alcohol + substance abuse Flashcards by L W

diagnosis of substance use disorder

2 of following over 1 year:

1) tolerance: more drug to achieve same effect
2) withdrawal sx: sx opposite of intoxication
3) persistent desire or unsuccessful attempt to cut down
4) significant energy spent obtaining, using, recovering
5) social, occupational activities reduced
6) continued use in spite of knowledge
7) craving
8) recurrent use in dangerous situations: drink + drive
9) failure to fulfill obligations at work, school, home
10) social or interpersonal conflicts

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stages of change in overcoming addiction

1) precontemplation: don’t acknowledge there is a problem
2) contemplation: acknowledge there is a problem, not ready/willing to change
3) preparation/determination: ready to make change
4) action/willpower: changing behavior
5) maintenance: of behavior change
6) relapse: return to old behaviors

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alcohol effects: CNS depressant

mood elevation
disinhibition
↓ anxiety
sedation
if severe:
somnolence: sleepy
resp depression

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alcohol withdrawal sx

agitation
anxiety
insomnia
tremor
tachycardia

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mechanism of action of alcohol

GABA R (like BZD, barbiturates)

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treatment for alcohol intoxication

wait for it to get out - give fluids

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life-threatening alcohol withdrawal syndrome
peaks at 2-3 days after last drink
initially: feel like ants crawling on them
then: autonomic system hyperactivity (tachycardia, tremors, fever, hypotension/hypotension, diaphoresis, anxiety, seizures)
pychotic: hallucinations (visual or auditory), nightmares

delirium tremens

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2-3 days post op seizure

consider delirium tremens

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treatment for delerium tremens

BZD: longer acting better to prevent withdrawal

alcohol

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complications of alcoholism

liver damage: ↑ GGT, AST>ALT (>2:1)
alcoholic cirrhosis
hepatitis
pancreatitis (gallstone + alcohol 2 main causes)
peripheral neuropathy
testicular atrophy
“saturday night palsy”: compression of radial artery/nerve in spiral groove (when pass out on couch with arm overhanging)
aspiration pneumonia (anaerobes, klebsiella: alcoholics have weak IS)

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screening for alcoholism

CAGE questionnaire
Cut back - ever had need
Annoyance - get annoyed when people ask
Guilt 
Eye opener - had a drink in morning after waking up?

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caused by thiamine deficiency (B1)

Wernicke-Korsakoff syndrome

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characterized by
wernicke encephalopathy: acute, life-threatening neuropathology
Korsakoff syndrome: long-term consequence of wernicke encephalopathy

Wernicke-Korsakoff syndrome

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confusion
nystagmus
opthalmoplegia
ataxia
coma, death if untreated

wernicke encephalopathy

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anterograde amnesia: can’t form new memories
retrograde amnesia: loss of existing memories
confabulation: false perception
hallucinations

korsakoff syndrome

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damage to:
medial thalamus
mammillary bodies of posterior hypothalamus

Wernicke-Korsakoff syndrome

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treatment of Wernicke-Korsakoff syndrome

IV thiamine BEFORE glucose: resolve wernicke encephalopathy

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alcohol impairs livers ability to undergo…

gluconeogenesis (and alcoholics don’t have good diet) → hypoglycemic
thiamine is a cofactor for glucose metabolism - but missing → if give glucose load in ER: become ueglycemic → comatose
always give THIAMINE before glucose for patient with AMS or malnourished or alcoholic

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longitudinal laceration of GE junction caused by excessive vomiting
presenting sx: hematemesis

mallory-weiss syndrome

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extremely dilated submucosal veins in lower third of esophagus
caused by portal HTN due to cirrhosis
“coffee ground” emesis
LIFE THREATENING

esophageal varices

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long-term treatment of alcoholics: prevent relapse in recovering alcoholic

AA: DOC for relapse prevention

naltrexone: opioid antagonist, endogenous opioids are associated with + feelings that come with alcohol use → don’t feel as good when drink
disulfiram: take before party so not tempted to drink →↑ acetylaldehyde: N/V, flush
topiramate: affects glutamate R (migraines + seizures too)
acamprosate: modulate glutamate R

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BZD and barbiturate effects

CNS depression
↓ anxiety
disinhibition
coma
severe respiratory depression

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barbiturates, BZD effect on GABA R

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BZD: ↑ FREQUENCY of Cl channel opening
barbiturates: ↑ DURATION of Cl- channel opening (wish BARs open longer)

withdrawal of BZD or barbiturates

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agitation
anxiety
seizures

treatment for BZD overdose

flumazenil (BZD antagonist): reverse effect | can induce withdrawal → seizure

opioid (morphine, heroin, methadon) effects

``` CNS depression euphoria n/v constipation pupillary CONSTRICTION (miosis) higher dose: seizures OD: resp depression ```

pupillary constriction

opioid

treatment of opioid overdose

will be VERY ANGRY that stopped high: naloxone naltrexone

opioid withdrawal

``` sweating dilated pupils piloerections yawning rhinorrhea flu-like symptoms not life-threatening ```

complications of IV heroin

IVDU: hepatitis HIV right sided endocarditis

treatment of opioid addiction

methadone: low-dose, long-acting opiate, prevents sx of opiod withdrawal suboxone (naloxone + buprenorphine: partial opioid agonist): decrease withdrawal sx naltrexone: opioid antagonist - prevent relapse once detoxified

opiod for pain control with less addiction

tramadol

amphetamines: CNS stimulant

↑ NE, epi, dopamine release

cocaine: CNS stimulant

block reuptake of NE, epi, dopamine

effect of amphetamines and cocaine

``` EUPHORIC ↑ energy agitation anxiety insomnia ↑ bp, tachycardia, cardiac arrest, stroke pupillary DILATION uses: ↑ attention, ↓ appetite (weight loss) ```

withdrawal sx of amphetamines and cocaine

``` ↓ catecholamines in synapse: ↓ neuronal firing severe depression lethargy insomnia/hypersomnia weight gain headache ```

cocaine overdose

BZD: if agitation only (calm patient) haloperidol: if agitation with paranoia

caffeine + nicotine: CNS stimulants

``` excitability restlessness diuresis premature atrial contractions premature ventricular contractions avoid in MIs (susceptible to arrhythmias) ```

caffeine + nicotine withdrawal

irritability anxiety craving weight gain

treatment for nicotine withdrawal

nicotine replacement

treatment for nicotine prevention

prevent relapse/craving: buproprion varenicline

types of hallucinogens

PCP LSD marijuana

PCP (phencyclidine) MOA

NMDA receptor antagonist inhibit nicotinic Ach receptors dopamine reuptake inhibitor

PCP (phencyclidine) effect

``` BELLIGERENT impulsiveness agitation NYSTAGMUS (horizontal + vertical) homicidal ideation violence pyschosis delerium ```

treatment of PCP

calm patient: BZD antipsychotic

PCP withdrawal

depression anxiety irritability VIOLENCE

LSD MOA

5HT receptors

LSD effect

``` anxiety paranoia delusions visual hallucinations FLASHBACKS (wks, mo, yrs after using lsd) pupillary DILATION can't die from drug ```

treatment for LSD intoxication

BZD: calm patient

marijuana MOA

tetrahydrocannabinol: effects THC receptors and CD1 R

marijuana effects

``` euphoria anxiety paranoid delusions perception of slowed time impaired judgement prolonged use: social withdrawal ↑ appetite dry mouth high dose: hallucinations red eyes ```

marijuana withdrawal

``` peak at 48 yrs and last 5-7 days detected in urine 1 mo after last use irritable insomnia nausea ```

MDMA "ectasy" effect

↑ 5HT release

MDMA effect

``` euphoria ↓anxiety sense of intimacy with others tachycardia jaw clenching like to DANCE → dehydration ```

treatment for MDMA "ectasy"

supportive care

organophosphate effect

MIOSIS sweating drooling

rebound anxiety, tremors, seizures, life-threatening

withdrawal from: alcohol BZD barbiturates

alcohol + substance abuse Flashcards

(57 cards)