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NMSP Exam 3 > Substance Use Disorders > Flashcards

Substance Use Disorders Flashcards

1
Q

Define Substance-Related Disorders according to the DSM 5

A
  • 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
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2
Q

What is the definition of Substance-Induced Disorders?

A

Includes intoxication and withdrawal

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3
Q

Define Addiction

A

An overwhelming involvement with seeking and using drugs or ETOH and a high tendency toward relapse after substance withdrawal

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4
Q

What is considered At-Risk drinking for men and women?

A

Men: >14 drinks per week or >4 per occasion

Women: >7 drinks per week or >3 drinks per occasion

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5
Q

Define Alcohol Tolerance

A

Need for increased amounts to achieve desired effect

Diminished effect with continued use and the same amount

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6
Q

What are the symptoms of Alcohol Withdrawal?

A

Autonomic hyperactivity

Increased hand tremor

Insomnia

N/V

Hallucinations

Psychomotor agitation

Seizures

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7
Q

What is the clinical presentation of a patient with Alcohol dependcy?

A

Daily or frequent drinking to function

Violence associated with drinking

Neglect of food intake, physical appearance and hygiene

N/V, shaking in morning, confusion

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8
Q

What is the CAGE screening for alcohol/drug abuse?

A

Cut Down-have you ever felt like you should?

Annoyed-when critised about drinking?

Guilty-about drinking

Early morning-drink to get going?

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9
Q

What are the s/s of intoxication based on ABV?

  1. 05:
  2. 08:
  3. 30:
  4. 40-0.50:

>0.50:

A

Judgement/restraint impaired

Legally intoxicated

Stupor/Stupid

Coma

Death

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10
Q

What are some mild signs of alcohol intoxication?

A

slurred speech, loss of coordination, unsteady gait

mood swings, increased pain threshold, N/V

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11
Q

What are some severe signs of alcohol intoxication?

A

Stupor, coma

Hypothermia

Tachycardia

Dilated pupuls

Slow respiration

Increased ICP

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12
Q

What is a serious outcome of Alcohol Withdrawal?

A

Delirium Tremens-30% mortality if not treated

  • Tremulousness
  • Delusions
  • Hallucinations
  • Seizures
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13
Q

How is Delirium Tremens prevented?

A

Detox order set including

Benzos

Antipsychotics

Fluids

Vitamins (thiamin and folate)

Restraints if needed

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14
Q

Why should IV Thiamine be given?

A

Deficiency in alcoholics can result in Wenicke’s Encephalopathy leading to Korsafoff’s Syndrome which is permanent damage to mammillary bodies

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15
Q

What is Acamprosate?

A

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

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16
Q

What is Naltrexone

A

opioid antagonist, cuts cravings

improves abstinence in alcohol dependence

May be synergistic when used with acamprosate

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17
Q

What is Disulfram?

A

Used to control ETOH intake as a deterrant

Produced unpleasant adverse effects if pt’s drinks alcohol

(makes them really sick)

18
Q

What are some signs and symptoms of stimulant withdrawal?

A

increased sleep

nightmares

increased appetite

depression

suicide attempts

drug cravings

19
Q

What is the withdrawal treatment for stimulants?

A

antidepressants and hospitalization

20
Q

Stimulants can cause hypertension and hyperthermia as well as psychotic symptoms. How are these treated?

A

Phentolamine for the HTN and hyperthermia

Haloperidol for the Psych stuff

21
Q

What are the signs of intoxication of Sedatives/Hypnotics?

A

Euphoria

Increased Seizure Threshold

Sedation/Coma

Respiratory Depression

Depressed Reflexes

Hypotension

Hypoxemia

Hypothermia

22
Q

What is the treatment for Sedatives/Hynotics intoxication/OD?

A

Airway

Oxygen

Ventilation

Warmth

Diuresis with alkalinization of urine

Hemodialysis

23
Q

What are the signs/symptoms of Sedatives/Hypnotics withdrawal?

A

Anxiety/Agitation

Orthostatic Hypotension

Weakness/Tremors

Hyperreflexia

Diaphoresis

Delirium

Seizures

Death

24
Q

What is Sedatives/Hypnotics Withdrawal treatment?

A

Phenobarbital to wean pt’s off

25
Q

What are some of the signs and symptoms of Hallucinogen Intoxication?

A

dilated pupils

increased heart rate and blood pressure

Paranoid and Anxiety

Hallucinations

PCP-violence, hyperactivity, nystagmus, rigidity, sz

26
Q

What is the treatment for hallucinogen intoxication?

A

Diazepam (sometimes)

Haloperidol if violent

27
Q

In Hallucinogen withdrawal, what is a common experience?

What is the treatment for withdrawal?

A

Flashbacks of hallucinogenic state

Reassurance, Benzos

28
Q

In addition to the physical symptoms of PCP, what are the psychiatric symptoms?

A

Agitation, blank stare, anxiety, stupor, aggression, panic, bizarre behavior

29
Q

In addition to the medical s/s of stimulants, what can the psychiatric symptoms present as?

A

Agitation, delusions, euphoria, irritability

30
Q

LSD can cause which physical and psychiatric symptoms?

A

Physical: Sympathetic excess

Psychiatric: sensory distortion, hypersensitivity of the sense, euphoria, hallucinations

31
Q

What are the s/s of opioid intoxication?

A

analgesia, c/o LOC

apathy/lethargy

euphoria

itching

miosis

constipation

flushed skin

respiratory depression

hypotension and decreased reflexes

32
Q

What is the treatment for opioid intoxication?

A

Supportive care

Naloxone to reverse coma/apnea

can cause vomiting and be given Intranasal

33
Q

Is withdrawing from Opioids deadly?

A

nope, they just feel bad

(restless, irritability, “violent yawning??”, cravings)

34
Q

What are the treatment options for opioid withdrawal?

A

burprenorphine or Methadone

Suboxone (buprenophrine and Naloxone)-specialized training

Clonidine for elevated BP

Diphenhydramine for lacrimation and rhinorrhea

Imodium for diarrhea

35
Q

What are the advantages of Buprenorphine w/wo Naloxone?

A

not an opioid, so minimal chance of overdose

prescribed by doc with special training

not long term

helps with mild to moderate pain

36
Q

What are the disadvantages of Buprenorphine w/wo Naloxone?

A

Cost

finding a legit provider

37
Q

What are the advantages of Methadone?

A

available through licensed clinics without Rx

Long half life

38
Q

What are the disadvantages of Methadone?

A

not closely monitored

have to go to methadone clinic daily

doses are high–>prolonged QT

pt’s remain opioid dependent

39
Q

Buprenorphine/Nalocone can be stopped in hospital and restarted upon D/C while Methadone

A

is continued as an outpatient and can treat acute pain

must monitor for sedation, respiratory depression

(so, how is that actually helping the addiction?)

40
Q

What are some s/s of MDMA (Molly)

A

tremors

hyponatremia and cerebral edema

auditory hallucinations

syncope

tachycardia

41
Q

How is MDMA intoxication treated?

A

hypertonic saline

hyperthermia ice bath

benzos

cyproheptadine for serotonin syndrome

NMSP Exam 3 (21 decks)

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