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BSP Exam I > Addiction Medicine > Flashcards

Flashcards in Addiction Medicine Deck (25)
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1
Q

Physical dependence alone is neither necessary nor sufficient to diagnose addiction, and it is important to be able to distinguish the two. What are some features of addiction?

A

Addiction is a primary, chronic disease of brain reward, motivation, memory, and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, and behavioral dysfunction.

This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors

2
Q

Diagnostic criteria for substance use disorders

A

Using larger amounts or for longer time than indicated

Persistent desire or unsuccessful attempts to cut down or control use

Great deal of time obtaining, using, or recovering

Craving

Fail to fulfill major roles (work, school, home)

Persistent social or interpersonal problems caused by substance use

Important social, occupational, recreational activities given up or reduced

Use in physically hazardous situations

Use despite physical or psychological problems caused by use

Tolerance

Withdrawal

3
Q

Criteria of a substance-induced mental disorder (A—>E)

A

A. The disorder represents a clinically significant symptomatic presentation of a relevant mental disorder

B. There is evidence of both of the following: the disorder developed during or within 1 month of a substance intoxication or withdrawal or taking a medication; AND the involved substance/med is capable of producing the mental disorder

C. The disorder is not better explained by an independent mental disorder; may include: the disorder preceded the onset of severe intoxication/withdrawal/exposure to med, OR the full mental d/o persisted for at least 1 month after cessation of acute withdrawal/intoxication/medication

D. The disorder does not occur exclusively during the course of a delirium

E. The disorder causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

4
Q

Up to 50% of addicts with substance abuse disorder have comorbid ________ disorder

A

Psychiatric (i.e., antisocial PD, depression, suicide)

5
Q

T/F: PCP does not exhibit a withdrawal syndrome

A

True

6
Q

Treatment options for substance abuse disorders [and in what scenarios they are indicated]

A

Hospitalization — due to drug OD, risk of severe withdrawal, medical comorbidities, restricted access to drugs, psychiatric illness with suicidal ideation

Residential treatment unit — no intensive monitoring needs, require a restricted environment, partial hospitalization

Outpatient program — no risk of med/psych morbidity and highly motivated pt

Motivational interviewing in primary care setting — family involvement, relapse prevention, 12-step facilitation, cognitive behavioral therapy

Pharmacologic intervention

Treat associated medical conditions (CV, cancer, endocrine, hepatic, hematologic, infectious, neuro, etc…)

7
Q

The most severe manifestation of alcohol withdrawal; occurs 3-10 days following the last drink; hallmark is profound global confusion

A

Delirium tremens

8
Q

Clinical manifestations and hallmark of delirium tremens

A

Agitation, global confusion, disorientation, hallucinations, fever, HTN, diaphoresis, and autonomic hyperreactivity (tachycardia and HTN)

HALLMARK is profound global confusion

9
Q

Set of criteria that assigns numerical values to alcohol withdrawal-related sxs including: orientation, N/V, tremor, sweating, anxiety, agitation, tactile/auditory/visual disturbances and HA. VS checked but not recorded. Total score of >10 indicates more severe withdrawal

A

Clinical Institute Withdrawal Assessment for Alcohol (CIWA)

10
Q

3 general pharmacologic tx for alcohol withdrawal

A

Benzodiazepines — GABA agonists that reduce risk of SZ; provide comfort/sedation

Anticonvulsants - reduce risk of SZ and may reduce kindling; helpful for protracted withdrawal; Carbamazepine or Valproic acid

Thiamine supplementation

11
Q

Medications historically used to treat alcohol abuse include disulfuram, naltrexone, and acamprosate.

T/F: Disulfiram is the most widely used option today d/t high efficacy

A

False — there is little evidence to support benefits of disulfiram, and it often does more harm than good

12
Q

What lab tests do you need to monitor while pt is on naltrexone vs. acamprosate for EtOH use disorder?

A

Naltrexone is hepatotoxic at high doses so check LFTs

Acamprosate is cleared renally so check renal function

13
Q

3 benzodiazepines metabolized through only glucuronidation in the liver, and not affected by age/hepatic insufficiency

A

Oxazepam
Temazepam
Lorazepam

14
Q

Opioid intoxication = pinpoint pupils, sedation, constipation, bradycardia, hypotension, and decreased RR. Withdrawal = dilated pupils, lacrimation, goosebumps, n/v, diarrhea, myalgias, arthralgias, dysphoria, agitation.

How is opioid withdrawal tx?

A

Symptomatically with antiemetic, antacid, antidiarrheal, muscle relaxant (methocarbamol), NSAIDs, clonidine, and maybe BZD

15
Q

Medication treatment for opiate use d/o

A

Methadone (opioid substitution)

Naltrexone

Buprenorphine (opioid substitution)

16
Q

Methadone maintenance is only available through a certified MAT program. It is an oral solution and a high-risk medication.

Why is it important to not combine benzodiazepines or other similar medications with methadone?

A

Methadone can be deadly when combined with a benzodiazepine — or other 3A4 substrate

Frequently causes QTC prolongation which may lead to torsade de pointes and sudden cardiac death

CARDIAC RISK

17
Q

Methadone maintenance is not used to treat pain. What is the protocol if a methadone maintenance patient is encountered in the ED and needs pain management?

A

Provider calls on-call service at methadone clinic and verifies dosage

The correct methadone dosage is continued while pt is hospitalized

If additional pain treatment is required, use another opioid like morphine — preferably not another 3A4 substrate like oxycodone or BZDs!!! Also, do not use additional methadone for pain as this will possibly disrupt the response to current methadone maintenance dosing

18
Q

Epidemiology of tobacco abuse

A

Most important preventable cause of death/disease in USA

20% of all US deaths

45% of smokers die of tobacco induced disorder

Second hand smoke causes significant death/morbidity

Psychiatric pts at risk for nicotine dependence — 75-90% of schizophrenic pts smoke

19
Q

Neuroadaptation associated with tobacco

A

nAChR on DA neurons in VTA release DA in nucleus accumbens

20
Q

Signs/sxs of MDMA toxicity

A

Common short term problems include tachycardia, sweating, muscle spasms, and EXTREMELY HIGH FEVER (38.5-43 C)

In cases of severe toxicity, the pt has high fever that can progress to rhabdomyolysis, renal failure, seizures, DIC, cardiac arrhythmias, and death

21
Q

MDMA affects serotonin, DA, and NE receptors, but they are considered predominantly ________ receptor agonists

A

5HT2

22
Q

Neuroadaptations to cannabis

A

CB1 and CB2 cannabinoid receptors coupled with G proteins and adenylate cyclase to Ca channel, inhibiting calcium influx

Neuromodulator effect; decrease uptake of GABA and DA

23
Q

T/F: adolescent males who use cannabis products regularly have a 7x decreased risk of psychosis

A

False; they have 7x increased risk of psychosis

24
Q

Drug of abuse associated with cerebellar symptoms like ataxia, dysarthria, NYSTAGMUS (vertical AND horizontal)

A

PCP (phenacyclidine)

25
Q

Neuroadaptation of PCP

A

Opiate receptor effects; allosteric modulator of glutamate NMDA receptor