Substance Abuse And Dependence

Question 1

definition/time course of abuse

Answer 1

impairment/distress for at least 12 months with problems

Question 2

definition of dependence

Answer 2

impairment or distress and 3 sx w/in 12 month period

Question 3

how to test for cocaine

Answer 3

urine + for 2-4 days

Question 4

how to test for amphetamines

Answer 4

urine + for 1-3 days, most assays not sensitive

Question 5

how to test for PCP

Answer 5

urine + for 3-8 days

CPK and AST are elevated

Question 6

how long does pentobarbital stay in the urine/blood?

Answer 6

24 hours

Question 7

how long does phenobarbital stay in the urine/blood?

Answer 7

3 weeks

Question 8

how long does lorazepam stay in the urine/blood?

Answer 8

3 days

Question 9

how long does diazepam stay in the urine/blood?

Answer 9

30 days

Question 10

how to test for opioids?

Answer 10

urine + 3-4 days

methadone and oxycodone come up negative on a general screen (order separate panel)

Question 11

how to test for marijuana

Answer 11

urine: heavy users (up to 4 weeks b/c adipose stores THC and THC gets released)
single use: 3 days

Question 12

mechanism of alcohol use

Answer 12

activates GABA and serotonin receptors in the CNS

inhibits glutamate receptors and voltage gated Ca channels

Question 13

BAL for intoxication

Answer 13

100 mg/dl: some signs

>150: obvious signs

Question 14

what 2 meds do you give for alcohol users?

Answer 14

thiamine and folate

Question 15

signs of alcohol w/d

Answer 15

sx begin b/w 6 and 24 hours after pt’s last drink
seizures b/w 6 and 48 hours
DT

Question 16

what fraction of pts with seizures from alcohol w/d develop DT?

Answer 16

1/3 (5% of pts hospitalized for EtOH w/d)

Question 17

how to treat DT?

Answer 17

benzos

Question 18

what are confabulations and what are they associated with?

Answer 18

memories of events that never occurred
associated with Korsakoff’s psychosis
pts are unaware they are making things up

Question 19

what other 2 meds can you use for alcohol taper (other than benzos)?

Answer 19

carbamazepine and VPA. these prevent seizures

Question 20

4 lab results caused by alcohol use

Answer 20

AST:ALT 2:1
elevated GGT
increased LFT’s
increased MCV

Question 21

4 treatments for alcohol abuse

Answer 21

disulfaram
naltrexone
acamprosate
topiramate

Question 22

how does naltrexone work for alcohol

Answer 22

opioid receptor blocker, decreases desire and craving and “high” associated with alcohol
great for pts with FHx of alcoholism
if pts are opioid dependent it will ppt w/d

Question 23

how does acamprosate work?

Answer 23

for alcohol
structurally similar to GABA
started post detox for relapse prevention in pts who have stopped drinking
*can be used in pts with liver disease
contraindicated in pts with severe renal disease

Question 24

how does topiramate work for alcohol

Answer 24

anticonvulsante, potentiates GABA, inhibits glutamate receptors
reduces cravings for alcohol

Question 25

Wernicke's vs korsakoff presentation

Answer 25

Wernicke's: ataxia (broad based), confusion, ocular abnormalities Korsakoff's: chronic amnesia

Question 26

pathophys of cocaine use

Answer 26

blocks dopamine reuptake

Question 27

how do amphetamines work?

Answer 27

block reuptake and facilitate release of dopamine and NE from nerve endings

Question 28

sx of amphetamine use (5)

Answer 28

dilated pupils, increased libido, perspiration, respiratory depression, chest pain

Question 29

how does MDMA (ecstasy) work?

Answer 29

release DA, NE, serotonin from nerve endings | stimulant and hallucinogenic properties

Question 30

what happens if you combine designer amphetamines (MDMA, MDEA) with SSRIs?

Answer 30

serotonin syndrome

Question 31

results of chronic amphetamine use

Answer 31

acne and accelerated tooth decay (meth mouth)

Question 32

sx of amphetamine OD (3) and w/d (2)?

Answer 32

OD: hyperthermia, dehydration (club), rhabdomyolysis --> renal failure w/d: prolonged depression, psychosis

Question 33

rotatory nystagmus is pathognomonic for what?

Answer 33

PCP intoxication

Question 34

how does PCP work?

Answer 34

antagonizes NMDA receptors and activates DA neurons | both stimulant and depressive fx, depending on dose

Question 35

what 2 drugs cause hallucinations?

Answer 35

cocaine, PCP

Question 36

use of what drug most commonly leads to violence?

Answer 36

PCP

Question 37

w/d sx of PCP use

Answer 37

none! but flashbacks can occur when PCP is released from adipose tissue

Question 38

how do benzos and barbituates work?

Answer 38

BDZ: increase frequency of Cl channel opening barb: increase duration of Cl channel opening both potentiate GABA effects

Question 39

GHB

Answer 39

causes memory loss, respiratory distress and coma | used as date rape drug

Question 40

w/d from what drug has the highest mortality rate?

Answer 40

barbiturates

Question 41

what to use for BDZ overdose?

Answer 41

flumazenil. be careful because can ppt seizures

Question 42

what to use for barb overdose?

Answer 42

alkalinize urine with sodium bicarbonate to promote renal excretion

Question 43

difference in w/d from sedating drugs vs stimulants

Answer 43

w/d from sedatives is life threatening | w/d from stimulants is not

Question 44

examples of opioids (7)

Answer 44

heroin, oxycodone, codeine, dextromethorphan, morphine, methadone, meperidine (demerol)

Question 45

3 most commonly abuse opioids

Answer 45

prescriptions! oxycontin (oxycodone), vicodin (hydrocodone/acetominophen), Percocet (oxycodone/acetaminophen)

Question 46

which opioid does not produce miosis?

Answer 46

demerol dilates pupils | meperidine

Question 47

eating poppy seeds --> + urine screen for what?

Answer 47

opioids

Question 48

what to use for treating pregnant opioid dependent women?

Answer 48

methadone

Question 49

s/e of methadone

Answer 49

QT prolongation, do EKG

Question 50

buprenorphine

Answer 50

use for opioid w/d

Question 51

complication of long term LSD use

Answer 51

flashbacks: last minutes to hours

Question 52

medical indications for using marijuana (3)

Answer 52

treat nausea in chemo pts increase appetite in AIDS pts decrease intraocular pressure, muscle spasms, and tremor

Question 53

are most inhalants stimulants or depressants?

Answer 53

depressants

Question 54

inhalant OD leads to ...

Answer 54

may be fatal 2/2 respiratory depression or cardiac arrhythmias

Question 55

mechanism of caffeine

Answer 55

adenosine antagonist, causing increased cAMP and stimulant effect via DA system

Question 56

cigarette smoking during pregnancy leads to... (2)

Answer 56

persistent pulmonary HTN of the newborn | low birth weight

Question 57

chantix

Answer 57

mimics action of nicotine and prevents w/d sx

Question 58

bupropion for smoking cessation

Answer 58

partial agonist of nAChR and inhibitor of dopamine reuptake, reduces w/d sx