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Psych clerkship > Substance Use Disorders > Flashcards

Substance Use Disorders Flashcards

1
Q

What medical problems are commonly associated with alcohol dependance?

A
  • Withdrawal seizures
  • Delirium tremens
  • Wernicke Korsakoff syndrome
  • Cerebellar degeneration
  • Peripheral neuropathy
  • Fetal alcohol syndrome (low birth weight, mental retardation, facial and cardiac abnormalities)
  • Hepatic Encephalopathy
  • Malabsorption syndromes
  • Pancreatitis
  • Cardiomyopathy
  • Macrocytic anemia (increased MCV)
  • Increased incidence of trauma
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2
Q

What is delirium tremens?

A

A delirium characterized by disorientation, fluctuation in the level of consciousness, elevated vital signs, and tremors as a result of an abrupt reduction in/cessation of heavy alcohol use

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3
Q

What is Korsakoff Syndrome?

A

State of amnesia (anterograde and retrograde) with confabulation that develops after chronic alcohol use.
- usually irreversible and also caused by thiamine (B1) deficiency.

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4
Q

What is Wernicke Encephalopathy?

A

An acute, but reversible encephalopathy resulting from thiamine (B1) deficiency and characterized by the triad of: delirium, opthalmoplegia (CN VI), and ataxia

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5
Q

What is the mechanism of action of Disulfiram (antabuse)?

A

Disulfiram blocks the enzyme acetaldehyde dehydrogenase => leads to nausea and vomiting upon consumption of alcohol

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6
Q

What is the mechanism of action of Naltrexone?

A

Naltrexone is an opioid antagonist and is believed to reduce the craving for alcohol through blocking the dopaminergic (rewarding) pathways in the brain

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7
Q

What is the mechanism of action of Acamprosate?

A

Acamprosate’s mechanism is unknown but is though to stabilize glutamtergic functioning => improves abstinence

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8
Q

How should thiamine be administered in relation to glucose in Wernicke encephalopathy?

A

IV thiamine should be given PRIOR to IV glucose administration
- giving dextrose before thiamine will exacerbate the process of cell death and worsen the condition because thiamine is a coenzyme used in carbohydrate metabolism

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9
Q

What behavioral changes are seen in cocaine use (narcotic)?

A
  • Euphoria or blunting of feelings
  • Hypervigilance or hypersensitivity
  • Heightened anxiety or irritability/anger
  • Impaired judgment
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10
Q

What physical changes are see in cocaine intoxication?

A
  • Dilated pupils
  • Autonomic instability: increased blood pressure, tachycardia (or bradycardia)
  • Chills/sweating
  • Nausea/vomiting
  • Psychomotor agitation/retardation
  • Chest pain/ arrhythmia
  • Confusion, seizures, stupor, or coma
  • Weight loss
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11
Q

What are the major health risks of cocaine use/dependance?

A
  • cerebral infarctions
  • transient ischemic attacks
  • seizures
  • myocardial infarctions
  • cardiomyopathies
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12
Q

What are the symptoms of cocaine withdrawal?

A
  • Cocaine withdrawal can last 2-4 days (or longer in heavy use)
  • Dysphoria/ depression with suicidal ideation
  • Irritability
  • Anxiety
  • Increased appetite
  • Hypersomnia
  • Cocaine cravings
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13
Q

What kind of hallucinations tend to occur 12-24 hours after alcohol abstinence in an alcohol dependent individual?

A

Patients dependent on alcohol who abstain from drinking may initially have visual hallucinations; however, they are often aware these are hallucinations

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14
Q

What is the mechanism of action of disulfiram/antabuse?

A

Inhibits Acetaldehyde Dehydrogenase => causing acetaldehyde to accumulate leading to acetaldehyde syndrome that can occur minutes after EtOH is consumed
- If alcohol is consumed while taking disulfiram: flushing, palpitations, n/v, diaphoresis, chest pain, etc. Severe rxns can lead to resp depression, CVS collapse (shock), seizures; death

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15
Q

Which drug is used to maintain alcohol abstinence after detox?

A

Acamprosate/campral

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16
Q

Why should acramprosate not be used in patients with renal disease?

A

Can cause acute renal failure

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17
Q

What are the indications for Naltrexone/ReVia?

A
  • Chronic EtOH dependence

- Opiate addiction (does not decrease cravings)

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18
Q

What is the mechanism of action of Naltrexone?

A

Opioid mu receptor antagonist

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19
Q

What is the potential toxicity for Naltrexone?

A

Liver toxicity

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20
Q

What is the mechanism of action of Buprenorphrine/Naloxone/Suboxone?

A

Is a mixed opioid agonist (Buprenorphine) & antagonist (Naloxone) used to tx opioid dependence

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21
Q

What is the indication of Naloxone/buprenorphine?

A

Naloxone given to decrease pleasure/”high” of Buprenorphine & to deter abuse of medication via IV use

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22
Q

What is the indication of methadone?

A

µ-opioid receptor agonist used for severe chronic pain and detox/maintenance of opiate addiction

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23
Q

What is the mechanism of action of methadone?

A

Has cross tolereance with other opiods thus blocks access of opioids (heroin, morphine) to µ-opiate receptors, decreasing euphoric effects and craving of opiates

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24
Q

Why should a baseline EKG be taken before using methadone?

A

Can prolong QTc this baseline EKG recommeded

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25
Q

Describe the action of alcohol on the brain.

A
  • Activates GABA and serotonin receptors in the CNS
  • Inhibits glutamate receptors and voltage gated calcium channels
  • Thus alcohol is a potent CNS depressant
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26
Q

What is the leading cause of mental retardation in the U.S.?

A

Fetal alcohol syndrome

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27
Q

What substances are a common cause of metabolic acidosis with an increased anion gap?

A
  • Ethanol
  • Methanol
  • Ethylene glycol
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28
Q

What is the next step in treating alcohol intoxication?

A
  • Monitor airway, breathing, circulation, glucose, electrolytes, and acid-base status
  • Give thiamine and folate (folic acid)
  • If opioids were ingested give naloxone
  • CT may be necessary to rule out subdural hematoma or other brain injury
  • Check for signs of hepatic failure (ascites, jaundice, kaput medusae, coagulopathy)
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29
Q

Describe the presentation of alcohol withdrawal.

A
  • Compensatory CNS excitation (as intoxication is characterized by inhibition)
  • Can be lethal
  • Insomnia, anxiety, hand tremor, irritability, anorexia, N/V
  • Autonomic hyperactivity (diaphoresis, tachycardia, hypertension)
  • Psychomotor agitation
  • Fever, seizures, hallucinations, delirium
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30
Q

When do the earliest signs of EtOH withdrawal occur?

A

6-24 hours after the patient’s last drink

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31
Q

When might tonic clonic seizures occur in alcohol withdrawal?

A

6-48hrs after cessation of drinking

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32
Q

What may predispose patients undergoing alcohol withdrawal to seizures?

A

Hypomagnesemia

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33
Q

What is the treatment for alcohol withdrawal seizures?

A

Benzodiazepines and anticonvulsants (phenytoin)

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34
Q

What is the most serious effect of alcohol withdrawal?

A
  • Delirium Tremens
    • Begins 48-72 hours after the last drink (but may occur later)
    • Delirium, (visual) hallucinations, tremor, autonomic instability, fluctuating levels of psychomotor activity
    • Tx with benzodiazepines
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35
Q

What liver function tests suggest excessive alcohol use?

A

AST: ALT > 2:1
Elevated GGT

  • alcohol use can also cause macrocytosis (Increased MCV)
36
Q

In what conditions is disulfiram/antabuse contraindicated in?

A
  • Severe cardiac disease
  • Pregnancy
  • Psychosis
37
Q

What is the mechanism of action of acamprosate/campral?

A
  • Structurally similar to GABA => inhibits the glutamatergic system
38
Q

What is the indication for acamprosate/campral?

A
  • Used postdetoxification to prevent relapse

- CAN be used in patients with liver disease

39
Q

In what group of patients is acamprosate/campral contraindicated in?

A

Patients with renal disease

40
Q

How does topiramate/topamax work as an anti-alcohol abuse drug?

A
  • Potentiates GABA and inhibits glutamate receptors

- Reduces cravings for alcohol

41
Q

Describe the action of cocaine on the brain

A

Cocaine blocks dopamine reuptake from the synaptic cleft, causing a stimulant effect

42
Q

What are the signs of cocaine intoxication?

A
  • Euphoria, increased self esteem, change in BP, change in heart rate, nausea, dilated pupils, weight loss, psychomotor changes, chills, and sweating
43
Q

What are the dangerous symptoms associated with cocaine intoxication?

A
  • Respiratory depression
  • Seizures
  • Arrhythmias
  • Paranoia and hallucinations
44
Q

What are the deadly effects of cocaine intoxication?

A
  • Cocaine’s vasoconstrictive effect may result in myocardial infarction or stroke.
45
Q

How do you manage cocaine intoxication?

A
  • Agitation and anxiety => benzodiazepines
  • Severe agitation and/or psychosis => antipsychotics (haloperidol)
  • Symptomatic support => hypertension, arrhythmias
  • Temperature >102 is medical emergency => ice bath, cooling blanket, etc
46
Q

What are the symptoms of cocaine withdrawal?

A
  • NOT life threatening

- Malaise, fatigue, hypersomnolence, depression, hunger, constricted pupils, vivid dreams, occasionally suicidal

47
Q

What are the effect of amphetamines on the CNS?

A
  • Block reuptake and facilitate release of dopamine and norepinephrine from nerve endings => stimulant effect
48
Q

What are the symptoms of amphetamine intoxication?

A
  • Dilated pupils
  • Increased libido
  • Perspiration
  • Respiratory depression
  • Chest pain
49
Q

What is the medical use of amphetamines?

A
  • Treatment of: narcolepsy, ADHD, depressive disorders
50
Q

How are designer amphetamines (club drugs) different from other amphetamines?

A
  • Release dopamine, norepinephrine, AND serotonin from nerve endings
    • stimulant and hallucinogenic properties
    • May induce a sense of closeness to others (MDMA/MDEA)
51
Q

What are some signs of chronic amphetamine use?

A
  • Acne

- Accelerated tooth decay

52
Q

What are signs of amphetamine overdose?

A
  • Hyperthermia
  • Dehydration
  • Rhadomyolysis => renal failure
53
Q

What are the symptoms of ketamine intoxication (special K)?

A
  • Tachycardia
  • Tachypnea
  • Hallucinations
  • Amnesia
  • Odorless and tasteless=> can be used as a date rape drug
54
Q

How is amphetamine intoxication treated?

A
  • Rehydrate
  • Correct electrolyte balance
  • Treat hyperthermia
55
Q

What is the mechanism of action of PCP/angel dust?

A
  • Dissociative hallucinogenic drug that antagonizes NMDA glutamate receptors and activates dopaminergic neurons
  • Stimulant OR depressive effect dependent on the dose
56
Q

What are the signs/symptoms of PCP intoxication?

A
  • Agitation, depersonalization, hallucinations, synesthesia
  • Impaired judgment, memory impairment, assaultiveness/VIOLENCE
  • Nystagmus (rotary, horizontal, or vertical)
    • Rotary nystagmus is pathognomonic for PCP intoxication
  • Ataxia, dysarthria
  • Hypertension, tachycardia, dry/red skin
  • Dilated pupils
  • Muscle rigidity and high tolerance to pain
57
Q

What are the potential consequences of PCP overdose?

A
  • Seizures, coma and death
58
Q

How should PCP intoxication be treated?

A
  • Monitor vitals, temperature, and electrolytes, minimize sensory stimulation
  • Benzodiazepines (lorazepam) for agitation, anxiety, muscle spasms, and seizures
  • Antipsychotics (haloperidol) to treat severe agitation and psychotic symptoms
59
Q

What withdrawal symptoms are associated with PCP use?

A
  • NO withdrawal symptoms

- However, “flashbacks” may occur due to drug release from adipose stores

60
Q

What is the mechanism of action of benzodiazepines?

A
  • Potentiate the effects of GABA by increasing the frequency of chloride channel opening (inhibitory)
61
Q

What is the mechanism of action of barbiturates?

A
  • Potentiate the effects of GABA by increasing the duration of chloride channel opening
62
Q

Which drug withdrawal has the highest mortality?

A
  • Barbiturate withdrawal has the highest mortality rate
63
Q

What is the clinical presentation of sedative (benzodiazipines/barbiturates) intoxication?

A
  • Drowsiness, confusion, hypotension, slurred speech, incoordination, ataxia
  • Mood lability, impaired judgment
  • Nystagmus, respiratory depression, coma, death
64
Q

What is used to treat benzodiazepine overdose and what is the primary precaution?

A
  • Flumazenil is a short acting benzodiazepine antagonist

- Should be used with caution as it may precipitate seizures

65
Q

What is the treatment for sedative intoxication?

A
  • Maintain airway, breathing and circulation, monitor vitals
  • Activated charcoal and gastric lavage to prevent GI absorption if drug was ingested in the last 4-6 hours
  • Barbiturates => alkalinize urine with sodium bicarbonate to promote renal excretion
  • Benzodiazepines => give flumazenil
66
Q

In general what is the major difference between sedative and stimulant withdrawals?

A
  • Sedative withdrawal can be life threatening (too much sympathetic response)
  • Stimulant withdrawal is not generally life threatening
67
Q

Sedative withdrawal symptoms are the same as which other drug?

A

Sedative withdrawal symptoms are the same as EtOH withdrawal

68
Q

What is the treatment for sedative withdrawal?

A
  • Benzodiazepine taper

- Carbamazepine or valproic acid taper may be used for seizure prevention

69
Q

What are the signs/symptoms of opiate intoxication?

A
  • Nausea/ vomiting
  • Sedation
  • Decreased pain perception
  • Decreased GI motility
  • Pupil constriction
  • Respiratory depression (lethal)
70
Q

Which opioid is the exception in that it produces miosis?

A

Meperidine/Demerol dilates pupils

71
Q

What are the symptoms of opioid overdose?

A
  • Respiratory depression
  • Altered mental status
  • Miosis
72
Q

What is the mechanism of action of opioids?

A
  • Stimulate opiate receptors (mu, kappa, and delta), which are normally stimulated by endogenous opiates and are involved in analgesia, sedation, and dependence
73
Q

What are examples of opiates?

A
  • Heroin
  • Oxycodone (hydrocodone)
  • Codeine
  • Dextromethorphan
  • Morphine
  • Methadone
  • Meperidine
74
Q

What opiate and MAOIs can cause serotonin syndrome?

A

Meperidine and MAOIs can cause serotonin syndrome (hyperthermia, confusion, changes in BP, and muscular rigidity)

75
Q

What is the treatment of opioid intoxication?

A
  • Ensure adequate airway, breathing and circulation
  • Naloxone or naltrexone => will improve respiratory depression but may cause severe withdrawal
  • Possible ventilatory support
76
Q

What drug is the gold standard in treating pregnant opioid dependent women?

A

Methadone => long acting opioid receptor agonist

77
Q

What is the major risk in using methadone to treat opioid dependance?

A

Methadone can cause QT interval prolongation => get baseline EKG

78
Q

What is buprenorphine?

A

Buprenorphine is a sublingual preparation that is safer than methadone for opioid dependence.
- Its effect reaches a plateau and makes overdose unlikely

79
Q

What is the mechanism of action of Naltrexone?

A
  • Competitive opioid antagonist

- Can precipitate withdrawal if used within 7 days of heroin use

80
Q

What are the symptoms of withdrawal in opioid dependence?

A
  • Not life threatening
  • Dysphoria, insomnia
  • Lacrimation, rhinorrhea, yawning, weakness, sweating, piloerection
  • Nausea, vomiting, fever
  • Dilated pupils, abdominal cramps, arthralgia, myalgia
  • Hypertension, tachycardia, and craving
81
Q

How is opioid withdrawal treated?

A
  • Moderate symptoms => symptomatic tx with clonidine (autonomic signs), NSAIDs (pain), Discyclomine (abdominal cramps)
  • Severe symptoms => Detox with buprenorphine or methadone
82
Q

What are the signs of hallucinogen intoxication?

A
  • Illusions, hallucinations, body distortions, synesthesia, labile affect
  • Dilated pupils, tachycardia, hypertension, hyperthermia, tremors, incoordination, sweating and palpitations
83
Q

How is hallucinogen intoxication treated?

A
  • Benzodiazepines and antipsychotics as needed for agitated psychosis
84
Q

What is the mechanism of action of cannabis?

A
  • Cannabinoid receptors in the brain inhibit adenylate cyclase
85
Q

What are the signs of marijuana use?

A
  • Euphoria, anxiety, impaired motor coordination, perceptual disturbances, mild tachycardia, anxiety, red eyes (conjunctival injection), dry mouth, and increased appetite
86
Q

What are the withdrawal symptoms associated with marijuana use?

A
  • Irritability, anxiety, restlessness, aggression, strange dreams, depression, headaches, sweating, insomnia, nausea, craving, and decreased appetite
87
Q

Cigarette smoking during pregnancy is associated with what conditions in the newborn?

A
  • Pulmonary hypertension of the newborn

- Low birth weight

Psych clerkship (13 decks)

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