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Flashcards in addiction Deck (49):
1

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

ever being dependent on a drug

2

Maladaptive pattern of substance use defined as 2 or more of the following signs in 1 year:

Tolerance, Wtihdrawal, Substance taken in larger amount or over longer time than desired, Persistent desire or unsuccessful attempts to cut down, Significant energy spent obtaining/using/or recovering from substance, Important social/occupational/recreational activities reduced because of substance use, Continued use despite knowing substance causes physical and/or psychological problems, Craving, Recurrent use in physically dangerous situations, Failure to fulfill major obligations at work/school/home due to use, social/interpersonal conflicts related to substance use

3

kindling can result in

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

4

acute manifest.: mild intoxication

Mild intoxication-euphoria, drowsiness, constricted pupils

5

acute manifest.: Severe intoxication

hypotension, bradycardia, hypothermia, coma, respiratory arrest, pulmonary edema

6

drugs to tx opioid abuse

buprenorphine-partial agonist, eases craving

methadone-stronger, may become addicted

naltrexone, nalaxone- blocking, reversal, used in OD, use quickly, fast acting, monitor 36 hrs

7

sedatives

anxiolytics- benzos

8

acute manifest w/ benzos

Disinhibition, ataxia, dysarthria, nystagmus, delerium
High doses can lead to respiratory depression, hypotension, shock, coma, death

9

special consid. benzos

Paradoxical agitation, anxiety, psychosis, confusion, mood lability, anterograde amnesia have been reported

10

this benzodiazepine antagonist, is effective in overdose of benzos

Flumazenil
but can potentiate seizures

11

benzo w/drawal symps

Somatic (disturbed sleep, tremor, nausea, muscle aches)
Psychological (anxiety, poor concentration, irritability, mild depression)
Perceptual (poor coordination, mild paranoia, mild confusion)

12

psychedelics

Common psychedelics (LSD, mescaline, psilocybin, dimethyltryptamine, and other derivatives of phenylalanine and tryptophan) can produce similar behavioral and physiologic effects

13

psychedelic acute manifests.

1-2 hours-Initial feeling of tension is followed by emotional release such as crying or laughing
2-3 hours-Perceptual distortions , visual illusions, hallucinations, and fear of ego disintegration
3-4 hours-Major changes in time sense and mood lability then occur
4-6 hours-Feeling of detachment and a sense of destiny and control occur

14

psychedelics spec. consids

"bad trip":panic, depression, confusion, or psychotic symptoms
-flashback effects
-consider preexisting emotional probs, attitude, setting

15

PCP (phencyclidine)

traditional psychedelic drug
PCP is a common deceptive substitute for LSD, tetrahydrocannabinol, and mescaline

16

acute manifest PCP:

Mild intoxication-euphoria accompanied by a feeling of numbness
Moderate intoxication-disorientation, detachment from surroundings, distortion of body image, combativeness, unusual feats of strength, and loss of ability to integrate sensory input, especially touch and proprioception
Severe intoxication-seizures, deepening coma, hypertensive crisis, and severe psychotic ideation

17

PCP: spec. consids.
clinical symps

dizziness, ataxia, dysarthria, nystagmus, retracted upper eyelid with blank stare, hyperreflexia, tachycardia, hypertension, increased respiratory rate, muscle tone, urine production
*don't use in 1st trimester-->spont. abort, cong defects

18

PCP: spec. consids.:

**Acute rhabdomyolysis has been reported and can result in myoglobinuric kidney failure**

19

THC manifests

Effects occur in 10–20 minutes and last 2–3 hours

20

THC spec. consids.
joints soaked in formaldehyde and dried...

("AMP") unusual effects, including autonomic discharge and severe though transient cognitive impairment
Type of cyclic vomiting syndrome
-"do hot showers help?"

21

amphetamines

Methamphetamine (“speed”)-one variant is a smokable form called “ice,” which gives an intense and fairly long-lasting high
Methylphenidate and dextroamphetamine-prescriptions

22

acute manifests: amphetamines

Sweating, tachycardia, elevated blood pressure, mydriasis, hyperactivity, and an acute brain syndrome with confusion and disorientation

23

spec. consids. amphetamines

Tolerance develops quickly
As dosage is increased, hypervigilance, paranoid ideation, stereotypy, bruxism, tactile hallucinations, full-blown psychoses occur

24

stimulant w/drawal

depression with symptoms of hyperphagia and hypersomnia

25

cocaine -stimulant, crack:

A purer (and stronger) derivative called “crack,” is prepared by simple extraction from cocaine hydrochloride.
Acute manifestations

26

acute manifests. cocaine

Euphoria, excitement, increased energy

27

Coca leaf chewing-onset

5–10 minutes and lasting for about an hour, mild high

28

cocaine: Intranasal use-onset

2–3 minutes and lasting 30 minutes, moderate high

29

cocaine: Intravenous use –onset

30 seconds and lasting 15 minutes, fairly intense

30

cocaine:
Smoking freebase-onset

seconds and lasting several minutes, intense high

31

spec. consids. cocaine

Intranasal use-causes vasoconstriction which may eventually cause tissue necrosis and septal perforation
Pulmonary complications

32

CXR cocaine

pneumomediastinum

33

laxatives

Electrolyte disturbances that may contribute to the manifestations of a delirium
Elderly, eating disorders

34

anabolic steroids

Acute manifestations-significant mood swings, aggressiveness, and paranoid delusions
Withdrawal symptoms-fatigue, depressed mood, restlessness, and insomnia

35

antihistamines

Produce some central nervous system depression
Mixture of antihistamines with sedatives exacerbates CNS effects

36

inhaling gases

gasoline, toluene, petroleum ether, lighter fluids, cleaning fluids, paint thinners, and solvents

euphoria, slurred speech, hallucinations, and confusion

37

inhaling gases bad effects

High doses unconsciousness and cardiorespiratory depression or failure
Chronic exposure produces a variety of symptoms related to the liver, kidney, bone marrow, or heart

38

amyl nitrites

Used as an “orgasm expander”
Changes in time perception, “rush,” and mild euphoria last from 5 seconds to 15 minutes

39

“Designer drugs”

Synthetic substitutes for commonly used recreational drugs
Methyl analogues of fentanyl-used as heroin supplements
MDMA (methylenedioxymethamphetamine)-often not detected by standard toxicology screens

40

“Designer drugs” problem for physicians..

faced with symptoms from a totally unknown cause

41

overcoming substance addiction stages

1. Precontemplation
2. Contemplation
3. Preparation/determination
4. Action/willpower
5. Maintenance*
6. Relapse

42

tox screen

alcholol, cannabis, cocaine, opioids
acid/LSD,PCP

43

tox screen: cannibis

cannabis 4-7wks, 12 wks(max w/ heavy use)

44

tox screen: alcohol

45

tox screen: cocaine

3-7 days, 10 days(w/ heavy use)

46

tox screen: opioids

2-3 days

47

why hospitals cannot prescribe THC even tho legal

medicaid does not pay for it

48

legal narcotics are schedule ???

2,3,4
regulated by DEA, pts tracked

49

DSM-5

need 2 out of 11 criteria in 12 mo period