Substance Use Disorder Flashcards by Nathan Koranda

Most important element

Build a trusting relationship with the

patient

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Assessment for SUD

Obtain a thorough medical history
• Know s/s of substance use,
withdrawal symptoms specific to each
substance
• Build a trusting relationship with the
patient
• Non-judgmental, empathetic attitude
• Be aware of resources in the community

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ETOH Intoxication S/S

Slurred speech, Dizziness,
Incoordination, Unsteady gait,
Nystagmus, Impaired attention/memory,
Coma or double vision

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ETOH Withdrawal 8 to 12 hours

Autonomic hyperactivity (hight BP, increased heart rate etc);
Perceptual disturbances and hallucinations

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ETOH Withdrawal 12-24 hours

Generalized/tonic-clonic seizures

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ETOH Withdrawal other

Nausea, vomiting; can be life-threatening

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CIWA Categories

Agitation (0–7)
Anxiety (0–7)
Auditory Disturbances (0–7)
Clouding of Sensorium (0–4)
Headache (0–7)
Nausea/Vomiting (0–7)
Paroxysmal Sweats (0–7)
Tactile disturbances (0–7)
Tremor (0–7)
Visual disturbances (0–7)

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CIWA <10

supportive, n on-pharmacologic therapy and close monitoring are indicated )unless patient has hx of alchol withdrawl seizures or co-morbid cardiovascular conditions

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CIWA 10 - 15

Lorazepam is indcated to reduce symptoms and the risk of major complications

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CIWA >15

Strong consideration should be given to hospitalizing inmates who exhibit severe symptoms, as they are at increased risk for serious complications

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ETOH WD treatment drugs

Benzodiazepines, anticonvulsants
(carbamazepine, gabapentin), clonidine,
propranolol

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ETOH treament supplement

Thiamine

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Why do we use thiamine

B1 deficiency can occur with chronic ETOH use. This results in wernkeis encephalopathy. Confusion CNS effects

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Naltrexone

mu opioid receptor antagonist - used in ETOH disorder

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Acamprosate used in ETOH MOA

binds to and blocks glutamate

receptors

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Disulfiram

irreversibly inhibits aldehyde

dehydrogenase preventing metabolism of alcohol

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Opioid Intoxication S/S

Pinpoint pupils; Psychomotor
retardation, “nodding off;” Drowsiness,
slurred speech; Impaired memory and
attention; Reduced respirations, respiratory
depression or distress

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Opioid Withdrawal

Dilated pupils, yawning, runny
nose/tearing; Piloerection; Restlessness,
muscle aches; Stomach cramps, diarrhea,
tachycardia; tremors (less common), hot/cold
sweats, insomnia; feels life threatening to the
person

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COWS categories.

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Resting heart rate (0–4)
Gastrointestinal upset in past
30 minutes (0–5)
Sweating (0–4)
Tremor of hands (0–4)
Restlessness (0–5)
Yawning during assessment (0–4)
Pupil size (0–5)
Anxiety or irritability (0–4)
Bone or joint aches associated with
withdrawal (0–4)
Gooseflesh skin (0–5)
Runny nose or tearing (0–4)

COWS mild

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5-12

COWS Moderate

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13-24

COWS moderately severe

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21-36

COWS severe

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Treatment of opoids includes

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alpha-2 adrenergic

agonists

Drugs used to treat OUD

Buprenophine, Methadone, Nextrexone, Naloxone

Bupreophine class

mu receptor partial agonist

Methadone class

Full opoid agonist

Naltrexone class

mu opoid receptor atnagonist

Benzo withdrawal symptoms

sx similar to alcohol | withdrawal

Benzo withdrawal starts

starts 2-3 days after cessation or up to 5 with long acting; can be life threatening

Do not prescribe ____ on a long term basis

benzos

Cannabis Intoxication S/S

Red eyes (dilation of conjunctival blood vessels, mild tachycardia, dry mouth; Heightened sensitivity to environmental stimuli, Slowing perception of time; Depersonalization, Derealization; Impaired memory, increased appetite; Delirium, paranoia, or psychosis; Impaired motor skills and attention (up to 8 to 12 hours after use)

Cannabis Withdrawal starts

1-2 weeks of cessation

Cannabis S/S

Irritability, cravings, headaches; Anxiety/restlessness, tremors; Insomnia, vivid dreams; Decreased appetite, wt loss, stomach pain; Hyperemesis syndrome

Nicotinic acetylcholine receptor agonist - half life

2 hour

Nicotine activates

dopamine vTa pathway, increases endogenous epinephrine and norepinephrine

nicotine has

stimulant effects on the body

Nicotine intoxication

skeletal muscle relaxation, improved | attention, learning, reaction time and probelm- solving (short term); decreased appetite

Nicotine withdrawal begins

within 2 hours and peaks 24 to 48 hours

Nicotine withdral S/S

Insomnia; Increased coughing (short- term); Irritability, cravings, tension; Increased appetite, weight gain; Poor focus

Nicotine Replacement therapy

Relieve nicotine withdrawal symptoms by providing nicotine | without the use of tobacco

NRT Side Effects

common to all NRT: GI symptoms, HA, local irritation

NRT forms

Patch, gum, lozenges, inhalers, nasal spray, mouth spray, SL | tablets

Varenicline (Chantix)

partial nicotine agonist

Varenicline (Chantix) MOA and use

Reduces the symptoms of nicotine withdrawal • Blocks nicotine from binding to the receptor that mediates the reinforcing effects of nicotine that leads to nicotine dependence. • Reduces rewarding aspects of cigarette smoking.

Bupropion (Zyban)

antidepressant,

Bupropion (Zyban) MOA and use

dopamine/norepinephrine-reuptake inhibitor | • Enhances CNS noradrenergic and dopaminergic release

Substance Use Disorder Flashcards

(47 cards)