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Substance Related Disorders Flashcards

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1
Q

Impairment or distress for at least 12 months with one or more of the following manifestations:

  1. Failure to fulfill obligations at work, school, or home
  2. Use in dangerous situations
  3. Recurrent substance related legal problems
  4. Continued use despite social or interpersonal problems due to the substance use
A

Abuse

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2
Q

Impairement or distress manifested by at least three of the following within a 12 month period:

  1. Tolerance
  2. Withdrawl
  3. use of substance more then originally intended
  4. Persistent desire or unsuccessful efforts to cut down on use
  5. Significant time spent in getting, using, or recovering from substance
  6. decreased social, occupational or recreational activities because of substance use
  7. Continued use despite subsequent physical or psychological problems
A

Dependence

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3
Q

True or false:

Mood symptoms are common among persons with substance abuse disorders

A

True (psychotic sx may occur w some substances)

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4
Q

Alcohol is sedating but alcohol withdrawl can lead to what?

A

Brain excitation and seizures

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5
Q

Alcohol stays in the system for how long?

A

only a few hours

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6
Q

Cocaine is positive in the urine drug screen for how long?

A

2-4 days

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7
Q

Amphetamines are in urine drug screen for how long?

A

1-3 days

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8
Q

Phencyclidine (PCP) in urine drug screen for how long?

A

3-8 days

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9
Q

Marijuana in urine drug screen for how long?

A

heavy users-4 weeks

one time user - about 3 days

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10
Q

Alcohol activates what neurotransmitter receptors?

A

GABA and serotonin (inhibitory effect that is why alcohol is a depressant)

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11
Q

Alcohol inhibits what neurotransmitters receptor and channel?

A

Glutamate and voltage gated calcium channels

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12
Q

Treatment for alcohol intoxication

A

Monitor: airway, breathing, circulation, glucose, electrolytes and acid base status
Give thiamine and folate and might need naloxone

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13
Q

Ethanol, methanol and ethylene glycol cause what kind of acid base status?

A

metabolic acidosis with increased anion gap

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14
Q

insomnia, anxiety, hand tremor, irritablility, anorexia, nausea, vomiting, autonomic hyperactivity (diaphoresis, tachycardia, hypertension), psychomotor agitation, fever, seizures, hallucinations, and delirium are signs and sx of what withdrawl?

A

Alcohol (treat with benzos and taper slowly)

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15
Q

what decreased element may predispose a pt with alcohol withdrawl to a seizure?

A

hypomagnesemia

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16
Q

Delirium Tremens (the most serious form of alcohol withdrawl) usually begins how long after the last drink?

A

48-72 hours (2-3 days) may occur later but 90% of cases within 7 days

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17
Q

Which gender develops DTs more often?

A

Men four to five times as often as women

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18
Q

Tx for DTs?

A 
Dilantin (phenytoin) and Benzos (chlordiazepoxide, diazepam or lorazepam) should be given in sufficient doses then tapered down slowly
Banana bags ( thiamine, and folate and multivitamin)
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19
Q

AST:ALT ratio of what? and an elevation of which biochemical marker suggest excessive alcohol use?

A

AST:ALT greater then or equal to 2:1 and elevated Gama-glutamy transpeptidase (GGT)

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20
Q

Alcohol can increase which function tests and what volume?

A

Liver function tests and macrocytosis (INCREASED MCV)

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21
Q

Medication for alcohol dependance that is anteabuse? who is it contraindicated in?

A

Disulfiram and it is contraindicated in severe cardiac disease, pregnancy and psychosis

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22
Q

Medication for alcohol dependance that decreases the desire or craving for alcohol?

A

naltrexone (revia, or IM- Vivitrol) it is an opioid receptor blocker.

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23
Q

medication that should be started postdetoxification for relapse prevention in patients who have stopped drinking

A

Acamprosate

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24
Q

what is the major advantage of acmprosate

A

it can be used in patients with liver disease

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25
Anticonvulsant that potentiates GABA and inhibits glutamate receptors reducing the cravings for alcohol?
Topiramate (topamax)
26
Ataxia (broad based), confusion and ocular abnormalities (nystagmus, and gaze palsies)
Wernicke's encephalopathy
27
All patients with altered mental status should be given thiamine and glucose in what order to prevent Wernicke- Korsakoff syndrome
Thiamine before glucose
28
blocks doapmine reuptake from the synaptic cleft, causing a stimulant effect
cocaine
29
Cocaine intoxication general sx?
Euphoria, heightened self esteem, increased or decreased blood pressure, tachy or bradycardia, nausea, DILATED pupils, weight loss, psychomotor agitation, depression or chills and sweating
30
What are dangerous sx of cocaine intoxication?
Respiratory depression, seizures, arrhythmias, paranoia, and hallucinations
31
Deadly sx of cocaine intoxication?
vasoconstrictive effect may result in MI.
32
Management of cocaine intoxication?
benzo's for moderate to mild agitations and axiety Antipsychotics (haloperidol) for severe if a temp over 102 then aggressive temperature control with ice baths, cooling blanket, etc
33
dilated pupils, increased libido, perspiration, respiratory depression and chest pain are sx of what abuse?
amphetamine
34
block reuptake and facilitate release of dopamine and norepi from nerve endings, causing a stimulant effect?
amphetamine
35
amphetamines are used to treat which conditions?
Narcolepsy, ADHD, depressive disorders
36
What makes substituted amphetamines different?
they release dopamine, norepi AND SEROTONIN from nerve endings (examples are MDMA "ecstasy" and MDME "eve")
37
chronic amphetamine use leads to?
acne and tooth decay ('meth mouth")
38
overdose of amphetamine can lead to ?
hyperthermia, dehydration and rhabdomylolysis which can lead to renal failure
39
amphetamine withdrawl can lead to
prolonged depression
40
amphetamine intoxication treatment
rehydration, electrolyte balance correction, and treat hyperthermia
41
PCP intoxication symptoms
Rage, Erythema (redness of skin), Dilated Pupils, Delusions, Amnesia, Nystagmus, Excitation, Skin dryness (RED DANES)
42
Drug sometimes used as date rap drug because it is tasteless and odorless
ketamine (special K)
43
Ketamine can produce what effects
tachycardia, tachypnea, hallucinations, and amnesia
44
PCP intoxication clinical presentation
Depersonalization, SYNESTHESIA, ROTATORY nystagmus, agitation, hallucination, HIGH TOLERANCE TO PAIN, ataxia, dysarthria, hypertension, muscle rigidity, tachycardia, MEMORY IMPAIRMENT, ASSAULTIVNESS
45
Treatment for PCP intoxication
monitor vitals, temp, and electrolyte and minimize SENSORY STIMULATION use benzo to treat muscle rigidity, agitation, anxiety and seizures, use antipsychotics for severe agitation or psychotic sx
46
Rotatory nystagmus is pathognomonic for what intoxication?
PCP
47
Tactile and visual hallucinations are found in both?
cocaine and PCP abuse
48
more than with other drugs intoxication with PCP results in?
violence
49
overdose of PCP can cause?
coma, seizures and even death
50
dose specific CNS depressant that produces memory loss, respiratory distress and coma and is commonly used as date rape drug
Gamma-hydroxybutyrate (GHB)
51
Potentiate the effects of GABA by increasing the frequency of chloride channels opening
Benzodiazepines
52
potentiates the effects of GABA by increasing the duration of chloride channel opening
Barbiturates
53
Benzo's are commonly used to treat?
anxiety disorders
54
Barbiturates are commonly used to treat?
epilepsy and as anesthetic
55
Withdrawl from what drug class has the highest mortality rate?
Barbiturates
56
Treatment strategy for barbiturate overdose only
Alkalinize urine with sodium bicarb to promote renal excretion
57
Treatment stragety for benzo overdose
Flumazenil
58
Tx of choice for opiate overdose?
Naloxone
59
in general withdrawl from what drugs is life threatening?
sedatives
60
opioid exception to producing miosis (constricted pupils)
Meperidine ("demerol dilates pupils")
61
opioid intoxication causes:
nausea, vomiting, sedation, decreased pain perception, decreased GI motility, pupil constriction (except meperidine), and respiratory depression (which is what can kill)
62
What should you be careful taking with Meperidine and why?
MAO-I's because they can cause serotonin syndrome ( hyperthermia, confusion, muscle rigidity and hyper or hypotension)
63
classic triad of opioid overdose
Respiratory depression, Altered Mental Status, Miosis (Rebels admire morphine)
64
Eating what can result in a positive urine drug screen for opioids?
poppey seed bagels or muffins
65
anxiety, insomnia, anorexia, fever, RHINORRHEA, PILOERECTION,
Opioid withdrawl sx. not life threatening
66
Gold Standard tx for opioid dependent pregnant women?
Methadone
67
precipitates withdrawl if used within 7 days of heroin use
Naltrexone
68
Marijuana has been used for what therapeutic effects?
Treat nausea in chemo pts, increase appetite in AIDS pts, and decrease intraocular pressure, muscle spasms, and tremor
69
chronic marijuana use may have side effects on which hormones?
reproductive hormones
70
which substances user is typically a preadolescent or adolescent
inhalants
71
increases cAMP and has a stimulant effect via the dopaminergic system
caffeine
72
effects of greater then 1 g of caffeine consumption
tinnitus, severe agitation, visual light flashes and cariac arrhythmias
73
effects of greater then 10 g of caffeine consumption
death may occur secondary to seizures and respiratory failure
74
nicotine is highly addictive through its effects on what?
the dopaminergic system
75
effects of nicotine
restlessness, insomnia, anxiety and increased GI motility
76
Tx of Nicotine dependence
Varenicline, bupropion
77
Name 7 opioids
Heroin, oxycodone, codeine, dextromethorphan, morphine, methadone, and meperidine (Demerol)

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