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Spring 2022 > SUD Screening > Flashcards

SUD Screening Flashcards

1
Q

What does SBIRT stand for?

A

Screening, Brief, Intervention, Referral to Treatment

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2
Q

What are the purposes of SBIRT?

A 
Quickly assess severity of SUD
Identify appropriate LOT
Increase insight/awareness of SUD
Motivate toward behavioral change
Identify and refer those needing extensive treatment/speciality care
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3
Q

Essentials of AUD diagnosis

A

Physiologic dependence (withdrawal symptoms)
Tolerance
Alcohol-associated illnesses (liver disease, cerebellar degeneration)
Continued consumption despite consequences
Impaired social/occupational functioning
Depression
Blackouts

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4
Q

What are the two phases of AUD syndrome?

A

At-risk drinking - minor

Alcohol misuse - moderate to severe

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5
Q

How is “At-risk drinking” classified?

A

Repetitive use of ETOH, used frequently, often to alleviate anxiety or solve emotional problems

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6
Q

At-Risk Drinking classification per NIAAA

A

Males: >4 drinks/day or >14 drinks/week
Females: >3 drinks/day or >7 drinks/week

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7
Q

How is “Alcohol Misuse” classified?

A

Recurrent use of ETOH despite disruptions in social roles (work, family, friend)
ETOH-related legal problems
Safety risks by oneself and with others

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8
Q

AUD DSM-5 Criteria

A

In the past 12 months have you

  • Drank more than intended
  • More than once wanted to cut down or stop, but couldn’t
  • Spent a lot of time
  • Craved so badly, couldn’t think of anything else
  • Drinking/after effects interfered with social roles
  • Drank despite consequences with fam/friends
  • Cut back on things that once gave pleasure
  • More than once engaged in risky behaviors
  • Continued to drink despite negative mood effects or after blackout
  • Drinking more to get desired effect, usual amount less effective
  • Withdrawal s/s
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9
Q

AUD DSM-5 Diagnosis per Criteria

A

Presence of at least two symptoms in the past 12 months

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10
Q

AUD DSM-5 Severity Indicator

A

Mild: +2-3 s/s
Mod: +4-5 s/s
Severe: 6+ s/s

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11
Q

Standard ETOH drink amounts

A

1 drink:

  • 12 oz beer 5%
  • 5 oz of wine
  • 1.5 oz of liquor
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12
Q

What is a fifth of ETOH?

A

26 oz of liquor

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13
Q

What is a handle of beer?

A

1/2 gallon or 3-5L

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14
Q

How many drinks in a bottle of wine? (26oz, 1 fifth)

A

6 drinks

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15
Q

AUD risk factors

A 
At-risk drinkers at >r/f AUD
Male:Female = 4:1
Psychiatric disorders
Japanese more susceptible to ETOH s/e
Majority of suicides/homicides involve ETOH
R/F rapes and assaults
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16
Q

What is the CAGE questionnaire?

A

Screening for AUD

  • Cut down
  • Annoyed you/criticized
  • Guilt
  • Eye Opener

No or Yes = 0 or 1
Score/4
Score 2+/4 is significant, further assessment required
Score 1+ in women should raise concern

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17
Q

What is the AUDIT questionnaire?

A

Alcohol Use Disorder Identification Test
10 items, 0-4
Score/40

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18
Q

AUDIT questionnaire classifications

A

Scoring/Intervention
0-7: Low-risk/Feedback
8-14: Hazardous-harmful/Feedback, brief intervention
15+: Alcohol-dependent range/Feedback, referral, detox? meds?

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19
Q

Clinical findings of AUD

A

Acute intoxication
Withdrawal
Alcoholic (Organic) hallucination
Chronic alcoholic brain syndromes

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20
Q

S/S of acute ETOH intoxication

A

drowsiness, errors, psychomotor dysfunction, disinhibition, dysarthria, ataxia, nystagmus
Severe overdose: resp depression, stupor, seizures, shock, coma, death

Dysarthria - speech impaired by motor impairment

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21
Q

S/S of ETOH withdrawal

A

anxiety, decreased cognition, tremulous, irritability, hyperreactivity, DTs
S/S may persist for 3-12 months and become chronic

22
Q

S/S of Alcoholic (organic) hallucinations

A

paranoid psychosis without tremulousness, confusion or withdrawal symptoms

23
Q

S/S of chronic alcoholic brain syndromes

A

Encephalopathies causing erratic behavior, impaired memory/recall, emotional instability
Eg: Wernicke encephalopathy & Korsakoff psychosis caused by thiamine deficiency results in confusion, ataxia, ophthalmoplegia

24
Q

AUD lab findings

A 
Increased liver enzymes 
GGT>30u/L suggestive of heavy drinking
MCV >95 for males, >100 for females
Increased uric acid
Increased triglycerides
Decreased K+ and Mg+

Elevated MCV and GGT helpful identifiers

25
Q

Physical complications of AUD

A

chronic brain syndromes, cardiomyopathy, cirrhosis, esophageal varices, liver failure, ETOH-related hypoglycemia, protein abnormalities (low albumin), impaired coagulation (increased r/f bleeding)

26
Q

Characteristics of fetal alcohol syndrome (FAS)

A

Low birth weight, small size (SGA), MR, Low IQ (avg 60), birth defects (facial, cardiac)

27
Q

Psychological management of AUD At-Risk Drinking

A

Psychological:

  • Clinician non-judgmental
  • Deal with enabling behavior of spouse/friends
  • Total abstinence goal, start with harm reduction model
  • Motivational interviewing
28
Q

Social Management of AUD At-Risk Drinking

A

AA, Al-Anon, SOS, Religious counseling

29
Q

Medical Management of AUD At-Risk Drinking

Three medications

A

PE, Labs

Medications:
Disulfiram 250-500mg daily (aversive)
Naltrexone 50mg daily (craving reduction, decreases pleasurable effects of ETOH)
Acamprosate 333-666 mg TID (decrease cravings, maintain abstinence)

30
Q

Behavioral Management of AUD At-Risk Drinking

A

Conditioning

Aversion therapy

31
Q

Naltrexone oral for AUD

Brand, dosage, route, duration, storage, cost

A 
ReVia 50 mg oral tablets
50 mg PO daily (FDAA)
Alt regimen: 
-50 mg weekdays, 100 mg Saturday
-100 mg QOD
-150 mg q3days
Duration of tx: 12 weeks

Cost: 30 tabs $128.12
Store room temp

32
Q

Naltrexone ER injection for AUD

Brand, dosage, route, duration, storage, cost

A

Vivitrol 380 mg IM gluteal injection q4wk
Duration of tx: 24 weeks

Store in refrigerator
Cost: 1 vial (380mg) $1570.80

33
Q

Management of ETOH hallucinations/withdrawal

A

Hallucinations: Antipsychotic (haldol)

Withdrawal:
Monitor CIWA
Onset of withdrawal

34
Q

Management of ETOH withdrawal

A

Monitor CIWA-Ar

Onset: 6-36 hours after last drink
Peak: 48-72 hours

Tx: Taper long-acting benzo (ativan, valium)
Hydrate, correct electrolytes, thiamine, folic acid, multivitamin injection (MVI)

35
Q

Classifications of withdrawal per CIWA-Ar

A

Minimal <8
Mild 8-15
Mod 16-20
Severe >20

36
Q

CIWA-Ar Symptoms/Score

A 
N/V 0-7
Anxiety 0-7
Paroxysmal Sweats 0-7
Tactile disturbance 0-7
Visual disturbance 0-7
Tremors 0-7
Agitation 0-7
Orientation/Clouding of sensorium 0-7
Auditory disturbance 0-7
Headache 0-7
37
Q

Essential of SUD diagnosis

A 
Psychologic dependence with evidence of withdrawal
Tolerance
Substance-associated illness
Continued use despite consequences
Impaired social/occupational functioning
Depression
Blackouts
38
Q

What screening tool should be administered prior to prescribing opioids for pain?

A

SOAPP - Screener and Opioid Assessment for Patients with Pain

-Screen for Risk of Substance Use Disorder - Acute Pain
14 items
Rated 0-4
Never/seldom/sometimes/often/very often

39
Q

Opioid Risk Screening Tools

***REVISE SLIDE 21

A

Opioid Risk Tool

***REVISE SLIDE

40
Q

What is another name for the Opioid Risk Tool (ORT)?

A

Screen for Risk of Substance Use Disorder - Chronic Pain

41
Q

What is the Rapid Opioid Dependence Screen (RODS)?

A 
In the past 12 months
1-Which drugs
2-Need to use more
3-Missing a dose make you anxious
4-Morning sickness or w/d
5-Worried about use
6-Difficult to stop/not use
7-Need to spend a lot of time or money
8-Miss important events
Yes or no
Score items 2-8
>3 yes = positive = opioid dependent
42
Q

What is the CRAFFT screening tool?

A 
Screening for Risk of SUD - Adolescent
Part A: 
-Drink alcohol
-Smoke MJ
-Use anything to get high

Part B:

  • Car - someone UI or self
  • Relax - with ETOH/drugs
  • Alone - used alone
  • Fam/Friends - concerned, cut down
  • Trouble - while using
43
Q

Opioid Use Disorder Psychiatric Assessment

HISTORY

A 
History
Consumption
Route
Tolerance 
Last use
Treatment hx
44
Q

Opioid Use Disorder Psychiatric Assessment

ASSESSMENT

A

PE, labs, health risks, infections, bowel syndrome, hyperalgesia, accidents, overdose, mortality

45
Q

I-STOP/PMP

A

Internet System for Tracking Over-Prescribing

Prescription Monitoring Program

46
Q

Symptoms/Grading of Opioid Withdrawal

A

Grade 0 - Anxiety, craving
Grade 1 - Yawning, lacrimation, rhinorrhea, perspiration
Grade 2: Yawning, lacrimation, rhinorrhea, perspiration PLUS mydriasis, piloerection, anorexia, tremors, hot/cold flashes, aching
Grade 3: Increased intensity of Grade 2 s/s PLUS increased temp, BP, PR, RR, and resp depth
Grade 4: Grade 3 PLUS Severe w/d: vomiting, diarrhea, weight loss, hemo-concentration, spontaneous ejaculation or orgasm

Grades 2-4 require tx program

47
Q

Medications for Opioid Dependence

A

Narcan (Naloxone): Reversal agent
Buprenorphine (Suboxone): Partial agonist, tx of w/d and maintenance (NPs need 24hrs of education to prescribe)
Methadone: Opioid agonist, tx of w/d and maintenance, Rx by speciality clinic with frequent obs. May be used for chronic pain.
Clonidine: Alpha-2 adrenergic agonist, Tx of w/d s/s

48
Q

What do you need to prescribe opioids as a provider?

A

Specialized training
DEA number
Minimum of 3 hours of course work and training in pain management, palliative care, and addiction

49
Q

USPSTF SUD Screening Recommendations

A

Screen all adults 18+ for drug/ETOH use and provide brief behavioral counseling

50
Q

AAP SUD Screening Recommendations

A

Screen adolescents for alcohol and drug use during visits with developmentally appropriate screening tool

51
Q

What are the preliminary research findings of OPRM1 G-allele carriers and Naltrexone for AUD treatment?

A

OPRM1 G-allele carriers tend to experience less benefit from naltrexone for AUD tx than those without OPRM1 G-allele.

52
Q

DSM-5 AUD Met Criteria for Dx

A

11 criteria

2+ in the past 12 months

Spring 2022 (14 decks)

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