Substance Use Disorders (Barash)

Question 1

Define # of symptoms for Severity:

• Mild:
• Moderate:
• Severe:

Answer 1

Mild=2-3

Moderate=4-5

Severe=6+

Question 2

Sustained remission=__

Answer 2

No criteria for >12 months (except craving)

Question 3

Type of seizure associated with Etoh withdrawal?

Answer 3

Grand mal, 24-48 hrs after consumption

Question 4

When do you generally see DT’s? Seriousness?

Answer 4

48-72 hrs

Life-threatening

Question 5

Test for alcohol withdrawal?

Answer 5

CIWA –> numerical values to orientation, N/V, tremor, sweating, anxiety, agitation, tactile/auditory/visual disturbances and HA

Question 6

CIWA score for severe withdrawal?

Answer 6

> 10

Question 7

Pharmacotherapy for Etoh withdrawal?

Answer 7

Benzos –> reduce risk of seizure

Anticonvulsants –> reduce risk of seizure, may reduce kindling; Carbamazepine or valproic acid

Thiamine supplementation

Question 8

Medications for Etoh tx?

Answer 8

Disulfiram (tertiary prevention)
Naltrexone
Acamprosate

Question 9

Toxicity of Naltrexone and what labs to check?

Answer 9

Hepatotoxic at high doses –> check LFTs

Question 10

Intoxication picture of benzos/barbiturates? withdrawal picture?

Answer 10

Similar to alcohol

Question 11

pin point pupils, think of what?

Answer 11

Opioid intoxication

Question 12

Meds for opiate use disorder?

Answer 12

Methadone (opioid sub) –> Mu agonist, titrate up until no cravings, need to be enrolled in certified opiate substitution proram
Naltrexone –> mu antagonist
Buprenorphine (opioid sub) –> Partial Mu agonist, ceiling effect, helpful for highly motivated pts who do not need high doses

Question 13

Greatest effect on what NT with amphetamines?

Answer 13

Greatest effect on Dopamine (inhibit reuptake of DA, NE, Serotonin)

Question 14

Tobacco induces what CYP?

Answer 14

CYP1A2 –> watch for interactions when start or stop (ex. olanzapine)

Question 15

meds for tx tobacco use disorder?

Answer 15

Bupropion

Varenicline

Question 16

predominant NT affected by MDMA?

Answer 16

predominantly 5HT2 receptor agonists

Question 17

increased conjunctival injx and increased appetite, think what drug?

Answer 17

Cannabis

Question 18

neuromodulator effect of canabis?

Answer 18

Decrease uptake of GABA and DA

Question 19

severe dissociative rxns, paranoid, hallucinations, can become very agitated/violent with decreased awareness of pain..what drug?

Answer 19

PCP

careful. they don’t feel pain

Question 20

MOA of Disulfiram?

Answer 20

Inhibit Aldehyde DH and DA beta-hydroxylase

Question 21

Which Benzos metabolized though only glucuronidation in liver and not affected by age/hepatic insufficiency?

Answer 21

“Outside The Lines”

• Oxazepam
• Temazepam
• Lorazepam

Question 22

Cocaine mainly prevents reuptake of __

Answer 22

DA

Question 23

Receptor targets of cannabis?

Answer 23

CB1 and CB2

Question 24

Tx for PCP intoxication?

Answer 24

antipsychotic drugs or BZD if required
Low stimulation environment
Acidify urine if severe toxicity/coma