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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
Physical complications of AUD
chronic brain syndromes, cardiomyopathy, cirrhosis, esophageal varices, liver failure, ETOH-related hypoglycemia, protein abnormalities (low albumin), impaired coagulation (increased r/f bleeding)
26
Characteristics of fetal alcohol syndrome (FAS)
Low birth weight, small size (SGA), MR, Low IQ (avg 60), birth defects (facial, cardiac)
27
Psychological management of AUD At-Risk Drinking
Psychological: - Clinician non-judgmental - Deal with enabling behavior of spouse/friends - Total abstinence goal, start with harm reduction model - Motivational interviewing
28
Social Management of AUD At-Risk Drinking
AA, Al-Anon, SOS, Religious counseling
29
Medical Management of AUD At-Risk Drinking | Three medications
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
Behavioral Management of AUD At-Risk Drinking
Conditioning | Aversion therapy
31
Naltrexone oral for AUD | Brand, dosage, route, duration, storage, cost
``` 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
Naltrexone ER injection for AUD | Brand, dosage, route, duration, storage, cost
Vivitrol 380 mg IM gluteal injection q4wk Duration of tx: 24 weeks Store in refrigerator Cost: 1 vial (380mg) $1570.80
33
Management of ETOH hallucinations/withdrawal
Hallucinations: Antipsychotic (haldol) Withdrawal: Monitor CIWA Onset of withdrawal
34
Management of ETOH withdrawal
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
Classifications of withdrawal per CIWA-Ar
Minimal <8 Mild 8-15 Mod 16-20 Severe >20
36
CIWA-Ar Symptoms/Score
``` 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
Essential of SUD diagnosis
``` Psychologic dependence with evidence of withdrawal Tolerance Substance-associated illness Continued use despite consequences Impaired social/occupational functioning Depression Blackouts ```
38
What screening tool should be administered prior to prescribing opioids for pain?
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
Opioid Risk Screening Tools | ***REVISE SLIDE 21
Opioid Risk Tool | ***REVISE SLIDE
40
What is another name for the Opioid Risk Tool (ORT)?
Screen for Risk of Substance Use Disorder - Chronic Pain
41
What is the Rapid Opioid Dependence Screen (RODS)?
``` 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
What is the CRAFFT screening tool?
``` 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
Opioid Use Disorder Psychiatric Assessment | HISTORY
``` History Consumption Route Tolerance Last use Treatment hx ```
44
Opioid Use Disorder Psychiatric Assessment | ASSESSMENT
PE, labs, health risks, infections, bowel syndrome, hyperalgesia, accidents, overdose, mortality
45
I-STOP/PMP
Internet System for Tracking Over-Prescribing | Prescription Monitoring Program
46
Symptoms/Grading of Opioid Withdrawal
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
Medications for Opioid Dependence
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
What do you need to prescribe opioids as a provider?
Specialized training DEA number Minimum of 3 hours of course work and training in pain management, palliative care, and addiction
49
USPSTF SUD Screening Recommendations
Screen all adults 18+ for drug/ETOH use and provide brief behavioral counseling
50
AAP SUD Screening Recommendations
Screen adolescents for alcohol and drug use during visits with developmentally appropriate screening tool
51
What are the preliminary research findings of OPRM1 G-allele carriers and Naltrexone for AUD treatment?
OPRM1 G-allele carriers tend to experience less benefit from naltrexone for AUD tx than those without OPRM1 G-allele.
52
DSM-5 AUD Met Criteria for Dx
11 criteria | 2+ in the past 12 months

Spring 2022 (14 decks)

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