lect 1

Question 1

what is misuse?

Answer 1

the use of any prescribed medication for non prescribed reasons:

-recreational use
-self treating acute pain
-to give to someone else
-sell
addiction

Question 2

what is abuse?

Answer 2

a condition characterized by a self destructive pattern of using a substance that leads to a significant problems and distress

Question 3

what is dependence

Answer 3

-characterized by SX of tolerance and withdrawal

person needs more and more of something to get the same effect (tolerance), and they experience unpleasant symptoms when they stop using it (withdrawal).

Question 4

tolerance?

withdrawal?

Answer 4

T: decrease response to a drug used repeatedly

W: unpleasant physical and mental effects that a person experiences after they stop using substance

Question 5

what is addiction?

Answer 5

marked by a change if behavior caused by biochemical changes in the brain after continued substance abuse.

-becomes the main priority of the addict regardless of the harm they cause to themselves or others

-makes them act irrational

Question 6

substance use disorder is?

Answer 6

abuse, dependence and addiction

Question 7

Substance Use disorder DSM-5

Answer 7

->2 in the last 12 months

-hazardous use
-social/interpersonal problems
-neglected major roles to use
-withdrawal
-tolerance
-used larger amounts for longer periods of time
-repeated attempts to control or quit
-much time spent using
-physical or psychological problems related to use
-activities given up to use
-cravings

Question 8

severity of disorder

2-3 criteria:

4-5 criteria:

> 6 criteria:

Answer 8

2-3 criteria: mild

4-5 criteria: mod

> 6 criteria: severe

Question 9

8 most common substances of abuse

Answer 9

-opioid
-alcohol
-tobacco
-cannabis
-stimulant
-hallucinogen
-inhalant
-sedative, hyponotic

Question 10

the # of criteria @ initial diagnosis is INVERSLEY proportional to success of rehab

Question 11

opioid misuse statistics:

Answer 11

11 million misuse opioids yearly

52 million misuse it lifetime

Question 12

screening for opioid:

Answer 12

-revised screener and opioid assessment for pts w pain (SOAPP-R):

> 18 is an increase risk for opioid misuse
-best sensitivity

Opioid risk tool: MC used
-4-7 mod risk
->7 high risk
-most commonly used
-takesgender differences into account

Question 13

in opioid risk tool: the males and females differ?

Answer 13

-males who do Opi has an assoc. of alcohol and illegal drugs

-females :16-45
-preadolescent sexual abuse

Question 14

Questions to ask for OPI pts:

Answer 14

-use of OPI
-other substances
-family hx
-psychiatric
-specific diagnoses (hep B)
-nicotine dependence
-unexplained pain

Question 15

Opioid DSM-5

Answer 15

2 of the following occur w/in 12 months that lead to impairment or distress:

-opioid taken in larger amounts or over long period of time

-desire to cut down
-much time using opioid
-craving/urge
-failure to fulfill obligations
-continues use despite the problems of opioid use
-recreational use caused social activities up
-tolerance
-withdrawal

Question 16

do not prescribe OPI:

Answer 16

-if pt has opi use disorder
-pre existing substance abuse
-hx of suicide attempt
-already on opi for chronic pain
-hx of overdose

Question 17

proper use of opi per cdc

Answer 17

-check database first
-NSAID first since its = to opi effects for pain

-if nsaids dont help, opi is second line
NO MORE THAN 3-7 days

Question 18

calculating MME categories:

Answer 18

safe: < 50 MME
borderline: 90 MME
tolerant: >200 MME

overdose is > 100 mme is 9x taking 20 MME

Question 19

50% of pts on opi for 90 days develop opi disorder

Question 20

what is the proper use of opi per cdc

Answer 20

-chronic pain
-terminal conditions
-hospice

any other chronic condition STOP

Question 21

how to stop opi :

what meds to use to get them off opi?

Answer 21

fast taper: if not appropiately used

slow taper: pts with long term use or w tolerance

medications:
naltrexone-opiod blocker [DONT USE ifpt was using opi in the LAST 7 days]

Question 22

treatin opioid withdrawal:

sweats, tremor, anxiety, htn:
insomnia, anxiety, restlessness:
fever, pain:
nausea and vomiting:
diarrhea:
muscle spasm:
dyspepsia:

Answer 22

sweats, tremor, anxiety, htn: clonindine (3x)

insomnia, anxiety, restlessness: : diphendramine, hydroxyzine

fever, pain: NSAID / acetaminophen

nausea and vomiting: promethazine, metaclopramide

diarrhea: loperamide

muscle spasm: methocarbamol

dyspepsia: symptomatic measure

Question 23

alcohol misuse:

Answer 23

drinking alot that causes harm to n others

drinking underage or pregnant

Question 24

binge drinking

Answer 24

NIAAA defines it as a:
-pattern of drinking that brings BAC to 0.08 g/dl or higher

-woman consumes 4 or more drinks– 2 hrs
-man 5 drinks or more –> 2 hrs

Question 25

binge drinking per SAMHSA:

Answer 25

-consuming more than 5 or more drinks in the same occasion or atleast one day a month

Question 26

high intensity drinking

Answer 26

consumption of 2 or more times gender specific thresholds for binge drinking which is to say 10 or more standard drinks for males and 8 or more for females

-high intensity drinking is consistent at binge levels II and III.

Question 27

alcohol stats for :

ppl in ED visits bc of alcohol:
traffic accidents:
cost national:
pregnant women:

fetal alcohol spectrum disorders:

Answer 27

ppl in ED visits bc of alcohol: 10.2%
traffic accidents: 18.5%
cost national: 249 billion
pregnant women: 9.5%

fetal alcohol spectrum disorders:1-5% 6000 first graders

Question 28

DSM-5 Alcohol Use Order

Answer 28

-a maladaptive pattern substance leading to impairment by 2 + in the 12 month period:
-alcohol often taken in longer period of times or larger amts.

-persistent desire to cut down
-great amount of time in activities getting alcohol or recovering
-failure to do activities
-craving, desire or urge for alcohol
-recreational use caused social activities up
-tolerance
-withdrawal

Question 29

Substance use disorder:
severity of disorder

Answer 29

-2-3: mild substance dis.
-4-5: mod.
>=6: severe

severe alcohol use order= alcoholism

Question 30

alcohol use disorder TX:

Answer 30

-pt must recognized he has a problem
-clinician recognizes severity

MHM: negotiate

Question 31

Screening tools for Alcohol use disorder:

Answer 31

-CAGE- specific high
-AUDIT [highest sens]
women>4 ;m>8
-AUDIT-C [3 ?s]

Question 32

CAGE:

Answer 32

-cut down
-annoyed
-guilty
-eye opener

1: low risk
2-3: high susp.
4: diagnosis for alcoholism

Question 33

Alcohol brief intervention:

Answer 33

enhance motivation instead of blaming, evoke a change in a person, trusting environment [no judges],

Question 34

outpatient rehabilitation:

Answer 34

-pts who have severe alcohol use or cant decrease

-includes psychotherapy
- or group therapy

Question 35

inpatient rehab

psychotherapy:

Answer 35

-for severe/dependent alcohol pts and those with comorbid psychoactive, abuse problems.

-teach pts. to avoid circumstances that could lead to drinking

Question 36

Disulfiram:

ABYSMAL COMPLIANCE- pt is non adherent n fails to take tx

Answer 36

interferes w ACETALDEHYDE accumulates

drinking alcohol w/in 12 hrs taken disulfiram:

-vasodilation, flushing, sweating, tachy

disulfiram purposely causes unpleasant side effects if alcohol is consumed.

Question 37

Naltrexone: opioid antagonist

Gaba

clonindine:dec htn n tachy withdrawal

Answer 37

decreases relapse rate, must be off opioid 7 days,