withdrawal

Question 1

dependency triad

Answer 1

psychological dependence
physiologic dependence
tolerance

term “dependency” not used anymore

all 3 typically present in long term abuse

Question 2

psychological dependence

Answer 2

craving and the behavior involved in procurement of the drug

Question 3

physiologic dependence

Answer 3

withdrawal symptoms on discontinuance of the drug

Question 4

tolerance

Answer 4

need to increase the dose to obtain the desired effects

Question 5

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

Answer 5

DSM-V

substance abuse disorder

Question 6

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

Answer 6

ever being dependent on a drug

Question 7

ddx withdrawal symptoms: tremors

Answer 7

hyponatremia, calcemia, kalemia
hypernatremic (hypovolemic)
anxiety-panic attack
uncontrolled HTN
etOH withdrawal
Parkinsons
cerebellar stroke
acute intoxication

Question 8

kindling

Answer 8

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

Question 9

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

Answer 9

stimulants and depressants

relatively spontaneous effects

Question 10

kindling effects may manifest as ???

Answer 10

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

Question 11

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

Answer 11

morphine

opioids
narcotics

Question 12

what to know with case 2: etOH, heroin

Answer 12

what route using?

Inject, etc

Question 13

3 problems faced w/ substance abuse disorders

Answer 13

(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

Question 14

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

Answer 14

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

Question 15

A drink defined by CDC as

Answer 15

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

Question 16

ddx etOH/heroine withdrawal symptoms

Answer 16

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

Question 17

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

Answer 17

and alcohol use disorder

lifetime psych disorders

Question 18

male: female etOH tx ratio

Answer 18

4:1

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

Question 19

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

Answer 19

depression
suicides and intrafamily homicides
in rapes and other assaults

Question 20

problems assoc. w/ etOH abuse

Answer 20

medical, economic, and psychosocial

Question 21

central and peripheral nervous system complications of etOH

Answer 21

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

Question 22

etOH: Direct effects on liver

Answer 22

cirrhosis, esophageal varices, and eventual hepatic failure

Question 23

Indirect effects etOH

Answer 23

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

Question 24

Wernicke’s encephalopathy

Answer 24

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

Question 25

Korsakoff's

Answer 25

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

Question 26

etOH toxic to

Answer 26

BM

Question 27

ddx of etOH btw

Answer 27

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!

Question 28

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

Answer 28

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

Question 29

hospitalization necessary?

Answer 29

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

Question 30

unhelpful etOH drugs

Answer 30

sedatives (to replace etOH) | lithium

Question 31

this helps reduce craving and maintain abstinence

Answer 31

Acamprosate (333–666 mg orally three times daily) | -can be continued even during relapse

Question 32

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

Answer 32

naltrexone (50 mg orally/day) lessens pleasurable effects of etOH

Question 33

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

Answer 33

disulfiram (250-500 mg/d oral) | alcohol dehydrogenase

Question 34

onset of w/drawal symptoms

Answer 34

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

Question 35

ddx of etOH w/drawal includes

Answer 35

other sedative withdrawals and other causes of delirium

Question 36

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

Answer 36

amphetamine psychosis, paranoid schizophrenia

Question 37

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

Answer 37

The history and laboratory test results

Question 38

alcoholic hallucinosis: typical withdrawal symptom?

Answer 38

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

Question 39

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

Answer 39

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

Question 40

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

Answer 40

adequate dose

Question 41

mild dependence req. ??? | use ???

Answer 41

"drying out" -short course of tapering long-acting benzodiazepine

Question 42

mod-sev. w/drawal tx: ??? | make sure to ??

Answer 42

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

Question 43

heroin use is on the increase bc ???

Answer 43

cheap | -snorting and inhaling increasing, esp in cocain users

Question 44

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

Answer 44

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

Question 45

v. severe withdrawal

Answer 45

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..  

Question 46

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

Answer 46

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

Question 47

also for w/drawal, this compares favorable with benzos

Answer 47

carbamazepine, 400-800 mg/day orally

Question 48

??? 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

Answer 48

atenolol (B-blocker) 100 mg 50 mg

Question 49

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

Answer 49

phenytoin | benzos

Question 50

give these vitamins in high doses

Answer 50

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

Question 51

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

Answer 51

no, not clearly

Question 52

strategies to address opioid abuse epidemic

Answer 52

- Establishing and strengthening prescription drug monitoring programs - Regulating pain management facilities and establishing dosage thresholds requiring consultation with pain specialists

Question 53

clinical s/s of mild narcotic intoxication

Answer 53

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

Question 54

opioid OD can cause

Answer 54

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

Question 55

opioid withdrawal: Grade 0

Answer 55

craving, anxiety

Question 56

opioid withdrawal: Grade 1

Answer 56

yawning, lacrimation, rhinorrhea, and perspiration

Question 57

opioid withdrawal: Grade 2

Answer 57

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

Question 58

opioid withdrawal: Grade 3,4

Answer 58

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

Question 59

tx for opioid w/drawal initiated @ stage ?

Answer 59

2

Question 60

tx for opioid w/drawal also, ??? for alleviating CV symptoms (but does not sig. relieve anxiety, insomnia, gen. aching)

Answer 60

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

Question 61

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

Answer 61

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

Question 62

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

Answer 62

**cognitive behavior therapy**, contingency management, couples and family therapy

Question 63

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

Answer 63

opioid antagonist (naltrexone)

Question 64

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

Answer 64

buprenorphine opioid and cocaine abuse

Question 65

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

Answer 65

methadone