Substance abuse
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Specifiers for substance abuse
• In early remission: no criteria for >3 months but < 12 months (except craving) • Sustained remission: no criteria for > 12 months (except craving)
withdrawal of PCP, other hallucinogens, inhalants?
none
what are the groups of people more likely to abuse alcohol
• men • American Indian • Whites • unemployed • Large metro areas • Parolees
Describe Alcohol withdrawal
• Early: Anxiety, irritability, tremor, HA, insomnia, nausea, tachycardia, HTN, hyperthermia, hyperactive reflexes • Seizures: 24-48 hours. most often Grand mal • Withdrawal Delirium (DTs): 48-72 hours, altered mental status, hallucinations, marked autonomic instability, life-threatening
What score on CIWA indicates more severe alcohol withdrawal?
> 10
Treatment for alcohol withdrawal
• Benzo: GABA agonist, cross-tolerant with alcohol. Reduces risk for Sz; provides comfort/sedation. if liver problems use a benzo with no metabolic metabolites • Anticonvulsants (Carbamazepine or valproic acid): reduce risk of Sz and may reduce kindling. helpful for protracted withdrawal • Thiamine supplementation
what do you need to check when patient taking Disulfiram
-check LFT’s and h/o hep C . . hepatotoxicity
MOA of Naltrexone? Risk for what at high doses?
• Opioid antagonist . .blocks mu receptors - Hepatoxicity . .check LFTs
What do you need to check in pt using Acamprosate for alcohol use?
-kidney function
what is a common detox mistake for Benzodiazepines?
tapering too fast; symptoms worse at end of taper -consider carbamazepine or valproic acid if doing rapid taper
What are the benzodiazepines that are metabolized only through glucuronidation in liver and not affected by age/hepatic insufficiency?
• Oxazepam • Temazepam • Lorazepam
symptoms of opioid intoxication
• pinpoint pupils • sedation • Constipation • bradycardia • HYPOtension • decreased respiratory rate
symptoms of Opioid Withdrawal
• Not life threatening but extremely uncomfortable • Dilated pupils • lacrimation • Goosebumps • n/v, diarrhea • Myalgias and arthralgies • dysphoria or agitation
Give what for opioid withdrawal
• antiemetic • antacid • antidiarrhea • muscle relaxant (methocarbamol) • NSAIDs • clonidine and maybe BZD
what is the neuroadaptation with opioid use
-increased DA and decreased NE
what medications for opioid use disorder
• Methadone (mu antagoist) • Naltrexone (mu agonist) • Buprenorphine (partial mu agonist with a ceiling effect)
psychological signs of acute stimulant intoxication
• euphoria • enhanced vigor • gregariousness • hyperactivity • Restlessness • Interpersonal sensitivity • anxiety • Tension • ANGER • impaired judgement • PARANOIA
Physical signs for acute stimulant intoxication
• Tachycardia • PAPILLARY DILATION • HTN • n/v • diaphoresis • chills • weight loss • chest pain • cardiac arrhythmias • confusion • seizures • coma
symptoms of chronic stimulant intoxication
• affective blunting • fatigue • sadness • social withdrawal • hypotension • bradycardia • muscle weakness
Stimulant withdrawal
• Not severe • exhaustion with sleep (crash) • treat with rest and support
complication of cocaine
• vasoconstrictive . . increase risk for CVA and MI (obtain EKG) • Can get rhabdomyolysis with compartment syndrome from hypermetabolic state • Can see psychosis associated with intoxication that resolves
Cocaine prevents reuptake of what?
DA
difference b/t cocaine and amphetamines on vessels
amphetamines have no vasoconstrictive effect
amphetamines inhibit reuptake of what?
-DA, NE, SE . . greatest effect on DA tho