substance use/withdrawal

Question 1

alcohol testing

Answer 1

breathalyzer and blood/urine

Question 2

cocaine testing - and how many days

Answer 2

urine screen: positive for 2-4 days

Question 3

amphetamine testing- how manny days

Answer 3

urine positive for 1-3 days

most will not be sensitive enough to detect

Question 4

PCP testing and days

Answer 4

urine- 3-8 days

CPK and AST will be elevated

Question 5

Barbituates- testing and days(short and long)

Answer 5

short acting - 24 hrs

long acting - 3 wks

Question 6

Benzo. testing and days

Answer 6

short- 3 days

long - 30 days

Question 7

opioids testing and days

Answer 7

urine- positive for 2-3 days

methodone and oxycodone will be negative on general screen - need to test separately

Question 8

marijuana testing and days

Answer 8

heavy users 4 wks

single use - 3 days

Question 9

bal of 100-150

Answer 9

ataxic gate and poor balance

Question 10

bal of 150-250

Answer 10

lethargy, difficulty siting up, difficulty with memory

Question 11

bal of 300

Answer 11

coma

Question 12

bal of 400

Answer 12

respiratory depression and death is possible

Question 13

naloxone

Answer 13

can reverse overdose if given alcohol and opioids together

Question 14

what to use in alcohol withdrawal

Answer 14

librium

Question 15

earliest symptom of alcohol withdrawl - begins when?

Answer 15

6-24 hrs

Question 16

6-48hrs after last alcohol drink

Answer 16

seizures

Question 17

alcohol withdrawal symptoms

Answer 17

mild - irritable, insomnia, tremor
mod - diaphoresis, hypertension, tachy, fever, disoriented
severe - tonic-clonic seizure, DTs and hallucinatiosn

Question 18

48-72 hrs from last drink

Answer 18

DTs

Question 19

DTs - what is it?

Answer 19

hallucination, tremor, autonomic instability, fluctuating taunting levels of psychomotor activity

Question 20

how to treat DTs

Answer 20

benzo

Question 21

antabuse

Answer 21

blocks aldehyde dehydrgoenase in the liver causing flushing, headache, vomit, and palitations, sob

Question 22

disulfiram (contraindications)

Answer 22

anatbuse

cardiac disease, pregnancy and psychosis

Question 23

naltrexone

Answer 23

opioid receptor blocker

decrease craving and “high” associated with alcohol

Question 24

campral (MOA and indication/contraindication

Answer 24

similar to GABA - inhibits glutamatergic system -
post-detox for relapse prevention if stopped drinking
can use if liver disease - contraindicated in severe renal disease

Question 25

topomax

Answer 25

anticonvulsant - potentiaties GABA and inhibits glutamate receptors - reduces alcohol craving

Question 26

cocaine intoxication

Answer 26

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

Question 27

what meds for cocaine dependence?

Answer 27

disulfiram and aripirazole

Question 28

cocaine withdrawal -

Answer 28

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

Question 29

substituted amphetamines - MOA

Answer 29

release dopa, NE, and serotonin from nerve ending

Question 30

amphetamine intoxication

Answer 30

hyperthermia, dehydration –> rehydrate –> hyponatremia

rhabdo –> renal failure

Question 31

amphetamine withdrawal

Answer 31

prolonged depression - can treat psychosis

Question 32

PCP and ketamine intoxication

Answer 32

agitation, depersonlization, hallucination, synesthesia, impaired judgmenet, memory impairment, assaultiveness, nystagmus, ataxia
Overdose- seizure, coma, death

Question 33

how to treat PCP intoxication

Answer 33

benzo for agitation, anxiety, muscle spasms, seizure

antipsychotics- control severe agitation, or psychotic symptoms

Question 34

pcp withdrawal

Answer 34

none- but they get flashbacks, as the substance is released and stored in lipid stores

Question 35

benzo intoxication

Answer 35

confusion, hypotension, slurred speech, incoordination, lability, impaired judgement, nystagmus, respitratory depression, coma, death

Question 36

benzo overdose treatment

Answer 36

activated charcoal if ingested within 4-6 hr

benzo: flumazenil
barbituates: alkalinize urine and sodium bicarb

Question 37

benzo withdrawal

Answer 37

can be life threatening

tonic clonic seizure might occur - similar withdrawal to alcohol

Question 38

treatment for benzo

Answer 38

benzo taper

carbamazepine or valproic acid for seizure prevention

Question 39

opioid intoxication

Answer 39

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

Question 40

treatment for opioid overdose

Answer 40

naloxone

Question 41

opioid withdrawal

Answer 41

non life threatening
dysphoria, insomnia, lacrimation, rhinorrhea, sweating, piloerection, n/v fever, dilated pupils, abdominal cramps, myalgia, hypertension, tachy

Question 42

opioid treatment

Answer 42

symptomatic treatment with clonidine - NSAID, cicyclomine for abdmominal cramps
severe- buprenorphine or methadone

Question 43

hallucinogen intoxication

Answer 43

illusions, hallucinations, body image distortion, dilated pupils, tachy, hypertension, hyperthermia, tremor, sweating, palpitation