Behavioral science > Substance abuse > Flashcards

Substance abuse Flashcards

(40 cards)

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1
Q

Specifiers for substance abuse

A
  • In early remission: no criteria for >3 months but < 12 months (except craving)
  • Sustained remission: no criteria for > 12 months (except craving)
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2
Q

withdrawal of PCP, other hallucinogens, inhalants?

A

none

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3
Q

what are the groups of people more likely to abuse alcohol

A
  • men
  • American Indian
  • Whites
  • unemployed
  • Large metro areas
  • Parolees
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4
Q

Describe Alcohol withdrawal

A
  • Early: Anxiety, irritability, tremor, HA, insomnia, nausea, tachycardia, HTN, hyperthermia, hyperactive reflexes
  • Seizures: 24-48 hours. most often Grand mal
  • Withdrawal Delirium (DTs): 48-72 hours, altered mental status, hallucinations, marked autonomic instability, life-threatening
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5
Q

What score on CIWA indicates more severe alcohol withdrawal?

A

> 10

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6
Q

Treatment for alcohol withdrawal

A
  • Benzo: GABA agonist, cross-tolerant with alcohol. Reduces risk for Sz; provides comfort/sedation. if liver problems use a benzo with no metabolic metabolites
  • Anticonvulsants (Carbamazepine or valproic acid): reduce risk of Sz and may reduce kindling. helpful for protracted withdrawal
  • Thiamine supplementation
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7
Q

what do you need to check when patient taking Disulfiram

A

-check LFT’s and h/o hep C . . hepatotoxicity

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8
Q

MOA of Naltrexone?

Risk for what at high doses?

A
  • Opioid antagonist . .blocks mu receptors

- Hepatoxicity . .check LFTs

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9
Q

What do you need to check in pt using Acamprosate for alcohol use?

A

-kidney function

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10
Q

what is a common detox mistake for Benzodiazepines?

A

tapering too fast; symptoms worse at end of taper

-consider carbamazepine or valproic acid if doing rapid taper

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11
Q

What are the benzodiazepines that are metabolized only through glucuronidation in liver and not affected by age/hepatic insufficiency?

A
  • Oxazepam
  • Temazepam
  • Lorazepam
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12
Q

symptoms of opioid intoxication

A
  • pinpoint pupils
  • sedation
  • Constipation
  • bradycardia
  • HYPOtension
  • decreased respiratory rate
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13
Q

symptoms of Opioid Withdrawal

A
  • Not life threatening but extremely uncomfortable
  • Dilated pupils
  • lacrimation
  • Goosebumps
  • n/v, diarrhea
  • Myalgias and arthralgies
  • dysphoria or agitation
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14
Q

Give what for opioid withdrawal

A
  • antiemetic
  • antacid
  • antidiarrhea
  • muscle relaxant (methocarbamol)
  • NSAIDs
  • clonidine and maybe BZD
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15
Q

what is the neuroadaptation with opioid use

A

-increased DA and decreased NE

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16
Q

what medications for opioid use disorder

A
  • Methadone (mu antagoist)
  • Naltrexone (mu agonist)
  • Buprenorphine (partial mu agonist with a ceiling effect)
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17
Q

psychological signs of acute stimulant intoxication

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A
  • euphoria
  • enhanced vigor
  • gregariousness
  • hyperactivity
  • Restlessness
  • Interpersonal sensitivity
  • anxiety
  • Tension
  • ANGER
  • impaired judgement
  • PARANOIA
18
Q

Physical signs for acute stimulant intoxication

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A
  • Tachycardia
  • PAPILLARY DILATION
  • HTN
  • n/v
  • diaphoresis
  • chills
  • weight loss
  • chest pain
  • cardiac arrhythmias
  • confusion
  • seizures
  • coma
19
Q

symptoms of chronic stimulant intoxication

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A
  • affective blunting
  • fatigue
  • sadness
  • social withdrawal
  • hypotension
  • bradycardia
  • muscle weakness
20
Q

Stimulant withdrawal

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A
  • Not severe
  • exhaustion with sleep (crash)
  • treat with rest and support
21
Q

complication of cocaine

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A
  • vasoconstrictive . . increase risk for CVA and MI (obtain EKG)
  • Can get rhabdomyolysis with compartment syndrome from hypermetabolic state
  • Can see psychosis associated with intoxication that resolves
22
Q

Cocaine prevents reuptake of what?

23
Q

difference b/t cocaine and amphetamines on vessels

Study These Flashcards
A

amphetamines have no vasoconstrictive effect

24
Q

amphetamines inhibit reuptake of what?

Study These Flashcards
A

-DA, NE, SE . . greatest effect on DA tho

25
tobacco induces what?
CYP1A2 . .watch for interaction when start or stop . .. example: Olanzapine
26
neuroadaptation of nicotine
-nicotine acetylcholine receptors on DA neurons in VTA release DA in nucleus accumbens
27
Nicotine withdrawal
- dysphoria - irritability - anxiety - decreased concentration - insomnia - increased appetite
28
medications for tobacco used disorder
- Bupropion | - Varenicline
29
what are the hallucinogens
- Naturally occurring: Peyote cactus (mescaline); Magic mushroom (psilocybin) - oral - synthetic - LSD (Lysergic acid diethyamide) - oral - DMT (dimethyltryptamine) - smoked, snuffed, IV - STP - oral - MDMA: ecstasy - oral
30
symptoms of MDMA (ecstasy) intoxication
- Illusions - HYPERACUSIS - sensitivity of touch, taste/smell altered - "oneness with the world" - tearfulness - euphoria - panic - paranoia - impaired judgment
31
what is an unpleasant side effect of continued used of MDMA
teeth grinding
32
neuroadaptation of MDMA
-affects serotonin (5HT), DA, NE but mostly 5HT2 receptor agonist
33
symptoms of Cannabis intoxication
- Appetite and thirst increase - Colors/sounds/tastes are clearer - increased confidence and euphoria - relaxation - increased libido - Transient depression, anxiety, paranoia - Tachycardia, dry mouth, conjunctival injection - slowed reaction time/motor speed - impaired cognition - psychosis
34
Neuroadaptation of Cannabis
- CB1 and CB2 coupled with G proteins and adenylate cyclase to Ca channel . . inhibits Ca influx - decrease uptake of GABA and DA
35
withdrawal symptoms of Cannabis
- insomnia - irritability - anxiety - poor appetite - depression - physical discomfort
36
symptoms of PCP (Phenacyclidine) "angel dust" intoxication
- Severe dissociative reactions: paranoid delusions, hallucinations, can become very agitated/violent with decreased awareness of pain - Cerebellar symptoms: ataxia, dysarthria, NYSTAGMUS (vertical and horizontal)
37
consequences of Severe PCP OD
- mute - catatonic - muscle rigidity - HTN - HYPERTHERMIA - RHABDO - seizures - COMA - DEATH
38
Treatment of PCP use
- Antipsychotic drugs or BZD if required - Low stimulation environment - Acidify urine if severe toxicity/coma
39
Neuroadaptation of PCP
- opiate receptor | - allosteric modulator of glutamate NMDA receptor
40
PCP withdrawal?
NO tolerance or withdrawal
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