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Flashcards in withdrawal Deck (65):
1

dependency triad

psychological dependence
physiologic dependence
tolerance

term "dependency" not used anymore

all 3 typically present in long term abuse

2

psychological dependence

craving and the behavior involved in procurement of the drug

3

physiologic dependence

withdrawal symptoms on discontinuance of the drug

4

tolerance

need to increase the dose to obtain the desired effects

5

The terms “dependency” and “abuse” were dropped in ??? for the term ???

DSM-V
substance abuse disorder

6

Many patients could have a severe and life-threatening abuse problem without ???

ever being dependent on a drug

7

ddx withdrawal symptoms: tremors

hyponatremia, calcemia, kalemia
hypernatremic (hypovolemic)
anxiety-panic attack
uncontrolled HTN
etOH withdrawal
Parkinsons
cerebellar stroke
acute intoxication

8

kindling

repeated stim. of brain,
renders the individual more susceptible to focal brain activity with minimal stimulation
*almost opposite of tolerance
"geared up" may cause seizures

9

kindling can be caused by ??? leading to ??? no longer dependent on original stimulus

stimulants and depressants
relatively spontaneous effects

10

kindling effects may manifest as ???

mood swings, panic, psychosis, and occasionally overt seizure activity

11

opioids and narcotics refer to group of drugs w. actions that mimic ???
which one implies controlled and which one illicit?

morphine

opioids
narcotics

12

what to know with case 2: etOH, heroin

what route using?
Inject, etc

13

3 problems faced w/ substance abuse disorders

(1) the prescribing of substances such as sedatives, stimulants, or opioids that might produce dependency
(2) the treatment of individuals who have already abused drugs, most commonly alcohol
(3) the detection of illicit drug use in patients presenting with psychiatric symptoms

14

The National Institute on Alcohol Abuse and Alcoholism formally defines at-risk drinking as more than ???

4 drinks per day or 14 drinks per week for men or more than 3 drinks per day or 7 drinks per week for women

15

A drink defined by CDC as

as 12 oz of beer
8 oz of malt liquor
5 oz of wine
1.3 oz or a “shot” of 80-proof distilled spirits of liquor

16

ddx etOH/heroine withdrawal symptoms

TB
HIV
Hep C
abcess/sepsis
bacterial endocarditis (tricuspid valve)
anemic
septic emboli (from IVDU/endocarditis)
on cocaine
cardiac toxicity
coronary vasospasm
PTH adenoma
drug impurity rxn
influenza/other viral
hypoglycemia
heroin withdrawal

17

individuals w/ at-risk drinking are at an inc. risk for developing/are developing ???
and have much higher prevalence of ???

and alcohol use disorder
lifetime psych disorders

18

male: female etOH tx ratio

4:1
maybe now more like 4:2, 4:3 (better at hiding it)

19

what is often present in etOH and should be carefully evaluated?
etOH commonly involved in ???

depression
suicides and intrafamily homicides
in rapes and other assaults

20

problems assoc. w/ etOH abuse

medical, economic, and psychosocial

21

central and peripheral nervous system complications of etOH

chronic brain syndromes, cerebellar degeneration, cardiomyopathy, and peripheral neuropathies

22

etOH: Direct effects on liver

cirrhosis, esophageal varices, and eventual hepatic failure

23

Indirect effects etOH

protein abnormalities, coagulation defects, hormone deficiencies, and an increased incidence of liver neoplasms

24

Wernicke's encephalopathy

short-term memory loss, thiamine deficiency involved, confabulation, AMS, confusion, amnesia

25

Korsakoff's

continuation of Wernicke's- chronic, permanent CNS damage, cerebellar damage; balance issues, tremor, vertigo, falls, Rombersgs, dysdiadokokinesia

26

etOH toxic to

BM

27

ddx of etOH btw

primary alcohol use disorder (when no other major psychiatric diagnosis exists) and secondary alcohol use disorder (when alcohol is used as self-medication for major underlying psychiatric problems such as schizophrenia or affective disorder)
-the latter req. psych tx!


28

the problem of ??? must be faced
do not be ???
emphasize ???
one of the most important considerations ??

denial
judgmental
things that can be done-motivational interviewing
pts. job - social

29

hospitalization necessary?

not usually, but
many medical complications of alcoholism; a complete physical examination with appropriate laboratory tests is mandatory, with special attention to the liver and nervous system

30

unhelpful etOH drugs

sedatives (to replace etOH)
lithium

31

this helps reduce craving and maintain abstinence

Acamprosate (333–666 mg orally three times daily)
-can be continued even during relapse

32

an opioid antagonist which lowers relapse rate of 3-6 mos post-drinking

mechanism?

naltrexone (50 mg orally/day)

lessens pleasurable effects of etOH

33

aversive drug for discouraging etOH use via inhibiting ??? -->toxic reactions when etOH consumed

disulfiram (250-500 mg/d oral)
alcohol dehydrogenase

34

onset of w/drawal symptoms

usually 8–12 hours and the peak intensity of symptoms is 48–72 hours after alcohol consumption is stopped

35

ddx of etOH w/drawal includes

other sedative withdrawals and other causes of delirium

36

acute alcoholic hallucinosis must be differentiated from other acute paranoid states such as

amphetamine psychosis, paranoid schizophrenia

37

??? are the most important features in differentiating chronic organic brain syndromes due to alcohol from those due to other causes

The history and laboratory test results

38

alcoholic hallucinosis: typical withdrawal symptom?

no, although it does occur during or on cessation of prolonged drinking period

39

hospitalization and adequate antipsychotics are often necessary, such as ???
and ??? to counteract excitability from sudden etOH cessation


Haloperidol, 5 mg orally twice a day for the first day or so, usually ameliorates symptoms quickly
CNS depressants (eg, benzodiazepines)

40

the choice of using specific sedative is less important than using ???

adequate dose

41

mild dependence req. ???
use ???

"drying out" -short course of tapering long-acting benzodiazepine

42

mod-sev. w/drawal tx: ???
make sure to ??

hospitalize the patient and use diazepam orally in a dosage of 5–10 mg hourly depending on the clinical need

monitor of vital signs and fluid and electrolyte levels

43

heroin use is on the increase bc ???

cheap
-snorting and inhaling increasing, esp in cocain users

44

In primary and secondary alcoholism, at-risk drinking can be distinguished from alcohol addiction by ???

taking a careful psychiatric history and evaluating the degree to which recurrent drinking impacts the social role functioning and physical safety of the individual

45

v. severe withdrawal

intravenous administration of diazepam maybe necessary
-After stabilization, the amount of diazepam required to maintain a sedated state may be given orally every 8–12 hours..  

46

also for w/drawal, this suppresses cardiovascular signs and has some anxiolytic effect

clonidine, 5mcg/kg orally every 2 hours (or patch form)

47

also for w/drawal, this compares favorable with benzos

carbamazepine, 400-800 mg/day orally

48

??? as an adjunct to benzos to reduce symptoms of etOH w/drawal
give ?? when HR above 80 bpm and ?? when HR btw 50-80 bpm

atenolol (B-blocker)
100 mg
50 mg

49

??? are not useful in managing etOH w.drawal seizure, but rather use ???

phenytoin
benzos

50

give these vitamins in high doses

thiamine, 50 mg intravenously initially, then orally on a daily basis; pyridoxine, 100 mg/d; folic acid, 1 mg/d; and ascorbic acid, 100 mg twice a day

51

Chronic brain syndromes secondary to a long history of alcohol intake: responsive to thiamine and vitamin replenishment?

no, not clearly

52

strategies to address opioid abuse epidemic

-Establishing and strengthening prescription drug monitoring programs
-Regulating pain management facilities and establishing dosage thresholds requiring consultation with pain specialists

53

clinical s/s of mild narcotic intoxication

changes in mood, with feelings of euphoria; drowsiness; nausea with occasional emesis; needle tracks; and miosis

54

opioid OD can cause

respiratory depression, peripheral vasodilation, pinpoint pupils, pulmonary edema, coma, and death

55

opioid withdrawal: Grade 0

craving, anxiety

56

opioid withdrawal: Grade 1

yawning, lacrimation, rhinorrhea, and perspiration

57

opioid withdrawal: Grade 2

previous symptoms plus mydriasis, piloerection, anorexia, tremors, and hot and cold flashes with generalized aching

58

opioid withdrawal: Grade 3,4

increased intensity of previous symptoms and signs, with increased temperature, blood pressure, pulse, and respiratory rate and depth. In withdrawal from the most severe addiction, vomiting, diarrhea, weight loss, hemoconcentration, and spontaneous ejaculation or orgasm commonly occur

59

tx for opioid w/drawal initiated @ stage ?

2

60

tx for opioid w/drawal

also, ??? for alleviating CV symptoms (but does not sig. relieve anxiety, insomnia, gen. aching)

methadone, 10 mg orally (use parenteral administration if the patient is vomiting), and observe

clonidine

61

rapid ??? has become a method for tx opioid dependence

opioid detoxification with opioid antagonist induction using general anesthesia
(overkill?)

62

important and effective types of behavioral treatment shown to be effective interventions for drug addiction

**cognitive behavior therapy**, contingency management, couples and family therapy

63

used successfully for treatment of the patient who has been free of opioids for 7–10 days, but not long term tx

opioid antagonist (naltrexone)

64

this partial agonist has become a mainstay of office-based treatment of opiate dependency-(outpt, methadone addicts)
also effective in reducing concomitant ???


buprenorphine

opioid and cocaine abuse

65

risk of OD with buprenorphine is lower than with ??? and preferred for pts @ high risk for that toxicity

methadone