SUBSTANCE-RELATED DISORDERS

Question 1

what is the difference between dependence and addiction

Answer 1

dependence manifests a withdrawal syndrome. addiction is characterized by craving and impulse control.

Question 2

What is considered “at risk drinking” for men, women, and elderly?

Answer 2

Question 3

what are the demographics for alcohol dependence

Answer 3

• Male
• white/native american
• single
• younger (<30)
• low income

Question 4

what is the CAGE questionnare

Answer 4

1. cut down
2. annoyed at people criticizing your drinking
3. guilty about your drinking
4. need an eye opener

Question 5

what are screening tools that can be used after a positive CAGE questionnare

Answer 5

1. Alcohol use disorders identification test (AUDIT)
2. Drug abuse screening test (DAST-10)
3. NIDA quick screening tool

Question 6

what is teh MOA of alcohol

Answer 6

• increases dopamine
• stimulates GABA
• affects glutamate (NMDA) and seratonin

Question 7

what is the triad of wenickes encephalopathy

Answer 7

confusion, ataxia, ophthalmoplegia

ophthalmoplegia = weakness of eye muscles

Question 8

what is the difference between wernickes encephalopathy and korsakoff psychosis

Answer 8

wernickes encephalopathy is often completely reversibel, whereas korsakof presents with more severe symptoms and is only reversible about 20% of the time

Question 9

what is the treatment of both wernickes encephalopathy and korsakoff syndrome

Answer 9

thiamine and other B vitamins

Question 10

what will liver enzymes look like in a patient with chronic alcohol use?

Answer 10

AST:ALT >2:1

Question 11

what is the timeline of the symptoms of alcohol withdrawal

Answer 11

8-12 hours: tremors, NV, insomnia, diaphoresis
12-48 hours: add hallucinations, seizures
48-96+: delirium tremens

Question 12

what are the s/s of delirium tremens

Answer 12

hallucinations, disorientation, tachycardia, hypertension, fever, and diaphoresis.

48+ hours after last drink

Question 13

what is the treatmen of acute alcohol withdrawal

Answer 13

• benzos
• BB for tachycardia or anxiety
• thiamine 1st then glucose

Question 14

what is used to evaluate the severity of alcohol withdrawal

Answer 14

CIWA scoring

Question 15

what medication is reccomended 1st line for alcohol dependence while the patient is still drinking

Answer 15

naltrexone

Question 16

what is the MOA of naltrexone

Answer 16

blocks release of dopamine in the brain (takes away the reward)

antagonizes mu receptor

Question 17

what is the CI for naltrexone

Answer 17

cant be given if the patient uses opioids

also causes liver problems, so pre-existing liver issues is probs a no

Question 18

what medication is reccomended 1st line for alcohol dependence if the patient has stopped drinking

Answer 18

acamprosate

Question 19

what is the MOA of acamprosate

Answer 19

• restores normal glutamate action
• stops glutamate excitation that causes withdrawal

Question 20

what is the CI for acamprosate

Answer 20

severe renal impairement

Question 21

which alcohol abuse treatment causes a bad reaction to alcohol

Answer 21

disulfuram (antabuse)

Question 22

what is the CI for antabuse

Answer 22

severe heart disease

Question 23

what is the MOA of nicotine in the body

Answer 23

• stimulates nicotinic cholinergic receptors in the brain
• triggers dopamine and epinephrine release

causes tolerance and upregulation of nicotinic (acetylcholine) receptors

Question 24

what are the s/s of nicotine withdrawal

Answer 24

• irritability
• insomnia
• increased appetite
• weight gain

Question 25

what are the nicotine metabolites

Answer 25

* continine (16 hours in serum, several weeks in urine) * anabasine (present in tobacco/vapes but not in nicotine replacement or second hand smoke)

Question 26

what is the MOA of bupropion

Answer 26

* blocks dopamine and NE reuptake * antagonizes nicotinic cholinergic receptors

Question 27

what are the SE of bupropion

Answer 27

insomnia agitation dry mouth headache seizure

Question 28

what is the MOA of chantix (varenicline)

Answer 28

* partial agonist of nicotinic cholinergic receptors * AKA decreases withdrawal and blocks "reward" from nicotine

Question 29

what are the 5 A's

Answer 29

* Ask: Identify and document the behavior being targeted * Advise: Provide clear, personalized guidance on the risks and benefits of changing the behavior * Assess: Evaluate the individual's readiness to change * Assist: Provide resources and support to help the individual change their behavior * Arrange: Schedule a follow-up contact to check in on progress

Question 30

what is the MOA of opioids in the body

Answer 30

acts on mu, kappa, and delta opioid receptors in the brain, digestive tract and spinal cord

Question 31

what are some of the s/s of severe opioid intoxication

Answer 31

* respiratory depression * peripheral vasodilation * pinpoint pupils * pulmonary edema * death

Question 32

what is the treatment for acute opioid overdose

Answer 32

naloxone (narcan)

Question 33

what is the MOA of naloxone

Answer 33

short-acting opioid antagonist

Question 34

what is the treatment of opioid withdrawal

Answer 34

* methadone or suboxone (buprenorphine) * clonidine or lofexidine for HTN, tacycardia, anxiety, ect. * Naltrexone

Question 35

what is the risk of using natrexone for opioid abusers

Answer 35

if they resume opioid use while on medication it can stimulate overdose

Question 36

what is the MOA of methamphetamine

Answer 36

cause release and block reuptake of domaine, NE, and seratonin

Question 37

what are s/s of acute amphetamine intoxication

Answer 37

* euphoria * psychosis * pupillary dilation * tachycardia/HTN

Question 38

what is the s/s of severe amphetamine intoxication

Answer 38

* hyperkalemia * hypertensive crisis * hyperthermia * metabolic acidosis * rhabdomyolysis

Question 39

What is the treatment for amphetamine intoxication

Answer 39

Symptomatic treatment * benzos * antihypertensives

Question 40

what are the s/s of amphetamine withdrawal

Answer 40

honestly every symptom ever

Question 41

what is the treatment regimen for amphetamine withdrawal

Answer 41

"no clear cut treatment" * bupropion + naltrexone used firstline per UTD

Question 42

what is the MOA of benzodiazepines

Answer 42

enhances GABA

Question 43

what is the presentation of benzo overdose

Answer 43

CNS depression with NORMAL vital signs

Question 44

what is the treatment for acute BZD overdose

Answer 44

flumazenil (can cause seizures!!)

Question 45

what is the presentation for BZD withdrawal

Answer 45

* Neuro - tremors, seizures, perceptual disturbances * Psych - anxiety, psychosis, dysphoria * very dangerous!

Question 46

what is the treatment of BZD withdrawal

Answer 46

long-acting BZD titrated down over months

Question 47

what is the MOA of cocaine

Answer 47

blocks dopamine reuptake

Question 48

what are s/s of cocaine use

Answer 48

* nosebleeds * arrhythmias/MI * HTN, tachycardia, fever * insomnia * mydriasis (pupillary dilation) * rhabdomyolysis

Question 49

what are the s/s of cocaine withdrawal

Answer 49

* craving * sleep disturbance * hunger * severe fatigue and depression

Question 50

with is the treatment for cocaine acute withdrawal

Answer 50

bromocriptine and symptomatic tx

Question 51

what is the treatment for cocaine dependence long term

Answer 51

topiramate (1st line)

Question 52

what is the MOA of marijuana

Answer 52

mimics anandamide and increases dopamine levels

Question 53

what is the s/s of acute marijuana intoxication

Answer 53

* euphoria * hunger * conjunctival injection | can have hallucinations/delusions/delerium in high doses

Question 54

what are the s/s of marijuana withdrawal

Answer 54

* fatigue * yawning * hypersomnia * anorexia * depression/anxiety

Question 55

what is the treatment of cannabis withdrawal

Answer 55

mild: no tx symptoms affecting work/school: dronabinol or gabapentin symptoms causing sleep disurbance: zolpidem

Question 56

describe the presentation of cannabis hyperemesis syndrome

Answer 56

* NVD abdominal pain * relieved by hot showers/baths | tx: abstinence

Question 57

just glance at whatever the heck this is