Substance Abuse

  1. T/F? There are more deaths, illnesses and disabilities from substance abuse than from any other preventable health condition?
  2. Addiction is characterized by the 5 C's, name them.
    • chronicity
    • impaired control over drug use
    • compulsive use
    • continued use despite harm
    • craving
  3. How does abuse and dependence of BZDs affect the body?
    • usually do not lead to life-threatening respiratory suppression
    • switching between agents won't help alleviate the problem
    • long term use can cause withdrawal if stopped abruptly
  4. Presentation of BZD intoxication
    • memory impairment
    • confusion
    • drowsiness
    • GI issues
    • visual disturbances
    • confusion
    • slurred speech
    • poor coordination
    • swaying
    • bloodshot eyes
  5. Lab tests for BZDs
    tox screen. can be positive up to 6 weeks with chronic use
  6. How to treat a BZD overdose?
    • do not induce emesis!!!!
    • gastric lavage if patient presents within 1 hour
    • administer activated charcoal
    • supportive measures for hypotension and bradycardia
    • Flumazenil rarely used anymore due to black box warning of seizures
  7. Presentation of BZD withdrawal
    • anxiety
    • agitaiton
    • muscle cramps
    • parasthesias, strange sensations
    • sleep disturbances
    • dizziness
    • seizures
    • delirium
  8. Use of Buspirone in BZD withdrawal
    can be used in place of BZD if anxiety develops during or following taper
  9. Signs of GHB toxicities
    • coma
    • seizures
    • respiratory depression
    • vomitting
    • bradycardia
    • hypotension
    • hypothermia
    • anterograde amnesia
  10. Is there an antidote for GHB toxicity?
    • No
    • good supportive care and patients should recover in about 7 hours
  11. How do you know if GHB is present?
    • patients presenting with unexplained or sudden coma with no evidence of head trauma or elevated ICP
    • GHB does have an unpleasant salty taste
  12. Presentation of opiate intoxication and withdrawal
    • acute phase: ranges from a few hours after stopping heroin to 3-5 days
    • methadone ranges from 3-14 days
    • development of delirium is a red flag!!!
    • withdrawal: piloeretion
  13. Lab tests to detect opiates
    • Tox screen
    • 1-2 days: codeine, heroin, hydromorphone, morphine
    • 2-3 days: methadone
  14. How to treat opiate overdose?
    Naloxone 2 mg iv (can be put into a drip with D5W
  15. What should you monitor in cocaine intoxication?
    • CBC
    • electrolytes
    • CPK
    • EKG (continuously monitor)
  16. What are drugs you need to avoid in cocaine overdose?
    • beta-blockers
    • use bzds, aspirin, and nitroglycerin
  17. Lab tests for amphentamine intoxication
    • urine screen for diagnostic purposes
    • positive for 24-48 hours from ingestion
  18. How to treat amphetamine intoxication?
    • induction of emesis is contraindicated (seizures)
    • monitor electrolytes, renal function, CPK, and EKG
    • treat agitaion with valium
    • threat hypertension with nitroprusside or a beta blocker
    • cooling blakets for hyperthermia
  19. How to treat NMDA (ecstasy)?
    • monitor electrolytes, BUN, creatinine, LFTs, CBC, coagulation, CPK
    • do not induce emesis
    • IV line and hydrate
    • bzds for agitation, seizures
    • beta blockers for hypertension and tachycardia
    • tx rhabdomyolysis
    • cool patient with evaporated cooling
  20. Treatment for PCP?
    • positive for 1 to 8 days
    • valium or haldol for agitaiton
    • diphenhydramine for dystonic reactions
    • beta blocker or nitroprusside for hypertension
    • cooling and hydration for hyperthermia
  21. Signs and Symptoms of ketamine
    • derivative of PCP
    • effects last about an 1 hr but can take 1-2 days to feel normal again
    • presents "floating over ones body"
    • colorless, odorless and tasteless
  22. Treatment for Ketamine intoxication
    • no antidote exists
    • spportive care focusing on cardiac and respiratory function
  23. Signs and symptoms of LSD intoxication
    • colors are heard, sounds are seen
    • not considered addictive
    • mood changing
  24. Presentation of marijuana intoxication
    • tchycardia and congestion
    • THC can be positive for 4-5 weeks (up to 11 weeks with heavy use)
  25. What blood alcohol levels are death commonly seen?
    greater than 400-500 mg/dL
  26. Cage questionaire
    • cut down
    • annoyed
    • guilty
    • eye opener
    • a positive respone to 2 or more questions suggests an increased likelihood of alcohol abuse
  27. Treatment of alcohol withdrawal
    • bzds
    • are the standard to minimize symptoms and avoid progression to more severe stages
    • thiamine (prevents wernicke-korsikoff syndrome)
    • multivitamin (can be added to fluids)
    • adjunct agents: beta blockers, clonidine
  28. Drugs to use for management of alcohol dependence
    • disulfiram (Antabuse)
    • natrexone (ReVia)
    • acamprosate (Campral)
Card Set
Substance Abuse
Therapeutics 3