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Flashcards in Substance Abuse/Dependence Deck (36):
1

Definition of Abuse

Impairment or distress for AT LEAST 12 months + 1 or more of these:

- can't fulfill obligations at work/school/home
- use in dangerous sit. (driving)
- recurrent legal problems a/w drug use
- cont. use despite soc/interpersonal problems caused by the use of the drug

2

Definition of Dependence

AT LEAST 3 OF THESE:
- Tolerance
- Withdrawl
- persistent desire or unsucc. efforts to cut downn
- dec. social, occupation, or recreational activities b/c of sub. abuse
- continued use despite subsequent phys or psych problems (drinking despite liver problems)

3

Cocaine in system

2-4 days

4

Amphetamines in system

1-3days

5

PCP in system

urine drug screen + for 3-8days
CPK and AST are elevated

6

Sedative-hypnotics in system
- Barbituates

long acting (phenobarb) - 3 weeks
short acting (pentobarb) - 24 hours

7

Sedative-hypnotics in system
- BZD

long-acting (diazepam) - 30 days
short acting (lorazepam) - 3 days

8

Opioids in system

urine test positive for 2-3 days
Methadone and oxycodone are NEGATIVE on GENERAL screen

9

Weed in system

urine test - up to 4weeks in heavy user (thc in fat)
after single use - 3days

10

EtOH BAL effects
- 20-50mg/dL
- 50-100mg/dL
- 100-150mg/dL
- 150-250mg/dL
- 300mg/dL
- 400mg/dL

- 20-50mg/dL ==> dec fine motor
- 50-100mg/dL ==> impaired judjge/coord
- 100-150mg/dL ==> ataxic gait/poor balance
- 150-250mg/dL ==> lethargy, diff. sitting up, difficulty w/ memory
- 300mg/dL ==> coma in novice drinker
- 400mg/dL ==> resp. dep./death

11

EtOH W/D sx

sx w/in 6-24 hrs and last 2-7days
Mild --> irritable, tremor, insomnia
Mod --> diaphoresis, hypertension, tachy, fever, disorient
Severe --> tonic clonic/DT/hallucinations

12

Opiod OD tx

Naloxone

13

EtOH poisoning

gastric lavage, induction of emesis, and charcol is NOT INDICATED unles....large volume was ingested in the last 30min-1hr

14

Seizures in EtOH W/d

occur 6-48hrs after lasrt drink (peak is 13-24hrs)
- generalized tonic clonic
- 30% --> DT M:F = 5:1
- inc seizures w/ hypoMg
- tx w/ BZD
-----can use carbamazepine or valproic acid taper

15

Meds for EtOH dependence

Disulfiram
- blocks Ald. DH in liver --> cases bad rxn to alcohol
- ^^^contraindicated in cardiac dx, pregnancy and psychosis
Naltraxone (Revia, IM-Vivitrol)
- opioid receptor blocker
- dec the desire/craving and high a/w Etoh
- better in pt who have FHx of etoh abuse
- if pt has phys opioid dependence it WILL precipitate withdrawal
Acamprosate (Campral)
- started post-detox FOR RELAPSE PREVENTION
- CAN be used in liver dx patients = main adv
---> CANNOT be used in SEVERE kidney dx
-

16

Tactile Hallucinations seen in

EtOH Withdrawl
Some Drug Abuse

17

Heroin Withdrawal Sx

Diarrhea
Runny Nose
lots of yawning
anxious and restless
vomitting
HTN
muscle twitch/myalgias
BLOWN pupils
Untx the sx resolve in 7-10 days

18

Long Acting Opiate withdrawal

w/d sx delayed 1-3 days after last dose
- seen with methadone withdrawal

19

Cog deficits in Fetal Alc Sx

Delayed dev
hyperactive
attn deficits
learning or IQ d/o
seizures

20

Severe Opiate Intox

Seizures (grand mal)
pinpoint/constricted pupils
stupor/coma
resp depression
+/- pulm edema

21

Less Severe opiate intox

slurred speech
drowsy
impaired attn/memory
early on pupils are constricted but they dilaot if pt becomes ANOXIC from resp depression
BP is low

22

Meperidine intox

if in chronic user, the NOr-meperidine is a toxic metabolite that causes cerebral irritant properties

23

steps in opiate intox tx

FIRST --> ventilation/airway (INTUBATE and ASPIRATE secretions)
THEN ---> give naloxone

24

in what drug intox is forced diuresis good

salicylates and acetominophen

25

Hallucinogen intox duration

usually 8-12 hrs
but the psychosis (esp in PCP) can last weeks

26

length of Marijuanna in sys

3days to 4weeks depending on use

27

lenght of PCP in sys

8days

28

length of BZD in sys

3days (longer if long acting or chronic use)

29

EtOH w/d timeline

8 hrs after last drink is when sx start
*** if chronic user***
PEAK at 2-3rd day
diminished by 5Th day

30

Wernicke's

in severe prolong alc abuse
due to thiamine def ==> ENCEPHALOPATHY
C.O.At (confusion, optahlmoplegia, and ataxia)

- hallucinations in wernicke's start shortlty after drink and are AUDITORY and vivid
- also these are assoc with ANS instability

31

4 nutrients given in etoh w/d

Folic Acid
Thiamine
Glucose
Mag Sulfate (if seizure ppx)
(+ BZD)

32

if naloxone/naltrexone not available what can you give for some of the CV effects of Opiate withdrawal

give clonidine 3-4x/ day
GOOD FOR ANS instability sx
NOT good for cravings, insomnia and muscle aches that coming from w/d
- good for methadone detox

33

in PCP intox

look for ANS and Neuro excitation
-ranges seizures to nystagmus
- rage

34

why not to give to anti=psychotic in acute etoh w/d

will LOWER the seizure threshold

35

EtoH W/D delerium

20% can die,
result of PNA, Heaptic dx, or heart fx
sx of EtOH W/D Delerium =
- ANS hyperactive
- hallucinations
- Fluctuating activity levels (acute agitation to lethargy)

36

amphetamine vs cocaine MOA

Amphet - > incR release of DA and NE into synaptic cleft
Cocaine -> inhib reuptake of NE, etc