Neuro Exam 2: Substance Abuse

Front 1

What is abuse?

Back 1

1+ of
Failure fulfilling role obligations
Recurrent use in physcially hazardous situations
Social or interpersonal problems
Legal problems

Front 2

What is dependence?

Back 2

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

Front 3

What are some screening tests for AUD?

Back 3

AUDIT-Core
CAGE

Front 4

What is important to assess when taking an AUD hx?

Back 4

daily drinking
binge pattern
periods of abstinence
hx of treatment
blackouts
withdrawals

Front 5

What lab markers are consistent w/ recent drinks of 5+ drinks/day?

Back 5

GGT (>35 is a red flag)
AST and ALT (2:1 ratio is a red flag)
Carbohydrate deficient transferrin (CDT)
MCV

Front 6

What are some usual signs and sx of misuse?

Back 6

Cardiac arrythmias
GI: enlarged tender liver, ascites, jaundice
Neuro: tremor, hyperactive reflexes, pulse, etc/

Front 7

Does BAC need to be 0 to have EtOH withdrawal?

Back 7

no

Front 8

What is Delirium Tremans (DTs)?

Back 8

disorientation, fluctuating levels of consciousness, hyperactivity, increased HR and BP, fever
frightening hallucinations

Front 9

When do DTs start?

Back 9

3-4 days after last drink

Front 10

What is the standard therapy of EtOH withdrawal?

Back 10

benzos (diazepam (Valium))

Front 11

T or F: Hyperactive delirium is a common sx of withdrawal?

Back 11

TRUE

Front 12

Which benzo would you give for EtOH withdrawal in elderly pts to prevent sedation?

Back 12

Lorazepam (Ativan)

Front 13

What are some sx of Wernicke-Korsakoff syndrome?

Back 13

Wernicke's encephalopathy
Cause: B1 deficiency
Confusion + Ataxia + Opthalmoplegia

Front 14

How do you treat Wernicke-Krosakoff syndrome?

Back 14

IV Thiamine

Front 15

What are some sx of Korsakoff's syndrome?

Back 15

impaired memory
pt has limited insight into memory loss
confabulation
retrograde and anterograde memory loss

Front 16

T or F: EtOH helps people with major depressive episodes?

Back 16

FALSE

Front 17

What are some drugs used to treat withdrawal and cravings?

Back 17

Naltrexone
Acamprosate
Disulfiram

Front 18

What's the difference b/w opiates and opioids?

Back 18

opiates are naturally occurring and opioids are synthetic

Front 19

What are the dx criteria for opiod OD?

Back 19

contricted pupils and 1+:
drowsiness/coma
slurred speech
imparied attn and memory

Front 20

Is opioid w/d fatal?

Back 20

no

Front 21

What are some options for withdrawl/detox?

Back 21

opioid receptor agonist substitution w/ slow taper (methadone, buprenorphine)
Alpha-2 AR agonist (clonidine)

Front 22

What is a blackbox warning for methadone?

Back 22

QT prolongation

Front 23

What receptor does methadone work on?

Back 23

mu

Front 24

What is buprenorphine?

Back 24

synthetic partial agonist w/ high affinity for the mu receptor used for treating opioid w/d

Front 25

Who can prescribe buprenorphine?

Back 25

any doc that has taken a training course

Front 26

T or F: buprenorphine can cause QT prolongation

Back 26

FALSE

Front 27

What is naltrexone?

Back 27

mu receptor antagonist that blocks the euphoric effects of opiates

Front 28

What are some health risks of cocaine use?

Back 28

heart attack --> CHF
arrythmias
stroke
seizure
spontaneous miscarriage
"crack lung"
infection (via nasal perfs, injection, high risk sex)
psychiatric: mood d/o, psychosis

Front 29

what is some cardinal features of cocaine withdrawal?

Back 29

bad mood
increased appetite

Front 30

How do you treat benzo OD?

Back 30

supportively

Front 31

How do you treat barbiturate OD?

Back 31

if awake give activated charcoal --> induce vomitting
if comatose support airway and vital signs

Front 32

What is the medical therapy for mild benzo w/d?

Back 32

long acting benzo

Front 33

What are some clinical uses of cannabis?

Back 33

severe nausea assoc w/ chemotherapy
cachexia in pts w/ AIDS or cancer
Spasticity in neurologic diseass
Pain mgt (neuropathic pain)

Front 34

What are some nicotine replacement therapies?

Back 34

Bupropion-SR
Varenicline

Front 35

Where does phencycline (PCP) act?

Back 35

NMDA antagonist

Front 36

What is angel dust?

Back 36

PCP

Front 37

what are some clinical features of PCP use?

Back 37

HTN, vertical/ROTARY NYSTAGMUS, hyperacusis seizures, coma, AGITATION, muscle rigidity

Front 38

How do you treat PCP OD?

Back 38

quiet room, benzos for seizures/agitation, Haldol if psychotic --> give them space and quiet...they are pissed

Front 39

What are brief interventions based on?

Back 39

FRAMES
Feedback
Responsibility (of pt)
Advice to cut down
Menu of options
Empathetic interviewing style
Self-efficacy --> pts must believe they can change