Substance Abuse Flashcards by Zachary Schulz

Up to __% of patients seen in an ambulatory may have associated substance abuse

20%

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About __% of american will show clinical dependence on a non-tobacco substance at some point in their lifetime

24.8%

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Are substance abuse disorders more common in men or women?

Men

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Intoxication associated with __% of MVAs, DV cases, and murders.

50%

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T/F: Addiction is a diagnostic term according to DSM-5

False

It is not

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How are substance abuse disorders defined in DSM-5?

Any inappropriate use of a substance versus previous definitions that separated this into abuse versus dependence

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_________ is defined as a reversible syndrome due to the recent use of substance

Intoxication

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_______ is defined by the following…..

1) Need to use an increased amount of a substance in order to achieve the desired effect
2) Markedly diminished effect with continued use of the same amount of the substance

Tolerance

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________ is defined as normal function only becomes possible with active use of a substance, and cessation of this substance causes adverse physiological consequences.

Dependence

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_______ is defined as a cluster of symptoms with an onset closely following the cessation (or reduction in dose) that is specific to a drug (or drugs). Symptoms can be both physiological and cognitive

Withdrawal

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What is the name of the questionnaire used in assessing alcohol dependence?

CAGE Questionnaire

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Should you complete a mental status examination when working up substance abuse?

Yes

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What co-morbid conditions are likely to accompany a patient with a substance abuse disorder?

Depression
Anxiety
Personality Disorder

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Why are the following ordered (to rule in/out) when working up Alcohol Abuse….

CBC
CMP
Thiamine

CBC - Anemia, Bone Marrow Depression

CMP - Liver Function

Thiamina - Wernicke’s Encephalopathy

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Which of the following would NOT be considered a direct diagnostic test for alcohol abuse

A) A blood alcohol level in excess of 300 mg/dL
B) A blood alcohol level of greater than 150 mg/dL without gross evidence of intoxication
C) A blood alcohol level of 100 with evidence of clinical intoxication
D) A blood alcohol level of greater than 100 mg/dL upon routine examination indicates alcoholism with a high degree of reliability

C) A blood alcohol level of 100 with evidence of clinical intoxication

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What are EARLY manifestations of chronic alcoholism with underlying organ disease?

Rosacea
Palmar erythema
Palpable liver from fatty liver disease
Respiratory infections
Easy bruising

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What are LATE manifestations of chronic alcoholism with underlying organ disease?

Caput medusae
Ascites
Jaundice
Esophageal varices/hemoptysis/hematochezia

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To be diagnosed with an alcohol use disorder…..

A patient must exhibit signs/symptoms/behaviors over a ___ _______ period

12 Month Period

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An uncomplicated withdrawal (“Shakes”) typically onsets when?

Peaks when?

Subsides when?

Onset: 7-38 hours after cessation

Peak: 24-48 Hours

Subsides: 5-7 Days

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What manifestation during a alcohol withdrawal period would be indicative of marked, chronic alcohol abuse?

Seizures

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A patient may develop alcoholic hallucinosis how long after cessation of alcohol?

What types of hallucinations may occur?

Can these be permanent?

Within 48 hours of cessation

Hallucinations can be auditory, visual, or tactile

These can sometimes become permanent

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What is the most severe form of alcohol withdrawal?

Delirium Tremens

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What are clinical manifestations of delirium tremens?

Confusion
Agitation
Mild fever 
Nausea
Irritability
Tremor
Autonomic hyperarousal*

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T/F: Delirium Tremens is NOT a medical emergency

False

It is

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T/F: Delirium Tremens can progress to cardiovascular collapse

True

What medication class is commonly used in alcohol withdrawal?

Benzodiazepines

T/F: Patients experiencing alcohol withdrawal and seizures, hallucinosis, or DTs should be hospitalized

True

What is the name of the 'score' used in alcohol withdrawal assessment?

CIWA-Ar

Other than benzodiazepines..... What are THREE medications used to treat alcohol abuse disorders?

1. Disulfiram (Antabuse) 2. Naltrexone (Avoid in liver disease) 3. Acamprosate (Compliance issues, need to take TID)

What is the number 1 goal of alcohol abuse rehabilitation?

Complete Sobriety

What percent of patients with alcohol abuse disorder will relapse following treatment? In what time interval is relapse most likely?

50% Relapse is most likely within the first 6 months following initial treatment

T/F: All alcohol abuse patients should be referred to AA in order to obtain further support from people going through the same issues

True

Abuse of the following would be considered a ______-abuse disorder ``` Morphine Heroin Hydrocodone Oxycodone Codeine Tramadol Meperidine Opium Methadone ```

Opioid

T/F: Opioid prescription users have a very LOW chance of becoming addicted to their medications

False They have a very high chance

Opioid abuse in general is more common in _____ (men/women).

Men

Prescription pain medication addiction is more common in ____ (men/women)

Women

In a patient intoxicated by opioids would you expect to see..... Mydriasis or Miosis? Bradycardia or Tachycardia? Tachypnea or Bradypnea? Hypertension or Hypotension? Excitation or Sedation?

Miosis Bradycardia Hypotension Bradypnea Hypotension Sedation

Is opioid withdrawal life threatening? What are symptoms of opioid withdrawal? How is this managed?

No (But very uncomfortable) Symptoms.... ``` Mydriasis Lacrimation N/V/D Myalgias Agitation ``` Management..... Symptomatic (Antiemetic, NSAIDs, Antidiarrheal, BZDs)

What is the name of the medication used in opioid withdrawal that is a long acting opioid itself? This can only be prescribed with a federal license

Methadone

Other than methadone.... What are two additional medications used in opioid withdrawal management?

Naltrexone | Beprenorphine

T/F: Intoxication from sedative, hypnotic, or anxiolytic medications will appear similar to opioid intoxication

False It will appear similar to alcohol intoxication with less cognitive/motor impairment

What are symptoms of sedative, hypnotic, or anxiolytic intoxication?

Lethargy Impaired Cognition Poor Memory If severe.... Slurred speech Ataxia Coordination Lose Respiratory Depression

What is a common cause of sedative, hypnotic, or anxiolytic withidrawal?

Tapering dose too quickly

What are symptoms of sedative, hypnotic, or anxiolytic withdrawal?

``` Anxiety Irritability Fatigue Headache Tremor Poor Concentration Diaphoresis ```

Abuse of the following medications would be considered a _______-abuse related disorder Cocaine, Crack Methylphenidate (Ritalin) Methamphetamine

Stimulant-Abuse Related Disorder

What are common symptoms of stimulant intoxication?

Autonomic hyperarousal Tachycardia HTN Mydriasis

T/F: Cocaine intoxication can induce tactile hallucinations

True

What are TWO concerning potential manifestations of cocaine intoxication/abuse?

Myocardial Infarction | Rhabdomyolysis with compartment syndrome

What are symptoms of stimulant withdrawal? When would you expect these symptoms to peak?

``` Fatigue Depression Nightmares HA Diaphoresis Muscle Cramps ``` Peak in 2-4 days from cessation and are self limiting

Although stimulant withdrawal is typically self-limiting..... What medications can be used to treat agitation in stimulant withdrawal?

Lorazepam | Diazepam

What are you concerned for 2 WEEKS after stimulant abuse cessation?

Depression

What are examples of common hallucinogens that are abused?

LSD MDMA PCP

How may a hallucinogen intoxication present?

``` Hallucinations Perceptual Disturbances Unreality Tachycardia HTN Diaphoresis Vision Changes Mydriasis ```

Is it possible for patients to have 'bad trips' or flashbacks while intoxicated on hallucinogens?

Yes

Are there often concerning symptoms when a patient is withdrawing from hallucinogens? What medication class can be used if the patient does develop agitation?

No Agitation: BZDs

T/F: Hallucinogen OD can result in life threatening symptoms such as arrhythmias or stroke

True

T/F: Hallucinogen withdrawal is treated with supportive care

True

The following are all symptoms of _______ intoxication. ``` Appetite Increase Relaxation Increased Libido Dry Mouth Tachycardia Impaired Cognition ```

Cannibis Intoxication

What are Sx of cannibis withdrawal?

``` Irritability Nervousness Poor Appetite Restlessness Depressed Mood Tremor Fevers Sweating ```

T/F: Cannibis withdrawal is primarily pharmacologically manged

False Supportive Care (Hydration, Supervision)

__% of US death have tobacco involvement

20%

What percent of smoker die from a tobacco induce disorder?

45%

__-__% of schizophrenic patients smoke tobacco

75-90%

Is there a tobacco intoxication diagnosis in DSM-5?

The following are all symptoms of _____ withdrawal ``` Dsyphoria Irritability Insomnia Increased Appetite Weight Gain Depression ```

Tobacco

How is tobacco withdrawal manged?

Cognitive Behavioral Therapy Agonist Therapy (Nicotine Gum, Lozange, TD Patch) Medications (Bupropion, Varenicline)

Substance Abuse Flashcards

(66 cards)