Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CSI > withdrawal > Flashcards

withdrawal Flashcards

1
Q

dependency triad

A

psychological dependence
physiologic dependence
tolerance

term “dependency” not used anymore

all 3 typically present in long term abuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

psychological dependence

A

craving and the behavior involved in procurement of the drug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

physiologic dependence

A

withdrawal symptoms on discontinuance of the drug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

tolerance

A

need to increase the dose to obtain the desired effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

The terms “dependency” and “abuse” were dropped in ??? for the term ???

A

DSM-V

substance abuse disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Many patients could have a severe and life-threatening abuse problem without ???

A

ever being dependent on a drug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

ddx withdrawal symptoms: tremors

A 
hyponatremia, calcemia, kalemia
hypernatremic (hypovolemic)
anxiety-panic attack
uncontrolled HTN
etOH withdrawal
Parkinsons
cerebellar stroke
acute intoxication
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

kindling

A

repeated stim. of brain,
renders the individual more susceptible to focal brain activity with minimal stimulation
*almost opposite of tolerance
“geared up” may cause seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

kindling can be caused by ??? leading to ??? no longer dependent on original stimulus

A

stimulants and depressants

relatively spontaneous effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

kindling effects may manifest as ???

A

mood swings, panic, psychosis, and occasionally overt seizure activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

opioids and narcotics refer to group of drugs w. actions that mimic ???
which one implies controlled and which one illicit?

A

morphine

opioids
narcotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what to know with case 2: etOH, heroin

A

what route using?

Inject, etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

3 problems faced w/ substance abuse disorders

A

(1) the prescribing of substances such as sedatives, stimulants, or opioids that might produce dependency
(2) the treatment of individuals who have already abused drugs, most commonly alcohol
(3) the detection of illicit drug use in patients presenting with psychiatric symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

The National Institute on Alcohol Abuse and Alcoholism formally defines at-risk drinking as more than ???

A

4 drinks per day or 14 drinks per week for men or more than 3 drinks per day or 7 drinks per week for women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

A drink defined by CDC as

A

as 12 oz of beer
8 oz of malt liquor
5 oz of wine
1.3 oz or a “shot” of 80-proof distilled spirits of liquor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

ddx etOH/heroine withdrawal symptoms

A 
TB
HIV
Hep C
abcess/sepsis
bacterial endocarditis (tricuspid valve)
anemic
septic emboli (from IVDU/endocarditis)
on cocaine
cardiac toxicity
coronary vasospasm
PTH adenoma
drug impurity rxn
influenza/other viral
hypoglycemia
heroin withdrawal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

individuals w/ at-risk drinking are at an inc. risk for developing/are developing ???
and have much higher prevalence of ???

A

and alcohol use disorder

lifetime psych disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

male: female etOH tx ratio

A

4:1

maybe now more like 4:2, 4:3 (better at hiding it)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is often present in etOH and should be carefully evaluated?
etOH commonly involved in ???

A

depression
suicides and intrafamily homicides
in rapes and other assaults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

problems assoc. w/ etOH abuse

A

medical, economic, and psychosocial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

central and peripheral nervous system complications of etOH

A

chronic brain syndromes, cerebellar degeneration, cardiomyopathy, and peripheral neuropathies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

etOH: Direct effects on liver

A

cirrhosis, esophageal varices, and eventual hepatic failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Indirect effects etOH

A

protein abnormalities, coagulation defects, hormone deficiencies, and an increased incidence of liver neoplasms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Wernicke’s encephalopathy

A

short-term memory loss, thiamine deficiency involved, confabulation, AMS, confusion, amnesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Korsakoff’s

A

continuation of Wernicke’s- chronic, permanent CNS damage, cerebellar damage; balance issues, tremor, vertigo, falls, Rombersgs, dysdiadokokinesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

etOH toxic to

A

BM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

ddx of etOH btw

A

primary alcohol use disorder (when no other major psychiatric diagnosis exists) and secondary alcohol use disorder (when alcohol is used as self-medication for major underlying psychiatric problems such as schizophrenia or affective disorder)
-the latter req. psych tx!

28
Q

the problem of ??? must be faced
do not be ???
emphasize ???
one of the most important considerations ??

A

denial
judgmental
things that can be done-motivational interviewing
pts. job - social

29
Q

hospitalization necessary?

A

not usually, but
many medical complications of alcoholism; a complete physical examination with appropriate laboratory tests is mandatory, with special attention to the liver and nervous system

30
Q

unhelpful etOH drugs

A

sedatives (to replace etOH)

lithium

31
Q

this helps reduce craving and maintain abstinence

A

Acamprosate (333–666 mg orally three times daily)

-can be continued even during relapse

32
Q

an opioid antagonist which lowers relapse rate of 3-6 mos post-drinking

mechanism?

A

naltrexone (50 mg orally/day)

lessens pleasurable effects of etOH

33
Q

aversive drug for discouraging etOH use via inhibiting ??? –>toxic reactions when etOH consumed

A

disulfiram (250-500 mg/d oral)

alcohol dehydrogenase

34
Q

onset of w/drawal symptoms

A

usually 8–12 hours and the peak intensity of symptoms is 48–72 hours after alcohol consumption is stopped

35
Q

ddx of etOH w/drawal includes

A

other sedative withdrawals and other causes of delirium

36
Q

acute alcoholic hallucinosis must be differentiated from other acute paranoid states such as

A

amphetamine psychosis, paranoid schizophrenia

37
Q

??? are the most important features in differentiating chronic organic brain syndromes due to alcohol from those due to other causes

A

The history and laboratory test results

38
Q

alcoholic hallucinosis: typical withdrawal symptom?

A

no, although it does occur during or on cessation of prolonged drinking period

39
Q

hospitalization and adequate antipsychotics are often necessary, such as ???
and ??? to counteract excitability from sudden etOH cessation

A 
Haloperidol, 5 mg orally twice a day for the first day or so, usually ameliorates symptoms quickly
CNS depressants (eg, benzodiazepines)
40
Q

the choice of using specific sedative is less important than using ???

A

adequate dose

41
Q

mild dependence req. ???

use ???

A

“drying out” -short course of tapering long-acting benzodiazepine

42
Q

mod-sev. w/drawal tx: ???

make sure to ??

A

hospitalize the patient and use diazepam orally in a dosage of 5–10 mg hourly depending on the clinical need

monitor of vital signs and fluid and electrolyte levels

43
Q

heroin use is on the increase bc ???

A

cheap

-snorting and inhaling increasing, esp in cocain users

44
Q

In primary and secondary alcoholism, at-risk drinking can be distinguished from alcohol addiction by ???

A

taking a careful psychiatric history and evaluating the degree to which recurrent drinking impacts the social role functioning and physical safety of the individual

45
Q

v. severe withdrawal

A

intravenous administration of diazepam maybe necessary
-After stabilization, the amount of diazepam required to maintain a sedated state may be given orally every 8–12 hours..

46
Q

also for w/drawal, this suppresses cardiovascular signs and has some anxiolytic effect

A

clonidine, 5mcg/kg orally every 2 hours (or patch form)

47
Q

also for w/drawal, this compares favorable with benzos

A

carbamazepine, 400-800 mg/day orally

48
Q

??? as an adjunct to benzos to reduce symptoms of etOH w/drawal
give ?? when HR above 80 bpm and ?? when HR btw 50-80 bpm

A

atenolol (B-blocker)
100 mg
50 mg

49
Q

??? are not useful in managing etOH w.drawal seizure, but rather use ???

A

phenytoin

benzos

50
Q

give these vitamins in high doses

A

thiamine, 50 mg intravenously initially, then orally on a daily basis; pyridoxine, 100 mg/d; folic acid, 1 mg/d; and ascorbic acid, 100 mg twice a day

51
Q

Chronic brain syndromes secondary to a long history of alcohol intake: responsive to thiamine and vitamin replenishment?

A

no, not clearly

52
Q

strategies to address opioid abuse epidemic

A
  • Establishing and strengthening prescription drug monitoring programs
  • Regulating pain management facilities and establishing dosage thresholds requiring consultation with pain specialists
53
Q

clinical s/s of mild narcotic intoxication

A

changes in mood, with feelings of euphoria; drowsiness; nausea with occasional emesis; needle tracks; and miosis

54
Q

opioid OD can cause

A

respiratory depression, peripheral vasodilation, pinpoint pupils, pulmonary edema, coma, and death

55
Q

opioid withdrawal: Grade 0

A

craving, anxiety

56
Q

opioid withdrawal: Grade 1

A

yawning, lacrimation, rhinorrhea, and perspiration

57
Q

opioid withdrawal: Grade 2

A

previous symptoms plus mydriasis, piloerection, anorexia, tremors, and hot and cold flashes with generalized aching

58
Q

opioid withdrawal: Grade 3,4

A

increased intensity of previous symptoms and signs, with increased temperature, blood pressure, pulse, and respiratory rate and depth. In withdrawal from the most severe addiction, vomiting, diarrhea, weight loss, hemoconcentration, and spontaneous ejaculation or orgasm commonly occur

59
Q

tx for opioid w/drawal initiated @ stage ?

A

2

60
Q

tx for opioid w/drawal

also, ??? for alleviating CV symptoms (but does not sig. relieve anxiety, insomnia, gen. aching)

A

methadone, 10 mg orally (use parenteral administration if the patient is vomiting), and observe

clonidine

61
Q

rapid ??? has become a method for tx opioid dependence

A

opioid detoxification with opioid antagonist induction using general anesthesia
(overkill?)

62
Q

important and effective types of behavioral treatment shown to be effective interventions for drug addiction

A

cognitive behavior therapy, contingency management, couples and family therapy

63
Q

used successfully for treatment of the patient who has been free of opioids for 7–10 days, but not long term tx

A

opioid antagonist (naltrexone)

64
Q

this partial agonist has become a mainstay of office-based treatment of opiate dependency-(outpt, methadone addicts)
also effective in reducing concomitant ???

A

buprenorphine

opioid and cocaine abuse

65
Q

risk of OD with buprenorphine is lower than with ??? and preferred for pts @ high risk for that toxicity

A

methadone

CSI (75 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions