptoms of stimulant withdrawal?
increased sleep
nightmares
increased appetite
depression
suicide attempts
drug cravings
What is the withdrawal treatment for stimulants?
antidepressants and hospitalization
Stimulants can cause hypertension and hyperthermia as well as psychotic symptoms. How are these treated?
Phentolamine for the HTN and hyperthermia
Haloperidol for the Psych stuff
What are the signs of intoxication of Sedatives/Hypnotics?
Euphoria
Increased Seizure Threshold
Sedation/Coma
Respiratory Depression
Depressed Reflexes
Hypotension
Hypoxemia
Hypothermia
What is the treatment for Sedatives/Hynotics intoxication/OD?
Airway
Oxygen
Ventilation
Warmth
Diuresis with alkalinization of urine
Hemodialysis
What are the signs/symptoms of Sedatives/Hypnotics withdrawal?
Anxiety/Agitation
Orthostatic Hypotension
Weakness/Tremors
Hyperreflexia
Diaphoresis
Delirium
Seizures
Death
What is Sedatives/Hypnotics Withdrawal treatment?
Phenobarbital to wean pt’s off
What are some of the signs and symptoms of Hallucinogen Intoxication?
dilated pupils
increased heart rate and blood pressure
Paranoid and Anxiety
Hallucinations
PCP-violence, hyperactivity, nystagmus, rigidity, sz
What is the treatment for hallucinogen intoxication?
Diazepam (sometimes)
Haloperidol if violent
In Hallucinogen withdrawal, what is a common experience?
What is the treatment for withdrawal?
Flashbacks of hallucinogenic state
Reassurance, Benzos
In addition to the physical symptoms of PCP, what are the psychiatric symptoms?
Agitation, blank stare, anxiety, stupor, aggression, panic, bizarre behavior
In addition to the medical s/s of stimulants, what can the psychiatric symptoms present as?
Agitation, delusions, euphoria, irritability
LSD can cause which physical and psychiatric symptoms?
Physical: Sympathetic excess
Psychiatric: sensory distortion, hypersensitivity of the sense, euphoria, hallucinations
What are the s/s of opioid intoxication?
analgesia, c/o LOC
apathy/lethargy
euphoria
itching
miosis
constipation
flushed skin
respiratory depression
hypotension and decreased reflexes
What is the treatment for opioid intoxication?
Supportive care
Naloxone to reverse coma/apnea
can cause vomiting and be given Intranasal
Is withdrawing from Opioids deadly?
nope, they just feel bad
(restless, irritability, “violent yawning??”, cravings)
What are the treatment options for opioid withdrawal?
burprenorphine or Methadone
Suboxone (buprenophrine and Naloxone)-specialized training
Clonidine for elevated BP
Diphenhydramine for lacrimation and rhinorrhea
Imodium for diarrhea
What are the advantages of Buprenorphine w/wo Naloxone?
not an opioid, so minimal chance of overdose
prescribed by doc with special training
not long term
helps with mild to moderate pain
What are the disadvantages of Buprenorphine w/wo Naloxone?
Cost
finding a legit provider
What are the advantages of Methadone?
available through licensed clinics without Rx
Long half life
What are the disadvantages of Methadone?
not closely monitored
have to go to methadone clinic daily
doses are high–>prolonged QT
pt’s remain opioid dependent
Buprenorphine/Nalocone can be stopped in hospital and restarted upon D/C while Methadone
is continued as an outpatient and can treat acute pain
must monitor for sedation, respiratory depression
(so, how is that actually helping the addiction?)
What are some s/s of MDMA (Molly)
tremors
hyponatremia and cerebral edema
auditory hallucinations
syncope
tachycardia
How is MDMA intoxication treated?
hypertonic saline
hyperthermia ice bath
benzos
cyproheptadine for serotonin syndrome
