Flashcards in withdrawal Deck (65):
term "dependency" not used anymore
all 3 typically present in long term abuse
craving and the behavior involved in procurement of the drug
withdrawal symptoms on discontinuance of the drug
need to increase the dose to obtain the desired effects
The terms “dependency” and “abuse” were dropped in ??? for the term ???
substance abuse disorder
Many patients could have a severe and life-threatening abuse problem without ???
ever being dependent on a drug
ddx withdrawal symptoms: tremors
hyponatremia, calcemia, kalemia
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
kindling can be caused by ??? leading to ??? no longer dependent on original stimulus
stimulants and depressants
relatively spontaneous effects
kindling effects may manifest as ???
mood swings, panic, psychosis, and occasionally overt seizure activity
opioids and narcotics refer to group of drugs w. actions that mimic ???
which one implies controlled and which one illicit?
what to know with case 2: etOH, heroin
what route using?
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
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
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
ddx etOH/heroine withdrawal symptoms
bacterial endocarditis (tricuspid valve)
septic emboli (from IVDU/endocarditis)
drug impurity rxn
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
male: female etOH tx ratio
maybe now more like 4:2, 4:3 (better at hiding it)
what is often present in etOH and should be carefully evaluated?
etOH commonly involved in ???
suicides and intrafamily homicides
in rapes and other assaults
problems assoc. w/ etOH abuse
medical, economic, and psychosocial
central and peripheral nervous system complications of etOH
chronic brain syndromes, cerebellar degeneration, cardiomyopathy, and peripheral neuropathies
etOH: Direct effects on liver
cirrhosis, esophageal varices, and eventual hepatic failure
Indirect effects etOH
protein abnormalities, coagulation defects, hormone deficiencies, and an increased incidence of liver neoplasms
short-term memory loss, thiamine deficiency involved, confabulation, AMS, confusion, amnesia
continuation of Wernicke's- chronic, permanent CNS damage, cerebellar damage; balance issues, tremor, vertigo, falls, Rombersgs, dysdiadokokinesia
etOH toxic to
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!
the problem of ??? must be faced
do not be ???
one of the most important considerations ??
things that can be done-motivational interviewing
pts. job - social
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
unhelpful etOH drugs
sedatives (to replace etOH)
this helps reduce craving and maintain abstinence
Acamprosate (333–666 mg orally three times daily)
-can be continued even during relapse
an opioid antagonist which lowers relapse rate of 3-6 mos post-drinking
naltrexone (50 mg orally/day)
lessens pleasurable effects of etOH
aversive drug for discouraging etOH use via inhibiting ??? -->toxic reactions when etOH consumed
disulfiram (250-500 mg/d oral)
onset of w/drawal symptoms
usually 8–12 hours and the peak intensity of symptoms is 48–72 hours after alcohol consumption is stopped
ddx of etOH w/drawal includes
other sedative withdrawals and other causes of delirium
acute alcoholic hallucinosis must be differentiated from other acute paranoid states such as
amphetamine psychosis, paranoid schizophrenia
??? 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
alcoholic hallucinosis: typical withdrawal symptom?
no, although it does occur during or on cessation of prolonged drinking period
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)
the choice of using specific sedative is less important than using ???
mild dependence req. ???
"drying out" -short course of tapering long-acting benzodiazepine
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
heroin use is on the increase bc ???
-snorting and inhaling increasing, esp in cocain users
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
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..
also for w/drawal, this suppresses cardiovascular signs and has some anxiolytic effect
clonidine, 5mcg/kg orally every 2 hours (or patch form)
also for w/drawal, this compares favorable with benzos
carbamazepine, 400-800 mg/day orally
??? 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
??? are not useful in managing etOH w.drawal seizure, but rather use ???
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
Chronic brain syndromes secondary to a long history of alcohol intake: responsive to thiamine and vitamin replenishment?
no, not clearly
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
clinical s/s of mild narcotic intoxication
changes in mood, with feelings of euphoria; drowsiness; nausea with occasional emesis; needle tracks; and miosis
opioid OD can cause
respiratory depression, peripheral vasodilation, pinpoint pupils, pulmonary edema, coma, and death
opioid withdrawal: Grade 0
opioid withdrawal: Grade 1
yawning, lacrimation, rhinorrhea, and perspiration
opioid withdrawal: Grade 2
previous symptoms plus mydriasis, piloerection, anorexia, tremors, and hot and cold flashes with generalized aching
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
tx for opioid w/drawal initiated @ stage ?
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
rapid ??? has become a method for tx opioid dependence
opioid detoxification with opioid antagonist induction using general anesthesia
important and effective types of behavioral treatment shown to be effective interventions for drug addiction
**cognitive behavior therapy**, contingency management, couples and family therapy
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)
this partial agonist has become a mainstay of office-based treatment of opiate dependency-(outpt, methadone addicts)
also effective in reducing concomitant ???
opioid and cocaine abuse