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45 Cards in this Set

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What percentage of patients admitted to the hospital have alcohol problems?
About 10-20% of patients admitted to the hospital have alcohol problems
What is the rate of substance abuse and primary care?
Are listed and prescription drug abuse varies from 5-10% and primary care
Where considered safe drinking limits?
Under 65 years old
5 drinks per day
14 drinks per week

female or over 65 years old
4 drinks per day
7 drinks per week
Define
at risk of drinking
At risk drinking =
safe limits of drinking are exceeded, but abuse or dependency criteria are not met
What percentage of college students report binge drinking?
40% of college students report binge drinking in prior 2 weeks

One third of college students meet criteria for alcohol abuse
Percentage of pregnant/nonpregnant women engage in binge drinking
2% of pregnant women engage in binge drinking

13% of nonpregnant women engage in binge drinking
First trimester drinking can produce:
Drinking during first trimester can produce:
Low birth weight
decreased birth length.
Decrease head circumference.
My are physical abnormalities.
Alcohol related neural developmental disorders
Second and third trimester drinking can produce
Developmental delay can be caused by drinking during second and third trimesters
Where the medical complications of illicit drug use
Drug use is associated with medical complications of pregnancy.
Placental abruption.
Placental insufficiency.
Chorioamnionitis.
Spontaneous abortion.
Postpartum hemorrhage.
Preeclampsia
What percentage of life threatening injuries involve alcohol?
70% of life threatening injuries involving alcohol
What is a chemical treatment of acute alcoholism?
Treatment of acute alcoholism
Thiamine 100 mg IM. To prevent Wernicke's encephalopathy.
Long-acting benzodiazepines to prevent and treat alcohol withdrawal syndrome
When does withdrawal from short acting benzodiazepines begin?

How long will it last?
Withdrawal from short acting benzodiazepines may occur within 24 hours and lasts for several days
What percentage of elderly have alcohol when admitted to the hospital?
6-11% of elderly have alcohol in them when admitted to the hospital
How does alcohol rank as a psychiatric disorder among elderly?
Alcohol is a third most common psychiatric disorder among elderly.

One third of older alcoholics are late onset alcoholics diagnosed after age 65
Why is alcohol metabolized different an elderly?
Elderly have altered pharmacokinetics because of:
More body fat
Less water than younger people.
Therefore higher alcohol concentrations with less alcohol ingestion
Conditions associated with alcoholism in the elderly
Conditions associated with alcoholism in the elderly include:
Depression.
Delirium.
Chronic fatigue.
Seizures.
Repeated infections.
Hypertension.
Malnutrition.
Peripheral neuropathy.
Sexual dysfunction.
Cardiomyopathy.
Limitations of hair analysis for drugs.
Hair analysis is:
More useful for forensic than clinical work.
Can be incorporated from external environment.
His present and higher concentrations in pigmented hair at the nonpigmented hair.
Cosmetic treatments and ultraviolet exposure decrease concentrations of drugs
What level of creatinine must be present and urine for a valid drug sample?
A urine must contain at least 20 ng/mL to be considered valid
Where the temperature limits for a valid urine for urinalysis
Urine must be between 90°-100°F within 4 minutes of collection
Define
dilute urine
A dilute urine contains to-20 mg/dL of creatinine
And
specific gravity between 1.0010-1.0200
Define
Substitute urine
Substituted Urine: Creatinine <2 mg/dL
And
specific gravity not between 1.0010-1.0200
What substances does DOT test for?
DOT tests for 5 substances.
Amphetamines.
Cannabinoids.
Cocaine.
Opiates.
PCP.
What are the best test for chronic alcoholism?
The best test for chronic alcoholism are:
GGT.
AST.
MCV
How much alcohol must one consume to elevate GGT?
5 drinks a day for 2 weeks Will elevated GGT in most individuals
How fast will GGT decline with abstinence?
GGT will decline
50% in 2 weeks.
To normal in 2 months
What are some non-alcohol related conditions that can increase the MCV?
Nonalcohol conditions that can raise MCV are.
Chronic liver disease.
Hypothyroidism.
Folate deficiency.
Megaloblastic disorder
What is NADH?
NADH is produced during oxidation of alcohol and can be a marker for alcohol abuse
What chemicals can falsely elevate NADH?
NADH can be falsely elevated with consumption of.
I so propanol.
Methanol.
Ethylene glycol.
Acetone and diabetic ketoacidosis or starvation acidosis
Was a ratio of blood alcohol to breath alcohol?
Ratio concentration of alcohol in the breath to alcohol in the blood is approximately 2100:1
How long after an alcoholic drink can of breath analysis be done?
Should wait 15 minutes after last drink before measuring blood alcohol limit the alcohol in the mouth
Describe instructions for breath alcohol analysis
Weight 15 minutes after less drink.
Subject takes deep breath and measures taken in the last third of breath.
Shallow breath usually underestimates blood level
Discuss urine tests for alcohol
Urine testing for alcohol is qualitative, not quantitative.
Positive tests indicates alcohol within preceding 8 hours.
Ethanol glucuronide (ETG) is metabolite of alcohol and urine.
Highly sensitive, but mouthwashes etc. we'll give false values
List most common amphetamines
Most common amphetamines are.
Amphetamine. Methamphetamine.
MDMA. = Ecstasy
MVA.
MDEA = Eve
With to the following stamp for?
MDMA.
MDA.
MDEA
MDMA = ecstasy = 3, 4 methylene dioxy methamphetamine.
MVA = 3, 4, methylene dioxy amphetamine.
MDEA = Eve = 3, 4 methylene dioxy N. Ethyl amphetamine
Which isomer of amphetamines as stronger effects?
D. isomer of amphetamines is more active and has more potential abuse
What will Vicks nasal inhaler give a false positive test for?
Vicks nasal inhaler will give a false positive test for methamphetamine. It is the L. isomer
What are some sympathomimetic amines that cross react with the urine test for amphetamines?
The following will cross-react immunoassay for amphetamines.
Phenylpropylanine
Pseudoephedrine.
L. methamphetamine (Vicks).
Appetite suppressants containing ephedrine and phentermine.
Selegiline
benzphetamine parent
How long are amphetamines detectable in urine?
Amphetamines are usually detectable for one-3 days and year
What chemicals will reduce detection of amphetamines in urine?
A high pH will reduce excretion therefore ingesting bicarbonate will reduce detection of amphetamines
What does urine test for amphetamines and methamphetamine actually test for?
The urine immunoassay for amphetamines actually test for amphetamine and methamphetamine.
What are the 3 classes a barbiturates based on duration of action?
The 3 classes of barbiturates based on duration of action are.
Thiopental = ultrashort acting.
Pentobarbital, secobarbital, amobarbital = short acting = most commonly abused.
Phenobarbital = long-acting, low abuse potential
How long or short acting barbiturates detectable and urine?
Short acting barbiturates are usually detectable for one-4 days in urine. This includes butabarbital, pentobarbital, secobarbital
What drugs metabolized to oxazepam ?
The following drugs metabolized to oxazepan.
Clorazepate.
Chlordiazepoxide.
Diazepam.
Temazepam
What benzodiazepines are likely to be missed in urine screen for benzodiazepines?
Urine test for benzodiazepines target oxazepam.
Can miss
clonazepam.
Lorazepam.
Triazolam
What common drugs can give false positive for benzodiazepines?
Urine test for benzodiazepines can give false positives with the following.
Oxaprozin.
Sertraline
tolmetin