substance use/withdrawal Flashcards
alcohol testing
breathalyzer and blood/urine
cocaine testing - and how many days
urine screen: positive for 2-4 days
amphetamine testing- how manny days
urine positive for 1-3 days
most will not be sensitive enough to detect
PCP testing and days
urine- 3-8 days
CPK and AST will be elevated
Barbituates- testing and days(short and long)
short acting - 24 hrs
long acting - 3 wks
Benzo. testing and days
short- 3 days
long - 30 days
opioids testing and days
urine- positive for 2-3 days
methodone and oxycodone will be negative on general screen - need to test separately
marijuana testing and days
heavy users 4 wks
single use - 3 days
bal of 100-150
ataxic gate and poor balance
bal of 150-250
lethargy, difficulty siting up, difficulty with memory
bal of 300
coma
bal of 400
respiratory depression and death is possible
naloxone
can reverse overdose if given alcohol and opioids together
what to use in alcohol withdrawal
librium
earliest symptom of alcohol withdrawl - begins when?
6-24 hrs
6-48hrs after last alcohol drink
seizures
alcohol withdrawal symptoms
mild - irritable, insomnia, tremor
mod - diaphoresis, hypertension, tachy, fever, disoriented
severe - tonic-clonic seizure, DTs and hallucinatiosn
48-72 hrs from last drink
DTs
DTs - what is it?
hallucination, tremor, autonomic instability, fluctuating taunting levels of psychomotor activity
how to treat DTs
benzo
antabuse
blocks aldehyde dehydrgoenase in the liver causing flushing, headache, vomit, and palitations, sob
disulfiram (contraindications)
anatbuse
cardiac disease, pregnancy and psychosis
naltrexone
opioid receptor blocker
decrease craving and “high” associated with alcohol
campral (MOA and indication/contraindication
similar to GABA - inhibits glutamatergic system -
post-detox for relapse prevention if stopped drinking
can use if liver disease - contraindicated in severe renal disease
topomax
anticonvulsant - potentiaties GABA and inhibits glutamate receptors - reduces alcohol craving
cocaine intoxication
euphoria, high or low BP, tachy, or brady, nausea, dilated pupils, sweating
dangerous: respiratory depression, seizure, arrhythmia, paranoia, hallucination
deadly - vasoconstriction might lead to MI
what meds for cocaine dependence?
disulfiram and aripirazole
cocaine withdrawal -
not life threatning
malaise, fatiue, hypersomnolence, depression, hunger, constricted pupils, vivid dreams, psychomotor agitation or retardation,
resolve within 18 hrs if mild user
if heavy user- resolve within weeks - peak in several days
substituted amphetamines - MOA
release dopa, NE, and serotonin from nerve ending
amphetamine intoxication
hyperthermia, dehydration –> rehydrate –> hyponatremia
rhabdo –> renal failure
amphetamine withdrawal
prolonged depression - can treat psychosis
PCP and ketamine intoxication
agitation, depersonlization, hallucination, synesthesia, impaired judgmenet, memory impairment, assaultiveness, nystagmus, ataxia
Overdose- seizure, coma, death
how to treat PCP intoxication
benzo for agitation, anxiety, muscle spasms, seizure
antipsychotics- control severe agitation, or psychotic symptoms
pcp withdrawal
none- but they get flashbacks, as the substance is released and stored in lipid stores
benzo intoxication
confusion, hypotension, slurred speech, incoordination, lability, impaired judgement, nystagmus, respitratory depression, coma, death
benzo overdose treatment
activated charcoal if ingested within 4-6 hr
benzo: flumazenil
barbituates: alkalinize urine and sodium bicarb
benzo withdrawal
can be life threatening
tonic clonic seizure might occur - similar withdrawal to alcohol
treatment for benzo
benzo taper
carbamazepine or valproic acid for seizure prevention
opioid intoxication
drowsiness, n/v, constipation, constricted pupils, seizures, respiratory depression, might lead to coma and death
could lead to seretonin syndrome - hyerthermia, confusion, hyer or hyotension and muscle rigidity
treatment for opioid overdose
naloxone
opioid withdrawal
non life threatening
dysphoria, insomnia, lacrimation, rhinorrhea, sweating, piloerection, n/v fever, dilated pupils, abdominal cramps, myalgia, hypertension, tachy
opioid treatment
symptomatic treatment with clonidine - NSAID, cicyclomine for abdmominal cramps
severe- buprenorphine or methadone
hallucinogen intoxication
illusions, hallucinations, body image distortion, dilated pupils, tachy, hypertension, hyperthermia, tremor, sweating, palpitation
