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Flashcards in Drugs of Abuse Deck (67)
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1

Opiate drug testing

Usual UDS's test for?

What is the standard cutoff for testing?

  • Tests for Codeine and Morphine metabolites usually
  • Cutoff is 2000 ng/ml

2

What are the barriers to naloxone use?

  • State law
  • Physician liability 
  • Bystander liability 
  • fear of being prosecuted (bystander)

3

What are the only drugs that will show up on a normal opioid drug screen

  • Heroin
  • Codeine
  • Morphine
  • Hydromorphone
  • Hydrocodone

4

What is the confirmatory test that is done if a patient preimptively tests positive for a substance?

Mass spec

5

Buprenorphine/ Naloxone? Advantages?

They cant shoot this up because it wont work due to the naloxone 

6

Treatment of opioid intoxication or OD?

Naloxone max 10 mg 

 

7

Your body has adapted to the medication and if you dont take it youll get withdrawals 

 

Physical Dependence

8

Naltrexone for maintenance

  • Must be detoxified prior to using
  • Many compliance issues
  • Monitor LFTs 
  • Vivitrol- monly IM injection 

9

Consequence of IV opioids?

  • Mood disorder, Dementia
  • Infection, Endocarditis
  • Disease, HIV, Hep, STD
  • Overdose

 

10

Symptoms based treatment 

Agitation?

Insomnia?

Headache, aches?

Abdominal cramps?

Diarrhea?

  • Clonidine
  • Diphenhydramine, Trazodone, Hydroxyzine
  • NSAID, Acetaminophen
  • Dicyclomine
  • Bismuth subcarbonate 

11

Treatment options and supportive care for AWS?

  • Thiamine
  • Folic Acid
  • Magnesium 
  • Multivitamin
  • Fluids
    • Bananas bag- NS, Thiamine, Folic Acid, MVI
  • Nonpharm
    • Quiet environment, Reduced light 

12

Effects of opiates?

  • Mood changes/depression 
  • Drowsiness
  • Inability to concentrate
  • Flushing in face and neck 
  • Constipation
  • N/V
  • Respiratory depression 

 

13

WHy is Rx drug abuse increasing?

  • Consumer
  • Industry
  • Physician
  • Society 

 

14

Other OTC or Rx abused meds?

  • Cough meds
  • Synthetic drugs (K2, Spice)

 

15

Types of narcotics?

  • Opium
  • Morphine
  • Codeine
  • Hydromorphone
  • Oxy
  • Fentanyl 

 

16

What are the symptoms of Karsakoff Psychosis?

  • Psychosis
  • Retrograde amnesia
  • Confabulation 

17

Why do people abuse opiates?

  • Euphoric feeling
  • Avoid emotional pain
  • Avoid physical pain
  • Supress withdrawal symptoms 

 

18

What is the long acting benzo used for AWS?

Why could this potentially be harmful?

  • Chlordiazepoxide
    • Its metabolized in the liver but is very long acting this can pose problems due to decreased liver function in alcoholics

 

19

What increases the risk of developing alcohol withdrawal syndrome? 2 of them

  1. At least 3 months of daily alcohol consumption
  2. Consumption of large quantities for the past week 

 

20

What increases your risk for Delirium Tremens (DT) 

  • Previous DT
  • Hx of using equivalent to 1 pint of whiskey per day for the last 10-14 days 
  • Cirrhosis (enlarged liver)
  • Early onset alcohol withdrawal 

21

What are the common Rxs of abuse?

  • Opiates
  • Benzos
  • Stimulants

 

22

Medications that can cause positive results for THC UDS

  • Efavirenz
    • Metabolite interferes with antibodies in immunoassay
  • NSAIDs
    • Conflicting studies
  • Pantoprazole 
  • Dronabinol (Synthetic THC) Its a positive 

23

What is naltrexones role in Alcohol Abstinence?

Been shown to reduce?

What to monitor?

  • It may reduce the reward that is associated with drinking 
  • Been shown to reduce cravings, number of drinks, and relapse
  • Monitor LFT

24

Detoxification?

  • Methadone
  • Bupronorphine
  • Other opioids
  • Symptomatic treatment (just when symptoms come up)

 

25

Before you interpret someones drug test you need?

  • Detailed Med Hx
    • Prescription
    • OTC
    • Herbal
  • Documentation of last use
  • Knowledge of which medications, metabolites can complicate accurate interpretation 

26

A limitation of urine drugs tests?

That if someone has just smoked or used they must be given at least 2 hours before testing, otherwise the results will be inconclusive. 

27

Treatments of withdrawal?

Difference?

Detoxification - get them off the drug 

Maintenance- prevent relapse stay on something forever 

 

28

Addiction?

3 Cs

  • Chronic Disorder characterized by compulsive use 
  • Continue to use despite adverse consequences 
  • Lost control
  • Denies there is a problem 

29

Wernickes Syndrome can lead to?

Reversible non reversible?

  • Karsakoff Psychosis (irreversible)

 

30

Signs and symptoms of opioid overdose or intoxication?

  • Pinpoint pupils
  • Cold clammy skin
  • Blue/pale lips
  • Confusion
  • Severe drowsiness (cant wake up)
  • respiratory depression