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Flashcards in ADDICTION Deck (31):
1

In order to diagnose a substance use disorder, there must be significant impairment or distress as manifested by at least 2 ways within a 12-month period.  What are the 11 ways?

Taking in larger amounts or over a longer period of time than intended.
              Persistent desire or unsuccessful efforts to cut down.
              Significant time is spent in activities necessary to obtain substance
              Craving
              Tolerance
              Withdrawal
              Failure to fulfill major role obligations at work, school, or home
              Continued use despite social or interpersonal problems
              Recurrent use in situations that are physically hazardous
              Continued use despite knowledge of having persistent problem

2

What is physical dependence?

Withdrawal symptoms in the absence of the drug

3

What is addiction?

A neurobiologic disease with genetic & psychosocial contributions leading to compulsive use and cravings despite harmful consequences

4

What are host factors to addiction & dependence?

Genetics, hereditary, improperly treated chronic pain, unhealthy behavioral patterns as learned from childhood experiences, and social forces

5

What often prevents those with addiction/dependency issues to enjoying fulfilling and enjoyable lives?

Stigma is a barrier to gainful employment and rewarding social contacts

6

What is more than half of alcohol related deaths are due to?

Binge drinking

7

What form of opiate use is increasing in the US?

Heroin

8

At what point do you screen a patient for substance use problems

Report new or increasing difficulty with work, relationships, or legal issues.  Areas of high prevalence; screen before prescribing a potentially addictive medication; during routine physical exams

9

If you are interviewing a substance user, what do you need to as

Drug of choice; route of administration; first use; when did it become a problem; most recent pattern of use; last use; other substances; negative consequences of use (been arrested/work or family problems); what is a perceived benefit; prior treatment

10

What are some other important factors you should consider with a substance user?

Social/sober support; Home Environment; Use in a significant other or family member; Mental health issues; prior suicide.

11

In general, how do we treat substance abuse?

Inpatient care (detox); residential programs; partial hospitalization program (PHP); intensive outpatient program (IOP); outpatient visits; support groups; and Medications

12

What type of medication can you prescribe to prevent the cravings?

Naltrexone & Baclofen (is on the $4 list)

13

At what point of treatment is critical to treating substance use?

The first few weeks!  Along with regular attendance to receive better outcomes

14

What types of factors influence relapse?

co-morbid psychiatric issues; sleep difficulties; poor social support; low motivation; high levels of personal stress/low stress tolerance; previous Hx; and continued use of substance early in treatment

15

What does excessive alcohol use lead to clinically?

HTN or arrhythmias (Holiday Heart à Afib), GI problems, neuropathy, liver disease, bone marrow suppression, electrolyte disturbance; pancreatitis; immunosuppression; increased risk of CA; exacerbation of depression or anxiety

16

What are the sxs of withdrawal?

Tremor, seizure, alcohol hallucinosis, delirium tremens; unstable vitals, encephalopathy, alcoholic ketoacidosis, liver failure, GI bleed, death

17

If a patient has disorientation, inattentiveness, oculomotor dysfunction, gait ataxia – what is occurring?  What would you see on labs?  Why?

Withdrawal; Wernicke encephalopathy.  Due to ACUTE, metabolic brain damage relating to a THIAMINE deficiency

18

What is the chronic consequence of wernicke encephalopathy?

Korsakoff Syndrome

19

How do you treat Wernicke Encephalopathy?

Give Thiamine

20

What 2 neuronal dysfunctions are occurring in ETOH withdrawal?

GABA & Glutamate

21

Which neuronal dysfunction is excitatory & inhibitory?

Excitatory = Glutamate – Sudden cessation leads to increased excitatory activity
Inhibitory = GABA – this is how TOLERANCE develops (without alcohol no brakes left in the body) similar to benzos

22

When you see a patient with tremor, seizure, and unstable vitals – you think it is withdrawal, but what do you need to do?

R/O ALTERNATE PATHOLOGY (trauma injury, CNS lesion, GL bleed, meningitis, thyrotoxicosis, drug overdose, sepsis)

23

What kind of labs do you order when someone is going through withdrawal?

Serum ETOH CBC, CMP, Mg, Phosphorus, UA, UDS
Lipase, PT/INR, ammonia level, TSH
EKG & Imaging

24

What does low Mg levels cause?

VTACH! (AKA death

25

How do we treat alcohol withdrawal?

IV fluids! Vitamins (Thiamine, Mg, K), electrolytes, PRN meds (nausea, pain, GI for high acid levels, anxiety)
Control seizure (benzos)
              Need a really good discharge plan

26

If we believe a patient is withdrawing from opiates, what do we need to look for during PE & labs?

Test for pregnancy
              Assess injection sites for infection
              STD testing
              Hep C!!

27

How do you treat opiate withdrawal?

Treat symptoms (muscle aches, stomach cramps, diarrhea, constipation) make sure they’re not due to anything else!
              Opiate replacement = suboxone, subutex (for preggo), methadone (hard to stop, daily clinic visits)

28

How do you treat opiate withdrawal?

Treat symptoms (muscle aches, stomach cramps, diarrhea, constipation) make sure they’re not due to anything else!
              Opiate replacement = suboxone, subutex (for preggo), methadone (hard to stop, daily clinic visits)

29

What is best to not ask an addict to do at the same time as they quit their substance?

Don’t ask them to quit smoking at the same time…

30

If you learn that a healthcare provider is utilizing substances, what must you do?
 

You have a duty to report

31

If a patient is on Ambien what MUST we educate them about?

Increased risk of death when combined with other sedatives or alcohol!!