Substance Use Disorders (Barash) Flashcards
Define # of symptoms for Severity:
- Mild:
- Moderate:
- Severe:
Mild=2-3
Moderate=4-5
Severe=6+
Sustained remission=__
No criteria for >12 months (except craving)
Type of seizure associated with Etoh withdrawal?
Grand mal, 24-48 hrs after consumption
When do you generally see DT’s? Seriousness?
48-72 hrs
Life-threatening
Test for alcohol withdrawal?
CIWA –> numerical values to orientation, N/V, tremor, sweating, anxiety, agitation, tactile/auditory/visual disturbances and HA
CIWA score for severe withdrawal?
> 10
Pharmacotherapy for Etoh withdrawal?
Benzos –> reduce risk of seizure
Anticonvulsants –> reduce risk of seizure, may reduce kindling; Carbamazepine or valproic acid
Thiamine supplementation
Medications for Etoh tx?
Disulfiram (tertiary prevention)
Naltrexone
Acamprosate
Toxicity of Naltrexone and what labs to check?
Hepatotoxic at high doses –> check LFTs
Intoxication picture of benzos/barbiturates? withdrawal picture?
Similar to alcohol
pin point pupils, think of what?
Opioid intoxication
Meds for opiate use disorder?
Methadone (opioid sub) –> Mu agonist, titrate up until no cravings, need to be enrolled in certified opiate substitution proram
Naltrexone –> mu antagonist
Buprenorphine (opioid sub) –> Partial Mu agonist, ceiling effect, helpful for highly motivated pts who do not need high doses
Greatest effect on what NT with amphetamines?
Greatest effect on Dopamine (inhibit reuptake of DA, NE, Serotonin)
Tobacco induces what CYP?
CYP1A2 –> watch for interactions when start or stop (ex. olanzapine)
meds for tx tobacco use disorder?
Bupropion
Varenicline
predominant NT affected by MDMA?
predominantly 5HT2 receptor agonists
increased conjunctival injx and increased appetite, think what drug?
Cannabis
neuromodulator effect of canabis?
Decrease uptake of GABA and DA
severe dissociative rxns, paranoid, hallucinations, can become very agitated/violent with decreased awareness of pain..what drug?
PCP
careful. they don’t feel pain
MOA of Disulfiram?
Inhibit Aldehyde DH and DA beta-hydroxylase
Which Benzos metabolized though only glucuronidation in liver and not affected by age/hepatic insufficiency?
“Outside The Lines”
- Oxazepam
- Temazepam
- Lorazepam
Cocaine mainly prevents reuptake of __
DA
Receptor targets of cannabis?
CB1 and CB2
Tx for PCP intoxication?
antipsychotic drugs or BZD if required
Low stimulation environment
Acidify urine if severe toxicity/coma
