Substance-Related Disorders Flashcards
(45 cards)
What is the diagnostic criteria for substance use disorder?
significant impairment or distress PLUS ≥ 2 sxs in 12 months
* using more/longer than intended
* desire/failed efforts to cut down
* significant time spent obtaining/using/recovering from substance
* cravings
* failure to fulfill work/school/home obligations
* continued use despite social/interpersonal problems
* limiting social/occupational/recreational activities b/c of use
* use in dangerous situations (driving)
* continued use despite physical/psych problems, development of tolerance
* withdrawal
What screening tool can be used for alcohol use disorder?
CAGE
* Cut down
* Annoyed/criticized for drinking
* Guilty
* Eye opener
How is alcohol use disorder treated?
- 1st line: Naltrexone or Acamprosate
- 2nd line: disulfiram or topiramate
What is the diagnostic criteria for alcohol intoxication?
Recent alcohol ingestion w/ problematic behavioral/psych changes that developed during, or shortly after, ingestion PLUS ≥ 1 sxs
* Slurred speech, incoordination, unsteady gait, nystagmus, impairment in attention or memory, stupor or coma
How is alcohol intoxication treated?
IVF, vitamins, thiamine, electrolytes
What tool can be used to assess alcohol withdrawl severity?
CIWA-Ar score
* Minimal (<8)
* Mild (8-15)
* Moderate (16-20)
* Severe (>20)
What is the diagnostic criteria for alcohol withdrawl?
Cessation or ↓ of heavy/prolonged alcohol use PLUS ≥ 2 sxs within hrs-days after stopping
What symptoms can be expected after 6 hours of alcohol withdrawal and how are they treated?
- Sx: Trembling, irritability, anxiety, headache, tachycardia, insomnia
- Tx: IVF, thiamine then glucose, folate
What symptoms can be expected after 12-24 hours of alcohol withdrawal and how are they treated?
- Sx: visual or auditory hallucinations s/w a clean sensorium & normal vitals
- Tx: begin BZD taper to avoid seizures
What symptoms can be expected after 48 hours of alcohol withdrawal and how are they treated?
- Sx: tonic-clonic seizures
- Tx: BZD taper, head CT
What symptoms can be expected after 48-96 hours of alcohol withdrawal and how are they treated?
- Sx: Delirium tremens - autonomic instability, disorientation, hallucinations, agitation
- Tx: BZD taper
What is the general treatment recommendation for alcohol withdrawal?
BZDs (Chlordiazepoxide, lorazepam) + IVF, vitamins, thiamine, folic acid
* Replace thiamine before giving any glucose to prevent Wernicke encephalopathy & Korsakoff psychosis
* Hallucinations: Haldol
What is the diagnostic criteria for cannabis intoxication?
Recent cannabis use w/ problematic behavioral/psych changes during or shortly after use PLUS ≥ 2 sxs w/in 2 hrs
* Conjunctival injection, increased appetite, dry mouth, tachycardia
What is the diagnostic criteria for cannabis withdrawl?
Cessation or ↓ of heavy/prolonged cannabis use PLUS ≥ 3 sxs within 1 week of stopping
* Irritability or aggression, anxiety, sleep difficulty (insomnia, disturbing dreams), ↓ appetite/weight, restlessness, depressed mood
* ≥ 1: abdominal pain, shakiness/tremors, sweating, fever, chills, or headache
How is cannabis intoxication and withdrawal treated?
Supportive
* cannabis hyperemesis syndrome: zofran
What is PCP (phencyclidine)?
NMDA receptor antagonist
* hallucinogenic
* Withdrawal: depression, anxiety, irritability, restlessness, anergia, disturbance of thought & sleep
What is LSD?
5-HT (serotonin) receptor
* Intoxication: visual hallucination, seeing sound as color, anxiety/depression, delusions, pupillary dilation & “bad trip” panic.
* Withdrawal: none since it does not affect dopamine
What is the diagnostic criteria for PCP intoxication?
Recent use of PCP w/ problematic behavioral changes during or shortly after use PLUS ≥ 2 sxs w/in 1 hr
* vertical or horizontal nystagmus, HTN or tachycardia, numbness or diminished responsiveness to pain, ataxia, dysarthria, muscle rigidity, seizures or coma, hyperacusis
How is PCP intoxication treated?
ABCs, BZDs (Lorazepam), adjunct antipsychotics (Haloperidol)
What is the diagnostic criteria for inhalant intoxication?
Recent high-dose exposure to inhalants w/ problematic behavioral/psych changes during, or shortly after, exposure PLUS ≥ 2 sxs
* dizziness, nystagmus, incoordination, slurred speech, unsteady gait, lethargy, depressed reflexes, psychomotor retardation, tremor, muscle weakness, blurred vision or diplopia, stupor or coma, euphoria
How is inhalant intoxication treated?
Antipsychotics (Haloperidol) if severe aggression
What is the MOA of opioids?
mu receptor agonist (morphine, heroin, methadone)
What screening tools can be used for opioid use disorder?
- Opioid Risk Tool, Screener & Opioid Assessment for Patient w/ Pain (SOAPP-SF)
- Current Opioid Misuse Measure (COMM)
How is opioid addiction treated?
Methadone or Suboxone (buprenorphine + naloxone)
