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65 Cards in this Set
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DSM-5 criteria for substance use disorder |
substance taken in larger amounts + persistent desire to quit + long time spent in activities related to substance |
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other DSM-5 criteria |
craving/urge for substance, recurrent use results in failure to fulfill major role obligations, continued use despite problems, give up important activities, use in dangerous situations, use despite physical/psych problems, tolerance, withdrawal |
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early remission |
3-12 months |
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sustained remission |
12 months or longer |
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mild substance use disorder |
2-3 symptoms |
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moderate disorder |
4-5 symptoms |
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severe disorder |
6+ symptoms |
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Alcohol mechanisms |
enhance GABA, reduce glutamate neurotransmission; stimulates opiate and cannabinoid receptors in ventral tegmental area |
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highest 12-month prevalence of alcohol use disorder - ages |
16.2% among 18-29 y/o |
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highest 12-mo prevalence of alcohol use disorder - ethnicity, 12-17 y/o |
Hispanics = 6%, Native Americans = 5.7%, Whites = 5% |
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highest 12-mo prevalence of alcohol use disorder - ethnicity, adults |
Native americans = 12.1%, Whites = 8.9%, Hispanics = 7.9% |
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diagnose alcohol use disorder |
BAC, GGT >35, CDT >20, MCV, liver enzymes increased |
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criteria for alcohol intoxication |
inappropriate sexual/aggressive behavior, mood lability, impaired judgment + >1 of: slurred speech, incoordination, unsteady gait, nystagmus (horizontal), impaired attn/memory, stupor/coma |
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manage alcohol intoxication |
support, hemodialysis (extreme), lorazepam/haloperidol to manage agitation |
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alcohol withdrawal |
2+: autonomic hyperactivity, increased hand tremor, insomnia, N/V, transient hallucinations, psychomotor agitation, anxiety, seizures |
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manage alcohol withdrawal |
benzos, lorazepam/oxazepam in elderly pts/liver impaired pts, symptom-triggered therapy |
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other alcohol withdrawal meds |
carbamazepine, valproate, clonidine, propranolol, thiamine |
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Alcohol Use disorder meds |
Naltrexone, Acamprosate, Disulfiram non-FDA approved: Topiramate, Ondansetron, Baclofen |
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Naltrexone contraindications |
liver failure, patient on narcotics |
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Naltrexone MOA |
opioid receptor antagonist |
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Disulfiram contraindications |
seizure disorder, liver failure, dementia, really bad to mix w/ alcohol |
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Sedative, hypnotic, or anxiolytic substances |
Benzodiazepines, barbiturates - work on GABA-A (alpha 1, 2, 3, 5) |
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manage benzodiazepines overdose |
support, flumazenil (competitive benzo antagonist) |
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DSM-5 caffeine intoxication |
5+: restless, excited, flushed face, GI disturbance, inexhaustibility, rambling thought/speech, tachycardia/arrhythmia, nervous, insomnia, diuresis, muscle twitching, psychomotor agitation |
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there is no DSM-5 caffeine... |
use disorder |
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Caffeine withdrawal |
3+: headache, fatigue/drowsy, dysphoric/depressed mood or irritability, difficulty concentrating, flu-like symptoms |
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Rimonabant |
"MJ antagonist"; used for alcohol, nicotine, MJ dependence, metabolic syndrome and weight gain |
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prevalence of cannabis use disorder |
highest in 12-17 y/o males (3.8%) |
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criteria for cannabis intoxication |
impaired motor coordination, euphoria, anxiety, slowed time, impaired judgment, social withdrawal; 2+: conjunctival injection, incr. appetite, dry mouth, tachycardia |
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criteria for cannabis withdrawal |
3+: irritable/anger/aggression, nervousness/anxiety, sleep difficulty, decr. appetite/weight loss, restless, depressed 1+: ab pain, tremors, sweating, fever, chills, H/A |
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Hallucinogen-related disorders |
phencyclidine use/other hallucinogen use disorder has same criteria of substance use disorder except for withdrawal |
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Phencyclidine (PCP) |
antagonist at NMDA receptors |
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hallucinogens and NT systems |
agonist at 5HT2A receptors (main) also: 5HT1A/2C, NorE, dopamine |
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PCP intoxication criteria |
belligerence, assaultive, impulsive, unpredictable, psychomotor agitation, impaired judgment 2+: vertical or horizontal nystagmus, HTN/tachy, numbness/diminished pain response, ataxia, dysarthria, rigid muscles, seizure/coma, hyperacusis |
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treat PCP intoxication |
symptoms, benzos/antipsychotics (control behaviors), gastric lavage in non-alert patients, diazepam for muscle spasms/seizures, minimal sensory stimulation, total body immobilization, ammonium chloride/cranberry juice |
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talking down with PCP intoxication? |
not useful!! |
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4-point restraint with PCP intoxication? |
dangerous - rhabdomyolysis |
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other hallucinogens intoxication criteria |
marked anxiety/depression, ideas of reference, fears of losing one's mind, paranoid ideation, impaired judgment 2+: pupillary dilation, tachy, sweating, palpitations, blurred vision, tremors, incoordination |
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LSD intoxication Rx |
talking down, diazepam 20 mg PO (better than talking down) |
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Inhalants |
direct releasers of dopamine in NA; same criteria for substance use disorder w/o withdrawal |
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Inhalant-related disorders - substances |
toluene, acetone, benzene etc. |
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adverse effects of inhalants |
death due to asphyxiation, aspiration, resp. depression, arrhythmias, accident, injury long term use: hepatic/renal damage, muscle damage, brain atrophy, temp. lobe epilepsy, decr. IQ, EEG changes, CV and pulm sx, GI, neuro sx |
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MJ use chronically <19 y/o... |
lowers IQ by 9 points |
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chronic use of MJ increases risk of |
schizophrenia |
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Rx inhalant intoxication |
symptomatic, acute resolves spontaneously, no Rx for cognitive impairment |
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Criteria for Inhalant intoxication |
belligerence, assaultive, apathy, impaired judgment 2+: dizzy, nystagmus, incoordination, slurred speech, unsteady gait, stupor/coma, euphoria, lethargy, depressed reflexes, psychomotor retardation, tremor, muscle weakness, blurred vision/diplopia |
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Opioids |
act as NTs released from neurons that arise in the arcuate nucleus and project to VTA and nucleus accumbens => release enkephalin |
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Opioid receptors |
mu, delta, kappa |
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Criteria for opioid intoxication |
initial euphoria followed by apathy, dysphoria, psychomotor agitation/retardation, impaired judgment 1+: drowsy/coma, slurred speech, impaired attn/memory |
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Rx opioid intoxication |
symptomatic, naloxone for life threatening intoxication |
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Criteria for opioid withdrawal |
3+: dysphoric mood, muscle aches, diarrhea, pupillary dilation/piloerection/sweating, N/V, fever, lacrimation/rhinorrhea, yawning, insomnia |
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Rx opioid withdrawal |
Methadone, Buprenorphine, Clonidine, symptomatic |
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Stimulants |
cocaine, amphetamine, methamphetamine, methylphenidate |
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Methamphetamine, amphetamine MOA |
release dopamine |
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Cocaine MOA |
block dopamine reuptake |
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criteria for stimulant intoxication |
euphoria/affective blunting, change in sociability, hypervigilance, interpersonal sensitivity, anxiety, tension, anger, stereotyped behaviors, impaired judgment 2+: tachy/brady, pupillary dilation, hypo/hypertension, perspirations/chills, N/V, weight loss, psychomotor agitation/retardation, muscle weakness, resp. depression, chest pain/cardiac arrhythmias, confusion/seizures |
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criteria for stimulant withdrawal |
dysphoric mood + 2+: fatigue, vivid unpleasant dreams, insomnia/hypersomnia, incr. appetite, psychomotor agitation/retardation |
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Nicotine |
receptors in brain = alpha4beta2 & alpha-7 release dopamine from VTA (to nucleus accumbens) |
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highest 12 mo prevalence of nicotine dependence |
17% adult 18-29 y/o |
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12 mo prevalence of nicotine dependence- ethnicity |
Native americans - 23%, whites - 14%, African americans - 10% |
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nicotine dependence among current daily smokers |
50% |
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nicotine withdrawal criteria |
4+: irritable/frustration/anger, anxiety, difficulty concentrating, incr. appetite, restlessness, depressed mood, insomnia |
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Nicotine withdrawal Rx |
replacement therapy (patch, gum, inhaler/lozenges), Bupropion, Varenicline |
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Bupropion |
anti-depressant; use nicotine replacement & quit smoking starting on day 8 contraindications = seizure disorder, eating disorder |
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Varenicline |
partial agonist-antagonist; quit smoking on day 8, no nicotine replacement contraindications = suicidal, mood instability S/E: nausea, vivid nightmares |
