Substance Abuse

Question 1

“Risky drinking” is when Males <65yo drink >____ drinks per week or >___ drinks a day
OR
Females (all ages) and Males 65yo+ drink >___ drinks per week or >___ drinks per day

Answer 1

• Males <65yo drink >14 drinks per week or >4 drinks a day
• Females (all ages) and Males 65yo+ drink >7drinks a week or >3drinks a day

Question 2

Binge drinking is when you drink so much within a 2hr period that your blood [alcohol] = ____g/dL

Answer 2

0.08

Question 3

Binge drinking is usually when females have ____ drinks or males have ___ drinks within 2Hr and it raises their blood [alcohol] to 0.08g/dL

Answer 3

F = 4 drinks
M = 5 drinks

Question 4

Tx for Mild ETOH use DO

Answer 4

Psychosocial therapy (motivational counseling, grp therapy)

Question 5

Tx for Mod/Severe ETOH Use DO

• if NO opiod use?
• if Opiod use?

Answer 5

• Psychosocial + meds
• Naltrexone (can start while actively drinking but cannot be taken if using opiods)
• Opiod use -> Acomprosate

Question 6

Tx for Refractory ETOH Use DO

Answer 6

Disulfiram, Topiramate

Question 7

Tx for ETOH Intoxication

• Mild?
• Mod/Severe?
• ETOH Poisoning?

Answer 7

• Mild -> monitor
• Mod/Sev -> fluids, labs, glucose q 8hr
• poisoning -> RESPIRATORY, Fluids, Thiamine

Question 8

Tx for Alcohol poisoning is based on which assessment?

Answer 8

CIWA-AR (Clinical Instutite Withdrawal Assessment for Alcohol, Revised)

Question 9

Tx for VERY Mild vs Mild ETOH Poisoning based on the CIWA-AR

Answer 9

• VERY Mild -> GABA (anticonsulsant)
• Mild -> Long-acting Benzo

Question 10

Tx for caffeine addiction

• Within 1hr?
• Within 2hr & has good mental status W/O Emesis

Answer 10

• within 1hr: NG tube aspiration/lavage
• within 2Hr: Activated Charcoal

Question 11

Labs to order for caffeine intoxication?

Answer 11

[serum caffeine]
electrolytes
Glucose
CBC
EKG

Question 12

Tx for Life-threatening dysrhythmia d/t caffeine intoxication?
SVT?
Ventricular?

Answer 12

• Life-threatening -> HEMODIALYSIS
• SVT -> Benzo or Cardioselective Beta-1 BB
• Ventricular -> ACLS/PALS

Question 13

Caffeine intoxication Tx
- HypoTN?
- Vomiting?
- Hypokalemia?

Answer 13

• HypoTN -> IV Fluids, Vasopressors, B-1 BBs
• Vomiting -> Odansetron, Metoclopramide
• Hypokalemia -> K+ Supplmentation

Question 14

Tx for Cannabis use DO
(NOTTTTTT INTOXICATION)

Answer 14

• set tx goals
• intervention, therapy
• NO MEDS BY FDA

Question 15

Tx for Cannabis INTOXICATION in PEDS

Answer 15

Peds (CNS Depression) -> ABCs

Question 16

Tx for Cannabis INTOXICATION in ADULTS

• CP?
• Cannabis Hyperemesis Syndrome?
• SEVERE Hallucinations?

Answer 16

• CP -> r/o other ET
• Vomiting -> IV Fluids, Antiemetics (Droperidol, Haloperidol)
• Severe Hallucinations -> Antipsychotic

Question 17

Tx for Phencyclidine Intoxication
- violent/aggravated?

Answer 17

ABCs
+/- Activated Charcoal
Violent/aggravated -> SEDATION

Question 18

Examples of Hydrocarbon-based Inhalants

Answer 18

Toluene
Gasoline

Toluene is found naturally in crude oil, and is used in oil refining and the manufacturing of paints, lacquers, explosives (TNT) and glues

Question 19

Tx for opiod intoxication
- Mild?
- Mod/Sev?
- OVERDOSE?

Answer 19

• Mild -> Naltrexone (Long-acting inject). MUST HAVE BEEN OFF OPIODS
• Mod/Sev -> Buprenorphine or Methadone
• OVERDOSE -> Narcan (Naloxone)

Question 20

Generally, Opiod intoxication causes pupilary _____

constrict/dilate

Answer 20

CONSTRICTION

Dilation if anoxia from severe overdose

Question 21

Opiod withdrawal causes pupillary _____

constrict/dilation

Answer 21

DILATION

Question 22

5 A’s approach for Tobacco DO

Answer 22

1. Ask about tobacco use
2. Advise quitting
3. Assess readiness to quit
4. Assist smokers ready to quit
5. Arrange FU

Question 23

Pharm Tx for Tobacco DO

Answer 23

• **Varenicline
• Combo Nicotine Replacement Therapy (NRT)
• Bupropion (Wellbutrin)**

Question 24

3 Screens for alcohol use DO

Answer 24

AUDIT-C, AUDIT, CAGE