Substance Use Disorders Flashcards
What symptoms are associated with an opioid overdose?
- Hypoventilation or respiratory depression
- CNS depression
- Miosis
- Bradycardia
- Hypoactive reflexes (hyporeflexia)
- Decreased bowel sounds
Modafinil has been used to treat dependency to which substance?
What is a severe side effect associated with Modafinil?
Methanphatamines
Steven-Johnson Syndrome
What are the indications of methamphetamines?
What are some common side effects?
- ADHD
- Exogenous Obesity
- Narcolepsy (off-label)
HTN, palpitations, tachycardia, alopecia, dizziness, HA, dysphoria, itch
Which over-the-counter decongestant can be used in the production of methamphetamine?
Pseudophedrine
What medications are first-line pharmacologic treatment for tobacco use disorder other than bupropion?
When should bupropion be avoided?
Nicotine replacement therapy and varenicline
Use of MOAI’s, seizure disorders, and eating disorders
A 46-year-old man presents for evaluation. He has a medical history of opioid use disorder and is currently on buprenorphine therapy. What is the mechanism of action of buprenorphine?
What are the adverse effects of buprenorphine?
Mu-opioid receptor partial agonist
Prolonged QT
What complication of methadone use in the management of opioid use disorder is more prevalent than that of buprenorphine or naltrexone use?
Respiratory Depression
Which pharmacologic treatment for smoking cessation is contraindicated in a patient with seizures?
Buproprion
Which pharmacologic intervention for smoking cessation has the fastest onset of action?
Nicotine gum or losanges but may need to be taken every hour to prevent withdrawal symptoms
What class of medications is recommended as first-line therapy in the treatment of moderate to severe alcohol withdrawal?
Benzo’s (e.g., diazepam, lorazepam, chlordiazepoxide)
What treatment is recommended for patients with delirium tremens refractory to high-dose benzodiazepines?
Phenobarbitol or Propofol
A 27-year-old male patient underwent pre-employment urine drug testing after being hired for a full-time hospital position. The patient admits to using recreational drugs in the past, but he claims he has not used anything for at least 2 weeks. The urine test returns positive.
Question
What substance is this patient most likely using?
A. Cannabinoids
B. Nicotine
C. Amphetamine
D. Cocaine
E. Opiates
Cannabinoids, the only drug listed that would be detectable after 2 weeks since last use.
Moderate-to-severe daily use of cannabis will be detected in the urine between 10-32 days
How long is nicotine detectable in urine after use?
About 12 hours
How long after use are amphetamines detectable in the urine?
What about opioids?
2-3 days
Variable but does not exceed 3 days
What symptoms are associated with chronic marijuana use?
- Sweet smell on clothes
- Lack of motivation (amotivation)
- Conjunctival injection
- Increased appetitie
- Social withdrawal
- Hallucinations
- Dry mouth
What conditions are associated with long-term chronic cannabis use?
- COPD
- Laryngitis
- Rhinitis
- Low testosterone
- Low sperm count
What physical symptoms are associated with phencyclidine (PCP) overdose?
What are the most common hallucinagens people abuse?
- Vertical or Horizontal Nystagmus
- Dilated pupils
- Ataxia or muscle rigidity
- Tachycardia
- Dizziness
- Prolonged glare or blank stare
Phencyclidine (PCP, or “angel dust”) or LSD
Phencyclidine is an antagonist to what receptor?
NMDA
Are there withdrawal symptoms associated with LCD?
No, LCD acts on 5-HT and therefore because it does not affect dopamine no withdrawal symptoms take place
What are the signs of an LSD intoxication?
visual hallucination, seeing sound as color, marked anxiety or depression, delusions, pupillary dilation and “bad trip” panic.
What is the pharmacologic treatment for a hallucinagenic intoxication?
- Antipsychotics (Haldol)
- Benzo’s
A 19-year-old male is brought to the emergency department by police after being arrested for petty theft. The patient complains of severe muscle aches and spasms. Upon questioning, he says he regularly uses heroin but has not had access to the drug for 15 hours. Which of the following is characteristic of heroin withdrawal?
A. Miosis, constipation
B. Mydriasis, diaphoresis, rhinorrhea
C. Delirium, cardiovascular collapse
D. Stomach cramps, hypersomnolence
E. Belligerence, impulsiveness
Mydriasis, diaphoresis, rhinorrhea
Miosis and constipation are seen in opioid intoxication
What is the difference between mydriasis and miosis?
Mydriasis is when the pupils are dilated, or enlarged
Drugs, such as amphetamines, cocaine, and LSD, can cause mydriasis
Miosis is when the pupils are constricted, or narrowed.
Opioids such as heroin, morphine, and fentanyl can cause miosis
What are the withdrawal symptoms associated with opioids?
What is the MOA of opioids?
- Anxiety, insomnia, anorexia, sweating, dilated pupils (mydriasis), piloerection (“cold turkey”),
- Fever, rhinorrhea, nausea, stomach cramps, diarrhea (“flulike” symptoms)
- Yawning
- Unpleasant but not life-threatening
MU receptor agonist
