Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Psychiatry Rotation > Substance-Related Disorders > Flashcards

Substance-Related Disorders Flashcards

(78 cards)

Start Studying
1
Q

WILD

A

Needed criteria to determine substance ABUSE

Work, school or home role obligation failure
Interpersonal or social consequence
Legal problems
Dangerous Use

More common in males
17% in america have substance abuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Dependence

A

impairment or distress manifested by (at least 3):
Tolerance
Withdrawal
Using substance more than originally intended
Persistent desire or unsuccessful attmepts to cut down
Significant time spent in getting, using or recovering from substance use
Decreased occupational or recreational activities
Continued use despite severe physical or psychological problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

WIthdrawal

A

Develpopment of a substance specific syndrome due to the cessation of substance used that has been heavy and prolonged.

Symptoms of withdrawal are often the opposite of what the effects of drug use are

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Tolerance

A

The need for greater amounts of substance to achieve the desired effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Basics of treatment for Substance abuse or Dependence

A

Behavioral Conseling
Psychosocial Treatment
Twelve Step Groups
Pharmacotherapy (if appropriate)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Phencyclidine

A

+ for 3-8 days. Creatine Phosphokinase and Aspartate Aminotranseferase are often elevated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Barbituates

A

In urine and blood for up to 3 weeks if long acting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Benzodiazepines

A

Short acting : 3 days

Long Acting: 30 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Marijuana

A

Up to 4 weeks in urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Alcohol mechanism of action and Metabolism

A

Activation of GABA and serotonin receptors in the CNS. Inhibits Glutamate …potent depressant.

Alcohol –> Acetaldehyde (Alcohol dehydrogenase)

Acetaldehyde – > Acetic Acid ( Aldehyde dehydrogenase.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Tx of acute intoxication

A

Monitor basics
Give thiamine and folate (Wernickes Encephalopathy)
Naloxone (Narcaine) if opiods taken concurrently
CT if thought of head trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

ALcohol: 20 -50 mg/dl

A

decreased fine motor control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

ALcohol - 50-100 mg/dl

A

Impaired judgement and coordination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

alcohol 100-150 mg/dl

A

Ataxic gait and poor balance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Alcohol 150-200 mg/dl

A

Lethargy, can’t sit upright, difficulty with memory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

alcohol 300 mg/dl

A

Coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Alcohol 400 mg/dl

A

Resp depression possible death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Dangers of Alcohol withdrawal ?DOC for acute alcohol withdrawal ?

A

Seizures, HTN and Arrythmias .

Librium (Chlordiazepoxide)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Symptoms of alcohol withdrawal

A

Insomina, anxiety, hand tremor (asterixis), irritability, anorexia, nausea, vomiting, autonomic hyperactivity (diaphoresis, tachycardia, HTN), Psychomotor agitation, fever, seizures, hallucination, delirium.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Seizures in alcohol withdrawal ?

A

occur between 6 and 48 hrs after cessation of drinking and peak around 13-24 hrs.

(Watch for hypomangnesemia, can predispose)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Tx of Seizures due to Alcohol withdrawal ?

A

Benzodiazepines in short term. Anti-convulsants in short term

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Delirium Tremens

A

May occur 48-72 hours after last drink
15-25% mortality rate . 5% of hospitalized patients with withdrawal develop DT’s.
Symptoms: Delirium, Hallucinations (often visual), gross tremor, autonomic instability,

TX:
Benzodiazepines are first line
Antipsychotics for severe agitation
Thiamine, Folic acid and nutritional IV (Wernicke Encephalopathy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Confabulations

A

False memories, often a sign of Korsakoffs Psychosis and patients are unaware they are making these up.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

CAGE Questionairs

A

Have you ever/wanted to CUTDOWN on drinking ?
Have you felt ANNOYED by people critical of your drinking ?
Have you ever felt GUILTY about drinking ?
Have you ever taken a drink as an EYE OPENER . To prevent shakes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Common biomarkers for Alcohol
``` Blood Alcohol Level Liver Function Tests (AST, ALT) Gamma Glutamyl Transpeptidase Carbohydrate deficient Transferrin Mean Corpuscular Volume ```
26
Disulfuram
Disulfuram (antabuse) : Blocks Aldehyde Dehydrogenase leading to build up of Acetaldehyde thus sick feelings when drinking alcohol Cannot use in severe cardiac disease, pregnancy, psychosis. Monitor LFT's
27
Naltrexone
Oral anti-opiod (opiod receptor blocker) | Decreases desired effects of alcohol
28
Acomprosate
Similar to GABA Started post detoxification Can be used in patients with liver disease Contradicted in severe renal disease
29
Topiramate
Anticonvulsant that potentiates GABA and inhibits glutamate receptors Reduces cravings for alcohol
30
Wernickes Encephalopathy
Due to a thiamine deficiency (poor nutrition in alcoholics) Acute and can be reversed with thiamine therapy Sx: ATaxia, confusion, occular abnormalities,
31
Korsakoff Syndrome
Chronic manifestation of untreated Wernickes Encephalopathy Chronic amnesitic syndrome Reversible in only about 20% of patients Sx: Impaired recent memory, anterograde amnesia, compensatory confabulation.
32
Mechanism of Action for Cocaine
Blocks dopamine reuptake from the synaptic cleft (DA reuptake inhibitor --> potentiated DA activity).Plays a large role in reward pathway.
33
Cocaine Intoxication
Euphoria, heightened self-esteem, Variable blood pressures (often HTN), Dilated pupils, weight loss, chills, sweating. Dangerous effects: respiratory depression, seizures, arrythmias , paranoia with hallucination (tactile) Deadly: Myocardial Infarction
34
Tx of Intoxication
Minor Agitation: Reassurance and Benzo | Severe: Antipsychotics (like Haldol)
35
Tx of cocaine dependence
No FDA approved pharm for treatment. Mostly supportive.
36
Cocaine Withdrawal
Abrupt abstinence is not dangerous Postintoxication depression: malaise, fatigue, depression, hunger, constricted pupils, vivid dreams, psychomotor retardation. Tx is supportive (may have psychotic symptoms)
37
MOA for Amphetamines
Block DA and NE reuptake in the synaptic cleft Designer amphetamines --> release of DA, NE and Serotonin from terminal endings. (MDMA etc). May cause serotonin syndrome
38
Amphetamine Intoxication
Similar to Cocaine MDMA may lead to feelings of closeness to others. Overdose --> Hyperthermia, HTN, Dehydration and thus rhabdomyloysis --> Renal Failure
39
Amphetamine Withdrawal
Prolonged depression Psychosis Tx is supportive and symptomatic.
40
Phencyclidine (PCP) MoA
Hallucinogenic drug that antagonizes NMDA glutamate receptors and activates Dopaminergic Neurons ( Leading to psychotic/hallucinogenic feelings) Note: Ketamine is similar the PCP
41
Phencyclidine Intoxication
Agitation, depersonalization, hallucination (tactile and visual), synesthesia, memory impairment, aggression, nystagmus (rototory nystagmus is pathognomnic), ataxia, dysarthria
42
RED DANES
For PCP intoxication Rage Erythema Dilated Pupils ``` Delusions Amnesia Nystagmus Excitation Skin Dryness ```
43
Tx of PCP intox
Monitor basics Benzos for agitation Antipsychotics for psychotic symptoms
44
PCP WIthdrawal
Does not really exist but can have "Flashbacks" where drug is released from lipid stores leading to symptoms of intoxication
45
Types of Sedative Hypnotics
Benzos, Barbs, zolpidem, zalepon, GHB, meprobamate,
46
MoA for Benzodiazepines
Potentiates GABA effects by increasing the opening of Cl- Channels
47
MoA for Barbituates
Potentiate the effects of GABA by increasing the open time of Cl- channels Typically lower margin of safety than Benzos (esp in high doses)
48
Tx of Benzodiazepine intoxication
Flumazenil (a short acting BDZ antagonist).. may cause seizure in some cases.
49
Sedative/Hypnotic Intoxication
drowsiness, confusion, HYPOTENSION, slurred speech, ataxia, mood lability, coma and death in OD.
50
Sedative/Hypnotic WIthdrawal
Abrupt abstinence after chronic use can be LIFE THREATENING. Dependence more likely with SHORT ACTING AGENTS Sx of Withdrawal: Same as Alchohol dependence withdrawal (since both worth through GABA). Tonic-Clonic Seizure is serious complication.
51
Tx of Barbituate Intoxication:
Alkalize urine with Sodium Bicarb to promote renal excretions
52
Tx of Benzodiazepine withdrawal
Taper BNZ | Valproic Acid or Carbamezepine for Seizure prophylaxis.
53
MoA for Opiod drugs
Bind to opiod receptors (Mu, Kappa, Delta) and mediate a analgesia, sedation and dependence. Also, have an effect on Dopaminergic system, mediating the reward/pleasure system--> addictive nature. Codeine, OxyContin, Morphine, Dextromethorphan, methadone and meperidine. Prescription opiods are most commonly abused.
54
Opiod Intoxication
Drowsiness, Nausea, Vomiting, constipation, CONSTRICTED PUPILS (except meperidine), seizure and respiratory depression.
55
Complication of meperidine or MAOi's taken with opiods ?
Serotonin Syndrome
56
Tx of Opiod Intoxication
Ensure the Airway is open (ABC's) If OD, give Naloxone (Narcaine) or Naltrexone. Can improve respiratory depression but can lead to severe withdrawal. Ventilation if needed
57
Opiod Withdrawal
Not life threatening | Dysphroria, insomnia, lacrimation, rhinorrhea, yawning, weakness, sweating, piloerection, NVD,
58
Tx of Opiod Withdrawal/Dependence
Moderate: Clonidine , NSAIDSs and Dicyclomine for abd. cramps Severe: Detox with buprenorphine or methadone
59
Methadone
LONG acting opiod receptor agonist. Give once daily, Gold standard in pregs Can cause QT interval prolongation, need ECG
60
Buprenorphine
Partial opiod receptor agonist (can act as antagonist then) | Sublingual prep is safer than methadone (Suboxone = buprenorphine + naloxone).
61
Naltrexone
Competitive Opiod antagonist, precipitates withdrawal Good for highly motivated individuals Compliance is on the low end
62
Hallucinogens
LSD, psilocybin, mescaline. | Act by various mechanisms.
63
Hallucinogen intoxication
Perceptual changes such as illusions, hallucinations, body image distortions and synesthesia), Dilated pupils, tachycardia, HTN, Hyperthermia,
64
Tx for Hallucinogen intoxication
Usually maintenance Benzos for anxiety Antipsychotics for dangerous ideations
65
MoA of Cannabis
Binds cannabinoid receptors in the brain which inhibit Adenylate Cyclase.
66
Sx of Cannabis intoxication
euphoria or anxiety, impaired motor coordination, perceptual disturbances, mild tachycardia, conjunctival injection, dry mouth and Increased appetite. Can cause induced psychotic disorders with paranoia, hallucinations or delusions. NO OVERDOSE Dependence in 5% of users.
67
Cannabis Withdrawal
irritability, anxiety, restlessness, aggression, strange dreams, depression, headaches, sweating, insomnia, nausea, cravings and dec. appetite.
68
Inhalants MoA
Typically a CNS depressant but with various mechanisms. Often inhaled or absorbed through skin Seen in adolescents
69
Inhalant Intoxication
Perceptual disturbances, psychosis, lethargy, dizziness, nausea, vomiting, headache, slurred speech etc.
70
Inhalant Overdose
Death via respiratory depression is common. CNS damage with long term use,
71
Inhaland overdose Tx
Chelation therapy if substance can be identified.
72
MoA for Caffeine
Adenosine antagonist, leading to increased cAMP (how ?) and stimulant effect due to Dopaminergic activation
73
Caffeine overdose
250 mg (2-3 cups) --> Anxiety, insomnia, muscle twitching, rambling speech, GI disturbances, tachycardia >1g : Tinnitus, severe agitation, visual light flashes, cardiac arrhythmias. >10 g : Death may occur secondary to seizure
74
Caffeine Withdrawal
headache, fatigue, irritability, nausea, vomiting, drowsiness, anxiety, muscle pain, mild depression. Typically resolves in one week
75
Nicotine MoA
Stimulates Nicotinic Receptors at the autonomic ganglia (both sympathetic and parasympathetic) Affects the dopaminergic system, mediating the reward center.
76
Nicotine withdrawal
Intense craving, dysphoria, anxiety, poor concentration, insomnia
77
Chantix
Vareniclene : a4b2 cholinergic receptor partial agonist. Mimics nicotine and limits withdrawal
78
Bupropion (wellbutrin, Zyban)
Antidepressant and partial agonist at nAChR. Inhibits DA reuptake also --> decreased withdrawal symptoms

Psychiatry Rotation (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions