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Psych Year 4 > Substances > Flashcards

Substances Flashcards

1
Q

Triad of altered consciousness, respiratory depression, pinpoint pupils

A

Heroin intoxication

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2
Q

Hypertension, respiratory depression, bradycardia

A

Cushing’s reflex: coning of the brainstem

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3
Q

Distractability, insomnia, grandiosity, flight of ideas, activity increase (goal-directed), speech (extreme talkativeness), thoughtlessness (impulsive)

A

3 or more = manic episode and symptoms must last for 1 week

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4
Q

Anxiety, aggression, agitation, psychosis or delirium + mydriasis + change in vital signs

A

Amphetamine or cocaine (less psychotic features than amphetamine)
Common symptoms of stimulant intoxication = dilated pupils, hypertension, tachycardia

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5
Q

Heroin withdrawal

A

muscle spasms, joint pain, N/V, diarrhea and abdominal cramps, rhinorrhea and lacrimation, sweating

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6
Q

Amphetamine withdrawal symptoms?

A

depression, irritability, fatigue, increased appetite, psychomotor disturbance

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7
Q

what is the typical time frame for alcohol withdrawal to occur?

A

within 72 - 92 hours of cessation of drinking

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8
Q

what is the management of long term dependence on alcohol?

A

group/individual support therapy + counselling therapy
disulfiram
acamprosate
naltrexone

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9
Q

what are some of the mechanisms of the medications for long term dependence for alcohol?

A

disulfiram: inhibits ADH, leads to unpleasant effects of alcohol (flushing, tachycardia, hypotension), discouraging patient from drinking
acamprosate: GABA agonist and glutamate antagonist. reverses GABA and glutamate imbalances when abstaining from alcohol,
naltrexone: acts on opioid receptor of opioid antagonist. stops craving for alcohol.

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10
Q

what is the diagnostic criterion for alcohol withdrawal?

A

cessation of alcohol use that has been heavy and prolonged
2 or more of the following symptoms: tremors, irritability, insomnia, n/v, anxiety, psychomotor agitation, grand mal seizures, autonomic hyperactivity (anxiety, arousal, sweating, facial flushing, mydriasis, tachycardia, mild hypertension)
causing significant distress and impairing functioning

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11
Q

what is the treatment for alcoholic withdrawal?

A

diazepam 20mg oral, 2 hours until symptoms resolve

+ add thiamine 300mg IM/IV daily for 3 - 5 days then move on to oral 300mg daily for next weeks

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12
Q

what is the diagnostic criterion for delirium tremens

A

alcohol withdrawal syndrome + clouding of consciousness and confusion, visual hallucinations, marked tremor + other signs of autonomic instability - paranoid delusions, agitation, sleeplessness

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13
Q

what is the treatment for delirium tremens?

A

ideally prevention - starting diazepam 20mg oral upon withdrawal symptoms, every 2 hourly until symptoms subside
delirium tremens - high doses may be required that require specialist review

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14
Q

what is the triad of wernicke and korsakoff’s syndrome?

A

wernicke: ataxia, oculomotor dysfunction (6th nerve palsy, nystagmus), confusion
korsakoff’s syndrome: anterogade and retrogade amnesia + confabulation

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15
Q

what is the treatment of wernicke’s encephalopathy and korsakoff’s syndrome?

A

thiamine (b1) 100mg oral 2 times BD for 1 - 2 weeks.

korsakoff’s require a longer period of b1 for about 3 - 12 weeks

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16
Q

what are the symptoms of opioid intoxication?

A 
(depressant) 
CNS depression 
GI dysmotility 
respiratory depression 
analgesia 
n/v
slurred speech 
hypotension, bradycardia, pupillary constriction
seizures (in overdose)
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17
Q

what are the symptoms of opioid overdose?

A

pinpoint pupils, respiratory depression, CNS depression (decreased HR, RR, LOC)

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18
Q

what are some common complications of opioid use?

A

HIV infection, hep b, hep c
sudden pulmonary oedema d/t opioid toxicity and respiratory depression
local abscess, venous thrombosis, myopathy
coma in overdose, cerebral oedema
perforation of nasal septum d/t repeated heroin sniffing
infective endocarditis (IV use)
peripheral nerve compression

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19
Q

what is the DSM 5 diagnostic criterion of opioid intoxication?

A 
must have pupillary constriction 
LOC/drowsiness
sluring of speech 
impairments in attention or memory 
psychological or behavioural changes that have arisen during or shortly after the usage
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20
Q

what is the DSM 5 diagnostric criterion of opioid withdrawal?

A

recent cesation of usage of opioid that was previously heavy or recent administraiton of an opioid antagonist
3 of the following developing within minutes to several days of criterion:
mood changes
Gi disturbances which cause n/v/d
muscular aches
lacrimination or rhinorrhea
pupillary dilatation, piloerection, sweatin g

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21
Q

what are the common symptoms of opioid withdrawal?

A 
(reverse of depresant effects) 
n/v/d
increased vital signs 
dilated pupils
sweating, hot and cold flushes 
piloerection, tremor, restlessness 
muscle aches, abdominal cramping
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22
Q

what are the common symptoms of opioid withdrawal?

A 
(reverse of depresant effects) 
n/v/d
increased vital signs 
dilated pupils
sweating, hot and cold flushes 
piloerection, tremor, restlessness 
muscle aches, abdominal cramping
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23
Q

Naloxone needs to be titrated when administered for opioid intoxication because?

A

if not titrated, can precipitate withdrawal and sudden reversal can lead to MI in elderly or CAD, agitated delirium

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24
Q

Naloxone needs to be titrated when administered for opioid intoxication because?

A

if not titrated, can precipitate withdrawal and sudden reversal can lead to MI in elderly or CAD, agitated delirium

25
Q

what is the treatment of heroin overdoses?

A

one dose of naloxone stat dose (because heroin is a short acting opioid - similar pethidine, fentanyl, immediate release morphine)

if long acting (such as methadone, or slow release formulations) - naloxone infusion is required after initial bolus

26
Q

what is the treatment for opioid withdrawal symptoms?

A

buprenorphine (partial agonist)

diazepam for anxiety and agitation - only prescribed if supervision is available as dependence/fatal overdose issue

27
Q

what is the long term treatment for opioid dependence

A

psychotherapy: counselling, CBT, social support

maintanance treatment; buprenorphine or methadone

28
Q

what is the differences between the usage of buprenorphine and methadone?

A

buprenorphine; partial agonist, has lower risk of OD and physical dependence
methadone; full agonist, better outcome if provided for long periods, may cause QT prolongation

29
Q

what is the pharmaco treatment of heroin overdoses?

A

one dose of naloxone stat dose (because heroin is a short acting opioid - similar pethidine, fentanyl, immediate release morphine)

if long acting (such as methadone, or slow release formulations) - naloxone infusion is required after initial bolus

30
Q

what is the differences between the usage of buprenorphine and methadone?

A

buprenorphine; partial agonist, has lower risk of OD and physical dependence
methadone; full agonist, better outcome if provided for long periods, may cause QT prolongation

31
Q

what are some methods of opioid administration?

A

IV
IM
intranasal
subcut

32
Q

what is the management strategy of acute opioid intoxication

A 
icu admission + support; in particular respiratory rate, airway, and circulation 
naloxone administration (50 - 200mcg IV bolus titrated to clinical effect every 2 - 3 minutes)
33
Q

what is the management strategy of acute opioid intoxication

A 
icu admission + support; in particular respiratory rate, airway, and circulation 
naloxone administration (50 - 200mcg IV bolus titrated to clinical effect every 2 - 3 minutes)
34
Q

what are the symptoms of BDZ withdrawal?

A

tremors, anxiety, perceptual disturbances (visual hallucinations), dysphoria, psychosis, seizures, hyperacusis, photophobia, palpitations

35
Q

what is the treatement for BDZ withdrawal?

A

diazepam 20mg orally every 2 hours, until withdrawal symptoms are controlled, gradually taper over a course of few months

36
Q

what is the prevention for BDZ withdrawal?

A

use of BDZ with long half life (diazepam, chlordiazepoxide) and a gradual tapering of the patient’s BDZ over a course of several months

37
Q

what are the symptoms of isolated BDZ overdose?

A

CNS depression w/ normal vitals. usually arousable and able to provide an adequate history.
patient w/ isolated BDZ overdose rarely cause significant toxicity, only when co-ingested w/ opioid and ETOH does that occur

38
Q

what are the investigations for BDZ use?

A

screening for metabolites of 1, 4 - benzodiazepines. it does not detect clonazepam, lorazepam, midazolam, alprazolam. can be detected as early as 3 hours and remain detectable for up to 2 weeks.

urine testing; up to 3 days after use, can only detect about 6 - 8 hours after drug use (not for current use)
hair testing; requires 2 weeks
sweat testing; requires 7 days
serum testing: dectable for 6 - 48 hours

39
Q

what are the intoxication symptoms of cocaine use?

A

psychological effects: anxiety and irritability, panic attacks, suspiciousness and paranoia, grandiosity and impaired judgement, psychotic symptoms such as delusions and hallucinations, sleep disturbances

behavioural effects: restlessness, agitation, tremor, dyskinesia, repetitive or stereotyped behaviours such as picking at the skin

physiological: tachycardia, pupil dilation, diaphoresis, nausea

40
Q

what are the withdrawal symptoms of cocaine use?

A

will have initial period of intense symptoms: psychomotor retardation, severe depression w/ suicidal ideation
depression, anxiety, fatigue, difficulty concentrating, hypersomnia, difficulty experiencing pleasure (anhedonia), increased appetite

41
Q

what are the withdrawal symptoms of cocaine use?

A

will have initial period of intense symptoms: psychomotor retardation, severe depression w/ suicidal ideation
depression, anxiety, fatigue, difficulty concentrating, hypersomnia, difficulty experiencing pleasure (anhedonia), increased appetite

42
Q

what is the treatment of cocaine withdrawal?

A

supportive treatment: allow patient to sleep and eat as needed in a supportive environment
use a short acting BDZ, anti-depressant if persistent depression or suicidal ideation

43
Q

what is the treatment of cocaine withdrawal?

A

supportive treatment: allow patient to sleep and eat as needed in a supportive environment
use a short acting BDZ, anti-depressant if persistent depression or suicidal ideation

44
Q

what is the treatment of chronic cocaine use disorder?

A

psychosocial treatment: motivational interviewing, psychodynamic, CBT including relapse prevention and contingency management

continuing care within the community w/ substance abuse treatment programme

45
Q

what is the treatment for BDZ withdrawal?

A

diazepam 20mg orally every 2 hours, until withdrawal symptoms are controlled, gradually taper over a course of few months

46
Q

what is the treatment of chronic cocaine use disorder?

A

psychosocial treatment: motivational interviewing, psychodynamic, CBT including relapse prevention and contingency management

continuing care within the community w/ substance abuse treatment programme

47
Q

what is the treatment for acute BZD overdose?

A

supportive care: most importantly to mantain airway patency, respiratory support, give O2 (d/t respiratory depression)

48
Q

what is the treatment for opioid withdrawal symptoms?

A

buprenorphine (partial agonist): 4 - 8 mg sublingually as single dose 1st day, and increasing to 12 mg as single dose on 3rd day then decreasing over the next 2 - 5 days

diazepam for anxiety and agitation - only prescribed if supervision is available as dependence/fatal overdose issue

49
Q

what is the management strategy of acute opioid intoxication

A 
icu admission + support - in particular respiratory rate, protection of airway, and circulation 
naloxone administration (50 - 200mcg IV bolus titrated to clinical effect every 2 - 3 minutes)
50
Q

what levels of alcohol for non alcohol tolerant person to start impairing function?

A

20 - 30 mg/dL

alcohol tolerant person - may be higher at 150mg/dL

51
Q

what are the symptoms of severe opiate intoxication?

A

pinpoint pupils, respiratory depression, CNS depression (stupor, coma)

52
Q

what are the effects of alcohol on sleep?

A

helps make sleep easier, reduces deep sleep, REM sleep, and makes sleep more fragmented

53
Q

what are the signs and symptoms of alcohol withdrawal?

A

coarse tremors, insomnia, anxiety, agitation, and autonomic hyperactivity. this can be made worse and accompanied by severe agitation, confusion, tactile/visual hallucinations.

54
Q

treatment of alcohol withdrawal?

A

diazepam (20mg, 2 hourly until symptoms resolve) + thiamine 100mg.

55
Q

features of caffeine withdrawal?

A

usually after 1 day, severe headache, fatigue, and subjective loss of concentration

56
Q

based on DSM- 5, what is the definition of substance use disorder?

A 
for 12 months, at least 2 of the following: 
tolerance or withdrawal symptoms 
no control 
need to cut down 
loses time 
craves
failed roles 
helpless 
trades off
57
Q

what are the signs and symptoms of alcohol intoxication

A 
slurred speech
incoordination 
unsteady gait 
stupor/coma 
impairment in attention or memory 
nystagmus
58
Q

what is the signs and symptoms of cannabis intoxication

A

conjunctival injection and dry mouth
increased appetite
euphoria and heightened senses
nystagmus/ataxia

59
Q

what are the signs and symptoms of cannbis withdrawal

A

agitation/anger/aggression
anxiety/irritability/restlessness
insomnia

Psych Year 4 (10 decks)

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