Alcohol & Substance Use Disorders

Question 1

Due to the recent ingestion of alcohol; clinically problematic behavioral or psychological changes (slurred speech, incoordination, unsteady gait, nystagmus, coma, etc.)

Answer 1

Alcohol Intoxication

Question 2

Cessation (or reduction in) alcohol that has been heavy and prolonged; involves autonomic hyperactivity (sweaty, tachycardia), hand tremor, insomnia, hallucinations, seizures, etc.

Answer 2

Alcohol Withdrawal

Question 3

Problematic pattern of alcohol use leading to clinically significant impairment or distress; involves large binges, persistent desire to cut down or control (usually unsuccessful), craving, desire and inability to complete obligations at work, school or home

Answer 3

Alcohol Use Disorder

Question 4

Numerical definitions of at-risk drinking per gender

Answer 4

Female: >3 drinks (one sitting) or 7/week
Male: >4 drinks (one sitting) or 14/week

Question 5

What does the Alcohol Screening mnemonic CAGE mean

Answer 5

C: Cut down?
A: Annoyed by others commenting?
G: Guilt associated?
E: Eye opening drink in the morning?

Question 6

What does the Alcohol Screening mnemonic CRAFFT mean?

Answer 6

C: Car (drive with anyone intoxicated)
R: Relax (use to relax)
A: Alone (drink/use alone)
F: Family or Friends (tell you to cut down)
F: Forget (things while drinking)
T: Trouble?

Question 7

What labs are elevated with Alcohol consumption

Answer 7

LFT (GGT, AST, ALT)
HDL
LDH
Uric Acid

Question 8

Consequence of alcohol withdrawal; onset is 2-4 days after last drink; hyperactivity, tachycardia, HTN, fever, halluinations and disoriented; CAN BE FATAL

Answer 8

Delirium Tremens

Question 9

Triad of confusion, ataxia and ophthalmoplegia (paralysis of eye muscles); can also see Korsakoff’s Syndrome; due to dec. thiamine (Vitamin B1); EMERGENCY as 20% of untreated patients will die; MUST give Thiamine before glucose

Answer 9

Wernicke’s Encephalopathy

Question 10

Potential consequence of Wernicke’s Encephalopathy; impaired memory in an otherwise alert, responsive patient; either retrograde or anterograde memory loss or confabulations

Answer 10

Karsakoff Syndrome

Question 11

Delirium Tremens (in alcohol withdrawal) is due to a deficiency in what vitamin

Answer 11

Vitamin B1 (Thiamine)

Question 12

Treatment for Delirium Tremens

Answer 12

Benzodiazepines (long acting)
Thiamine
Folate

Question 13

What if your Delirium Tremens patient starts to seize? (what treatment)

Answer 13

Benzodiazepines

Question 14

What if your Delirium Tremens patient starts to hallucinate?

Answer 14

Haloperidol (low dose)

Question 15

Examples of treatment for Alcohol Dependence (pharmacologic)

Answer 15

Disulfiram
Acamprosate
Naltrexone

Question 16

Drug for Alcohol Dependence; opioid receptor antagonist to reduce cravings

Answer 16

Naltrexone

Question 17

Sedative infamous for respiratory depression

Answer 17

Barbiturates

Question 18

Flumazenil is good for sedative (overdose/withdrawal)

Answer 18

Overdose

Question 19

Benzodiazepines are good for sedative (overdose/withdrawal)

Answer 19

Withdrawal

Question 20

Symptoms of Opioid OVERDOSE

Answer 20

Mood elevation
Sedation
Analgesia
Resp. Depression
Pupil Constriction

*everything kinda relaxes

Question 21

Symptoms of Opioid WITHDRAWAL

Answer 21

Depression
"Flu-like" symptoms (muscle aches, chills, etc.)
Piloerection
Pupil Dilation
Stomach Cramps

*everything kinda get excited

Question 22

Drug for Opioid overdose

Answer 22

Naloxone (Narcan)

Question 23

Drugs for Opioid Withdrawal

Answer 23

Naltrexone
Buprenorphine
Methadone taper

Question 24

Partial opioid agonist + opioid antagonist

Answer 24

Buprenorphine

Question 25

Symptoms of Stimulant use

Answer 25

``` Elevated mood Anxiety Insomnia Psychosis HTN DILATED pupils ```

Question 26

Symptoms of Stimulant withdrawal

Answer 26

``` Depression Irritable Lethargy Fatigue Hypotension Dec. Neurologic activity ```

Question 27

Symptoms of Stimulant withdrawal

Answer 27

Cardiac monitoring Benzodiazepines Antipsychotics (if psychosis)

Question 28

Symptoms of Hallucinogen use

Answer 28

Hallucinations (visual) | Hyperalert (EEG)

Question 29

Examples of NMDA antagonists (Dissociatives)

Answer 29

Dextromethorphan PCP Ketamine NO

Question 30

Symptoms of NMDA antagonists (Dissociatives)

Answer 30

``` Dissociation/Hallucinations Invulnerability Agitation/Violence Nystagmus HYPERreflexia HTN/Tachycardia ```

Question 31

Treatment for NMDA antagonists (Dissociatives)

Answer 31

Benzodiazepines | Antipsychotics

Question 32

Examples of Inhalants/Fumes

Answer 32

Fuels Paint Anesthetics NO

Question 33

Symptoms of Inhalants/Fumes

Answer 33

``` Euphoria Disinhibited Dizzy Ataxia Dysrhythmias Slurred speech ```