Substance Use Disorders Flashcards
(49 cards)
What are some signs of inhalant intoxication
dizziness, nystagmus, incoordination, slurred speech, unsteady gait, lethargy, depression of reflexes, psychomotor retardation, tremor, generalized muscle weakness, blurred vision, diplopia, stupor, coma, euphoria
What are the 10 classes of substances?
1 - alcohol
2 - caffeine
3 - cannabis
4 - hallucinogens (phenylcyclidine)
5 - inhalants
6 - opioids
7 - sedatives/hypnotics/anxiolytics
8 - stimulants
9 - tobacco
10 - other
What is the general severity specifier for substance use disorders?
Mild - presence of two or three symptoms
Moderate - presence of four or five symptoms
Severe - presence of 6 or more symptoms
What are the DSM 5 criteria for alcohol use disorder?
A - problematic pattern of alcohol use leading to clinically significant impairment of distress as manifested by at least two of the following in a 12 month period
1 - often taken in larger amounts or over a longer period than intended
2 - persistent desire or unsuccessful efforts to cut down or control use
3 - great deal of time spent in activities necessary to obtain alcohol, use alcohol or recover from its effects
4 - craving or strong desire/urge to use alcohol
5 - use resulting in failure to fulfil major role obligations at work, school or home
6 - continued use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol
7 - important social, occupational or recreational activities are given up or reduced because of alcohol use
8 - recurrent use in situations where it would be physically hazardous
9 - alcohol use continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol
10 - tolerance - either a need for markedly increased amounts of alcohol to achieve the same intoxication or desired effect or a markedly diminished effect with continued use of the same amount of alcohol
11 - withdrawal - either having the classic withdrawal syndrome or alcohol is taken to relieve or avoid symptoms.
What are the clinical signs of opioid intoxication or OD
Respiratory depression
Unconsciousness
Pinpoint pupils
Behavioral and psychological changes such as apathy, dysphoria
Psychomotor agitation or retardation
Slurred speech, impaired attention or memory
What are some of the physical signs and symptoms of both short term and sustained opioid use
Dry mouth
Constipation - slows gut motility
Sclerosed veins and many puncture sites
If all veins are sclerosed, individuals may inject directly into the skin causing cellulitis, abscesses and tetanus
Bacterial endocarditis
HIV infection
Hepatitis C infection
Tuberculosis - (??)
Perforation of the nasal septum
Sexual dysfunction
Increased sensitivity to pain
Dependence among neonates
Sweating
Depressed cognitive functioning
Resp depression
What are the signs and symptoms of opioid withdrawal?
Dysphoric mood
Nausea and vomiting
Muscles aches
Lacrimation
Rhinorrhea
Pupil dilation
Piloerection
Sweating
Diarrhea
Yawning
Fever
Insomnia
Anxiety and restlessness
Pain - arthralgia and myalgia
Tachycardia
Miscarriage
What are the signs and symptoms of sedative intoxication?
Slurred speech
Incoordination
Unsteady gait
Nystagmus
Stupor
Coma
What are some of the physical and physiological effects of stimulants?
Short Term
Decreased appetite
Increased energy
Elevated temperature
Irregular heartbeat
Increased blood pressure
Seizures
Manic episodes
Paranoia
Aggression
Confusion
Tactile hallucinations
Loss of smell
Nose bleed
Inflamed runny nose
Lung damage and infections
HIV and Hep C for injectables
Long Term
Addiction
Suicidal ideation
Poor interpersonal relationships
Weight loss and wasting
What are some signs and symptoms of alcohol withdrawal?
Anxiety and restlessness
Insomnia
PDs
N and V
Diaphoresis
Tachycardia
Tremors
Psychosis
Seizures
Delirium tremens - decreased LOC, disorientation, tachycardia, hypertension, agitation, hallucinations - generally visual but may also be tactile or auditory
Treatment is long acting benzos such as clonazepam, monitor vitals, fluid resuscitation, vitamin B complex, thiamine, taper down the benzos slowly
What are some pharmacological options for the treatment of stimulant use disorder?
Modafinil and topiramate
What are some of the signs and symptoms of stimulant intoxication?
Tachycardia
Bradycardia
Pupillary dilatation
Elevated or low blood pressure
Perspiration or chills
N and V
Weight loss
Psychomotor agitation or retardation
Muscle weakness
Resp depression
Cardiac arrhythmias
Confusion
Coma
Dyskinesia or seizures
What are some of the signs and symptoms or stimulant withdrawal?
Dysphoric mood
Fatigue
Vivid unpleasant dreams
Insomnia or hypersomnia
Increased appetite
Psychomotor agitation or retardation
Describe the MOA of cocaine
Increases monoamine neurotransmitter activity in the central and peripheral nervous system through the blockade of presynaptic reuptake pumps - basically like a antidepressant MOA
Increase in dopamine in the corticomesolimbic pathway have proven to play a large role in its addictive qualities
The second MOA is that it blocks sodium ion channels, creating an anesthetic effect
Powder form is easily absorbed into any mucosal membrane
Comment briefly on the MOA of amphetamines
Sympathomimetic amine
Comment briefly on the MOA of metcathinone
Blocks reuptake of dopamine, norepinephrine and sodium
Stimulates dopamine release
What are some of the signs and symptoms of tobacco withdrawal?
Irritability
Frustration
Anger
Anxiety
Difficulty concentrating
Increased appetite
Restlessness
Depressed mood
Insomnia
What are some of the prominent symptoms of cocaine withdrawal?
Depression
Anorexia
Insomnia
Vivid unpleasant dreams
Severe cravings
Hypersomnia
Hyperphagia
Pregnancy - miscarriage
Cocaine withdrawal occurs in phases
What are some of the more severe effects of cocaine intoxication and how do you manage them?
CVS - tachy or brady, hypertension or hypotension, dose dependent risk of cardiac ischaemia. Reduced cardiac output with severe tachy
CNS - hyperthermia, dilated pupils, panic and seizures
Resp - resp depression, angioedema, pharyngeal burns, pulmonary embolism
GIT - N and V, perforation of peptic ulcers, bowel ischemia
Placental abruption
End organ toxicity in virtually every organ system, primarily through the hemodynamic effects
Management
Sedation
BP control
Heart rate control
Temp regulation - aggressive sedation, neuromuscular paralysis with a non-depolarizing paralytic agent
Antipyretics have no role in the treatment
Fluid resuscitation
What are some of the key steps in motivational interviewing?
Empathy
Ask Open questions
Listen with acceptance and reflectively
Affirm, compliment and use statements of appreciation
Summarize - use to link together and reinforce the material
Elicit self-motivating statements
Recognizing disadvantages of the status quo and the advantages of chance
Avoid argumentation and avoid confronting denial, rather encourage change
Roll with resistance - divert the client towards positive change
Develop discrepancy - promote awareness of consequences of continuous use
Support self-efficacy and elicit and support hope
Briefly comment on how opioids have both their analgesic and euphoric effects
Analgesic effects - inhibition of nociceptive information
Euphoric effects - increase dopamine release in the mesolimbic system
Comment briefly on the MOA of cannabis
Cannabinoid receptors are found in the central nervous system in the basal ganglia, substantia nigra, cerebellum, hippocampus and cerebral cortex.
Cannabis inhibits the release of multiple neurotransmitters including acetylcholine, L-glutamate, GABA, norepinephrine, dopamine
What are the signs and symptoms of cannabis intoxication?
Euphoria
Anxiety
Dysphoria
Paranoia
Tachycardia
Postural hypotension
Increased resp rate
Red eyes
Dry mouth
Increased appetite
Ataxia
Nystagmus
Slurred speech
Perceptual disturbance
Impairment in memory, attention, complex processing faculties
What are the signs and symptoms of cannabis withdrawal?
Unexplained mood changes
Restlessness
Aggression
Sleep disturbance
Decreased appetite or weight loss
Abdominal pain
Tremors
Headache
