[10.29] Sedative-Hypnotics and Anxiolytics V2.pdf

Intoxication

What is the term for a reversible substance-specific syndrome due to recent ingestion or exposure?

Withdrawal

What is the development of a substance-specific maladaptive behavioral change due to cessation or reduction of heavy/prolonged use?

Tolerance

What is the need for greatly increased amounts of a substance to achieve intoxication or desired effect?

Behavior tolerance

What is the ability to perform tasks despite a high level of substance intoxication?

Cross-tolerance

What is the condition where tolerance to one drug leads to tolerance to another in the same class?

Dependence

What is the cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use despite significant problems?

Psychological dependence

What is also known as habituation or a craving for the substance's effects?

Misuse

What term refers to the incorrect use of prescribed medications?

Toxidrome

What is the term composed of the words toxic and syndrome?

Substance, dose, duration, and individual tolerance

What are four factors that determine the clinical picture of intoxication and withdrawal?

Rapidly acting substances

What type of substances are more likely to produce immediate intoxication?

Longer acting substances

What type of substances typically produce longer withdrawal durations?

Treat the patient rather than the poison

What is the first basic principle of management in toxicology?

Mental status

What is the CNS component checked in a toxidrome assessment?

Pupil size

What is the ophthalmic system sign checked in a toxidrome assessment?

Peristalsis

What is the gastrointestinal system sign checked in a toxidrome assessment?

Dryness vs diaphoresis

What is the dermatologic system sign checked in a toxidrome assessment?

Anticholinergics

Which toxidrome presents with delirium, dilated pupils, dry skin, and urinary retention?

Cholinertics

Which toxidrome presents with salivation, lacrimation, diarrhea, and fasciculations?

Sympathomimetics

Which toxidrome is characterized by agitation, hypertension, tachycardia, and dilated pupils?

Opioids

Which toxidrome features depressed mental status, pinpoint pupils, and decreased respiratory rate?

Ethanol or sedative-hypnotics

Which intoxication toxidrome involves depressed mental status, variable pupils, and decreased vitals?

Withdrawal from ethanol/sedatives

Which syndrome presents with agitation, tachycardia, hypertension, and dilated pupils?

Withdrawal from opioids

Which syndrome features anxiety, dilated pupils, and diarrhea?

Regular drinker

What is the term for a person who drinks 4 or more times per week?

Heavy drinker

What is a person who drinks more than 12 drinks on an average drinking day called?

4.8 percent

What percentage of drinkers are classified as heavy drinkers?

6.6 percent

What percentage of male drinkers are heavy drinkers?

1.3 percent

What percentage of female drinkers are heavy drinkers?

15 to 20 mg/dL

How much does one drink typically increase the blood alcohol level of a 150-pound man?

12 oz

How many ounces of beer constitutes one drink?

5 oz

How many ounces of wine constitutes one drink?

1.5 oz

How many ounces of liquor constitutes one drink?

Small intestine

Where is the majority of alcohol absorbed?

30 to 90 minutes

How long does it take to reach peak blood concentration of alcohol?

Empty stomach

What condition enhances alcohol absorption?

90 percent

What percentage of alcohol is metabolized in the liver?

1 drink per hour

What is the typical rate of alcohol metabolism for the body?

15 to 20 mg/dL/hour

What is the general rate at which BAL decreases?

13 to 15 mg/dL/hour

What is the rate of alcohol metabolism in non-alcoholics?

More than 30 mg/dL/hour

What is the rate of alcohol metabolism in chronic alcoholics?

Zero-order kinetics

What type of kinetics does alcohol metabolism follow in cases of intoxication?

100 mg/kg/hour

In cases of intoxication, what is the constant rate of metabolism in mg/kg/hour?

0.08 to 1.15 g/dL

What is the legal definition range of BAL for intoxication?

Mood lability, impaired judgment, and ataxia

What are three primary symptoms of alcohol intoxication?

Thiamine 100 mg IM/IV

What is the first medication listed for managing alcohol intoxication?

Slowed motor performance and decreased thinking

What impairment is likely at 20-30 mg/dL BAL?

Nystagmus, slurred speech, and blackouts

What impairments are seen at 200-300 mg/dL BAL?

Rising BAL

Are signs of intoxication more intense when the BAL is rising or falling?

Questionnaires

What type of screening tool has greater sensitivity and specificity than laboratory tests for alcohol use?

GGT (Gamma-glutamyl transferase)

Which is the most sensitive laboratory test for monitoring alcohol abstinence?

CDT (Carbohydrate-deficient transferrin)

Which test is good for monitoring abstinence if someone drinks heavily for at least a week?

MCV (Mean corpuscular volume)

Which laboratory value is elevated in about 1/4 of long-term heavy drinkers?

4 to 12 hours

When does alcohol withdrawal typically begin after cessation or reduction?

2nd day of abstinence

When does alcohol withdrawal reach peak intensity?

3 to 6 months

How long can anxiety and insomnia persist at lower intensities after alcohol cessation?

Fewer than 3 percent

What percentage of individuals develop tonic-clonic seizures during alcohol withdrawal?

Minor withdrawal symptoms

Insomnia, tremulousness, and mild anxiety appearing within 6-12 hours describe what?

Alcoholic hallucinosis

What develops 12-24 hours after cessation and usually resolves within 48 hours?

24 to 48 hours

When do withdrawal seizures typically occur after stopping alcohol?

48 to 72 hours

When does Delirium Tremens typically begin?

5 days

When does alcohol withdrawal delirium peak?

CIWA

What scale is used to assign numerical values to the severity of alcohol withdrawal?

Score greater than 8

At what CIWA score are medications typically given?

Agitation, disorientation, visual hallucinations, and high fever

Name four main features of Delirium Tremens.

Age greater than 30

What age factor is a risk for Delirium Tremens?

Benzodiazepines

What drug class is used to reduce the risk of seizures and provide comfort during alcohol withdrawal?

Antipsychotics

What drug class should be avoided in alcohol withdrawal because it lowers the seizure threshold?

Symptom-triggered therapy

What is the preferred method of pharmacologic treatment for alcohol withdrawal?

Diazepam 5 to 10 mg every 6-8 hours

What is the common dosing for diazepam in alcohol withdrawal?

Wernicke s, cerebellar ataxia, and peripheral neuropathy

What three conditions does thiamine treat or prevent?

Maintain euglycemia

Why is D50-50 fast drip IV given during alcohol withdrawal management?

Potassium, phosphate, and magnesium

Which three electrolyte supplements are mentioned for alcohol withdrawal?

Loperamide

What is an example of an antidiarrheal agent used p.r.n. in withdrawal?

CNS depression

What is the primary effect of all sedative-hypnotics?

GABA-mediated chloride channels

Which channels do sedative-hypnotics enhance?

Glutamate

Sedative-hypnotics decrease the effects of which excitatory neurotransmission?

Lipophilicity

What property determines how fast a drug penetrates the blood-brain barrier?

Short-acting and highly lipophilic

What combination of drug properties makes a BZD more addicting?

Anterograde amnesia

What memory impairment resembles alcoholic blackouts in BZD intoxication?

20 to 30 percent

What percentage of individuals undergoing untreated BZD withdrawal may experience grand mal seizures?

Disturbances in consciousness and cognition

What characterizes withdrawal delirium?

Clear sensorium with intact reality testing

Under what condition is the specifier with perceptual disturbances used in BZD withdrawal?

Shorter half-life

Does a shorter or longer half-life predict more severe withdrawal?

6 to 8 hours

When do withdrawal symptoms begin for BZDs with a half-life of 10 hours or less?

2nd week

When do withdrawal symptoms reach peak intensity for substances with longer half-lives?

Flumazenil

What is the competitive BZD antagonist used for overdose?

Arrhythmias and withdrawal

What are two potential dangerous side effects of giving Flumazenil?

Tapering too fast

What is the most common detoxification mistake for BZDs?

Convert to longer elimination drug

What is the correct first step in BZD detoxification?

5 mg diazepam equivalent

What is the maximum dose decrease recommended per 1-2 weeks during taper?

Carbamazepine or valproic acid

What two drugs can be considered if a rapid BZD taper is required?

Diazepam 5 mg

What is the dose equivalent for 0.5 mg of clonazepam?

Midazolam

Which BZD listed has the shortest half-life (1-5 hours)?

CB1 receptors

Which receptors are distributed throughout the brain and responsible for clinical cannabinoid effects?

Basal ganglia, hippocampus, and cerebellum

Name three brain regions with high densities of CB1 receptors?

CB2 receptors

Which receptors are located peripherally in the immune system tissues?

Inhalation

Which route of administration for THC results in effects within minutes?

1 to 3 hours

How long does it take for ingested cannabis to show psychoactive effects?

3 to 4 hours

What is the typical duration of cannabis intoxication effects?