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Behavioral Health > Substance Disorders & Treatment > Flashcards

Substance Disorders & Treatment Flashcards

(153 cards)

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1
Q

Define Substance Use

A

Sporadic consumption of alcohol/drugs with no adverse consequences

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2
Q

Define Abuse

A

Frequency of alcohol/drug use may vary, there are adverse consequences experienced by the user
Increase in the frequency to eventually all day

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3
Q

Define Physical Dependence

A

State of adaptation that is manifested by a drug class-specific withdrawal syndrome

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4
Q

Define Psychological Dependence

A

Subjective need for a specific psychoactive substance, either for its positive effect or to avoid negative effects of its abstinence
Positive: euphoric
Negative: withdrawal

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5
Q

Define Addiction

A

Primary, chronic, neurobiology disease, with genetic, psychosocial, & environmental factors

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6
Q

What is addiction characterized by?

A

Behaviors that include impaired control over drug use, compulsive use, continued use despite harm & craving

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7
Q

Define Tolerance

A

Must increase dose of the substance to get the high associated with the substance

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8
Q

Special Populations with Increase Risk of Substance Abuse

A 
Adolescents
Anyone with a psychiatric comorbidity
Those who smoke or who abuse alcohol
Elderly
Health care workers
Pregnant women
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9
Q

What questions to ask for each substance the patient uses?

A 
Quantity
Amount $ daily/weekly/monthly
Frequency of use & time of last use
Route of administration
Prior detox or addiction treatment & abstinence periods
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10
Q

Physical Changes in Substance Abuse

A 
Impotence
Weight loss
Sleep disturbance
Localized or systemic infections
Enlarged/shrunken liver
Respiratory or nasal problems
Track marks
STI's
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11
Q

CAGE Questionnaire

A

C: cut down on drinking
A: annoyed by criticism of your drinking
G: guilty about drinking
E: eye-opener (morning)

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12
Q

Define risky or hazardness drinking

A

Men 14 drinks/week

Women 7 drinks/week

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13
Q

Define Unhealthy Alcohol Use

A

Uses that can result in health consequences

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14
Q

Alcohol abuse is associated with one or more of the following occurring in a 12-month period

A

Failure to fulfill work, school or social obligations
Recurrent substance use in physically hazardous situations
Recurrent legal problems related to substance use
Continued use despite alcohol-related social or interpersonal problems

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15
Q

Alcohol dependece is a maladaptive patterns of use associated with 3 or more of the following, occurring at any time in the same 12-month period

A

Tolerance
Withdrawal
Substance taken in larger quantity than intended
Persistent desire to cut down or control use
Time spent obtaining, using, or recovering from the substance
Social, occupational or recreational tasks are sacrificed
Use continues despite physical & psychosocial problems

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16
Q

Medical Morbidity with Alcohol Abuse

A

HTN, cardiomyopathy
Hepatitis, cirrhosis, pancreatitis
TB, pneumonia
Anxiety, depression & eating disorders
CA of the stomach, mouth, larynx, breast, & esophagus

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17
Q

Screening Tools for Alcohol Use/Abuse

A

Alcohol Use Disorders Identification Test (AUDIT)

CAGE questions

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18
Q

Which patients are essential for screening for alcohol use/abuse?

A

+ family history
Smoke
Frequent ER visits
On meds that interact with ETOH

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19
Q

Screening Tool for Adolescents & College Students

A

CRAFFT

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20
Q

What does CRAFFT stand for?

A

ridden in Car driven by someone
alcohol or drugs to Relax, feel better about yourself, or fit in
alcohol or drugs while Alone
Forget things while on alcohol/drugs
family/Friends tell you to cut down on drinking/drug use
Trouble while using alcohol/drugs

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21
Q

Define Moderate Drinking

A

Men:

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22
Q

Define Heavy Drinking

A

Men: >14 drinks/week or >4 drinks/occasion

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23
Q

Define Binge Drinking

A

Men: 5+ drinks in a row
Women: 4+ drinks in a row

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24
Q

Define drink of 80-proof liquor

A

1.5 fluid ounces

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25
Define drink of wine
5 fluid ounces
26
Define drink of beer or wine cooler
12 fluid ounces
27
Etiology of Alcohol-Related Disorders
Psychosocial factors Genetic factors Behavioral factors
28
How does genetics play a factor in alcohol-related issues?
3-4 x higher for ETOH problems in first degree relatives with ETOH problems Problems increase with # of alcoholic relatives & severity
29
What does pylorospasm result in?
Vomiting
30
What 2 enzymes metabolize alcohol?
``` Alcohol dehydrogenase (ADH) Aldehyde dehydrogenase (ALDH) ```
31
Effects of Alcohol on the Brain
CNS depression
32
Effects of Alcohol on the Brain with Relatively Mild Levels
Thought, judgement, & restraint are loosened
33
Effects of Alcohol on the Brain with Increasing Levels
Voluntary muscle dysfunction & entire motor area of the brain depressed (walking, stupor)
34
Effects of Alcohol on the Brain with "Yet Increasing Levels"
Confusion, stupor, coma and primitive centers that control breathing & HR are affected & can result in death due to secondary to direct respiratory depression or aspiration of vomitus
35
Effects of Alcohol on the Liver
Metabolism leads to chemical attack on the liver | Processes that damage liver cells may continue for weeks to months
36
What are the 3 patterns of hepatocellular injury?
Fatty liver Alcoholic hepatitis Cirrhosis
37
What is caused by thiamine deficiency due to poor nutrition/malabsorption?
Wenicke-Korsakoff Syndrome
38
Define Wernicke's Encephalopathy
Acute symptoms which are reversible when treated with high dose thiamine
39
What is Wernicke's Encephalopathy characterized by?
``` Gait ataxia Vestibular dysfunction Confusion Ocular abnormalities Nystagmus ```
40
Define Korsakoff's Syndrome
Chronic condition 20% recover PO thiamine
41
Korsakoff's Syndrome Characterized by
Impaired recent memory Anterograde amnesia Brain injury
42
Short Term Goals for Treating Alcohol Dependence
ID & initiate treatment for pets. at risk for withdrawal Promote attendance at AA & support groups Early intervention
43
Long Term Goals for Treating Alcohol Dependence
Extended management over time | Determine efficacy of treatment
44
Mild Symptoms of Alcohol Withdrawal
``` Insomnia Tremulousness Mild anxiety GI upset/anorexia Headache Diaphoresis Palpitations ```
45
Alcohol Withdrawal Seizures
Occur within 48 hours after last drink Tonic-clonic 3% of chronic alcoholics Treat with benzodiazepines
46
Alcoholic Hallucinosis
12-24 hours of last drink Resolves 24-48 hours Not delirium tremens Usual visual
47
Agents that should NOT be used Routinely
``` Ethanol Antipsychotics Anticonvulsants Central acting alpha-2 agonists Beta-blockers Baclofen ```
48
Symptoms/Signs of Delirium Tremens
``` Hallucinations Disorientation Tachycardia HTN Low grade fever Agitation Diaphoresis ```
49
Delirium Tremens
48-96 hours after last drink | Last 1-5 days
50
Risk Factors for Delirium Tremens (DT)
``` Hx of sustained drinking Hx of previous DTs Age >30 Concurrent illness Mortality rate: 5% ```
51
Treatment of Minimal Delirium Tremens
Thiamin | Supportive care
52
Treatment of Mild Delirium Tremens
Thiamin Supportive care Medications to reduce symptoms & monitoring
53
Treatment of Moderate & Severe Delirium Tremens
Thiamin Supportive care Hourly monitoring Benzodiazepines
54
Which benzodiazepines are used?
Diazepam (Valium) Chlordiazepoxide (Librium) Lorazepam
55
Scheduled Targeted Treatment of Delirium Tremens
4-6 hours on the clock | Fairly sedated
56
Symptom Targeted Treatment of Delirium Tremens
Treat symptoms | More alert
57
Treatment of Refractory Delirium Tremens
Add phenobarbitol or propofol
58
Outpatient Therapy of Alcoholism
Acomprosate (Campral) | Disulfiram (Antabuse)
59
SE of Acomprosate (Campral)
``` Diarrhea Low pulse High or low BP Headaches Impotence ```
60
Contraindication of Acomprosate (Campral)
Kidney disease
61
MOA of Disulfiram (Antabuse)
Inhibits the activity of acetaldehyde dehydrenase (ALDH)
62
What does disulfiram (Antabuse) lead to if the patient drinks?
``` Flushing Dyspnea N/V Headache Blurred vision Vertigo Anxiety ```
63
Disulfiram (Antabuse) SE
Hepatotoxic Depression Psychosis
64
What do you need to monitor with Disulfiram (Antabuse)
LFTs | Psychologically
65
Examples of Stimulants
Methamphetamine | Cocaine
66
MOA of Methamphetamine
Displaces epinephrine, norepinephrine, dopamine, & serotonin into synaptic cleft
67
Signs/Symptoms of Methamphetamine
``` High energy Tachycardia Pupil dilation Increased BP Psychosis Agitation ```
68
How is methamphetamine absorbed?
``` Oral Pulmonary Nasal IM IV Rectal Vaginal routes Body stuffing ```
69
General Appearance of Methamphetamine Intoxicated Patient
Malnourished, agitated, disheveled Severe intoxication has changes in behavior & become violent "Meth mouth"
70
Vital Signs in a Methamphetamine Intoxicated Patient
Tachycardic HTN Hyperthermic
71
Signs/Symptoms of Methamphetamine Intoxication
N/V Seizures Delirium Psychosis
72
Differential Diagnosis of Methamphetamine Intoxication
``` Cocaine & PCP Theophylline & aspirin overdoses MAOI, seretonin syndrome, anticholinergic poisoning Heat stroke Thyrotoxicosis Pheochromocytoma ```
73
Treatment for Methamphetamine Intoxication
Sedation for agitation Protect airway Control BP & temp
74
Risk of Methamphetamine Intoxication Treatment
CV collapse
75
MOA of Cocaine
Blocks presynaptic reuptake pumps for dopamine, norepinephrine, & serotonin Blocks voltage-gated membrane sodium ion channels
76
Methods of Cocaine Ingestion
"Crack, freebase": smoked Salt: injected or snorted ETOH forms: cocaethylene
77
Intended Effects of Cocaine Intoxication
Increased energy, alertness, sociability Elation or euphoria Decreased fatigue, need for sleep, & appetite "Total body orgasm"
78
Adverse Effects of Cocaine Intoxication
``` Anxiety Irritability Panic attacks Paranoia Grandiosity Impairment in judgment Psychotic symptoms ```
79
Physiological Effects of Cocaine Intoxication
Tachycardia Pupil dilation Diaphoresis Nausea
80
CV Effects of Cocaine Intoxication
Arterial vasoconstriction Enhanced thrombus formation Tachycardia HTN
81
CNS Effects of Cocaine Intoxication
``` Agitation Seizures Headache Coma Intracranial hemorrhage ```
82
Lung Effects of Cocaine Intoxication
Smoked: angioedema & pharyngeal burns | Passive exposure: can present with toxicity
83
Stimulant Intoxication Management Initial Labs
Fingerstick glucose Acetaminophen & salicylate levels EKG Pregnancy test
84
Specific Management for Stimulant Intoxication
Toward patient's condition | Toward symptomatic problems
85
Three Drug Products of Cannibis (Marijuana)
Herbal cannabis: dry leaves/flowers Hashish: pressed, dry resin or secretion Hash oil: oil
86
Who uses cannabis more?
Men > Women | Blacks > Whites & hispanics
87
What is cannabis use associated with?
Alcohol dependence | Another illicit drugs
88
Co-morbid Mental Illnesses with Cannabis Use
Mood disorders | Anxiety disorders
89
What does cannabis do for a persons psychosocially?
Relieve tension & cope with stress Young adults feel it's harmless Leads to school dropout, use other illicit drugs, interpersonal problems, crime & unemployment
90
Cannabis Effects on Mood, Perception, & Thought Content
``` Euphoria, decreases anxiety, & tension Time perception distorted Increased self consciousness Transient grandiosity Paranoia Psychosis ```
91
Cannabis Effects on Cognition & Psychomotor Function
Decreases reaction time Impairs attention, concentration, short term memory, & risk assessment Impairs motor coordination & ability to do complex tasts
92
Cannabis Physiologic Signs
``` Tachycardia Increased BP Increased RR Conjunctival injection Dry mouth Increased appetite ```
93
Marijuana Withdrawal Symptoms
``` Craving for marijuana Irritability Restlessness Depression Anxiety Decreased quantity & quality of sleep Vivid/strange dreams Decreased food intake with associated weight loss Increased aggression Physical tension Sweating Runny nose Stomach pain Nausea ```
94
Treatment for Marijuana Addiction
``` Buspirone (Buspar): withdrawal symptoms Inpatient advised Change setting/routine Oral THC Treat underlying co-morbid psychiatric disease ```
95
Define Hallucinogens
Describes substances whose primary effects include the alteration of sensory perception, mood, & thought
96
Define "Bad Trip"
Acute intoxication with dysphoria, fear, agitation or other unwanted effects predominate
97
Define "Flashback"
Recurrence of symptoms associated with hallucinogen after the effects of the acute intoxication have worn off May occur months or years later
98
Effects of Hallucinogens
Synesthesia | Feel like their entire body is alive
99
Specific Hallucinogens
``` LSD Dextromethorphan (DXM) Mescaline "Bromo"- gentler LSD "Blue Mystic" Phencyclidine (PCP) ```
100
Adverse Issues with Dextromethorphan (DXM)
Anticholinergic delirium | Acetaminophen toxicity
101
What precedes the onset of psychedelic effects of Mescaline?
N/V
102
Distinguishing Features of PCP Intoxication
Bizarre violent behavior Nystagmus Catatonic stupor & coma
103
What is PCP commonly added to for smoking?
Cigarettes Marijuana Other herbs
104
Treating Patients on Hallucinogens
Quiet, calm environment Supportive care Careful, mild sedation if agitated
105
Why is inhalant abuse a common problem in adolescents?
Readily accessible Inexpensive & legal to buy/possess Perceived risk of use is low
106
What do Inhalants act as?
CNS depressants
107
What do nitrites in inhalants cause?
Intense vasodilation producing a sensation of heat & warmth Prolong penile erection
108
3 Techniques of Inhaling
Sniffing Huffing Bagging
109
Define Sniffing
Spray directly on heated surface to vaporize
110
Define Huffing
Saturate a cloth & hold near nose or mouth
111
Define Bagging
Put substance in a bag that is placed over nose, mouth, or head
112
Inhalant CNS Effects
Immediate: slurred speech, ataxia, disorientation, headache, hallucinations, violent behavior, seizure Long term: neurocognitive impairment, cerebellar dysfunction & peripheral neuropathy
113
Inhalant GI Effects
N/V Anorexia & weight loss Hepatotoxic (some substances)
114
Inhalant Hematologic Effects
Aplastic anemia | Malignancy
115
Define "Sudden Sniffing Death"
Cardiovascular collapse
116
Presentation of Inhalant Intoxication
Extreme behavior problems Neuropsychiatric problems Altered mental status
117
Labs for Inhalant Intoxication
``` CBC CMP UA ABGs Pulse oximetry EKG monitor ```
118
Treatment of Inhalant Intoxication
Supportive
119
Nicotine is and Etiology of what
``` Lung CA COPD CV disease URI- second hand SIDS- second hand ```
120
What does nicotine activate in the brain?
Dopamine reward system
121
Mortality of Nicotine Abuse
CVD Lung CA COPD
122
Nicotine Withdrawal Symptoms
``` Loss of euphoric effects Dysphoric or depressed mood Insomnia Irritability, frustration, anger, anxiety Difficulty concentrating Restlessness Decreased HR Increased appetite/weight gain ```
123
Stages of Change in Behavioral Approaches of Nicotine Treatment
``` Precontemplation Contemplation Determination Action Maintenance ```
124
Smoking Cessation Treatment Strategies
Social support Pharmacological therapy Skills training or problem solving techniques
125
What to discuss in smoking cessation counseling?
Congratulate on quitting Encourage continued abstinence Discuss problems that have arisen as a result of smoking cessation Extend/increase pharmacotherapy if withdrawal symptoms persist
126
MOA of Varenicline (Chantex)
Partial agonist of nicotinic acetylcholine receptors Reduces withdrawal symptoms Blocks nicotine from tobacco
127
SE of Varenicline (Chantex)
Nausea Insomnia Abnormal dreams Depression & suicidality
128
MOA of Bupropion (Zyban)
Enhances CNS noradrenergic & dopaminergic function
129
SE of Buproprion (Zyban)
``` Dry mouth Insomnia Headache Seizures Monitor for neuropsychiatric symptoms ```
130
Contraindications of Bupropion (Zyban)
Seizure disorders & pregnancy
131
Treatment for Nicotine Cessation
Gum or lozenge Gum use: chew & park Withdrawal symptoms not totally prevented Transdermal patches
132
Opiods include
Heroin Opium Prescription opiates
133
Which Prescription Drugs are Abused?
``` Fentanyl Percocet (oxycodone/acetominophen) Vicodin (hydrocodone/acetominophen) ```
134
MOA of Opioids
Activation of CNS mu receptors results in euphoria, respiratory depression, analgesia, & miosis
135
Classic Signs of Opioid Toxicity
Depressed mental status Decreased RR Decreased TV Miotic pupils
136
VS Changes in Opioid Toxicity
Low HR Mild hypotension Hypothermia
137
Why do we use naloxone in opioid toxicity?
Increase respirations to 12 or greater
138
Withdrawal symptoms of Opiods within 3-4 hours of last dose
Drug craving Anxiety Fear of withdrawal
139
Withdrawal Symptoms of Opioids between 8-14 hours of last dose
Anxiety, restlessness, insomnia, & yawning Rhinorrhea, lacrimation, & diaphoresis Stomach cramps & mydriasis
140
Withdrawal Symptoms of Opioids between 1-3 days of last dose
``` Tremor, muscle spasm Vomiting Diarrhea HTN Tachycardia Fever, chills Piloerection ```
141
Symptoms Management for Acute Withdrawal
``` Muscle relaxants NSAIDs Antiemetics Antidiarrheal agents Sleeping agent with low abuse potential ```
142
Long-term Opioid Addiction Treatment
Abstinence based treatment Naltrexone Opioid agonists: methadone, buprenorphine
143
Which patients is naltrexone most effective?
Highly motivated patients
144
Naltrexone
Administered after patient completely detoxed
145
Methadone
Long term opioid treatment Single daily dose in controlled setting >180 days = maintenance
146
SE of Methadone
``` Constipation Drowsiness Reduced libido Excess sweating Peripheral edema Prolonged QT ```
147
Buprenorphine
Partial opioid agonist Sublingual Combine with naloxone Schedule III drug
148
Clonidine
May decrease withdrawal symptoms in patients using low doses of opioids
149
SE of Clonidine
Orthostatis hypotension Dry mouth Constipation
150
Benzodiazepine Withdrawal
``` Increased body temperature Elevated BP Increased pulse & RR Aroused level of consciousness/ delirium Tremulousness Increased DTRs/seizures Disorientation Psychotic behavior/ hallucinations ```
151
Treatment of Mild to Moderate Benzodiazepine Withdrawal
Slow taper of drug they were on for several months | Determining drug tolerance may be difficult
152
Treatment of Severe Benzodiazepine Withdrawal
Life-threatening | Watch for respiratory depression
153
Treatment of Severe/Serious Benzodiazepine Withdrawal
Carbamazepine Valproate Symptom rebound: insomnia & anxiety ICU for abnormal vitals

Behavioral Health (25 decks)

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