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47 Cards in this Set
- Front
- Back
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People who start drinking (before/after) age 21 are more likely to develop alcoholism |
before age 21
*specifically at age 14 or younger |
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BAL > ______ can lead to comatose & death
*As ppl become more tolerant, sxs are less at higher levels (more functional) |
BAL > 350
(BAL= blood alcohol levels) |
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Alcoholism is Mc in who? |
men
esp w/ antisocial personality, anxiety, & mood disorders *strong familial predisposition |
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What abnormal labs may indicate alcoholism? |
High blood alcohol concentration (BAC) Elevated WBC Macrocytosis (inc MCV) Elevated liver enzymes Elevated Uric acid Elevated GGT * |
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What physical findings may indicate alcoholism?
What circumstances are suspicious? |
Enlarged red nose & red palms Enlarged liver & spider veins Gynecomastia & testicular atrophy
*be suspicious if pt has accidents, falls, lying, blackouts |
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What is the CAGE questionare?
_____ + answer = 90% likelihood of alcoholism |
CAGE: Have you ever- felt you should Cut down drinking? felt Annoyed by criticism of drinking? felt bad or Guilty about drinking? taken an Eye-opener drink in morning to steady nerves or cure hangover?
1 + answer = 90% |
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_____________, problematic pattern of alcohol use cause 2+ of the following in a 12 month period; -alcohol drank in larger amounts or longer period than intended -persistent desire or unsuccessful efforts to control use -significant time spent drinking or recovering from drinking -craving for alcohol -failure to do school, work, or home duties -continued use despite recurrent problems -given up important activities -recurrent physically hazardous use -continued use despite causing physical or psych issues -tolerance (need more to get same effect) -withdrawal (characteristic syndrome) w/o alcohol
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Alcohol Use disorder |
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What is the role of dopamine in alcohol addiction? |
involved in the pleasure & reward system stimulated by alcohol consumption |
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______________ is cessation of alcohol (usually w/i 12- 18 hrs) leading to 2+ of following; -ANS hyperactivity (sweating or HR >100) -increased hand tremor -insomnia -Nausea or vomiting -Hallucinations or sensory illusions -Psychomotor agitation -anxiety -Grand mal seizures |
Withdrawal syndrome |
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Withdrawal symptoms are d/t disturbances in ____________ |
GABA & Glutamine
alcohol enhances the inhibitory effects of GABA & inhibits the excitatory effects of Glutamate
chronic use---> decr sensitivity of GABA receptors & upregulated NMDA glutamate receptors = tolerance
alcohol cessation--> huge drop in GABA & unopposed sensitivity to Glutamine--> hyperactivity = sweating, tachycardia, etc = withdrawal sxs |
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_______ also enhance the inhibitory effects of GABA, & are a good choice for treating the sxs of withdrawal
What else should you give to tx withdrawal? |
Benzodiazepines *usually for 5 days, taper dose* (long acting chlordiazepoxide or diazepam unless liver disease or brain damage- give shorter oxazepam or lorazepam)
+ fluids + thiamine + folic acid + anticonvulsants (valproic acid, carbamazepine, gabapentin) |
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___________ can follow Withdrawal Syndrome if untreated |
alcohol withdrawal delirium (DT's)
-disturbance of consciousness w/ reduced ability to focus -change in cognition or perceptual disturbances |
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What are the 5 stages of change? |
1. Precontemplation: no interest in change 2. Contemplation: thinking about change 3. Preparation: decision to change 4: Action: modifying behavior 5: Maintenance: changed behavior & prevention |
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Alcohol abuse disorder: Rehabilitation psychotherapy |
CBT- group & individual 12 step programs Tx underlying psych illness
*network, family, couple, inpatient, & therapeutic communities also available options |
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Alcohol abuse disorder: Relapse prevention medications |
Disulfiram: inc acetaldehyde w/ alcohol consumption--> causes vomiting, HA, etc *difficulty w/ pt compliance
Naltrexone: opioid antagonist--> blocks pleasure (dopamine release) w alcohol use *good for decr craving, CI in liver dz*
Acamprosate: NMDA antagonist--> decr withdrawal sxs & decr intensity of cravings *ok in liver dz*
Psych meds for comorbid disorders |
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What is the MC used illicit drug? |
Marijuana |
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What is the MC abused prescription drug (non-medical use)?
Where are they usually obtained? |
Pain relievers
*MC from friend or relative for free
(old lady may also sell for extra cash) |
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Opioid tolerance can develop rapidly via receptor desensitization. How do opioids increase dopamine? |
Opioids inhibit GABA---> Increase Dopamine-->
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What medical problems may suggest opioid use? |
Menstrual abnormalities Constipation* Respiratory depression |
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What are symptoms of opiate withdrawal?
*usually lasts about 48-96 hrs
(taper dose to avoid these in medical use) |
severe bone pain chills piloerection sweating extreme restlessness nervousness yawning rhinorrhea N/V diarrhea |
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How do you treat opiate withdrawal? |
Methadone: detoxification & symptom relief, NMDA antagonist, non-opiate substitute opioid *long-acting, cheap, safe *use equivalency dose, too much= hypothermia, drowsy, miosis, possible OD
Buprenorphine: detoxification, pain relief & blocks opioid effects (relapse prevention), mixed meu receptor agonist/antagonist, non-opiate substitute *precipitates withdrawal (give during) *long acting, safe
Clonidine: relief of hyperactive symptoms (not irritability, insomnia, or muscle aches) *may cause hypotension, sedation, dizzy |
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What drug can be used to confirm physical opiate dependence (precipitates withdrawal) AND to reverse opioid OD? |
Naloxone (Narcan) |
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opioid rehabilitation program |
Opiate substitute (Methadone or Buspirone) + counselling
*clinic daily injections, reward (-) drug tests w/ take home doses |
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T/F You should take a pregnant pt off opiate substitues |
FALSE
withdrawal sxs are very dangerous--> abortion, stillbirth, prematurity, developmental anomalies |
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Considerations for Methadone use in pregnancy |
-may need to inc dose (also in dose if taken w/ other CYP450 inducers) -infant will be born dependent & may need to be withdrawn w/ tincture of opium -no birth defects assoc w/ methadone use
(buprenorphine also works but not FDA approved yet) |
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What are prescription monitoring programs (PMP)? |
Computerized data base used to look up patients & physicians who are receiving/ writing opiate prescriptions |
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ALL sedative-hypnotic & anxiolytic meds are cross-tolerant w/ each other & alcohol
DON'T combine! *Most interact w/ GABA receptors
What is the main problem assoc w/ these? |
produce physical & psychological dependence
--> cessation leads to withdrawal symptoms |
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Barbiturates, Valerian, Meprobamate, & Quaaludes are mostly replaced by Benzodiazpines
New sedatives Zolpidem (Ambien) & Eszopiclone (lunesta) have what advantage? |
less/no physical dependence, still may cause psychological dependence
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If a patient comes in and they appear drunk (ataxic, slurred speech, poor coordination), you should suspect _____________abuse
*heavy use can lead to lethargy, cognitive dysfxn, blackouts, accidents, disinhibition, & self-neglect (pts may develop tolerance)
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Benzodiazepines
Long- chlordiazepoxide, diazepam, flurazepam Medium- alprazolam, clonazepam, temazepam Short- lorazepam, oxaxepam, triazolam Very short- midazolam (surgical use only) |
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If an addict stops taking or decreases dose of ________________, withdrawal symptoms, including seizures may occur
To help a patient stop use, what should you do to avoid withdrawal sx? |
Benzodiazepines
taper slowly & switch to a long acting (Chlordiazepoxide, diazepam, or flurazepam) + anticonvulsant (to prevent withdrawal seizures) +/- inpatient detox |
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If a patient comes in w/ dilated pupils, elevated HR & BP & acting psychotic (highly irritable, euphoric, paranoid, hallucinating), you should suspect ______________ abuse |
Stimulant abuse
*also by autonomic hyperarousal (inc BP & HR) |
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Stimulants are prescribed to tx; ADHD: methylphenidate, dextroamphetamine Depression: " " " " Sleep disorders & weight loss Cold congestion: pseudoephedrine
What effects lead to abuse? |
Stimulants are highly addictive & cause; mood elevation, incr energy & alertness, & decr appetite (weight loss) |
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______________ was originally a local anesthetic, derived from the coca plant of South America
*Increases dopamine in synapse by blocking reuptake ---> Leads to rapid sense of intense pleasure |
Cocaine *illegal stimulant
*crack, a derivative is smoked |
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_____________is easily synthesized from common items *Increases dopamine release at the synapse
You should suspect abuse in pts w/ psychotic symptoms, self-neglect, serious dental problems |
Methamphetamine *illegal stimulant *speed, meth, smoked or injected
(causes "meth mouth") |
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Stimulant abuse can lead to psychotic symptoms, MI, strokes, anoxic brain damage from seizures, & infections (HIV, Hep B & C)
Stimulant withdrawal can lead to irritability & depression. How should you tx these pts? |
antipsychotics (for psychotic sxs) + Benzodiazepines (for irritability) + Supportive psychotherapy or CBT
+/- antidepressants IF depression lasts > 2 wks, usually short lasting during "crash" & doesn't need tx |
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______________ induce psychotic like experiences such as misperceptions, visual hallucinations & feelings of unreality
*also cause sympathomimetic effects: inc HR, inc BP, pupillary dilation, blurry vision, sweating & tremors
Actions are mediated by .......... |
peyote, mescaline, LSD, & MDMA (Ecstasy) (hallucinogens)
affect dopamine, serotonin, Ach, & GABA (multiple NTs) |
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Hallucinogens can cause bad "trips" w/ severe anxiety & paranoia, & long-term effects of flashbacks or chronic psychosis, even cognitive & memory deficits (ecstasy).
How should you tx these patients? |
if OD---> medical emergency, hospitalize
*help calm pts w/ benzos |
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____________ was originally an animal anesthetic *induces euphoria, derealization, tingling warm feeling via ______________ *may lead to bizarre behavior, myoclonic jerks, confusion, delirium, psychosis, mood disorders, flashbacks, agitation & violence |
PCP (Phencyclidine)
NMDA receptor antagonist & activation of dopamine neurones |
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_________ OD may result in coma, seizures, & death from respiratory depression (pts will have small pupils)
How should you tx these pts? |
PCP
admit to ICU & tx w/ benzodiazepines, antipsychotics (low anticholinergic), phentolamine (for high BP) |
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_____________ is considered the "gateway drug" -contains THC, which accumulates in fat cells
-intoxication lasts 2-4 hrs & results in euphoria & serenity, slowed rxn time, & heightened senses & red eyes (conjunctivitis), dry mouth, tachycardia, coughing
What are some possible SEs of use? |
Cannabis
may precipitate psychosis in vulnerable, perceptual disturbances, anxiety, paranoia, poor attention, decreased motivation, poor coordination, & memory problems |
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_____________ produce psychoactive vapors --> short term CNS depression --> feelings of excitation, disinhibition, & euphoria *use mc in young poor males
what are the adverse effects? |
Inhalants: airplane glue, paint thinner, nail polish remover, gasoline, laboratory solvents
--> hallucinations & delusions, dizziness, slurred speech, ataxia -------> possible liver & renal toxicity & brain damage |
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____________ is highly addictive & dependence develops rapid *commonly used by psych pts
Withdrawal begins in 1 hr, peaks at 24 hrs & may last months--> cravings, irritability, anxiety, restlessness, decr HR followed by---> weight gain & depression
How should you tx withdrawal to help pts abstain for re-use?
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Nicotine
tx: nicotine replacement (transdermal patch, gum, lozenge, inhaler) Antidepressant (Bupropion) Varenicline (nicotine partial agonist) |
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_____________ is a stimulant that increases alertness & improves verbal & motor performance
*You should always suspect this in pts complaining of insomnia* Also causes restlessness, irritability--> seizures & coma (massive dose) |
Caffeine |
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Heavy caffeine can worsen esophageal & gastric disorders.
Withdrawal from heavy caffeine use can cause ..... |
HA, lethargy, irritability, depression & worsen anxiety syndromes |
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Substance abuse disorders commonly co-occur w/ psychiatric disorders, especially _________ & __________
Should you wait to tx the underlying psych disorder until abstinence has been reached? |
Anxiety & depression
NO! Tx the substance abuse disorder & the psychiatric disorder at the SAME time
*DO NOT WAIT |
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______________, persistent & recurrent problematic gambling behavior, exhibiting 4+ of the following in 12 month period; -need inc amount of money for excitement -restless/ irritable when attempt to stop -repeated failed attempts to stop/ decr -preoccupation w/ gambling -gambles when distressed -returns to "get even" after losing money -lies to conceal gambling -jeopardized or lost relationship/job/ school -relies on money from others fix finances *& NOT explained by MANIC episode |
Gambling Disorder
*CANNOT be part of manic episode*** |
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Gambling Disorder is frequent co-occurring w/ ____________
How do you tx? |
alcohol (73%), nicotine (60%), personality disorder (60%), mood disorder, anxiety, drug abuse
Tx: Supportive psychotherapy (gamblers annonymous), CBT, marriage/family therapy |
