Flashcards in Addiction Deck (36):
Disorders associate with alcohol dependence?
- abuse of other substances
- Personality Disorders
Medical Comorbidities related to alcohol dependence?
Wernicke’s encephalopathy and Korsakoff’s psychosis.
GIT system: esophagitis, gastritis, pancreatitis, alcoholic hepatitis, liver cirrhosis.
Tuberculosis, all types of accidents, suicide, and homicide
1) Alcohol and CNS depressants
2) Cocaine and amphetamines
1) act on GABA receptors*.
2) act on the dopamine system.
Korsakoff’s (psychosis) is characterized by?
mental confusion, confabulation, and amnesia
Cause of Wernicke-Korsakoff Syndrome?
Wernicke's encephalopathy is characterized by?
ophthalmoplegia, ataxia, and confusion.
Signs of Heroin dependence?
Signs of Heroin Withdrawal?
Loss of appetite.
Vomiting, diarrhea, fever/joint pain.
4 phases of heroin intoxication?
1) euphoria - facial flushing and deepening of voice
2) the High - sense of well-being
3) "the nod"- escape from reality ranging from lethargy to unconsciousness
4) Period B4 withdrawal - seek more of drug to avoid withdrawal
3 or more of these are needed for a diagnosis of dependence?
- Withdrawal symptoms.
- Large amounts for longer period than intended.
- Unsuccessful or persistent desire to cut down or control use.
- increase in getting, taking and seeking the substance
- substance use despite knowledge of risks or problems it causes
Symptoms of Alcohol Intoxication?
- Slurred speech.
- Unsteady gait.
- Impaired in attention and memory.
- Symptoms not due to another medication.
Signs of alcohol withdrawal? (2 or more needed)
- Nausea and vomiting.
- Transient visual, tactile, and auditory hallucinations.
- Autonomic hyperactivity**
- Psychomotor agitation.
- Increased hand tremor.
- Grand mal seizures.
After 5-10 yrs of heavy alcohol use, what manifestation may be seen?
withdrawal delirium, is considered a emergency
signs of alcohol withdrawal delirium?
- Autonomic hyperactivity (tachyHR, HTN)
- Severe disturbance in sensorium.
- Perceptual disturbances.
- Fluctuating levels of consciousness.
- Delusions (paranoid), agitated behaviors & fever.
Effects after 1-2- drinks
changes in mood/behavior, judgement is impaired
effects after 5-6
legal level of intoxication in most states
effects of 10-12 drinks
ataxia, emotional liability
effects of 15-18 drinks
effects of 20-24 drinks
effects of >24 drinks
death due to respiratory depression
excessive emotional or psychological reliance on a partner, typically a partner who requires support due to an illness or addiction.
psychological symptoms of chemical dependency?
Denial, depression, anxiety, dependency, hopelessness, low self esteem
Psychotherapy for dependence?
- Alternative coping mechanisms to reduce reliance on substances.*
- Confidentiality must be maintained.**
- Many changes occur during the first 6 months of sobriety.***
- Psychotherapy needs to be directive, open and honest and caring.
Three basic fundamental concepts of 12 step programs?
- Individuals with addictive problems are powerless.
- Not responsible for their disease but responsible for their recovery.
- They must face their problems and their feelings.
Drug category of choice for to treat alcohol withdrawaland why?
- Are cross addicting, provide safe withdrawal and have anticonvulsant effects.
List of benzos used to treat alcohol withdrawal?
- Chlordiazepoxide (Librium)
- Diazepam (valium)*
- Oxazepam (Serax)**
- Lorazepam (Ativan)**
Chlordiazepoxide (Librium) dosage for tx of alcohol withdrawal?
25-100 mg PO q 4h tapered to zero over 5-7 days.
Diazepam (valium) dosage for tx of alcohol withdrawal?
5-10 mg PO q 2-4h in tapering doses
Oxazepam (Serax) dosage for tx of alcohol withdrawal?
15-30 mg tid or qid.
Lorazepam (Ativan) dosage for tx of alcohol withdrawal?
2-6 mg daily in divided doses
Treatment of Alcohol Withdrawal Delirium (Thiamine (Vitamin B1))?
100 mg PO qd for 3 days.
Given IM or IV before Glucose loading.
Prevents Wernicke’s encephalopathy
Treatment of Alcohol Withdrawal Delirium (Magnesium Sulfate)?
1 gm IM q6h for 2 days.
Especially if history of seizures.
Increases effectiveness of vitamin B1.
Help reduce postwithdrawal seizures.
Why is Phenobarbital used in the treatment of Alcohol Withdrawal Delirium?
For seizure control
An agent use for narcotic addiction and sometimes used in the treatment of alcoholism especially for those with high levels of craving and somatic symptoms.
Naltrexone (Trexan, Revia)
Helps the client to abstain from alcohol although the action is not understood.