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CCFP 3 > Substance Use *** > Flashcards

Substance Use *** Flashcards

1
Q

RF

A

More EtOH than recommended
>4 joints a week
Any illicit drug use
Hx of personal or family addiction
Age <40
Active mental health disorder

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2
Q

DSM-V criteria for SUD

A

CHEW THAT COP
Cut down - unsuccessful
Health/ harm - continued use despite impact on health
Excessive use
Withdrawal
Time - spending lots procuring/ using/ recovering
Hazardous use
Activities - decreased participation
Tolerance - increases
Craving
Obligations - not met
Personal problems

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3
Q

DSM-V criteria for addiction - 4Cs

A

4Cs
Loss of Control
Use despite Consequences
Compulsion to use
Craving

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4
Q

Sx that should prompt screening

A

Warning signs in teens e.g. failing school
Resistant medical conditions such as increased triglycerides or poor asthma control
Absenteeism, depression, anxiety
Accidents
Unexplained GI S+S
Sexual dysfunction
Sleep dysfunction
Tremor

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5
Q

Screening for AUD

A
  • AUDIT-C
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6
Q

Ix for SUD

A

HIV, Hep A/B/C, ALT, AST, bili, TB, STIs

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7
Q

General management

A

Support for pt + family
- CBT, family therapy
Vaccines (HPV, hepatitis)
Assess for comorbidity (STI, mental health)
Tx barriers
Harm reduction
Referral - mutual help meetings, supervised withdrawal, treatment programs, supervised consumption

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8
Q

Symptom management
Pain
Diarrhea
Sneezing/ tearing
N+V
Tachycardia/ HTN
Anxiety/ insomnia

A

Pain - OTC analgesia, NSAIDs
Diarrhea - immodium, Lomotil
Sneezing/ tearing - H1 antihistamine
N+V - ondansetron, promethazine
Tachycardia/ HTN - clonidine
Anxiety/ insomnia - benzo

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9
Q

Motivational interviewing fundamentals

A

PEARL
- pt’s motivation
- empower
- affirm
- reflect
- listen

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10
Q

Screen for comorbidities

A

Poverty
Crime
STIs
MH
Long term complications like cirrhosis
DV
ADHD
HIV/ hepatitis

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11
Q

Sympathomimetic causes + sx of intoxication

A

Causes: epinephrine, cocaine, amphetamines
Tachycardia, hypertensive, dyspnea, febrile, dilated pupils, increased BS, diaphoretic, N/V, hallucinations, increased reflexes

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12
Q

Anticholinergic causes + sx of intoxication

A

Causes: APs, TCAs, oxybutynin, ipratropium
Tachycardia, hypertensive, febrile, dilated pupils, reduced BS, dry

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13
Q

Cholinergic causes + sx of intoxication

A

Causes: ACh receptor antagonist
Pinpoint pupils, increased BS, diaphoretic

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14
Q

Toxins that cause sedation + sx of intoxication

A

Causes: benzos, antihistamines
Bradycardia, hypotension, reduced RR, afebrile, reduced BS, dry, nystagmus, ataxia

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15
Q

Opioid sx of intoxication

A

Bradycardia, hypotension, reduced RR, afebrile, reduced BS, dry, nystagmus, ataxia, pinpoint pupils

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16
Q

Toxins that cause Bradycardia

A

BB, opioids, antiarrhythmias, CCB, clonidine, digoxin

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17
Q

Toxins that cause Tachycardia

A

cocaIne, APs, amphetamines, alcohol withdrawal, TCA

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18
Q

Toxins that cause Hypothermia

A

CO, opioids, hypoglycemics, insulin, alcohol, sedatives

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19
Q

Toxins that cause Hyperthermia

A

NMS, nicotine, alcohol withdrawal, salicylates, serotonin syndrome, anticholinergics, antidepressants

20
Q

Toxins that cause Hypotension

A

clonidine, CCB, antidepressants, antihypertensives, sedatives, opioids

21
Q

Toxins that cause Hypertensive

A

cocaine, caffeine, anticholinergics, amphetamines, nicotine

22
Q

Cannabis Problematic use

A

daily use, anxiety, unsuccessful attempts to quit, family concern, financial implications

23
Q

Strategies to minimise use

A

Record on calendar
Purchase smaller amounts
Prepare smaller joints
Certain number of days without
Avoid high risk situations
Coping mechanisms

24
Q

PCP sx

A

muscle rigidity, sz, rhabdomyolysis

25
Q

Amphetamines (ecstasy) complications + withdrawal

A

Complications: coma, serotonin syndrome
Withdrawal: depression, increased appetite, diarrhea, HA, abdo pain

26
Q

Cocaine complications + withdrawal

A

Complications: MI, stroke, pulmonary edema, rhabdomyolysis, sz, arrhythmias
Withdrawal: increased sleep, fatigue, irritability

27
Q

Alcohol At risk

A

consuming more than amounts recommended but does not meet criteria for AUD

28
Q

CAGE alcohol questions

A

Have you ever felt you should CUT down on your drinking?
Have people ANNOYED you by criticizing your drinking?
Have you ever felt bad or GUILTY about your drinking?
Have you ever had a drink first thing in the morning (EYE-OPENER) to steady your nerves or to get rid of a hangover?

29
Q

AUD definition

A

Larger amount or longer periods than intended
Persistent desire, unable to cut down
++ time spent obtaining alcohol
Cravings
Recurrent use despite failure to fulfil obligations
Continued use despite social or interpersonal problems
Responsibilities given up d/t alcohol
Physically hazardous
Continued use despite harm
Increasing tolerance
Withdrawal sx

30
Q

Recommended amounts of alcohol

A

<2/d
<9/wk for women and <14/wk men

31
Q

Complications of AUD

A

CNS: wernicke’s encephalopathy (nystagmus, ataxia, confusion), Korsakoff’s psychosis, dementia
CVS: HTN, cardiomyopathy, AF
GI: cirrhosis, PUD, gastritis, pancreatitis, carcinoma
Psych: depression, anxiety

32
Q

Sx of alcohol withdrawal

A

Irritability, Anxiety, Tremors, Sweating, Nausea, Vomiting, Headaches, Fatigue, Insomnia, Confusion, Racing heart, Hallucinations

33
Q

Sx of B12 deficiency

A

Ataxia (sub-acute combined degeneration of the cord), Paresthesia, Cognitive impairment, Numbness, Personality changes, Gait changes, Dementia, Psychosis, Forgetfulness, Visual disturbances, Weakness/paraplegia/incontinence, Lhermitte sign, Extrapyramidal signs (dystonia, dysarthria, rigidity)

34
Q

Motivational interviewing for AUD

A

Goal of amount/d and amount/wk, non-drinking days
Record drinks on calendar
Switch to less preferred alcoholic drink
Pace 1 drink/ hr
Alternate w/ non-alcoholic drink
Avoid triggers
Reduce stress
Support - AA or friends

35
Q

Withdrawal management

A

PAWSS (prediction of alcohol withdrawal severity scale)
>4 = inpatient
Diazepam 5-10mg QID x 1 day, then decrease by 5mg/day
Consider carbamazipine 200mg QID, clonidine 0.1-0.2mg BID or gabapentin 300mg TID for sx relief

36
Q

Pharmacotherapy for AUD

A

Naltrexone 12.5mg BID x3d then increase to 50mg/d (CI in liver failure or ongoing opioid use), check LFTs 1, 3 + 6mo. Use for abstinence or reduction
Acamprosate 666mg TID - use for abstinence
Topiramate or gabapentin 300mg TID
Disulfram 250mg/d - only use in pt preference

37
Q

What lab results would you expect to see in alcohol abuse?

A

Elevated AST, Elevated ALT, AST/ALT Ratio (2:1), Elevated GGT, Elevated MCV
Hemoglobin (anemia)
Platelets (thrombocytopenia)
INR (increased; decreased clotting capability)
Albumin (hypoalbuminemia)
Thiamine (reduced)
Uric Acid (hyperuricemia)

38
Q

Contraindications to outpt detox

A

<19 or >65 y/o
Hx of sz during withdrawal
Drinks non-beverage alcohol
Uncontrolled medical condition
Severe liver dz

39
Q

Opioid use complications + withdrawal sx

A

Complications: pulmonary edema, resp failure, skin infections, endocarditis, HIV, hepatitis
Withdrawal: peaks 48-72hrsm subsides after 1wk
Tears, diarrhea, abdo pain, rhinorrhea

40
Q

Acute opioid intoxication management

A

naloxone 0.4-0.8mg IV q3 min, up to 10mg

41
Q

Norepinephrine dump rx

A

clonidine (start 17mcg/kg/d x several days then taper)

42
Q

False positives for UDS:
Amphetamines
Opioids
Cocaine
Benzos

A

Amphetamines – ibuprofen, cough + cold, ranitidine
Opioids – codeine
Cocaine – usually true positive
Benzos – clonazepam doesn’t show up as a positive

43
Q

Benzo withdrawal sx + rx for withdrawal

A

Withdrawal: grand mal sz, agitation, restless, insomnia, tremors, febrile
Rx for withdrawal: benzo taper

44
Q

What tool to use to screen for AUD?

A

M-SASQ - how many times have you had >8 (men) or >6 (women) drinks in a single sitting?

45
Q

SE of OAT

A

constipation, amenorrhea, low testosterone

CCFP 3 (67 decks)

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