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39 Cards in this Set
- Front
- Back
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What is abuse?
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1+ of
Failure fulfilling role obligations Recurrent use in physcially hazardous situations Social or interpersonal problems Legal problems |
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What is dependence?
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3+ of
Tolerance Withdrawal unable to quit use more or longer than intended (+) time finding, using, etc Give up important activities Use despite med consequences |
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What are some screening tests for AUD?
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AUDIT-Core
CAGE |
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What is important to assess when taking an AUD hx?
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daily drinking
binge pattern periods of abstinence hx of treatment blackouts withdrawals |
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What lab markers are consistent w/ recent drinks of 5+ drinks/day?
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GGT (>35 is a red flag)
AST and ALT (2:1 ratio is a red flag) Carbohydrate deficient transferrin (CDT) MCV |
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What are some usual signs and sx of misuse?
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Cardiac arrythmias
GI: enlarged tender liver, ascites, jaundice Neuro: tremor, hyperactive reflexes, pulse, etc/ |
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Does BAC need to be 0 to have EtOH withdrawal?
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no
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What is Delirium Tremans (DTs)?
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disorientation, fluctuating levels of consciousness, hyperactivity, increased HR and BP, fever
frightening hallucinations |
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When do DTs start?
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3-4 days after last drink
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What is the standard therapy of EtOH withdrawal?
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benzos (diazepam (Valium))
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T or F: Hyperactive delirium is a common sx of withdrawal?
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TRUE
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Which benzo would you give for EtOH withdrawal in elderly pts to prevent sedation?
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Lorazepam (Ativan)
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What are some sx of Wernicke-Korsakoff syndrome?
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Wernicke's encephalopathy
Cause: B1 deficiency Confusion + Ataxia + Opthalmoplegia |
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How do you treat Wernicke-Krosakoff syndrome?
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IV Thiamine
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What are some sx of Korsakoff's syndrome?
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impaired memory
pt has limited insight into memory loss confabulation retrograde and anterograde memory loss |
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T or F: EtOH helps people with major depressive episodes?
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FALSE
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What are some drugs used to treat withdrawal and cravings?
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Naltrexone
Acamprosate Disulfiram |
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What's the difference b/w opiates and opioids?
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opiates are naturally occurring and opioids are synthetic
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What are the dx criteria for opiod OD?
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contricted pupils and 1+:
drowsiness/coma slurred speech imparied attn and memory |
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Is opioid w/d fatal?
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no
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What are some options for withdrawl/detox?
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opioid receptor agonist substitution w/ slow taper (methadone, buprenorphine)
Alpha-2 AR agonist (clonidine) |
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What is a blackbox warning for methadone?
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QT prolongation
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What receptor does methadone work on?
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mu
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What is buprenorphine?
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synthetic partial agonist w/ high affinity for the mu receptor used for treating opioid w/d
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Who can prescribe buprenorphine?
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any doc that has taken a training course
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T or F: buprenorphine can cause QT prolongation
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FALSE
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What is naltrexone?
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mu receptor antagonist that blocks the euphoric effects of opiates
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What are some health risks of cocaine use?
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heart attack --> CHF
arrythmias stroke seizure spontaneous miscarriage "crack lung" infection (via nasal perfs, injection, high risk sex) psychiatric: mood d/o, psychosis |
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what is some cardinal features of cocaine withdrawal?
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bad mood
increased appetite |
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How do you treat benzo OD?
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supportively
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How do you treat barbiturate OD?
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if awake give activated charcoal --> induce vomitting
if comatose support airway and vital signs |
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What is the medical therapy for mild benzo w/d?
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long acting benzo
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What are some clinical uses of cannabis?
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severe nausea assoc w/ chemotherapy
cachexia in pts w/ AIDS or cancer Spasticity in neurologic diseass Pain mgt (neuropathic pain) |
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What are some nicotine replacement therapies?
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Bupropion-SR
Varenicline |
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Where does phencycline (PCP) act?
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NMDA antagonist
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What is angel dust?
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PCP
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what are some clinical features of PCP use?
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HTN, vertical/ROTARY NYSTAGMUS, hyperacusis seizures, coma, AGITATION, muscle rigidity
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How do you treat PCP OD?
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quiet room, benzos for seizures/agitation, Haldol if psychotic --> give them space and quiet...they are pissed
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What are brief interventions based on?
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FRAMES
Feedback Responsibility (of pt) Advice to cut down Menu of options Empathetic interviewing style Self-efficacy --> pts must believe they can change |
