SUD Flashcards
mu agonist
opioids (heroin)
GABAa channel opening duration increased
barbiturates
GABAa channel opening frequency increased
benzodiazepines
injection drug users at risk for (5)
right-sided endocarditis (Tricuspid valve) abscesses hepatitis HIV hemorrhoids
for heroin use, look for
track marks (needle injections)
opioid withdrawal is ___ fatal
NOT
- it is just unpleasant
opioid withdrawal can cause what pulmonary dysfunction?
pulmonary edema
Presents with: anxiety, insomnia, anorexia, sweating, dilated pupils, piloerection, fever, rhinorrhea, N/V/D
Opioid Withdrawal
treatment of Opioid withdrawal (3)
Clonidine (α2 agonist)
Subaxone (Buprenorphine + Naloxone)
Methadone
Subaxone (buprenorphine + naloxone) can precipitate opioid withdrawal if
given too soon (partial mu agonist) after intoxication
or
injected while using opioids
naloxone is not active when taken orally, so withdrawal symptoms occur only if
injected
Treatment of Barbiturate withdrawal
Long-acting benzodiazepines with taper
or
Long-acting barbiturates (phenobarbital)
DO NOT treat benzodiazepine overdose in chronic Benzodiazepine users with ____
because it can cause seizures.
Flumazenil
*use for patients who do not have a chronic history of using benzos due to no GABA/Glutamate inbalance.
DO NOT restrain patients overdosed on stimulants because it may result in
rhabdomyolysis ?????
MDMA overdose treatment is
supportive for symptoms
Pregnant women using cocaine can lead to
Placental Infarction (Abruption)
*vasospasm of placental vessels
contraindicated in MI secondary to cocaine due to HTN crisis (unopposed alpha)
beta-blockers
Treatment of cocaine overdose
Benzos
2 treatments for smoking cessation
Bupropion
Varenicline (partial nicotine receptor agonism)
PCP overdose treatment
Benzos
antipsychotic (2nd line)
Intoxication presents with short lived slurred speech, disorientation, blurred vision, and possibly coma
Inhalant
Teenagers/ poor people
Alcohol Withdrawal treated with
Thiamine, Folate, Multivitamin, Dextrose, IV Fluids
Lorazepam or Diazepam (PRN)
alcohol is a depressant that INCREASES ________ opening.
GABAa channel opening
long term use of alcohol leads to down regulation of ____ and up regulation of
GABA channels (inhibitory)
NMDA-Glutamate receptors (excitatory)
Alcoholic Hallucinosis seen within ____ hours of last drink
12-24
Presents with AVH or Tactile Hallucinations
no autonomic instability (as opposed to DT).
Alcohol Withdrawal Tonic-Clonic Seizures seen within ____ hours of last drink
48 hours
2 days
Delrium Tremens seen within ____ hours of last drink
48- 96
(2-4 days)
Autonomic instability + AVT Hallucinations
Disorientation
Agitation
Minor Alcoholic withdrawal seen within ____ hours of last drink
6
Trembling, Irritability, Anxiety
Headache, Tachycardia, Insomnia
How to tell the difference between Alcoholic Hallucinosis and DT?
DTs usually present 2 days after last drink and with autonomic instability.
AHs happens within 1 day of withdrawal and NO autonomic instability
disulfiram - inhibits
acetaldehyde dehydrogenase
(aversive conditioning)
2nd line treatment for AuD & only if pt is abstinent already
List the 6 stages of quitting SuD
- Pre-contemplation (denial)
- Contemplation (accepting)
- Preparation/Determination (ready to change)
- Action/ Willpower (actively changing)
- Maintenance
- Relapse
most addictive drugs act on the ____ reward pathway
dopamine mesolimbic
LONG acting opioid COMPETITIVE antagonist
Naltrexone
Naloxone has same MOA, but SHORT acting
weak partial mu AGONIST
Buprenorphine
Subaxone = (Buprenorphine + Naloxone)
