psych substance related disorders Flashcards
(116 cards)
1
Q
abuse def
A
pattern of substance use that leads to impairment or distress for at least 12 mos with one or more of the following: failure to fulfill obligations at home or work, use in dangerous situations, recurrent substance related legal problems, continued use despite social or interpersonal problems due to the substance use
2
Q
dependence def
A
substance use leading to impairment or distress manifested by at least three of the following in 12 mo period: tolerance, withdrawal,
3
Q
cocaine use- how long is the urine drug screen pos for?
A
2-4 days
4
Q
amphetamines- how long is the urine drug screen pos for?
A
3-4 days
5
Q
PCP- how long is the urine drug screen pos for?
A
3-8 days
6
Q
what lab values are elevated in PCP use?
A
CPK and AST
7
Q
examples of sedative-hypnotics
A
barbiturates and benzos
8
Q
short acting barbiturate
A
pentobarbitol; in your system for 24 hours
9
Q
long acting barbiturate
A
phenobarbitol; stays in system for 3 weeks
10
Q
short acting benzo
A
lorazepam; in your system for 3 days
11
Q
long acting benzo
A
diazepam; in your system for 30 days
12
Q
examples of opioids
A
methadone and oxycodon
13
Q
urine drug test for opioids
A
pos for 2-3 days, depengind on the opioid used; methadone and oxycodon will come up neg on a general screen (must order separate panel)
14
Q
urine drug test for marijuana
A
in heavy users, up to 4 weeks; after single use, about 3 days
15
Q
what are the mechanisms of alcohol in the CNS?
A
activates GABA and serotonin; inhibits glutamate and voltage gated calcium channels; it is a potent CNS depressant
16
Q
how is alcohol metabolized?
A
alcohol–>acetaldehyde–>acetic acid
17
Q
enzyme that converts alc to acetaldehyde?
A
alcohol dehydrogenase
18
Q
enzyme that converts acetaldehyde to acetic acid
A
aldehyde dehydrogenase
19
Q
asians have less of what enzyme?
A
aldehyde dehydrogenase
20
Q
the effects/BAL may be decreased if high tolerance has been developed
A
right
21
Q
treatment for alcohol intox
A
ABC; thiamine and folate
22
Q
when is GI evacuation indicated in alcohol poisoning
A
when a signif amount of alc was ingested in the past 30-60 mins
23
Q
symptoms of alc withdrawal
A
insomnia, anxiety, diaphoresis, and tachycardia; anorexia, n/v, psychomotor agitation, fevers, seizures, hallucinations, and delirium
24
Q
treatment for alc withdrawal
A
benzo taper (chlordiazepoxide (librium) is drug of choice); thiamine, folic acid, and multivitamin; correct electrolyte abnormalities; check for signs of hepatic failure
25
what can kill a person in alc withdrawal
seizures, htn, and arrythmias
26
when do the earliest signs of alc withdrawal occur?
6 to 24 hours after the patient's last drink
27
seizures in alc withdrawal
between 6 and 48 hours after the patient's last drink, with a peak around 13 to 24 hours
28
treatment for seizures in alc withdrawal>
benzos
29
alc withdrawal symptoms usually last how long?
2-7 days
30
when does delirium tremens begin?
48-72 hours after the last drink, but may occur later
31
mortality of DT if not treated
15 to 25%
32
symptoms of DT
delirium, visual hallucinations, gross tremor, autonomic instablity, and fluctuating levels of psychomotor activity
33
benzos
chlordiazepoxide, diazepam, or lorazepam
34
CAGE questionaire for alcohol abuse
have you ever wanted to cut down; have you ever felt annoyed by criticism of your drinking; have you ever felt guilty about drinking; have you taken a drink as eye opener
35
medications for alcohol dependence
disulfuram (antabuse); naltrexone (revia, IM-vivitrol); acamprosate (campral); topiramate (topamax)
36
disulfuram (anatabuse)
blocks aldehyde dehydrogenase and causes aversive reaction to alcohol; contraindic in cardiac disease, pregnancy, psychosis; need compliance
37
naltrexone
opioid receptor blocker; workse by decreasing the craving and high assoc with alc; in patients with opioid dependence, it will precipitate withdrawal
38
acamprosate
similar to GABA; inhibits the glutamatergic system; should be used for relapse preventation in patients who have stopped drinking; can be used in patients with liver disease; contraindic in renal disease patients
39
topiramate
anticonvulsant that potentiates GABA and inhibits glutamate receptors; reduces cravings for alcohol
40
features of wernicke's encephalopathy
ataxia, confusion, ocular abnormalities (nystagmus, gaze palsies)
41
korsakoff syndrome
chronic amnestic syndrome, reversible in only 20% of patients; impaired recent memory, anterograde amnesia, compensatory confabulation
42
how does cocaine work?
blocks dopamine reuptake from the synaptic cleft; plays a role in the reward system of the brain
43
cocaine intoxication features
euphoria, heightened self-esteem; hypo or hypertension; tachycardia or bradycardia, nausea; dilated pupils (sympathetic!); chills and sweating
44
dangerous effects of cocaine
respiratory depression, seizures, arrhythmias, paranoia, hallucinations (esp tactile)
45
what is deadly about cocaine
vasoconstrictive effect may result in MI or stroke
46
management of cocaine intoxication
for mild or moderate, reassurance of patient or benzos; for severe agitation, antipsychotics (haldol); temp greater than 102 is a med emergency and should be treated withice bath, cooling blanket, and other supportive measures
47
treatment of cocaine dependence
no FDA approved drug; off label you can use disulfiram and ariprazole
48
withdrawal from coke
not life threatening; produces crash (fatigue, hypersomnolence, depression, constricted pupils, hunger)
49
how do amphetamines work
block reuptake and facilitate release of dopamine and norepi from nerve endings; causes a stimulant effect
50
examples of amphetamines
dextroamphetamine (dexedrine); methylphenidate (ritalin); methamphetamine ("speed," Desoxyn)
51
what are amphetamines used for medically?
treatment of narcolepsy, ADHD, and depressive disorders
52
what are the substituted ("designer") amphetamines?
MDMA (ecstasy); MDEA ("eve")
53
what is different about the substituted amphetamines?
release dopamine, norepi, and serotonin; they have both hallucinogenic and stimulant properties; assoc with clubs and raves
54
risk of serotonin syndrome with substituted amphetamiens
serotonin syndrome can occur if designer amphetamines are combined with SSRIs
55
symptoms of amphetamine intoxication
similar to those of cocaine; MDMA and MDEA can induce a sense of closeness to others
56
overdose of amphetamines
hyperthermia, dehydration, and rhabdomyolysis (leading to renal failure)
57
amphetamine withdrawal
prolonged depression
58
treatment for amphetamine intoxication
rehydrate, correct electrolyte imbalance, and treat hyperthermia
59
mechanism of PCP
antagonizes NMDA glutamate receptors and activates dopaminergic neurons; can be stimulant or depressant depending on the dose
60
relationship between ketamine and PCP
ketamine is less potent PCP
61
date rate drug
ketamine; it is odorless and tasteless
62
clinical presentation of PCP patient
agitation, depersonaliztion, hallucinations, synesthesia, impaired judgment, memory impairment, assaultiveness, nystagmus, ataxia, dysarthria, hypertension, tachycardia, muscle rigidity, and high tolerance to pain
63
overdose of PCP
seizures, coma, and even death
64
treatment for PCP
minimize sensory stimulation, benzos for agitation, anxiety, muscle spasms, and seizures; use antipsychotics for severe agitation or psychotic symptoms
65
withdrawal from PCP
no withdrawal syndrome, but flashbacks (recurrence of intoxication symptoms due to release of the drug from lipid stores)
66
sedative-hypnotic examples
benzos, barbiturates, zolpidem, zaleplon, GHB, meprobate, and others; these are highly abused
67
how do benzos work?
potentiate GABA by increasing the freq of chloride channel opening
68
when are barbiturates used?
treatment of epilepsy and as anesthetics
69
mechanism of barbiturates
potentiate GABA by increasing the duration of chloride channel opening
70
complication of too much barbiturates
respiratory depression
71
intox with sedatives- symptoms
drowsiness, confusion, hypotension, slurred speech, incoordination, ataxia, mood lability, impaired judgment, nystagmus, resp depression, and coma or death in overdose
72
long term sedative use
may lead to dependence and may cause depressive symptoms
73
treatment for sedative intoxication
maintain ABC; use activated charcoal and gastric lavage to prevent further GI absorption (if drug was ingested in the prior 4-6 hours); supportive care
74
treatment for barbiturate intox specifically
alkalinize urine with sodium bicarb to promote renal excretion
75
treamtne for benzo intox
flumazenil in overdose
76
physiologic dependence on sedatives is more likely in long or short acting?
short acting; but long acting agents can also cause dependence and withdrawal symptoms
77
withdrawal symptoms from sedatives
same as from alcohol; worst sx in barbiturates
78
treatment for sedative withdrawal
benzo taper; carbamazepine or valproic acid can be used for seizure prevention
79
mechanism of opioids
stimulate opiate receptors (mu, kappa, and delta); involved in analgesiaa, sedation, and dependence
80
examples of opiates
heroin, oxycodone, codeine, dextromethorphan, morphine, methadone, and meperidine (Demerol)
81
major neurotransmitter involved with opioids
dopamine
82
most commonly abused opiods
NOT heroin; actually the prescribed opioids like Vicodin, OxyContin, and percocet
83
clinical presentation of opiate intoxication
drowsiness, n/v, constipation, constricted pupils (parasymp), seizures, and resp depression
84
serotonin syndrome
can be seen when meperidine and MAOI are taken in combo; sx are hyperthermia, confusion, hyper or hypotension, and muscular rigidity
85
treatment of opiod overdose
naloxone or naltrexone (opioid antagonists) will improve resp depression but may cause severe withdrawal in an opioid-dep patient
86
withdrawl from opioids
not life-threatening; unpleasant syndrome characterized by dysphoria, insomnia, lacrimation, rhinorrhea, yawning, weakness, sweating, piloerection, n/v, fever, dilated pupuls
87
treatment for opioid withdrawal
moderate sx can be treated with clonidine (for autonomic signs and sx of withdrawal), NSAIDs for prain, dicyclomine for abdominal cramps
88
severe symptoms of opioid withdrawal- what is treatment?
detox wth buprenorphine or methadone
89
three meds that treat opiod dependence
methadone, buprenorphine, naltrexone
90
how does methadone work?
long-acting opioid receptor antag; administered once daily, signif reduces morbidity and mortality; gold standard for pregnant women
91
buprenorphine
partial opioid receptor agonist; sublingual and safer than methadone; comes as Suboxone (buprenorphine plus naloxone)
92
naltrexone
competitive opioid antagonist; precipitates withdrawal if used within 7 days of heroin use; compliance is an issue
93
examples of hallucinogenic drugs of abuse
psilocybin (mushrooms); mescaline (peyote cactus), and LSD
94
proposed mechanism for LSD
serotonergic systems
95
physical dependence or withdrawal in hallucinogens?
no
96
intoxication of hallucinogens; symptoms
perceptual changes; labile affect, dilated pupils, tachycardia, hypertension, hyperthermia, tremors, incoordination, sweating, and palpitations; usually lasts 6-12 hours but may last for days
97
treatment for hallucinogens
monitor for dangerous behavior and reassure patient; use benzos and anti-psychotics if necessary for agitated psychoiss
98
withdrawal symptoms from hallucinogens
none, but longterm LSD use may cause a patient to have flashbacks later in life
99
how does marijauna work in the brain?
cannabinoid receptors in the brain inhibit adenylate cyclase
100
benefits of marijuana
decrease nausea, increase appetite in AIDS patients, and derease intraocular pressure, muscle spasms, and tremor
101
symptoms of marijuana
euphoria, anxiety, impaired motor coordination, perceptual disturbances, mild tachycardia, red eyes, dry mouth, and increased appetitie
102
chronic marijuana use
resp problems like asthma and chronic bronchitis, suppression of immune system, and effects on reproductive hormones
103
withdrawal from marijuana
irritability, anxiety, restlessnes, aggression, depression, strange dreams, headaches, sweating, insomnia, nausea, craving, and decr appetite
104
mechanism of inhalents
CNS depressants
105
examples of inhalents
solvents, glue, paint thinners, fuels, isobutyl nitrates ("huff," "laughing gas," "rush," "bolt")
106
effects of inhalents
perceptual disturances, psychosis, lethargy, dizziness, n/c. headache, euphoria, hypoxia, cloudiness of consiousness, stupor, or coma
107
acute intoxication of inhalents lasts how long?
minutes, stupor may last for hours
108
overdose of inhalents
may be fatal secondary to resp depression or cardiac arrhythmias
109
long term use of inhalents
permanent brain damage, peripheral nervous system, liver, kidney, heart and muscle
110
treatment for inhlaent intoxication
ABCs; identify solvent because some (leaded gasoline) may require chelation
111
mechanism of caffeine
adenosine antagonists causing increase cAMP and a stimulant effect via the dopaminergic system
112
death by caffein
over 10 g (1000 cups); death may occur secondary to seizures and resp failure
113
nicotine is addictive through actions on what neurotransmitter
dopamine
114
Varenicline (chantix)
nicotinic cholinergic receptor partial agonist that mimics the action of nicotine and prevents withdrawal
115
buproprion (zyban)
antidepressant that is also partial agonist at nACHR and inhib of dopamine reuptake; helps reduce withdrawal symptoms
116
Nicotine replacement therapy
transdermal patch, gum, lozenge, nasal spray, and inhaler
