Substance Abuse Flashcards
(141 cards)
1
Q
How many high school seniors have reported using an illicit drug at least once?
A
1/2
2
Q
How many high school seniors report having been drunk within the past month?
A
1/3
3
Q
What OTC drug are students abusing?
A
Dextromethorphan (cough medicine)
4
Q
What type of drug are students using now with increased frequency?
A
Prescription (oxycodone)
5
Q
True or False: Use of more than one drug is more common than single use drug in kids?
A
True
6
Q
True or False: The earlier a child starts using a drug, the more likely it is that they will develop dependency
A
True
7
Q
What is he most common substance of abuse by young people?
A
Alcohol
8
Q
What is the most common illicit drug used by young people?
A
Marijuana
9
Q
True or False: More ER visits are due to the ill effects of marijuana (and/or drugs that might be mixed with it) than for alcohol
A
True
10
Q
Name 12 risk factors for drug abuse
A
- Low self esteem/poor coping skills
- Alienation from conventional norms
- Homosexuality
- Use of performance-enhancing drugs
- Parental use/abuse of drugs
- Child abuse
- Inconsistent parenting
- Drug use among close friends
- Early academic failure
- Disconnect from family/school/community
- Early behavior problems (ADHD/ODD/Moos and disruptive behavior disorders)
- Depression, conduct disorders, antisocial personality disorders
11
Q
True or False: Studies show that the media plays a powerful role in influencing adolescent behaviors related to alcohol and tobacco
A
True
12
Q
True or False: Parents should be encouraged to discuss and help their teenagers understand the circumstances under which they will be pressured to try drugs
A
True
13
Q
How should a pediatrician approach talking about drug use?
A
Open-ended questions asked in confidence
Ask about attitude in general regarding drug/alcohol use
14
Q
Why should casual use of drugs/alcohol not be dismissed?
A
The transition from casual use to dependence may occur more quickly in adolescents than adults
15
Q
What is a red flag to substance abuse?
A
Declining school performance
16
Q
What psychiatric comorbidity is common in kids who use drugs?
A
Conduct disorder
17
Q
What happens with psychiatric disorders after drug use?
A
Usually worsens after onset of drug use (and often precedes use of drugs)
18
Q
True or False: Kids with ADHD who are appropriately treated are less likely to abuse drugs that those who aren’t treated
A
True
19
Q
True or False: Drug abuse can mimic and worsen psychiatric disorders
A
True
*Alcohol/cocaine can induce depression or depression can lead to substance abuse
20
Q
True or False: Alcohol and drug use can cause psychosis or mimic anxiety disorders
A
True
21
Q
There is a higher likelihood of what type of trauma in kids who are abusing drugs?
A
Physcial
22
Q
What is one of the strongest predictors of substance use?
A
Hanging around peers who use substances
23
Q
Do urine drug screens have high sensitivity or specificity?
A
Sensitivity
24
Q
What time frame to urine drug screens reflect?
A
Substance use within the previous 48 hours
25
How long can marijuana be detected in a urine drug screen for?
Several weeks
26
What 2 things impact the validity of drug tests?
1. Urine specific gravity
| 2. Creatinine concentration
27
What are positive urine tox screens confirmed by?
Gas chromatography and mass spectrometry
28
What other factors are important in identifying besides which drugs are being used by teens?
1. How often
| 2. Context within which they are being used
29
True or False: Obtaining information from the school and/or law enforcement is considered appropriate when dealing with teen drug use
True
30
How should urine drug screen specimens be collected?
Under direct observation
31
What is one exception to strict confidentiality with regards to drug abuse?
If adolescent is at risk of harming themselves or others
32
Who is expected to track progress when an adolescent is placed into a drug treatment program?
The pediatrician
33
True or False: Random drug screening isn't recommended
True- If parents are requesting and teen is refusing, you should do a good H&P to address risks and concerns
34
If parents are requesting a random drug test for their child, what might be something to ask when doing history?
Parents for their mental health and drug use history
35
What is important to remember for any overdose victim?
Consider multiple drugs or potential combination of drugs from what is reported to you
36
What is one of the most commonly used drugs by adolescents?
Inhalants
37
Name commonly used inhalants
1. Volatile hydrocarbons: Paint thinner, gasoline, cleaning fluids, aerosols, lighter fluid, organic solvents, glue, spray paint
2. Nitrite compounds: Nitrous oxide, amyl nitrate
38
How do you inhale an aerosol?
Spray into a bag and then inhale from the bag
39
How do you inhale a liquid?
Pour onto a rag, then place it against the nose/mouth
40
What are the immediate effects of inhalant abuse?
Decreased inhibition, short-lived drowsiness/lightheadedness leading to ataxia and disorientation
41
How long does it take to feel the effects of inhalants and how long to the effects last?
Effects noticed within seconds and last 5-15 minutes (makes drug testing very hard)
42
What are some exam findings in someone who abused inhalants?
1. Sluggish pupillary responses
2. Bradycardia
3. "Glue-sniffer's rash" around nose and mouth
43
What are findings with inhalant intoxication?
Generalized muscle weakness, confusion, hallucinations, ataxia, delirium, nystagmus, and/or lack of coordination
44
True or False: You can have a hangover from inhalant intoxication
True (similar to alcohol hangover)
45
Which groups is inhalant use more common in?
Lower SE groups, Hispanic, Native American
46
What can repeated use of inhalants lead to?
Psychosis, dementia, bone marrow suppression
47
Name 3 fatal effects of inhalants
1. Asphyxia
2. Cardiac arrhythmia
3. Aspiration
48
What is the most common fatal complication of inhalant use?
Cardiac arrhythmia
49
How will an adolescent who is high from inhalant use present?
Mental status changes, but head CT and urine tox will be negative
50
What 2 substances might inhalant intoxication present similarly to?
1. Alcohol (agitation/ataxia)
| 2. PCP
51
What are 2 potential clues for inhalant intoxication versus alcohol or PCP?
1. Negative tox screen
| 2. Abnormal smell on their breath
52
What 3 things can long-term use of inhalants lead to?
1. Liver/kidney damage
2. Encephalopathy
3. Hematologic aberrations`
53
What problem can gasoline sniffers develop?
Lead toxicity
54
How many high school seniors have reported using marijuana at some point?
Close to half
55
What % of high school seniors report using marijuana daily?
5%
56
What is the potency of marijuana today compared to in the past?
Much more potent
57
Name 5 psychological consequences from marijuana use
1. Learning problems
2. Deficits in problem-solving skills
3. Memory impairment
4. Symptoms from underlying personality disorders, depression, and anxiety can worsen
5. Worse school performance
58
How long can memory impairment from marijuana last?
Up to 1 month after last use
59
Name 6 acute physiologic effects of marijuana
1. Dry mouth
2. Dilated pupils
3. Drowsiness
4. Distortion of time
5. Tachycardia (up to 3 hours)
6. Increased BP
60
How do you monitor the discontinuation of marijuana use?
Serial measurements of urine THC:Creatinine ratio (should decrease as marijuana use is discontinued)
61
Name 3 long-term physiological consequences of marijuana use
1. Compromised immune function
2. Decreased sperm count (reversible)
3. Impaired coordination (regular use)
62
What 2 systems does chronic marijuana use effect?
1. Pulm- Carcinogens
| 2. CV- Tachycardia/poor stamina
63
True or False: Gynecomastia is a consequence of chronic marijuana use
True
64
Name 4 symptoms of marijuana withdrawal
1. Irritability
2. Insomnia
3. Tremor
4. Nystagmus
65
When does marijuana withdrawal peak and how long can it last?
Peak: 4 days
Duration: 2 weeks
66
When do the effects of marijuana use begin?
Seconds after inhalation, fall rapidly within 30 minutes
67
Where is marijuana and its metabolites stored?
Lipid-soluble... stored in fatty tissue and released slowly
68
How long can tests for marijuana remain positive?
Month
69
What is the most common substance of abuse by young people?
Alcohol
70
What % of high school seniors report having used alcohol at some point in their lives?
80%
71
True or False: There may be a genetic association with alocoholism
True
72
Describe some findings of acute alcohol toxicity
1. Ataxia
2. Slurred speech
3. Visual disturbance
4. Nausea
5. Vomiting
6. Sluggishly reactive pupils (but normal pupil size)
7. Excessive sweating
8. Flushed skin
9. Hypoglycemia
10. Irritability
11. Stupor
12. Coma
73
What system do the medical effects of alcohol abuse typically hit?
GI- Esophagitis, gastritis, peptic ulcer disease
74
True or False: Teens with alcohol abuse may have liver cirrhosis
False- Teens haven't used long enough to have these effects
75
What are the 2 primary consequences of alcohol use/abuse in teens?
1. Physical trauma
| 2. Overdose
76
True or False: The majority of adolescents who binge drink aren't at risk for becoming alcoholics as adults
True
77
What are adolescents who binge drink at risk for having?
Pre-existing depression
78
What category of drugs are amphetamines?
Stimulants
79
What are the primary effects of amphetamines?
Sympathomimetic
80
What are some short-term physiologic signs of amphetamine toxicity?
Adrenergic: Tachycardia, high BP, sweating, agitation, fever, hyperthermia, dilated pupils with slow reaction to light, fatal arrhythmias
81
Feels like insects are crawling on one's skin... drug abused?
Amphetamines
82
True or False: Nystagmus is a common finding in amphetamine use
False
83
What is treatment for amphetamine overdose
1. Symptomatic
2. Decontamination: Gastric lavage/activated charcoal
3. ABC's
84
What should you always monitor for in amphetamine overdose?
Arrhythmias
85
What can be used for high BP and agitation in patients with amphetamine overdose?
Benzos
86
What can be used for psychosis seen in amphetamine overdose?
Haloperidol
87
What is needed for hyperthermia in amphetamine overdose?
Cooling blanked
88
What may be required in amphetamine overdose if other measures fail?
Hemodialysis
89
What type of drug is cocaine?
Stimulant
90
Name toxic effects of cocaine at lower doses
1. Euphoria
2. Overconfidence
3. Irritability
4. Insomnia
5. Tremors
6. Tachycardia
7. HTN
8. Hyperreflexia
9. Diaphoresis
10. Dilated pupils
11. Flushing
91
Name toxic effects of cocaine at higher doses
1. Aggressive/violent behavior
2. Hypertensive crises
3. Dysrrhythmias
4. Seizures
5. Coma
6. Myocardial infarction
7. Stroke
8. Cardiovascular collapse
9. Renal complications
92
In chronic abuse of cocaine, what can be seen on neuro exam?
Choreoathetotic movements (due to depletion of dopamine storage)
93
True or False: Death secondary to cocaine ingestion isn't dose dependent
True
94
How long are stimulants detected in blood/urine?
48 hours after lase dose (rapid metabolism)
95
How can cocaine be taken?
Pill, nasally, IV
Smokeable: Cocaine (crack), Meth (Ice)
96
What kind of effect do smokeable forms of cocaine and meth have?
Instant, extreme, intense, short-lived euphoria or rush
97
Typical presentation of opiate toxicity
1. Comatose
2. Responsive to painful stimuli
3. Pinpoint, but reactive pupils
4. Cyanosis
5. Respiratory depression
6. Decreased/shallow breaths
7. Bradycardia
8. Hypotension
9. Low temps
98
What is a miotic pupil?
Pinpoint (O is pinpOint)
99
What is a mydriatic pupil?
Dilated (myDriatic is Dilated)
100
Features that distinguish DKA from opiate toxicity in child with depressed level of consciousness
- DKA is rapid deep breathing
| - DKA no pupil constriction
101
Features that distinguish organophosphate toxicity from opiate toxicity in a child with depressed level of consciousness
- Both have constricted pupils
| - Organophosphate has profuse sweating, tearing, abdominal pain, wheezing, respiratory distress
102
Features that distinguish head trauma from opiate toxicity in a child with depressed level of consciousness
-Head trauma is often dilated, non-reactive pupils
103
What is a narcotic analgesic which also presents with ventricular arrhythmias, seizures, and/or pulmonary edema?
Propoxyphene
104
What is the treatment and diagnosis for opiate toxicity?
Naloxone
105
What type of drugs are barbiturates?
Sedatives
106
What are signs and symptoms of barbiturate overdose?
1. Bradycardia
2. Bradypnea
3. Hypotension
4. Hypothermia
5. Hypoactive bowel sounds
6. Hyporeactive pupillary reflex
107
True or False: Pupil size in barbiturate overdose is normal
True (If miosis- think opiate, not barbiurate)
108
What are the initial symptoms of barbiturate overdose and what could they be mistaken for?
Slurred speech, unsteady gait, impaired judgement, poor impulse control- Alcohol intoxication
109
What is a big clue for barbiturate overdose?
Nystagmus
110
What are the 4 categories of effects from Hallucinogens?
1. Sympathomimetic
2. Cholinergic
3. Cerebellar
4. Psychological
111
What are some sympathomimetic effects seen from hallucinogens?
1. Tachycardia
2. HTN
3. Increased reflexes
112
What are some cholinergic effects seen from hallucinogens?
1. Miosis
2. Flushing
3. Diaphoresis
113
What are some cerebellar effects seen from hallucinogens?
1. Vertical/horizontal nustagmus
2. Ataxia
3. Lack of coordination
114
What are some psychological effects seen from hallucinogens?
1. Disinhibition
2. Euphoria
3. Psychosis (looks like schizophrenia)
115
Name some examples of hallucinogens
1. Mescaline (peyote cactus)
2. Psilocybin (mushrooms)
3. Jimsonweed
4. LSD
5. PCP
6. Ecstasy
116
How are hallucinogens taken?
Orally
117
Name 5 presentations consistent with hallucinogen use
1. Distortion of body image
2. Paranoia
3. Agitation
4. Auditory and visual hallucinations
5. Distortions of time
118
Child who is mydriatic, violent, asymmetric pupils, anasarca... drug abused?
PCP
119
How is hallucinogen toxicity treated?
Supportive: Calm environment, dim lighting, talk back to reality about familiar things in reassuring tone
120
What can help alleviate risk for seizures, HTN, and hyperthermia in hallucinogen intoxication?
Cooling blanket
121
What medications may be helpful in hallucinogen intoxication?
1. Haloperidol
2. Chlorpromazine
3. Lorazepam
122
What can the effects of hallucinogens be similar to?
Schizophrenia
123
If you are questioning schizophrenia versus hallucinogen use, what should your do?
Re-evaluate after off drugs for 2-4 weeks
*Absence of family history of schizophrenia and absence of symptoms when patient is drug free points towards hallucinogens
124
Which type of hallucinations are more common with hallucinogen ingestion?
Visual
125
What type of hallucinations are more common with schizophrenia?
Auditory (in addition to completely disorganized and delusional thinking)
126
What is the most potent hallucinogen?
LSD
127
True or False: Ecstasy will not show up in most drug screens
True
*Unless high quantities ingested, then shows as amphentamines
128
Name 6 drugs that can present with combativeness
1. Cocaine
2. Alcohol
3. Inhalants
4. Opiates
5. Amphetamines
6. PCP
129
Name distinguishing features of cocaine intoxication
1. Tachycardia
2. Temulousness
3. HTN
4. Mydriasis
130
Name distinguishing features of alcohol intoxication
1. Combative behavior
2. Agitation
*Tremulousness isn't common in teens with this
131
Name distinguishing features of inhalant intoxication
1. Quick drunk
2. Disinhibition
3. Agitation
4. Halluincations
5. Generalized muscle weakness
6. Nystagmus
132
Name distinguishing features of opiate intoxication
1. Agitation
| * No tremulousness and tachycardia
133
Name distinguishing features of amphetamine intoxication
1. Combative
2. Tachycardia
3. Mydriasis
*No nystagmus
134
Name distinguishing features of PCP intoxciation
1. Combative
| 2. Vertical/horizontal nystagmus
135
Name 5 short term physiologic effects of nicotine
1. Increased alertness
2. Muscle relaxation
3. Enhanced memory and alertness
4. Decreased appetite
5. Decreased irritability
136
What are some adverse effects of nicotine?
1. PUD
| 2. Nausea and vomiting (initially, but wear off quickly)
137
Why is smoking cessation difficult?
Discomfort caused by withdrawal (verses absence of pleasurable symptoms)
138
What is one of the more important adverse effects of withdrawal?
Increased appetite
139
What are the 5 A's for brief intervention in smoking cessation?
1. Ask about tobacco use: Every patient/every visit
2. Advise to quit: Clear, strong, personalized manner
3. Assess willingness to attempt quitting: Is now a good time
4. Assist in quit attempt: Counseling, referral, pharmacotherapy
5. Arrange follow-up: Preferably within first week of quit date
140
True or False: Scare tactics about long term ill effects of smoking rarely work with adolescents
True: They view themselves as immortal
141
What are 3 things that the nicotine in chewing or smokeless tobacco can cause?
1. Early fatigue during sports
2. Tachycardia
3. Vasoconstriction
