Substance Related And Addictive Disorders

Front 1

What are the 3 C's of substance-related and addictive disorders?

Back 1

Compulsive

Consequences

Control

Front 2

What is the hallmark of substance and addictive disorders? In which forms do they come in?

Back 2

Dependence is the hallmark.

Behavioural: subtance-seeking activities

Psychological: cravings

Physical: withdrawl effects

Front 3

What is the cause of addiction?

Back 3

Almost all drugs (and activities) of abuse increase dopamine in the nucleus accumbens, which contributes to euphoric properties and change brain's reward system

Front 4

How are substance disorders measured?

Back 4

From mild-severe based on number of criteria met in one year

Front 5

If a person is addicted to both stimulants and alcohol, how would you classify their diagnoses?

Back 5

Each substance is meant to be addressed separately

Diagnosed using the same criteria

Front 6

What is the criteria for SUD? PEC WITH MCAT

Back 6

1. use despite physical/psychological problem

2. failures in external roles

3. cravings

4. withdrawl

5. continue despite interpersonal problems

6. tolerance

7. use in harzardous situations

8. more substance for longer than intended

9. difficulty to cut down

10. activites given up due to substance

11. excessive time spent on using or finding substance

Front 7

Which substances are depressants?

Back 7

Alcohol

Opioids

Barbituates

Benzos

GHB

Front 8

Which substances are stimulants?

Back 8

Amphetamines

Methylphenidate

MDMA

Cocaine

Front 9

Which substances are hallucinogens?

Back 9

LSD

Mescaline

PCP

ketamine

Salvia

Front 10

What does withdrawal from depressants look like?

Back 10

Anxiety, anhedonia, tremor, seizures, insomnia, psychosis, delirium, death

Front 11

What does withdrawl from stimulants look like?

Back 11

Crash, craving, dysphoria, suicidality

Front 12

How can a person stop using/abusing substances?

Back 12

Patient will only change when the pain of change appears less than he pain of staying the same

Front 13

What is the CAGE questionnaire?

Back 13

Alcohol screening questionnaire

Front 14

What are the compoenents and results of the CAGE questionnaire?

Back 14

C= need to cut down?

A= annoyed at criticism?

G= guilty about drinking?

E= drink first thing in the morning?

Men= 2 or more

Women= 1 or more

Front 15

What is the level for alcohol intoxication

Back 15

2-3 drnks/h men

1-2 drinks/h women

Front 16

What are the stages of alcohol withdrawal?

Back 16

Stage 1= the shakes, tremor, sweating, agitation, GI

Stage 2= seizures

Stage 3= hallucinations

Stage 4= delirium tremens, confusion, delusions, hallucinations, tremor, autonomic hyperactivity

Front 17

What is delirium tremens? Which stage of alcohol withdrawal is this found in?

Back 17

Alcohol withdrawal delirium

Stage 4

- autonomic hyperactivity

- hand tremor

- insomnia

- psychomotor agitation

- anxiety

- nausea or vomiting

- tonic-clonic seizures

- visual/tactile/auditory hallucinations

- persecutory delusions

Front 18

How is alcohol withdrawal managed? Which areas are assessed in this protocol?

Back 18

Monitoring using the CIWA-A scale

1) Physical

2) Psychological/cognitive

3) Perceptual

Front 19

Which med is used to treat alcohol withdrawal?

Back 19

Diazepam

Front 20

What is Wernicke-Korsakoff syndrome?

Back 20

Alcohol-induced amnestic disorder due to thiamine deficiency

Front 21

What is the triad for Wernicke's encephalopathy?

Back 21

CN 6 palsy- nystagmus

Ataxia

Confusion

Front 22

Which is more reversible and acute, Wernicke's or Korsakoff?

Back 22

Wernicke's= acute and reversible

Front 23

How are Wernicke's and Korsakoff syndrome managed?

Back 23

PO thiamine

Front 24

What is the pharmacological treatment of alcohol use disorder?

Back 24

Natrexone (opioid antagonist)

Front 25

Which types of opioids are abused?

Back 25

Heroin

Morphine

Oxycodone

Codeine

Hydromorphone

Fentanyl

Front 26

What is the major risk of opioid abuse?

Back 26

Contaminated needles --> increased risk of hepatitis B + C, bacterial endocarditis, HIV/AIDS

Front 27

What are the symptoms of acute opioid intoxication?

Back 27

Decreased pain perception, sedation, decreased sex drive, nausea/vomiting, constipation, resp depression

Front 28

What are the symptoms of toxic opioid reaction?

Back 28

Shallow respirations, miosis, bradycardia, hypothermia, decreased level of consciousness

Front 29

What is the management of toxic opioid reaction?

Back 29

ABCs (intubation, ventilation)

IV glucose

Naloxone

Front 30

What are symptoms of opioid withdrawal?

Back 30

Depression

Insomnia

Drug-cravings

Myalgias

Nausea

Chills

Front 31

What are complications of opioid withdrawal?

Back 31

Loss of tolerance (overdose on relapse)

Miscarriage

Premature labor

Front 32

How is opioid withdrawal managed?

Back 32

Long-acting oral opioids (methadone, buprenorphine), alpha-adrenergic agonists (clonidine)

Front 33

What is the long-term treatment of opioid use disorder?

Back 33

Withdrawal maintenance treatment:

Methadone (opioid agonist)

Buprenorphine (mixed agonist-antagonist)

Suboxone (sublingual)

Front 34

What are some street names for cocaine?

Back 34

Blow, C, coke, crack, flake, freebase, rock, snow

Front 35

What are some effects of cocaine?

Back 35

Blocks presynaptic uptake of dopamine (euphoria)

NE and E (vasospasm, HTN)

Front 36

What does cocaine overdose look like?

Back 36

HPTN, tachycardia, seizures, dyspnea, ventricular arrythmias

Front 37

How is cocaine overdose treated?

Back 37

IV diazepam (seizures)

Propranolol (HPTN, arrythmias)

Front 38

What increases during cocaine withdrawal period?

Back 38

Suicide

Front 39

Rx of cocaine use disorder?

Back 39

No pharmaco agents have widespread evidence or acceptance of use

Front 40

What are some medical complications of cocaine use disorder?

Back 40

Nasal septal deterioration, lung injury, increased risk of CTD

Front 41

Name some amphetamines

Back 41

Ritalin

Adderall

Front 42

What are symptoms of amphetamine intoxication?

Back 42

Euphoria, improved concentration, sympathetic + behavioural hyperactivity

Front 43

Rx amphetamine induced psychosis

Back 43

Antipsyhcotics for acute presentation

Benzos for agitation

Beta-blockers for tachycardia

HPTN

Front 44

What are some symptoms of cannabis intoxication?

Back 44

Tachycardia

Conjunctival vascular engorgement

Dry mouth

Increased appetite

Increased sense of well-being

Euphoria

Muscle relaxation

Impaired driving

Front 45

High doses of cannabis can precipitate...

Back 45

Psychosis and schizophrenia if predisposed

Front 46

Name some hallucinogens

Back 46

LSD, mescaline, mushrooms, DMT, PCP, ketamine, salvia, ibogaine

Front 47

What are symptoms of hallucinogen intoxication?

Back 47

Tachycardia, HPTN, mydriasis, tremor, hyperpyrexia, depersonalization, derealization, paranoia, anxiety

Front 48

What is hallucinogen persisting perception disorder?

Back 48

DSM-5 Dx

Long-lasting spontaneous, intermittent visual perceptual changes reminiscent of those experienced with hallucinogen exposure

Front 49

What are roofies?

Back 49

Potent benzos

Front 50

What is ketamine?

Back 50

NMDA receptor antagonist