Substance Related Disorders Flashcards
(146 cards)
1
Q
what do you think when you see a pt w. anxiety, tremors, sadness, and hematemesis
A
alcohol use disorder
2
Q
definition of alcohol use disorder
A
problematic pattern of etoh use leadint to clinically significant impairment or distress
3
Q
alcohol intoxication includes one or more of what symptoms (6)
A
slurred speech
incoordination
unsteady gait
nystagmus
impairment in attention or memory
stupor or coma
4
Q
criteria for etoh withdrawal
A
2 or more of the following developwing w.in several hours to a few days after cessation or reduction of etoh:
-autonomic hyperactivity (sweating, tachy, etc)
-increased hand tremor
-insomnia
-n/v
-visual, tactile, or auditory hallucinations or illusions
-psychomotor agitation
-anxiety
-generalized tonic clonic sz
5
Q
tx for etoh withdrawal (5)
A
thiamine
Mg
MV
dextrose
benzos
6
Q
addiction medications (5)
A
disulfram (antabuse)
naltrexone
acamprosate
topiramate
gabapentin
7
Q
tx for delirium tremens
A
high dose benzos asap (preferably in ICU)
8
Q
which addiction med inhibits acetaldehyde dehydrogenase and leads to aversive conditioning
A
disulfram (antabuse)
9
Q
which addiction medication is contraindicated in a pt who is still drinking
A
disulfram (antabuse)
10
Q
which 2 addiction medications decrease desire
A
oral naltrexone
gabapentin
11
Q
contraindication for oral naltrexone
A
opioids
12
Q
which addiction med changes brain chemistry in a way that reduces anxiety, irritability, and restlessness associated w. early sobriety
A
acamprosate
13
Q
caution w. acamprosate
A
renal impairment -> dose reduction required
14
Q
which addiction med reduces drinking at least as well as naltrexone and acamprosate
A
topiramate
15
Q
timeline for etoh withdrawal sx
A
6 hr: minor sx
12-24 hr: hallucinations
48 hr: sz
delirium tremens: 48-96 hr
16
Q
minor etoh withdrawal sx (6)
A
trembling
irritability
anxiety
HA
tachycardia
insomnia
17
Q
sx of delirium tremens (4)
A
autononmic instability
disorientation
hallucinations
agitation
18
Q
management of minor etoh withdrawal (5)
A
thiamine
folate
MV
dex
IVF
19
Q
what sx of etoh withdrawal indiacates initiation of benzos
A
hallucinations
20
Q
tx for etoh withdrawal hallucinations
A
benzos
+/- haldol
21
Q
management of etoh withdrawal sz (2)
A
benzos
head CT
22
Q
what drug is useful to reduce noradrenergic sx of etoh withdrawal
A
clonidine
23
Q
t/f: barbituates can be used for etoh withdrawal
A
t - sometimes used as anticonvulsant
24
Q
mainstay of etoh withdrawal therapy
A
long acting benzo taper:
diazepam, chlordiazepoxide, and clorazepate
25
definition of etoh withdrawal syndrome
syndrome of drug-specific withdrawal signs and symptoms follows the reduction or cessation of drug use
26
moa for psychoactive constituent of cannabis
delta-9-tetrahydro-cannabinol (THC) binds to CB1/CB2 receptors
27
3 PE finding suggestive of cannabis-related disorders
conjunctival injection
xerostomia
tachycardia
28
what do you think when you see a pt w. increased appetite, lack of motivation, slowed speech, and paranoia
cannaboid use disorder
29
criteria for cannabis use disorder
-problematic pattern of cannabis use leading to clinically significant impairment/distress
-occurs w.in 12 mo period
30
UA can detect cannabis for _ days in occasional users
and up to _ days in chronic users
occasional: 4-6 days
chronic: 50 days
31
complications of chronic cannabis use (5)
laryngitis
rhinitis
low testosterone
low sperm count
COPD
32
sx of cannabis intoxication (the snozzberries taste like snozzberries!)
euphoria
anxiety
disinhibition
paranoid delusions
perception of slowed time
conjunctival injection
impaired judgment
social withdrawal
increased appetite
dry mouth
hallucinations
33
withdrawal from cannabis sx (5)
irritability
dpn
insomnia
nausea
anorexia
34
cannabis withdrawal sx peak at _ hr
and last for _ days
48 hr
5-7 days
35
tx for cannabis intoxication/withdrawal
symptomatic only
36
when you see conjunctival injection on the exam, your answer should be
marijuana intoxication
37
what do you think when you see a pt who is extremely aggressive and becomes enraged when sudden movements or loud sounds are made
PCP (phencyclidine)
38
6 PE findings of PCP intoxication
nystagmus (horizontal and vertical)
htn
tachycardia
ataxia
dysarthria
muscle rigidity
39
moa of of PCP
NMDA receptor antagonist
similar to ketamine
40
sx of pcp intoxication
belligerenve
impulsiveness
fear
homicidality
psychosis
delirium
sz
coma
psychomotor agitation
41
management of pcp intoxication (4)
haloperidol
benzos
low stimulus environment
+/- restraints
42
withdrawal sx of pcp intoxication (6)
dpn
anxiety
irritability
restlessness
anergia
disturbance of thoughts and sleep
43
tx for pcp intoxication/withdrawal
symptomatic only
44
what do you think when you see a pt who wants to hurt himself and has been freaking out and seeing things that are not there
maybe he even tried to ride a bike off of his roof
LSD
45
3 PE findings of LSD intoxication
abnormal gait
diffuse tremors
dilated pupils
46
moa for LSD intoxication
5-HT receptor agonist
47
sx of lsd intoxication (5)
visual hallucinations and synesthesias
anxiety
dpn
delusions
"bad trip" panic
48
what is synesthesia
seeing sound as color
49
tx for lsd intoxication (3)
haldol
benzos
supportive counseling
50
t/f: lsd is not associated w. withdrawal
t!
it does not affect dopamine
51
what do you think when you see a pt from low socioeconomic background that arrives in ED w. HA, loss of appetite, rhinorrhea, injected sclera, dizziness, photopobia, and a cough
inhalant-related d.o
52
5 commonly inhaled substances
paint
petroleum
toluene
glues
nail polish
53
4 hallmarks of inhalant intoxication
euphoria
slurred speech
confused state
auditory/visual hallucinations
54
6 PE findings of inhalant intoxication
watery eyes
impaired vision
rhinorrhea
perinasal/perioral rash
HA
nausea
55
4 complications of inhalant abuse
cardiopulmonary failure
liver failure
renal failure
bone marrow suppression
56
moa of opioid intoxication
mu receptor agonist
57
sx of opioid intoxication
constipation
respiratory dpn
pupillry constriction
sz
58
which sx of opioid intoxication is not associated w. tolerance
constipation
59
sx of opioid withdrawal
anxiety
insomnia
anorexia
sweating
mydriasis
piloerection
flu like sx
yawning
60
tx of opioid overdose
naloxone
symptomatic
61
moa of naloxone
opioid receptor antagonist
62
tx for opioid withdrawal (4)
clonidine
methadone
buprenorphine + naloxone (suboxone)
zofran
63
which drug used for opioid withdrawal decreases NE and sympathetic output making autonomic sx less intense
clonidine
64
what happens if you use naloxone for opioid withdrawal
opioid receptor antagonist -> makes symptoms worse
65
which drug used for opioid withdrawal is long acting
methadone
66
which drug used for opioid withdrawal can precipitate withdrawal if given too soon
buprenorphine + naloxone
67
tx for opioid addiction
methadone
suboxone
68
2 indications for methadone
heroine detox
long-term maintenance
69
routes of administration for methadone
PO
IV
70
suboxone is a combo of (2)
buprenorphine
naloxone
71
benefit of suboxone over methadone
fewer withdrawal sx
72
moa for suboxone
partial opioid agonist
73
t/f: naloxone is ineffective when taken orally
t!
74
what class of drug are benzos
anxiolytics
75
moa for benzos
increased frequency of opening of GABA channel
76
common history finding for pt who presents w. benzo intoxication
panic disorder
77
PE findings of benzo intoxication (7)
respiratory depression
hypotn
amnesia
ataxia
stupor/somnolence
coma
death
78
HEENT findings for benzo intoxication
normal
79
t/f: benzos are associated w. withdrawal
t!
80
sx of benzo withdrawal (3)
rebound anxiety
sz
tremor
81
which type of benzo is withdrawal mc associated w.
short acting -> alprazolam
82
tx for benzo overdose
supportive
flumazenil only if very severe w. airway compromise
83
moa for flumazenil
GABA antagonist
84
why should flumazenil generally be avoided in management of benzo overdose
it can precipitate withdrawal and sz
85
tx for benzo withdrawal
long acting benzo taper -> clonazepam
86
moa for barbituates
increased duration of opening of GABA channel
87
PE findings of barbituate intoxication
extreme drowsiness
poor concentration
impaired memory
minimally responsive
respiratory depression
CNS depression
88
t/f: barbituates do not have a depression ceiling
t!
more dangerous than benzos
89
do barbs and benzos cause pupil dilation
no
90
sx of barbituate withdrawal (4)
anxiety
sz
delirium
cardiovascular collapse
91
tx for barbituate intoxication
symptomatic
respiration
intubation
bemegride
92
moa for bemegride
GABA antagonist
93
tx for barbituate withdrawal
long acting benzo taper
94
what do you think when you see a pt w. dilated pupils, tachycardia, aggression, diaphoresis, prolonged wakefulnessm, and sympathetic activation
cocaine
95
moa for cocaine
blocks biogenic amine (DA/NE) and serotonin reuptake (5HT/5-hydroxytryptamine)
96
sx of cocaine intoxication (5)
euphoria
psychomotor agitation
grandiosity
hallucinations (tactile)
paranoid ideations
97
PE findings of cocaine intoxication
sympathetic activation:
tachycardia
pupil dilation
htn
angina
stereotyped behavior - repetitive motions
98
complications of cocaine abuse
-severe vasospasm -> MI
-placental vasospasm/infarction
-kiesselbach plexus spasm -> nasal septum perforation
-CVA
99
sx of cocaine withdrawal (6)
severe dpn and suicidality
hyperphagia
hypersomnolence
fatigue
malaise
severe cravings
100
tx for cocaine intoxication
haldol
benzos
anti HTN (alpha 1 blockers)
vitamin C
101
moa of vitamin C in cocaine intoxication
promotes excretion
102
what should you never do in management of cocaine intoxication
never restrain -> can lead to rhabdo
103
tx for cocaine withdrawal
bupropion
bromocriptine
SSRI's
104
name 3 amphetamines
methamphetamine
dextroamphetamine (dexedrine)
methylphenidate (concerta)
105
moa for amphetamines
-stimulates biogenic amine (DA/NE) and serotonin (5 hydroxytryptamine/5HT)
-high dose: promote release AND decrease uptake
106
sx of amphetamine intoxication (5)
euphoria
impaired judgment
delusions
hallucinations
prolonged wakefullness/attentiveness
107
PE findings of amphetamine intoxication
sympathetic activation:
psychomotor agitation
pupillary dilation
HTN
tachy
fever
cardiac arrhythmias
108
tx for amphetamine intoxication
haldol
benzos
vitamin C
alpha 1 blockers
propranolol
109
moa for MDMA/ecstasy
-similar to amphetamine but affect 5HT more than DA
-may damage serotonergic neurons
110
sx of MDMA intoxication
hyperthermia
social closeness
hyponatremia
111
sx of MDMA withdrawal
mood offset for several weeks
112
tx for mdma intoxication/withdrawal
symptomatic
113
leading cause of preventable death in US
cigarette smoking
114
t/f: smoking causes more deaths each year than HIV, illegal drugs, etoh, MVA, and firearms combined
t!
115
sx of tobacco intoxication (4)
restlessness
insomnia
anxiety
arrhythmias
116
sx of tobacco withdrawal (5)
irritability
HA
anxiety
wt gain
cravings
117
tx for tobacco cessation
bupropion
varenicline (chantix)
NRT
118
moa for varenicline (chantix)
partial nicotinic acetylcholine receptor (a4-b2) agonist -> mediates partial reward of nicotine AND blocks reward of nicotine
119
most successful nicotine cessation drug
varenicline (chantix)
*esp when used w. NRT
120
contraindication for varenicline (chantix)
banned from use by pilots and air traffic controllers
121
s.e of varenicline (chantix)
n/v
insonmnia
HA
neuropsych disorders: suicide, dpn, homicidal ideation
122
tx for lithium od
dialysis
123
longterm tx for etoh wd
librium
124
tx for benzo od PLUS HTN
labetalol
125
antidote for pyrexia
dantrolene
126
ccb antidote
calcium chloride
127
benzo antidote
flumazenil
128
TCA antidote
sodium bicarbonate
129
digoxin antidote
digoxin immune fab (Digibind)
130
amphetamine antidote
benzos
131
warfarin antidote
vitamin K
fresh frozen plasma
132
heparin antidote
protamine sulfate
133
APAP antidote
n-acetylcysteine
134
opiate antidote
naloxone
135
bb antidote
glucagon
136
cocaine antidote
benzos
137
tx for psychosis related to drug od
haldol
138
tx for acute sz
benzos
139
taking these drugs causes constricted pupils
-opiates
140
taking these drugs causes dilated pupils
stimulants
etoh
hallucinogens
antidepressants
141
loss of control over urges to take a drug even tho the consequences are unknown
addiction
142
using a substance to maintain normal functioning
dependence
143
amnesia, ataxia, stupor, somnolence
benzo and etoh intoxication
144
miosis, drowsiness, constipation
opioid intoxication
145
hyperphagia, hypersomnolence, and fatigue
cocaine wd
146
restlessness, diuresis, muscle twitching, cardiac arrhythmias
caffeine intoxication
