Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

PSYCH > Substance Abuse/Addictive > Flashcards

Substance Abuse/Addictive Flashcards

(79 cards)

Start Studying
1
Q

How long can amphetamines be detected on UDS for?

A

1-3 days, but LOW Se/Sp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How long can cocaine be detected on UDS for?

A

2-4 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How long can PCP be detected on UDS for?

A

4-7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How long can opioids be detected on UDS for?

A

1-3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How long can THC/cannabinoids be detected on UDS for?

A

3days - 4weeks (released from adipose stores)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How long can barbiturates be detected on UDS for? Specifically pentobarbital vs phenobarbital?

A 
PENTObarbital = short-acting - 24hrs 
PHENObarbital = long-acting - 3wks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How long can benzodiazepines be detected on UDS for? Specifically lorazepam vs diazepam

A 
Lorazepam = short-acting - 5days
Diazepam = long-acting - 30days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

ALCOHOL: What are the supposed mechanisms of EtOH?

A

ACTIVATES GABA, dopamine, 5-HT/Ser

INHIBITS GLU, voltage-gated Ca

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

ALCOHOL: What are the components of a CIWA protocol?

A 
ANXIETY/AGITATION 
AH/VH/TH (formication) 
HA/ORIENTATION 
TREMOR/PAROXYSMAL SWEATS
N/V
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

ALCOHOL: What is the short-term treatment for EtOH withdrawal?

A

BZ taper - CHLORDIAZEPOXIDE (librium), LORAZEPAM (Ativan) moreso than DIAZEPAM (Valium - Longer acting)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

ALCOHOL: What is the course of EtOH withdrawal sx?

A

Onset: 6hrs and can last up to 2-7days

1) Generalized tonic clonic seizures (GTC) - 12-48hrs, peaks at 12-24hrs
2) Delirium tremens (DT) only occurs in 5% of population - have associated sx, peaks at 48-96hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

ALCOHOL: What electrolyte abnormality predisposes to alcohol withdrawal-related GTCs?

A

HYPOMAGNESIUM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

ALCOHOL: What are the 3 risk factors that predisposes to alcohol withdrawal-related DTs?

A

Medical illness, age>30yo, prior DT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

ALCOHOL: What is in the BANANA BAG for actively withdrawing from alcohol pts?

A

THIAMINE/VIT B1 + FOLATE + MULTIVITAMIN

Mainly to prevent Wernicke’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

ALCOHOL: What are the 2 1ST LINE MEDICATIONS used for LONG-TERM ALCOHOL USE DISORDER?

A

1) NALTREXONE (Oral Revia, IM-Vivitrol) - ACTIVELY drinking

2) ACAMPROSATE (Campral) - ABSTINENT maintenance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

ALCOHOL: 1st LINE: How does NALTREXONE work for ALCOHOL USE DISORDER? Contra-indicated in which pts?

A

Opioid antagonist that decreases “cravings” or the “high” associated with EtOH

Contra-indicated in pts w/ physiologic dependence to opioids + ACUTE LIVER FAILURE/hepatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

ALCOHOL: 1st LINE :How does ACAMPROSATE work for ALCOHOL USE DISORDER? Can it be used in pts with severe liver dz or severe renal dz?

A

Modulates (Decreases) GABA transmission - Started POST-DETOX to prevent relapses?

YES, can be used for LIVER Dz
NO, can NOT be used for RENAL Dz pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

ALCOHOL: What are the 2 2ND LINE MEDICATIONS used for LONG-TERM ALCOHOL USE DISORDER?

A

1) DISULFURAM (Antabuse)

2) TOPIRAMATE (Topamax)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

ALCOHOL: 2nd LINE: How does DISULFURAM work for ALCOHOL USE DISORDER? Contra-indications?

A

Blocks ALDEHYDE DEHYDROGENASE in liver -> Causes aversive rxn to EtOH (flushing/HA/N/V/palpitations/SOB)

CONTRA-INDICATIONS: Pregnancy + Psychosis + Severe cardiac dz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

ALCOHOL: 2nd LINE: How does TOPIRAMATE work for ALCOHOL USE DISORDER?

A

Potentiates GABA, Inhibits Glu -> Reduces cravings and decreases EtOH use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

ALCOHOL: In managing alcohol withdrawal pts with altered mental status (AMS), what is critical about the order of treatment?

A

Give THIAMINE/VITB1 BEFORE Glc infusion

If Glc is given first, will precipitate Wernicke-Korsakoff encephelopathy bec any limited VitB1 leftover will immediately be utilized with Glc by carbohydrate metabolism -> Acute neuronal damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

ALCOHOL: What are the 2 LONG-TERM COMPLICATIONS of ALCOHOL USE DISORDER?

A

1) WERNICKE ENCEPHELOPATHY - Confusion + Broad-based ataxia + Ophthalmoplegia (horizontal nystagmus, gaze palsy)
2) KORSAKOFF SYNDROME - Impaired recent memory + Chronic amnesia, anterograde amnesia + Compensatory confabulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

ALCOHOL: What is the cause of Wernicke Encephalopathy? Is this reversible?

A

ALCOHOLISM -> Decreased nutrition -> DECREASED VITB1/THIAMINE

YES, Reversible with VITB1 therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

ALCOHOL: Is Korsakoff syndrome reversible?

A

MORESO IRREVERSIBLE

Reversible in only 20% of patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
COCAINE: What is the mechanism of Cocaine?
BLOCKS presynaptic-reuptake of NE/E, DOPAMINE -> Increases Neurotransmitters in cleft "reward" system
26
COCAINE: How can cocaine use be lethal?
VASOCONSTRICTIVE effect-mediated MI, ICH, STROKE Respiratory depression/arrhythmia, Tactile hallucinations
27
COCAINE: What is the mgmt of a cocaine user pt?
1) MILD-MOD Agitation - Reasurrance + BZ 2) SEVERE Agitation - Haloperidol 3) Monitor VS, HTN, arrhythmia 4) If Temp>102, AGGRESSIVE - Cooling blanket + ice bath + supportive measures
28
COCAINE: Is abrupt abstinence and withdrawal lethal? | Common pinpoint sx of cocaine withdrawal?
NO, withdrawal is not life-threatening CONSTRICTED PUPILS (PNS), CRASH/DEPRESSION/INCREASED SI + Hyperphagia + increased dreamings
29
AMPHETAMINES: What is the mechanism of amphetamines?
Blocks re-uptake + facilitates release of NE + DOPAMINE
30
AMPHETAMINES: What are the examples of amphetamines?
DEXTROAMPHETAMINE (Dexedrine) METHYLPHENIDATE (Ritalin) METHYAMPHETAMINE (Desoxyn, "ice, speed, crystal meth, crank")
31
AMPHETAMINES: What are the examples of substituted "designer/club drugs" amphetamines? Mechanism?
MDMA (ECSTASY) + MDEA (EVE) | Releases NE + DOPAMINE +5-HT/SER
32
AMPHETAMINES: When ECSTASY/MDMA are combined with SSRIs, what can happen?
SER SYNDROME
33
AMPHETAMINES: Sx of overdose
DILATED PUPILS + euphoria/increased libido, tachy/perspirations, grinding teeth, chest pain, hyperthermia, dehydration, rhabdo, renal failure CHRONIC methamphetamine use - TOOTH DECAY/POOR DENTITION "meth mouth" + TACTILE HALLUCINATIONS/ PARANOIA/ EXCORIATIONS due to skin picking MDMA/MDEA - Induces sense of closeness
34
PCP: What is the mechanism of PCP?
PCP = angel dust = stimulant or depressant (dependent on dose) Antagonizes NMDA Glu-R + Activates dopaminergic neurons
35
PCP: Which drug is similar to PCP, but less potent - odorless/tasteless/date rape drug - tachy/tachypnea/hallucinations + amnesia?
KETAMINE
36
PCP: What is the cardinal symptom of PCP intoxication?
NYSTAGMUS (**rotatory, horizontal, or vertical) | + VIOLENCE/DELIRIUM/dissociation/ataxia
37
Which two substances can produce both TACTILE + VISUAL HALLUCINATIONS?
COCAINE + PCP
38
PCP: What is the treatment of PCP INTOXICATION?
1) Control environment - minimize sensory stimulation 2) Monitor VS, temperature, electrolytes 3) Agitation/anxiety/muscle spasms/seizures - Use BZ (lorazepam) 4) Severe agitation/psychosis - Use antipsychotics haloperidol
39
Intoxication of which drug is most likely to result in violence?
PCP
40
SED/HYPNOTIC: Which drug is a dose-specific CNS depressant that produces confusion/dizziness/drowsiness/memory loss + respiratory depression/coma commonly used as a date rape drug?
GAMMA HYDROXYBUTYRATE (GHB)
41
SED/HYPNOTIC: What is the mechanism of BZ? What is the mechanism of BARBITURATES?
BOTH potentiate GABA effects. BZ: Modulate GABA-R -> Increases FREQUENCY of Cl- channel opening BARBITURATES: Binds GABA-R -> Increases DURATION of Cl- channel opening
42
SED/HYPNOTIC: Why do BARBITURATES have a lower margin of safety than BZ?
AT HIGH DOSES: Barbiturates can act as DIRECT GABA AGONISTS Synergistic in combination with other CNS depressants - BZ, EtOH, opioids, narcotics -> can result in respiratory depression
43
SED/HYPNOTIC: Of all kinds of drug withdrawals, which withdrawal has the highest mortality rate?
BARBITURATE WITHDRAWAL
44
SED/HYPNOTIC: What is the REVERSAL AGENT for BZ OVERDOSE? Mechanism? Used with caution bec it may precipitate __?
FLUMAZENIL = Short acting BZ antagonist | May precipitate seizures
45
SED/HYPNOTIC: What is the REVERSAL AGENT for BARBITURATE OVERDOSE? Mechanism?
SODIUM BICARBONATE = Alkalinize urine to promote renal excretion of barbiturates
46
SED/HYPNOTIC: If BZ/barbiturates are ingested within 4-6hrs, what can be done?
ACTIVATED CHARCOAL, GASTRIC LAVAGE - Prevent further GI absorption
47
SED/HYPNOTIC: Is withdrawal from chronic BZ/BARBITURATE use life-threatening?
YES, life-threatening - GTC SEIZURES** (same as EtOH withdrawal) BARBITURATE withdrawal has the highest mortality rate
48
Rule of thumb for life-threatening withdrawal from substances
Withdrawal from DEPRESSANTS (EtOH, BZ, Barbiturates) = Life-threatening Withdrawal from STIMULANTS (cocaine, amphetamines, PCP) = NOT life-threatening
49
OPIOIDS: What is the mechanism of opioids?
1) STIMULATE MU, KAPPA, DELTA opiate receptors - normally stimulated by endogenous opiates 2) DOPAMINERGIC system - mediates addictive/rewarding paths
50
OPIOIDS: Name the common opioids.
HEROIN, OXYCODONE, CODEINE, DEXTROMETHORPHAN (cough syrup), MORPHINE, METHADONE, MEPERIDINE (demerol)
51
OPIOIDS: What is a common cause of morbidity from street heroin use?
INFECTION SECONDARY TO NEEDLE SHARING
52
OPIOIDS: Intoxication symptoms, CLASSIC TRIAD?
MIOSIS (CONSTRICTED) + CONSTIPATION + N/V + RESPIRATORY DEPRESSION CLASSIC TRIAD: AMS + MIOSIS + Respiratory depression
53
OPIOIDS: Which opioid is the only exception to producing MIOSIS?
DEMEROL DILATES PUPILS | DEMEROL/mepiridine
54
OPIOIDS: Which opioid taken with MAO inhibitors can cause SER SYNDROME?
MEPERIDINE + MAO-I can cause SER SYNDROME
55
OPIOIDS: What is the agent used for OPIOID OVERDOSE?
NALOXONE - opioid antagonist | Will improve respiratory depression but can cause SEVERE WITHDRAWAL in opioid-dependent pt
56
OPIOIDS: Cardinal sx for opioid withdrawal
DILATED PUPILS + RHINORRHEA/LACRIMATION/YAWNING + Piloerection + ARTHRALGIA/MYALGIA + abdominal cramping + Hyperactive bowel sounds
57
OPIOIDS: What in the diet can give a false positive for opioids in UDS?
Large amts of poppy seed bagels/muffins
58
OPIOIDS: What is the gold-standard treatment for pregnant opioid-dependent women? What is its mechanism of action?
METHADONE - LONG-ACTING opioid-R antagonist
59
OPIOIDS: Adverse components of METHADONE
Can OD QTc prolongation, caution with cardiac dz pts Only federally licensed substance abuse programs can dispense
60
OPIOIDS: Which is a safer alternative for OPIOID DEPENDENCE than methadone due to "ceiling effect"? Mechanism of action?
BUPRENORPHINE - partial opioid-R agonist | Effects reach a plateau -> Make overdose unlikely
61
OPIOIDS: What is the preparation of SUBUTEX and SUBOXONE?
SUBUTEX - Sublingual buprenorphine | SUBOXONE - Sublingual buprenorphine/naloxone
62
OPIOIDS: What is the purpose of naloxone in SUBOXONE?
Naloxone only acts as a DETERRENT if pt tries to inject suboxone BUPRENORPHINE = fat-soluble = sole molecule in suboxone responsible for diminishing cravings NALOXONE = water-soluble = normally no action if used properly; if injected, will precipitate withdrawal
63
OPIOIDS: Other than methadone and buprenorphine, what is another pharmacological treatment of opioid use disorder? Mechanism of action?
NALTREXONE - Oral daily OR IM depot injection monthly | Competitive opioid antagonist - will precipitate withdrawal if used within 7d of heroin usage
64
OPIOIDS: What is the biggest hindrance for subscribing NALTREXONE for opioid use disorder?
COMPLIANCE - Have to take daily or monthly injection
65
OPIOIDS: Is withdrawal from opioids life-threatening?
NOT life-threatening, but does show severe symptoms - anxiety/anorexia + insomnia/fever/rhinorrhea/piloerection
66
OPIOIDS: What is the management of OPIOID OVERDOSE?
1) Moderate sx - symptomatic tx: Pain - NSAIDs, abdominal cramps - dicyclomine, autonomic signs/withdrawal - clonidine 2) Severe sx - detox with buprenorphine/methadone
67
HALLUCINOGEN: What are the common hallucinogens? Proposed mechanism of action?
PSILOCYBIN (MUSHROOMS), MESCALINE (PEYOTE CACTUS), LSD | Acts on 5-HT/serotonergic system
68
HALLUCINOGEN: Cardinal sx of halucinogen overdose
LSD flashback - recurrence of symptoms mimicking prior LSD trip that occurs spontaneously and lasts for mins-hrs
69
MARIJUANA: What is the most common active component in marijuana? Mechanism of action?
THC = most common active component | Cannabinoid-R in brain inhibit adenylate cyclase
70
MARIJUANA: Medical conditions treated by THC
1) N/V in chemotherapy pts 2) Decreases pain from cancer pts 3) Increases appetite in AIDS 4) Decreases IOP in glaucoma pts
71
MARIJUANA: What is the pill form of THC that is FDA-approved for certain indications?
DRONABINOL
72
NICOTINE: What is the supposed mechanism of action of nicotine?
NICOTINE stimulates nicotinic-R in autonomic ganglia of SNS and PNS + effects on dopaminergic system
73
NICOTINE: What are 2 FDA-approved pharmacotherapy for nicotine dependence?
1) VARENICLINE - alpha4beta2 cholinergic receptor partial agonist mimics action of nicotine - reduces awarding aspects + prevents withdrawal 2) BUPROPION - antidepressant NET, DAT inhibitor
74
SED/HYPNOTIC: What are signs of BZ ONLY overdose? At what point do you think of co-ingestion of another hypnotic/sedative?
ALTERED LOC + SLURRED SPEECH + ATAXIA = BZ only VS alteration (hypotension, bradycardia, decreased respiratory rate) = BZ + ETOH (most common co-ingested)
75
INCREASED AGGRESSION + MALE PATTERN BALDNESS (receding hair line) + GYNECOMASTIA + DECREASED TESTICULAR SIZE/SPERM COUNT/VIRILIZATION + ACNE + DECREASED HDL + HEPATIC DYSFUNCTION = abuse of __?
ANABOLIC STEROIDS (testosterone)
76
ALCOHOL: Which BZ should NOT be used in pts undergoing EtOH Withdrawal with suspected liver disease? Which is safer for liver disease pts?
CHLORDIAZEPOXIDE (Librium) is NOT used LORAZEPAM (Ativan) is SAFER
77
Which ELECTROLYTE abnormality is common with MDMA (ECSTASY) INTOXICATION?
HYPONATREMIA -> Can result in COMA/DEATH/SEIZURES
78
Which amphetamines can NOT be detected on UDS? What can give false positives?
BATH SALTS | FALSE +: BUPROPRION, DECONGESTANT (PSEUDOPHEDRINE), SELEGILINE
79
ANTICHOLINERGIC TOXICITY and AMPHETAMINE intoxication both present with tachy, htn, mydriasis. How do you differentiate between the two?
ANTICHOLINERGIC TOXICITY: Dry as a bone - dry skin/mucous membranes, + MOTOR sx (Myoclonic jerks, tremors), Delirium rather than psychosis +Other sx (ileus, urinary retention) AMPHETATMINE INTOXICATION: Diaphoretic/profuse sweating, - Motor Sx, Isolated psychosis sx

PSYCH (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions