Substance Abuse Disorders Flashcards by Kara Albright

Criteria for Substance Use Disorder dignosis

maladaptive patterns of substance use that impair work, physical, social functioning

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Substance induced disorder

induced disorder: intoxication and withdrawal

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What drugs fall under stimulant use disorders?

amphetamines

cocaine

***dilated pupils

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What drugs fall under sedatives/hypnotics/anxiolytic use disorders?

benzos

barbiturates

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What drugs fall under hallucinogen use disorders?

LSD

PCP

Synthetics (K2, bath salts, molly/ecstasy)

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What drugs fall under opioid use disorders?

morphine

heroin

codeine

methadone

***constricted pupils

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Define at risk drinking

men: more than 14 drinks per week or more than 4 per occasion
female: more than 7 drinks per week or more than 3 per occasion

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Define moderate drinking

men: 2 drinks or fewer per day

females and over 65: 1 or fewer per day

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List childhood factors that can lead to alcohol abuse

environmental stressors: abuse, around alcohol so started drinking or saw alcoholic parents

ADHD

conduct or antisocial personality disorders: under 18, act inappropriate in public with rage, start fires, kill animals
—> AKA psychopaths and sociopaths

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Describe social/culture factors that can lead to alcohol abuse

Native Americans have highest rates of abuse

More frequent in non-African American races
—> HOWEVER, AA more likely to need tmt but don’t get it

Low rates in Asians

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When can you diagnose alcohol abuse?

clinically significant impairment or distress of 2+ in a 12 month period:

alcohol in large amounts over longer period of time than was intended
persistent desire or ineffective efforts to cut down
excessive amount of time trying to get alcohol or recover
cravings
recurrent use despite failures to meet obligations

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Describe tolerance

need for increased amounts to achieve desired effect

diminished effect with continued use of same amount

sign of dependence

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Describe sx of alcohol withdrawal

autonomic hyperactivity
increased hand tremor
insomnia
N/V
hallucinations
psychomotor agitation
seizures

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What are 3 things that can be fatal with sudden withdrawal?

3 Bs

booze
benzos
barbiturates

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Clinical presentation of alcohol abuse

solitary drinking with rationalization about their need to drink

daily or frequent drinking to function

loss of control over drinking, defensive, hostile

neglect food intake, physical appearance, hygiene

N/V, shaking in the morning, confusion

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What questions to ask alcoholic

CAGE

cut down, annoyed, guilty, early-morning to get through day or eliminate shakes

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List some alcohol induced disorders

intoxication, withdrawal
delirium (wernicke/korsakoff)
dementia
amnesic disorder
psychotic disorder
mood disorder
sexual dysfunction d/t neuropathy
sleep disorder (alcohol pass out but doesn't keep you asleep)

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Medical complications of alcohol abuse

decreased REM, awaken form sleep

fatty liver, cirrhosis, alcoholic hepatitis

GI varices, ulcers, pancreatitis

MI, cardiomyopathy, stroke

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Blood levels of alcohol

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.05 judgement and restraint impaired
.08 legally intoxicated
.30 stupor
.4-.5 coma
over .5 death

with chronic drinkers, can be way higher without meeting these criteria (can have .4 and be walking/talking)

Signs of alcohol intoxication

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slurred speech
loss of coordination
unsteady gait
nystagmus
------------> above checked by police
impaired attention or memory
stupor or coma

mild: overconfidence, mood swings, increased pain threshold, N/V
severe: hypothermia, tachy, dilated pupils, slow respirations, increased ICP

Signs of alcohol withdrawal

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delirium tremens—> 30% MORTALITY if not treated

-> tremulousness
-> delusions
-> hallucinations
-> seizures

around day 3, up to 2 weeks

Treatment of alcohol withdrawal

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benzos
antipsychotics only when necessary (if delirium tremens)
fluids (help mag, potassium)
vitamins (thiamine, folic acid)
restraints if needed

if conscious, wait it out with IV thiamine/fluids

What drug is used to maintain abstinence in alcoholics following withdrawal?

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acamprosate

reduces voluntary ingestion of alcohol via inhibition of GABA, also antagonizes receptor

doesn’t treat withdrawal or prevent intoxication

What drug is used to reduce alcohol cravings?

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Naltrexone (opioid antagonist)

improves abstinence

can be injected monthly

What is disulfram?

antabuse drug--> alcohol intake is deterrent produces adverse effects if drinks alcohol: flushing, tachy, SOB, N/V, throbbing headache, visual shit some don't have sx or have sx that can be tolerated--> decreased abstinence effectiveness

Signs of stimulant intoxication

AKA meth, cocaine, Adderall ``` hypervigilance anxiety/irritable insomnia, exhaustion hyperthermia loss of appetite and weight hallucinations DILATED pupils elevated BP and pulse seizures ``` pick at skin--> lesions necrotic teeth

Signs of stimulant withdrawal

``` increased sleep nightmares increased appetite depression suicide attempts craving for drug ``` won't die--> just sleep and eat

Treatment for stimulant withdrawal

antidepressants, hospitalization phentolamine for hypertension and hyperthermia Halperidol (Haldol) for psychotic sx

Sx of sedatives/hypnotics/anxiolytic intoxication

AKA benzos and barbiturates euphoria increased seizure threshold sedation, coma RESPIRATORY DEPRESSION depressed reflexes hypotension hypoxemia hypothermia

Treatment of sedative intoxication

protect airway oxygen ventilation prevent loss of body heat forced diuresis with alkalinization of urine hemodialysis

Sx of sedative withdrawal

FATAL****** ``` anxiety/agitation orthostatic hypotension weakness/tremulousness hyperreflexia diaphoresis delirium seizures ```

Tmt of sedative withdrawal

phenobarbital weans pt off sedatives

Signs of hallucinogen intoxication

AKA LSD and PCP ``` DILATED pupils increased heart rate, BP paranoia anxiety hallucinations ``` PCP--> violent behavior, hyperactivity, nystagmus, muscular rigidity, seizures

Tmt of hallucinogen intoxication

diazepam sedation with Haldol/haloperidol if violent

Sx of hallucinogen withdrawal

flashbacks of hallucinogenic state | --> several days to weeks

Tmt of hallucinogen withdrawal

reassurance benzo

Sx of opioid intoxication

AKA morphine, heroin, codeine, methadone ``` analgesia /t LOC apathy/lethargy euphoria itching CONSTRICTED pupils constipation flushed, warm skin ``` RESP Depression hypotension and depressed reflexes

Tmt of opioid intoxiation

supportive care NARCAN (naloxone) - -> reverse coma and apnea - --> causes vomiting - -> intranasal

Sx of opioid withdrawal

lacrimation, rhinorrhea, coryza sweating restlessness/sleepiness gooseflesh DILATED pupils irritability violent yawning craving NOT FATAL

Tmt of opioid withdrawal

buprenorphine or methadone buprenorphine and naloxone - -> suboxone - -> requires specialized training and DEA number clonidine for elevated BP diphenhydramine for itching and rhinorrhea imodium for diarrhea

Advantages/Disadvantages of Buprenorphine

with or without naloxone +: -not an opioid (partial ag/antag @ opioid receptor, minimal chance of overdose) - prescribed by physician with special training - not long term - helps with mild-moderate pain -: -cost -finding legitimate licensed providers

Advantages/Disadvantages of methadone

+: -available through licensed clinics without prescription -long half life (if missed dose, won't withdraw) - : - not closely monitored - have to go to clinic daily - doses are high--> prolonged QT/cardiac issues - pt remain opioid dependent

What meds to stop while pt is in hospital (recovering opioid addict)?

buprenorphine/naloxone (restart on discharge) continue methadone and treat pain

What is K2?

synthetic cannabis | --> really bad

What is molly?

MDMA/ecstasy hyperthermia, jaw clenching and teeth grinding nystagmus, dilated pupils tremors tachy, increased BP psychogenic polydipsia hyponatremia, CEREBRAL EDEMA sensation of chills auditory hallucinations orthostatic issues

What is wet?

cocktail of PCP mixed with formaldehyde and dipped into cigarettes

Tmt for molly intoxication

hypertonic saline solution (slow) hyperthermia ice bath for rapid cooling benzo for psychomotor agitation and shivering cyproheptadine for signs of serotonin syndrome

Substance Abuse Disorders Flashcards

(47 cards)