Term
| What is the the definition in DSMIV terms of substance abuse? |
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Definition
-pattern of substance use leading to impairment or distress for at least 1 year that leads to 1 or more of the following:
1. failure to fulfill obligations
2. use in dangerous situations
3. Recurrent legal problems
4. Continued use despite social or personal problems due to the substance use |
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Term
| What is the definition of substance Dependence? |
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Definition
| Use leading to impairment or distress with 3 of the following over 12 months: 1. Tolerance 2. Withdrawal 3. Using substance more than originally intended 4. Persistent desire or unsuccessful cut down attempts 5. Significant time spent getting, using, or recovering from a substance 6. Decreased social, occupational, or recreational activities 7. Continued use despite subsequent physical or psychological health problem |
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Term
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Definition
| The development of a substance-specific syndrome due to the cessation of substance use that has been prolonged and heavy |
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Term
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Definition
| The need for increased amounts of a substance to achieve the desired effect |
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Term
| What is the effect of alcohol on GABA, serotonin, and glutamate receptors? |
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Definition
-inc gaba-r stimulation
-inc serotonin-r stim
-dec. glutamate effect
-net effect is sedation |
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Term
| Describe how alcohol is metabolized (i.e. which enzymes are involved?) |
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Definition
Alcohol metabolized to acetaldehyde (enzyme: alcohol dehydrogenase) then to acetic acid (aldehyde dehydrogenase)
-levels of these substances are upregulated in heavy drinkers |
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Term
| How do you screen for alcohol abuse? |
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Definition
CAGE questionnaire
-<2 yes responses-->positive abuse screen |
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Term
| Differential diagnosis of acute alcohol intoxication |
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Definition
| -hypoglycemia, hypoxia, mixed (EtOH-drug)overdose, ehtylene glycol or methanol poisoning, hepatic encephalopathy, psychosis, psychomotor seizures |
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Term
| Dx of acute alcohol intox |
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Definition
-blood alcohol levels
-CT to r/o subsdural or other brain injury |
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Term
| decreased fine motor control, impaired judgment and coordination, ataxia, poor balance, lethargy (+/- coma), respiratory depression |
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Definition
Acute alcohol intoxication
-Treatment:
-ensure ABCs, fingerstick glucose to r/o hypoglycemia, thiamine, naloxone (to reverse the effect of any opioids that may have been ingested), folate
-The liver will eventually metabolize alcohol without any other interventions if reliable airway is maintained |
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Term
| All patients with acute altered mental status should receive |
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Definition
| thiamine, glucose, naloxone |
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Term
| What are some treatment options for alcohol dependence? |
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Definition
1. AA
2. Disulfiram (inhibits aldehyde dehydrogenase causing retching when the person drinks)
3. Therapy, SSRIs
4. Naltrexone- opioid antag that reduces alcohol cravings |
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Term
| Describe the timeline of alcohol withdrawl syndrome |
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Definition
| -6-24 hrs after last drink: irritability, insomnia (mild); fever, disorientation, seizures, hallucinations (severe)
-72 hrs + of last drink: DTs |
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Term
| Delirium, visual hallucinations, gross tremor, autonomic instability, fluctuating levels of psychomotor activity |
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Definition
Delirum Tremens
-72 hours after last drink
-15-20% mortality if not treated
-gibe BDZs |
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Term
| Treatment of alcohol withdrawal |
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Definition
-Tapering doses of BDZs (chlordiazepoxide, lorazepam)
-Folic acid, thiamine
-Mag-sulfate for withdrawal seizures |
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Term
| ataxia, confusion, opthalmoplegia |
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Definition
| Wernicke's encephalopathy
-caused by thiamine deficiency
-give thiamine before glucose
-giving glucose first exacerbates thiamine deficiency (thiamine is a coenzyme used up in carbohydrate metabolism) |
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Term
| impaired recent memory, anterograde amnesia, -/+ confabulation |
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Definition
Korsakoff's syndrome
-progression from Wernicke's encephalopathy
-chronic, often irreversible |
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Term
| Why is cocaine appealing? |
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Definition
blocks dopamine reuptake from the synaptic cleft-> stimulant effect
-dopamine is involved in the reward system of the brain |
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Term
| Euphoria, increased or decreased BP, tachycardia or bradycardia, nausea, dilated pupils, weight loss, psychomotor agitation or depression, sweating, chills +/- respiratory depression, seizures, arrhythmias, hallucinations |
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Definition
Cocaine intoxication
-ddx: PCP or amphetamine intoxication, sedative withdrawal
-Dx: Urine Drug test (positive for 3 days)
-Treatment: symptoms (agitation with BZDs, psychosis with Haldol, control of HTN, arrythmias) |
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Term
| Treatment of cocaine dependence |
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Definition
| TCAs, group therapy, dopamine agonists (bromocriptine, amantidine) |
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Term
| dysphoric "crash": malaise, fatigue, depression, hunger, constricted pupils, vivid dreams, psycomotor agitation or retardation |
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Definition
Cocaine withdrawal:
tx: supportive; let patient sleep off crash |
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Term
| sxs similar to cocaine intoxication or PCP intoxication |
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Definition
Amphetamine intoxication
Dx: UDS (positive for 1-2 days)
tx: similar to cocaine
-withdrawal is also similar to cocaine withdrawal |
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Term
| Recklessness, impulsiveness, impaired judgment, assualtiveness, rotary nystagmus, atxia, HTN, tachycardia, muscle rigidity, high tolerance to pain |
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Definition
PCP intoxication (phencyclidine)
-antagonizes NMDA receptors-->activation of dopinergic neurons
-Ddx: acute psychosis
-Dx: UDS (positive for >1 week); CPK and AST often elevated
-Tx: monitor electrolytes, vitals; acidify urine with ammonium chloride, ascorbic acid; diazepam for muscle spasms and seizures, Haldol for severe agitation or psychotic sxs |
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Term
| How does PCP withdrawal manifest? |
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Definition
| No withdrawal syndrome, but flashbacks may occur |
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Term
| What is the difference between the mechanism of action between BDZ and barbituates? |
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Definition
BDZ: increase the frequency of chloride channel opening
Barbituates: increase duration of chloride channel opening, at high doeses they act as direct GABA agonists and have a lower margin of safety |
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Term
| Drowsiness, slurred speech, incoodination, mood lability, nystagmus, respiratory depression |
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Definition
| Sedative-hypnotic intoxication (ddx=alcohol intox, generalized cerebral dysfunction)
-Dx: UDS (positive for 1 week), electrolytes, ECG
Tx: ABCs, activated charcoal; for BDZs give flumazenil (beware seizures), for barbs alkalinize urine with sodium bicarb to promote excretion |
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Term
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Definition
-Short-acting BDZ antagonist
-Remember that BDZs may be used to control seizures, so rapid correction of toxicity may lead to seizures |
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Term
| In general, withdrawal from drugs that are ______ is life threatening, while withdrawal from drugs that are ______ is not. |
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Definition
| sedating, stimulants/hallucinogens |
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Term
| Tachycardia, sweating, insomnia, anxiety, tremor, hallucinations, seizures |
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Definition
Sedative-hypnotic withdrawal (barbs, BDZs)
-Can be life threatening, more commonly seen with abuse of short-acting agents
-Tx: give long-acting BDZ such as Chlorodiazepoxide or diazepam with tapering of the dose
-control of seizures with valproic acid or carbemazepine |
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Term
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Definition
a common date rape drug
-dose-specific CNS depressant that produces memory loss, respiratory distress, and coma |
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Term
Triad: resp depression, AMS, Miosis +/-
seizures,drowsiness, n/v, constipation, slurred speech. |
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Definition
Opiate intoxication
-ddx: sedative-hypnotic intox, severe alcohol intoxication
-dx: rapid recovery of consciouness after administration of IV naloxone
-Urine and blood tests positive for 12 to 36 hrs.
-Tx: naloxone or naltrexone (both diagnostic and therapeutic, nut may cause acute withdrawal in dependent patient so ventilator may be necessary) |
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Term
| Treatment of opioid dependence |
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Definition
| Oral methadone daily tapered over months to years; Narcotics anonymous |
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Term
| Dysphoria, insomnia, lacrimation, rhinorrhea, yawning, weakness, piloerection, dilated pupils |
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Definition
Opiate withdrawal
-tx: clonidine, buprenorphine or detox with methadone tapered over 7 days |
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Term
| Which opiate causes dilation instead of pupil constriction? |
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Definition
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Term
| Mushrooms, LSD, mescaline are examples of |
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Definition
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Term
| Perceptual changes, papillary dilation, tachycardia, sweating, palpitations |
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Definition
Hallucinogen intoxication
-Tx: reassurance
-patients may experience "flashbacks" but no formal withdrawal syndrome |
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Term
| Euphoria, impaired coordination, mild tachycardia, conjunctival injection, dry mouth, increased appetite |
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Definition
Marijuana intoxication
tx: supportive
dx: UDS (positive for up to 4 weeks in heavy users) |
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Term
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Definition
| -an andenosine antagonist, causing increased cAMP and stimulant effect via the dopaminergic system |
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Term
| Stimulates nicotinic receptors in autonomic ganglia of the sympathetic and parasympathetic nervous systems |
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Definition
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Term
| restlessness, insomnia, anxiety, incrased gastrointestinal motility, improved attention, improved mood, decreased tension |
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Definition
Nicotine intoxication
tx: cessation |
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Term
| Craving, dysphoria, anxiety, increased appetite, irritability, insomnia |
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Definition
Nicotine withdrawal
tx: smoking cessation |
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Term
| What are some options for smoking cessation assistance? |
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Definition
-Behavioral counseling
-Nicotine replacement
-Zyban
-Clondine |
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Term
| what drug is known to cause bruxism? (teeth grinding) |
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Definition
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Term
| How do methamphetamines work? |
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Definition
Classic meths: increase release of dopamine from nerve endings
Designer meths: increase release of dopamine and serotonin |
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Term
| Impaired judgement, belligerence, peripheral neuropathy, muscle weakness |
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Definition
Inhalant syndrome
dx: serum drug screen (positive for 4-10 hrs)
tx: supportive |
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Term
| HOw long is the urine/serum drug screen positive for various substances? |
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Definition
Cocaine: UDS- 3 days
Amphetamines: UDS-1-2 days
PCP: UDS- >1 week
Sedative-hypnotics: UDS- 1 week
Opiate- UDS-12-36 hrs
Marijuana-UDS-4 weeks
Inhalants- serum ds-4-10 hrs |
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