BH 6 - Substance Abuse

substance use disorder

substance abuse and substance dependence

true

true or false: the DSM-5 criteria is the same for all substance use disorder subtypes

true

true or false: different substance use disorders are named for specific substance being abused

dependence

an adaptive state that the body develops from repeated drug administration which results in withdrawal upon cessation of substance use

misuse

use of a substance for a purpose that is not consistent with legal or medical guidelines, most often with prescription medications

abuse

a pattern of harmful use of any substance for mood-altering purposes

addiction

repeated, increased usage of a substance, the deprivation of which causes symptoms of distress and irresistable urge to use again; leads to physical and mental deterioration

intoxication

reversible syndrome caused by a specific substance that affects one or more of the following: memory, orientation, mood, judgement and behavioral, social or occupational functioning

withdrawal

substance specific syndrome that occurs after stopping or reducing the amount of substance used regularly; + physical and psychological changes/symptoms

tolerance

phenomenon where a repeatedly administrated dose of a drug results in decreased effect or need for increasing doses to maintain previous effects

risky use

characterized by consumption amounts that increase the likelihood of health consequences

cannabis

opioids

cocaine

hallucinogens

what are the top 4 illicit drugs of abuse in order?

cannabis

what is the TOP illicit drug of abuse?

drug availability, social acceptability, peer pressure

what are some factors/determinants of initial experimentation with drugs?

false

true or false: behavioral and personality does NOT play a factor to substance abuse

true

true or false: there is a strong genetic component to substance abuse

self medication

patient medicating themselves with drugs to cope with illness or mental health struggles

males

what gender is more likely to suffer from substance use disorder?

AUDIT-C

a simple 3 question screen for hazardous or harmful drinking that can stand alone or be incorporated into general health history questionaire

CAGE-ID

commonly used 5 question tool with questions about alcohol and drug abuse

TAPS

tobacco, alcohol, prescription meds, and substance use that puts you at either low risk or high risk for substance abuse

TAPS-1

4 item screening for tobacco, alcohol, illicit drugs, and perscription drugs.

TAPS-2

if a patient scores highly on TAPS-1, we follow up with this brief assessment to help arrive at the risk level for that substance

BSTAD

screening tool to identify risky substance use in ADOLESECENT PATIENTS

S2BI

screening tool for frequency of use questions to categorize substance use by adolescent patients into different risk categories

depression, anxiety, agitation, sleep disturbance, psychosis, behavioral changes

what are some psychiatric findings for substance use?

true

true or false: positive drug screening tests should be confirmed

2 or more symptoms within 12 months

what is the duration and amount of DSM-5 criteria for substance use disorder?

tolerance

a need for markedly increased amounts of substance to achieve the same effect. markedly dimished effect with continued use of the same amount of substance.

withdrawal

characteristic symptoms when halting using a drug. the same substance is taken to relieve or avoid these symptoms

reversible

is intoxication reversible or irreversible?

false

true or false: tolerance and withdrawal are NOT substance specific

alcohol intoxication

slurred speech, incoordination, unsteady gait, nystagmus, impairment in attention or memory, stupor, or coma

alcohol withdrawal

autonomic hyperactivity, increased hand tremor, insomnia, various hallucinations, anxiety, grand mal seizures

benzodiazepines: valium, ativan, librium (intermediate and long acting)

what is the treatment for tremors, seizures, and hallucinations in alcohol withdrawal?

dysarthria

slurred speech

ataxia

unsteady gait

minor withdrawal

occurs within 6-24 hours of patient's last drink. tremors, anxiety, nausea, vomiting, insomnia, AUTONOMIC HYPERACTIVITY

major withdrawal (alcoholic hallucinations)

occurs 24-72 hours after the last drink. visual and auditory hallucinations, whole body tremors, vomiting, diaphoresis, hypertension

withdrawal seizures

within 6-48 hours after abrupt cessation of alcohol. a sign

profound global confusion (altered mental status)

what is the hallmark for delirium tremors (DTs)?

delirium tremens (DTs)

occurs 3-10 days after cessation of alcohol.

thiamine deficiency and folic acid deficiency

what are 2 deficiencies that can occur with alcohol withdrawal that we can treat?

delirium tremens (DTs)

altered mental status (global confusion) and sympathetic overdrive (autonomic hyperactivity) which can progress to cardiovascular collapse

5%

delirium tremens occur in ___% alcohol withdrawals?

thiamine

______ deficiency can lead to cell death

valium (Diazepam)

ativan (lorazepam) and librium

what is the 1st drug of choice for alcohol withdrawal treatment?

2 alternatives?

wernicke's encephalopathy

result of thiamine deficiency assocaited with chronic alcoholism

wernicke-korsakoff syndrome

wernicke's encephalopathy can lead to what syndrome?

encephalopathy, ataxia, oculo-motor dysfunction

what is the classic triad for wernicke's encephalopathy?

confabulation

making up stories

wernicke-korsakoff syndrome

inability to form new memories, loss of memory is severe, making up stories, hallucinations

wernicke's encephalopathy

global confusion, gait ataxia, and ocular symptoms

NYSTAGMUS

what is the hallmark symptom for wernicke's encephalopathy?

Antabuse (disulfiram)

what medication that causes alcoholics to become severely ill if drinking alcohol, that helps maintain sobriety?

Antabuse (disulfiram)

to use this medication for alcoholism, the patient must be abstinent from alcohol for over 12 hours to begin treatment

Campral (acamprosate)

what medication that decreases the cravings for alcohol?

naltrexone (ReVia, Vivitrol)

what medication is used for opioid addiction, alcohol dependence, and other addictions?

naltrexone (ReVia, Vivitrol)

what medication blocks the brain from having the "high" sensation, or blocks the dopamine sensation?

naltrexone (ReVia, Vivitrol)

what medication is a pure opioid antagonist?

naltrexone (ReVia, Vivitrol)

what mediation for alcoholism treatment has a risk of hepatotoxicity?

irritability, anxiety, difficulty concentrating, increased appetite, restlessness, depressed mood, insomnia

what are some symptoms of tobacco withdrawal?

nicotine patch, nicotine gum, nicotine lozenge

what are OTC nicotine dependence products?

nicotine nasal spray, nicotine inhaler

what are prescription nicotine dependence products?

bupropion, varenicline, notriptyline

what meds can we use for nicotine dependence treatment that are non-nicotine medications?

Chantix

what specific medication can be used for smoking cessation, needs to be taken with food, and started 1 week before someone PLANS TO QUIT if QUIT DATE IS PLANNED

8-35 days after starting Chantix

those quitting smoking using Chantix needs to quit smoking how many days after starting Chantix?

total of 24 weeks

how long does a patient take Chantix for?

Chantix

what smoking cessation med has this BBW: neuropsychiatric symptoms, suicide, insomnia, and nightmares/night terrors

24 hours

what is the half life of chantix?

stimulant

caffine acts as a (stimulant, non stimulant, depressant)

early as 15 minutes, lasts up to 6 hours

what is the duration of caffeine effects?

restlessness, nervousness, excitement, insomnia, flushed face, GI disturbance, muscle twitching, tachycardia/arrythmia

what are some symptoms of caffeine intoxication?

headaches, marked fatigue, depressed mood, difficulty concentrating, flu like symptoms

what are some symptoms of caffeine withdrawal?

none, its symptomatic

what is the treatment for caffeine withdrawal?

stimulants

______________ speed up the body's systems

stimulants

perscription drugs such as amphetamines and methylphenidates

stimulants

cocaine, MDMA

amphetamines

prescription stimulants used to treat ADHD

slower, longer

amphetamines have a (slower, faster) onset than cocaine.

amphetamines have a (shorter, longer) duration that cocaine

schizophrenia

chronic abuse of amphetamines produces a psychosis that resembles _____________

amphetamines (and amph. chronic abuse)

patient appears with increased body temperature, blood pressure and pulse rates, insomnia, loss of appetite, and physical exhaustion.

chronic abuse results in paranoia, hallucinations, violent, and erratic behavior

methamphetamines

stimulant that speeds up the body's system that comes as a pill or powder

crystal meth

glass fragments that is an illegally altered version of methamphetamine that is cooked with other drugs in meth labs

ingested, crushed, snorted, dissolved, smoked

what are methods of admin for meth?

methamphetamines

patient has agitation, increased HR, BP, respirations, temperature

anxiety, paranoia

high doses can result in convulsions, cardio collapse, stroke or death

cocaine

obtained from the leaves of the "coca" plant

freebase (smoked)

hydrochloride salt (dissolves in water)

what are the 2 forms of cocaine?

crack cocaine

the smokeable form of cocaine, intense euphoric rush

dilation

** cocaine causes pupillary (constriction, dilation)

sympathetic

what nervous system does cocaine target?

cocaine

tachycardia, PUPIL DILATION, elevated BP, cardiac arrythmia, weight loss, restless, anxiety, paranoia

cocaine-induced myocardial ischemia or MI

cardiovascular complications caused by cocaine

cocaine

what street drug can cause cardiovascular complications like angina, MI, and sudden cardiac death?

beta blockers

too much of an opposite effect

what medication can worsen cocaine-induced myocardial ischemia or MI? why?

benzodiazepines

what is the medication treatment of choice for cocaine-induced myocardial ischemia or MI?

nitroglycerin and phentolamine

what meds are used for cocaine induced hypertension?

crash

following a cocaine high, there is mental and physical exhaustion, sleep, and depression lasting several days

fatigue, vivid or unpleasant dreams, insomnia, agitation

what are some symptoms of cocaine withdrawal?

there are no physiological disturbances that necessitate drug withdrawal treatmetn

what is the treatment for cocaine withdrawal?