Class 6

Question 1

Blackouts

Answer 1

anesthetize the hippocampus

Question 2

First 24h ROH withdrawal

Answer 2

tremors (6-8h), sweating, anxiety, autonomic instability, GI sx

Question 3

day 2 roh withdrawal

Answer 3

seizures

Question 4

Day 3 roh withdrawal

Answer 4

autonomic instability, disorientation, confusion, delirium tremens

Question 5

CAGE

Answer 5

cutting down, annoyed by your drinking, guilt, eye-opener

Question 6

genetics and roh

Answer 6

ROH, 4x more, accounts 40-60%. Gene for SERT: short version = SUD, mood and anxiety dis, genes that metabolize alcohol
How to break down alcohol: alcohol dehydrogenase = acid aldehyde (flushing) = broken down by aldehyde dehydrogenase

Question 7

High risk drinking

Answer 7

doesn’t fill criteria for SUD, but puts person at high risk of negative consequences if she continues. 50-60% risk that it will continue to SUD

Question 8

Alcohol use disorder:

Answer 8

Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home.
Recurrent substance use in situations in which it is physically hazardous.
Continued substance use despite having persistent and recurrent social or interpersonal problems caused or exacerbated by the effects of the substance.
Withdrawal
Important social, occupational, or recreational activities are given up or reduced because of substance use.

Question 9

Labs ROH

Answer 9

High uric acid, triglycerides, AST, ALT, MCV, γ-glutamyl transpeptidase

Question 10

What mental health disorders are commonly co-morbid with Substance Use Disorders?

Answer 10

MDD, GAD, personality disorder

Question 11

Cocaine withdrawal

Answer 11

After stimulant intoxication, a “crash” occurs with symptoms of anxiety, tremulousness, dysphoric mood, lethargy, fatigue, nightmares (accompanied by rebound rapid eyemovement [REM] sleep), headache, profuse sweating, muscle cramps, stomach cramps, and insatiable hunger. The withdrawal symptoms generally peak in 2 to 4 days and are resolved in 1 week. The most serious withdrawal symptom is depression, which can be particularly severe after the sustained use of high doses of stimulants and which can be associated with suicidal ideation or behavior. A person in the state of withdrawal can experience powerful and intense cravings for cocaine, especially because taking cocaine can eliminate the unpleasant withdrawal symptoms. Persons experiencing cocaine withdrawal often attempt to self-medicate with alcohol,
sedatives, hypnotics, or antianxiety agents such as diazepam (Valium).

Question 12

Untreated, DTs has a mortality rate

Answer 12

of 20 percent, usually as a result of an intercurrent medical illness such as pneumonia, renal disease, hepatic insufficiency, or heart failure.

Question 13

DT

Answer 13

The essential feature of the syndrome is delirium occurring within 1 week after a person stops drinking or reduces the intake of alcohol. In addition to the symptoms of delirium, the features of alcohol intoxication delirium include autonomic hyperactivity such as tachycardia, diaphoresis, fever, anxiety, insomnia, and hypertension; perceptual distortions, most frequently visual or tactile hallucinations; and fluctuating levels of psychomotor activity, ranging from hyperexcitability to lethargy. About 5 percent of persons with alcohol-related disorders who are hospitalized have DTs. Because the syndrome usually develops on the third hospital day, a patient admitted for an unrelated condition may unexpectedly have an episode of delirium, the first sign of a previously undiagnosed alcohol-related disorder. Episodes of DTs usually begin in a patient’s 30s or 40s after 5 to 15 years of heavy drinking, typically of the binge type. Physical illness (e.g., hepatitis or pancreatitis) predisposes to the syndrome; a person in good physical health rarely has DTs during alcohol withdrawal.

Question 14

Cannabis prevalence Canada

Answer 14

6.1%

Question 15

Effects cannabis timeline

Answer 15

When cannabis is smoked, the euphoric effects appear within minutes, peak in about 30 minutes, and last 2 to 4 hours. Some motor and cognitive effects last 5 to 12 hours.

Question 16

Cannabis intoxication

Answer 16

Cannabis intoxication commonly heightens users’ sensitivities to external stimuli, reveals new details, makes colors seem brighter and richer, and subjectively slows the appreciation of time. In high doses, users may experience depersonalization and derealization. Motor skills are impaired by cannabis use, and the impairment in motor skills remains after the subjective, euphoriant effects have resolved. For 8 to 12 hours after using cannabis, users’ impaired motor skills interfere with the operation of motor vehicles and other heavy machinery. Moreover, these effects are additive to those of
alcohol, which is commonly used in combination with cannabis.

Question 17

Cannabis withdrawal

Answer 17

Studies have shown that cessation of use in daily cannabis users results in withdrawal symptoms within 1 to 2 weeks of cessation. Withdrawal symptoms include irritability,cannabis cravings, nervousness, anxiety, insomnia, disturbed or vivid dreaming, decreased appetite, weight loss, depressed mood, restlessness, headache, chills, stomach pain, sweating, and tremors.

Question 18

PCP effects

Answer 18

visual hallucinations + paranoia

Question 19

Drug induced psychosis

Answer 19

cannabis, pcp, ketamine, amphetamine, cocaine

Question 20

Is CBD psychoactive

Answer 20

Cbd in high concentration is actually psychoactive

Question 21

short duration and short action =

Answer 21

more addictive

Question 22

true or false Group therapy more efficace than individual

Answer 22

true

Question 23

Schizo and suicide + SUD

Answer 23

10 % + SUD 3x higher

Question 24

methadone

Answer 24

36-72h half life long action opioid agonist. Will still feel a bit buzzed. Stop it: withdrawal sx when you try to withdraw methadone: most relapse

Question 25

Methadone + relapse heroin:

Answer 25

overdose.

Question 26

Buprenorphine:

Answer 26

partial agonist so turns it on enough to prevent withdrawal but not enough to overdose, binds more strongly that heroin. Relapse: take heroin, you won’t feel the buzz, won’t overdose. They will no longer be tolerant to heroin, could die if you take same hit

Question 27

Naloxone:

Answer 27

opioid antagonist, undue the effect the overdose, IM only, very short acting

Question 28

Naltrexone

Answer 28

oral form opioid antagonist long acting

Question 29

Subaxone

Answer 29

buprenorphine and naloxone to prevent high, the naloxone does nothing but if you crush the pill and inject the naloxone will block the high from the buprenorphine

Question 30

when to use Epival and tegretol

Answer 30

very roh use disorder with or without benzos abuse, overwight with sleep apnea, half benzos half epival or history of seizures.

Question 31

when to use Gabapentin, pregabalin:

Answer 31

decrease glutamate excitatory activity instead of benzos, even with cocaine withdrawal good anxiolytic for short term use