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PSYCH EOR > SUD 14% > Flashcards

SUD 14% Flashcards

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1
Q

tx of alcohol intoxication

A

Thiamine, magnesium, multivitamin, dextrose (particularly if chronic alcoholism)

Benzodiazepines (if withdrawal)

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2
Q

define at-risk drinking (men vs women)

A

Continuous use of alcohol

  • men: 4 drinks/day or 14 drinks/week
  • women: 3 drinks/day or 7 drinks/week
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3
Q

define alcohol tolerance

A

need for increased amounts of alcohol; diminished effect with continued use of same amount

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4
Q

define 2 complications of alcohol intoxication

A

Wernicke’s TRIAD:

  • confusion
  • ataxia, ophthalmalgia
  • thiamine deficiency ^^

Korsakoff: IRREVERSIBLE

anterograde and retrograde amnesia, aphasia, apraxia (difficulty with skilled movement), agnosia

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5
Q

si/sx of alcohol withdrawl

A
  • sweating
  • tachycardia
  • increased hand tremor
  • insomnia
  • N/V
  • hallucinations
  • agitation
  • anxiety
  • seizure
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6
Q

list steps of alcohol withdrawal

uncomplicated

withdrawl sz

alcohol hallucinosis

DT

A
  • uncomplicated (6-24h): increased CNS activity (tremors, anxiety, diaphoresis, palpitations, insomnia)
  • withdrawal seizure (12-24h): MC tonic-clonic
  • alcoholic hallucinosis (48h): hallucinations with normal vital signs
  • delirium tremens (2-5d): delirium, hallucinations, agitations, abnormal vitals
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7
Q

differentiate b/w

  • alcoholic hallucinosis
  • delirium tremens
A
  • alcoholic hallucinosis (48h): hallucinations with normal vital signs
  • delirium tremens (2-5d): delirium, hallucinations, agitations, abnormal vitals
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8
Q

tx of acute alc withdrawal

A
  • Benzos, Clonidine, Barbiturates, Anticonvulsants
  • •IV fluids
  • •Thiamine & Magnesium
  • •Glucose
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9
Q

tx of chronic alc withdrawal

A
  • Naltrexone
  • Acamprosate
  • Thiamine

Antabuse (punishes you for drinking)

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10
Q

lsit alc withdrawal meds

A

Disulfiram (Antabuse) - inhibits acetaldehyde dehydrogenase, aversive conditioning

Naltrexone - dec desire

Acamprosate - changes brain chemistry in a way that reduces anxiety, irritability, and restlessness associated with early sobriety

Topiramate

Gabapentin - dec desire

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11
Q

alc withdrawl sx & mgt

Time since last drink:

6 hrs

12-24 hrs

48 hrs

48-96 hrs

A
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12
Q

si/sx of Marijuana intox & withdrawal

A

Moderate dose:

  • •euphoria, giddiness
  • •dry mouth (cotton mouth)
  • •conjunctival erythema
  • •tachycardia, hypotension

High Dose: hallucinations, paranoia, delusions

Withdrawal:

  • •irritable
  • •insomnia & restless
  • •diaphoresis
  • •diarrhea
  • •twitching
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13
Q

testing and tx of marijuana intoxication

A

Urine drug test can detect for 4-6 days and up to 50d in chronic users

Treatment: Symptomatic

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14
Q

tx of tobacco dependence

A

Nicotine Replacement

  • Bupropion
  • Varenicline (Chantix)
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15
Q

Urine drug test: can detect cannabis for ___-___days in occasional users and up to____ days in chronic users.

A

Urine drug test: can detect cannabis for 4-6 days in occasional users and up to 50 days in chronic users.

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16
Q

si/sx of marijuana

intox

withdrawal

A

Intoxication: Euphoria, anxiety, disinhibition, paranoid delusions, a perception of slowed time,

conjunctival injection, impaired judgment, social withdrawal, ↑ appetite, dry mouth, hallucinations

Withdrawal: Irritability, depression, insomnia, nausea, and anorexia.

  • Most symptoms peak at 48 hours and last for 5-7 days.
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17
Q

tx of marijuanan OD

A

No specific treatment is required. Symptomatic treatment only

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18
Q

si/sx of PCP intoxication

A

Patient that is extremely aggressive and becomes enraged when sudden movements or loud sounds are made.

Belligerence, impulsiveness, fear, homicidality, psychosis, delirium, seizures, psychomotor agitation, vertical and horizontal nystagmus, tachycardia, ataxia

physical detachment, unusual strength, dilated pupils, body distortion

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19
Q

si/sx of LSD intox

A

Patient wants to hurt himself. They say that he has “been freaking out” and seeing things that are not there.

  • visual hallucinations and synesthesias (seeing sound as color)
  • marked anxiety or depression, delusions, pupillary dilation
  • “bad trip” panic
  • abnormal gait
  • tremors
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20
Q

tx og LSD/PCP

A

antipsychotics (e.g., haloperidol)

benzodiazepines

LSD: talking down, supportive counseling

PCP: low stimulus environment

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21
Q

23-year-old male is brought into the ED by his friends at 1 a.m. They are afraid that he is going to hurt himself. They say that he has “been freaking out” and seeing things that are not there. At one point, he tried to ride a bike off the roof of a house. On exam, you see a young man who appears to be in a panic. His gait is abnormal, he has diffuse tremors and his pupils are dilated.

dx/tx

A

LSD intox

antipsychotics (e.g., haloperidol)

benzodiazepines

talking down, supportive counseling

22
Q

24-year-old who was brought into the ED and has attempted to assault a nurse several times. He is extremely aggressive and becomes enraged when sudden movements or loud sounds are made. The patient is escorted to a dimly lit, quiet exam room where he becomes much calmer. On physical exam, the patient is agitated and has nystagmus. His blood pressure in the ED is 180/100 mmHg

dx/tx

A

PCP

antipsychotics (haloperidol)

benzodiazepines

low stimulus environemnt

23
Q

si/sx of opioid intoxication / withdrawl

A

Constipation - no tolerance to this side effect

Respiratory depression - life-threatening

Pupillary constriction (pinpoint pupils)

Seizures (overdose is life-threatening)

withdrawal

  • Anxiety, insomnia, anorexia, sweating, dilated pupils, piloerection (“cold turkey”),
  • Fever, rhinorrhea, nausea, stomach cramps, diarrhea (“flulike” symptoms)
  • Yawning
24
Q

tx of opioid intox / withdrawl

A

naloxone

Symptomatic treatment

withdrawl:

  • Clonidine: α2 agonist that decreases NE and sympathetic output making autonomic symptoms less intense
  • Methadone (long-acting)
  • Buprenorphine + naloxone (Suboxone): can precipitate withdrawal if given too soon (partial mu agonist)
  • Zofran for nausea/vomiting
25
Q

tx BZD intoxication / withdrawal

A

intoxication with flumazenil which is a competitive GABA antagonist.

withdrawal with long-acting benzo such as clonazepam w/ taper

26
Q

si/sx od BZD intox / withdrawal

A

Intoxication: respiratory depression, hypotension, amnesia, ataxia, stupor/somnolence, coma, death.

Withdrawal: _rebound anxiety, seizures (life-_threatening) and tremor-most commonly found in short-acting benzos such as alprazolam.

27
Q

35-year-old female who arrives at the ED with impaired memory, poor concentration, and extreme drowsiness. Pupils are not dilated on the exam and the patient is minimally responsive. Of greatest concern is the patient’s respiratory rate of 5/min

A

barbituate OD

Tx:

Intoxication: symptom management, support BP, assist respiration, intubation, and bemegride,

Withdrawal: long-acting benzodiazepines with taper

28
Q

21-year-old male is brought into the ED by the police for an altercation. Last night, the patient was at a party and seemed much more active than usual according to his girlfriend. He punched another male at the party in the face claiming that he was hitting on his girlfriend. On exam, you see an agitated young male with dilated pupils, and his pulse is 128/min.

Dx//Tx

A

cocaine intox

Antipsychotics (haloperidol)

  • Benzodiazepines
  • Antihypertensives (labetalol - need alpha-1 blockade)
  • Vitamin C - promotes excretion

Do not restrain patients - may result in rhabdomyolysis

29
Q

tx of cocaine withdrawal

A

bupropion

bromocriptine

SSRIs for depression

30
Q

si/sx of cocaine intox

A

↓ appetite

tachycardia

pupillary dilation

hypertension, angina

31
Q

23-year-old female is brought into the ED by her friends as they are concerned about her behavior. She seems more energetic than usual and this has gone on well past the end of the rave. On exam, you see a young female in neon clothing, consumed with the colors of her outfit, and very affectionate towards you.

si/sx of intox

A

MDMA

Intoxication: hyperthermia and social closeness, “club drug,” hyponatremia

32
Q

A young child from low socioeconomic background arrives in the ED with a headache, loss of appetite, rhinorrhea, injected sclera, dizziness, photophobia, or a cough

dx///tx

A

dx: inhalanat related disorders

tx: Antipsychotics (haloperidol) if severe aggression

33
Q

si/sx of inhalant tox

A

Mild/moderate: euphoria, slurring speech, confused, hallucinations, watery eyes, impaired vision, rash

High dose: cardiopulm failure, liver, kidney, bone marrow suppression *all organ failure

34
Q

PCP vs LSD??

Patient that is extremely aggressive and becomes enraged when sudden movements or loud sounds are made.

Patient wants to hurt himself. They say that he has “been freaking out” and seeing things that are not there.

A

1 - PCP

2- LSD

35
Q

which SUD ODs present w/

mydriasis

miosis

A

mydriasis (dilation) - stimulant / hallucingins (PCP, LSD)

miosis (constriction) - opiod

36
Q

A young child from low socioeconomic background arrives in the ED with a headache, loss of appetite, rhinorrhea, injected sclera, dizziness, photophobia, or a cough

A

inhalant related disorder

Antipsychotics (haloperidol) if severe aggression

37
Q

watery eyes, impaired vision and cough makes you think??

A

inhalant

38
Q

Wrenekies encephalopathy is caused by??

A

thiamine deficency (vit B1)

39
Q

when tx AUD you must give IV ____ & ___ before glucose

A

thiamine & Mg

40
Q

differentiated b/w opiod intoxication vs withdrawal

A

INTOX

  • euphora
  • •sedation & impaired memory
  • •slurred speech
  • •impaired social function
  • •pupil constriction
  • •respiratory depression
  • •bradycardia & hypotension
  • •N/V, flushing

​WITHDRAWL

  • lacrimation
  • •HTN, tachycardia
  • •pruritic
  • •piloerections (goose bumps)
  • •pupil dilation
  • •flu-like symptoms
  • •yawning
41
Q

tx of OUD intox vs withdrawl

A

Intoxication:

  • Naltrexone (1st line)
  • Methadone,
  • Buprenorphine

OD: Naloxone

Withdrawal:

  • Methadone
  • Clonidine
  • LofexidineSuboxone
42
Q

do not restrain due to rhabdo risk

A

stimulants

43
Q

dilayed pupils and sniffles / nasal congestion

A

cocaine

44
Q

tx withdrawal of cocaine

A

Bromocriptine

Bupropion

45
Q

sympathomimetic toxodrone - how to tx HR??

A

NO BB - use CCB!

46
Q

differentiate b/w amphetamine vs cocaine intox

A

cocaine - “sniffles”, perf septum, duration of high <2 hrs

Amplet - duration of high 4-6 hrs

47
Q

excoration b/w toes is unique to what stimulate disorder?

A

amphetamines

48
Q

methadone MOI

CI??

A

synthetic opioid acting on Mu - prvents euphjoria

QTc Prolongation

49
Q

MOI of buprenorphine

A

partial Mu agonist

K antagonist

50
Q

MOI of disulfram

A

accumlated acetylaldehydr in blood – produce adverse side effects of drinking

PSYCH EOR (8 decks)

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