Substance Abuse

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Questions and Answers

Which symptom is most commonly associated with PCP intoxication?

Skin dryness

Erythema

Nystagmus (correct)

Amnesia

What is a notable treatment approach for agitation in PCP intoxication?

Using benzodiazepines like lorazepam (correct)

Avoiding monitoring of vitals

Administering barbiturates

Increasing sensory stimulation

Which of the following is NOT a symptom of PCP intoxication?

Delirium

Hypertension (correct)

Coma

Seizures

What might occur during withdrawal from PCP use?

Flashbacks Signup and view all the answers

In cases of severe agitation or psychotic symptoms due to PCP, which medication is recommended?

Haloperidol Signup and view all the answers

Which physiological parameters should be monitored in PCP intoxication treatment?

Temperature and electrolytes Signup and view all the answers

What is the primary action of benzodiazepines in treating PCP intoxication?

Controlling anxiety and muscle spasms Signup and view all the answers

Which category does gamma-hydroxybutyrate (GHB) belong to?

Sedative-hypnotics Signup and view all the answers

What is the primary mechanism of action of Disulfiram in alcohol dependency treatment?

Blocks aldehyde dehydrogenase Signup and view all the answers

What are common adverse effects associated with Topiramate when used for alcohol cravings?

Impaired cognition and nausea Signup and view all the answers

Which of the following conditions contraindicates the use of Disulfiram?

Severe cardiac disease Signup and view all the answers

What should be monitored while a patient is on Disulfiram?

Liver function tests (LFTs) Signup and view all the answers

What is Wernicke’s encephalopathy primarily treated with?

High dose parenteral thiamine Signup and view all the answers

What are the symptoms of Wernicke’s encephalopathy?

Ataxia and confusion Signup and view all the answers

How long is high dose parenteral thiamine typically administered for the treatment of Wernicke’s encephalopathy?

2-7 days Signup and view all the answers

What can occur if Wernicke’s encephalopathy is left untreated?

Korsakoff syndrome Signup and view all the answers

What is a potential effect of a blood alcohol level (BAL) between 150 mg/dL and 250 mg/dL?

Lethargy and difficulty with memory Signup and view all the answers

Which treatment is essential to prevent Wernicke's encephalopathy in alcohol intoxication?

Parenteral thiamine Signup and view all the answers

What is the effect of high tolerance individuals on their response to a given BAL?

Diminished effects at that BAL Signup and view all the answers

Which of the following is NOT a factor influencing the effects of ethanol?

Individual's history of drug use Signup and view all the answers

At what BAL is respiratory depression and possible death a risk?

At or above 400 mg/dL Signup and view all the answers

What monitoring is crucial in the treatment of acute alcohol intoxication?

Airway, breathing, and circulation Signup and view all the answers

Which symptom is associated with a blood alcohol level (BAL) between 15 and 35 mg/dL?

Difficulty sitting upright Signup and view all the answers

What role does naloxone play in the context of alcohol intoxication?

Reverses effects of co-ingested opioids Signup and view all the answers

What phase involves a patient beginning to think about cutting down on alcohol usage?

Contemplation Signup and view all the answers

What action demonstrates a patient in the Preparation phase?

Researching self-help strategies for reducing alcohol intake Signup and view all the answers

Which of the following best describes the Maintenance phase?

Patient has successfully made significant behavior changes Signup and view all the answers

What is a common misconception about the Relapse phase?

It means the treatment was unsuccessful Signup and view all the answers

What mental state might a student exhibit if they recognize benefits from cutting down on alcohol but feel unable to do so?

Ambivalence Signup and view all the answers

Which healthcare professionals are mentioned as part of the treatment process for substance use?

Primary care doctors Signup and view all the answers

In which phase does a patient start using naltrexone as part of their treatment?

Action Signup and view all the answers

What is the purpose of community-based groups like SMART Recovery or AA?

To support individuals in maintaining sobriety Signup and view all the answers

What is a common withdrawal symptom associated with nicotine use?

Headache Signup and view all the answers

How long do withdrawal symptoms from nicotine typically last?

Approximately 1½ weeks Signup and view all the answers

What is one of the leading health risks associated with cigarette smoking during pregnancy?

Sudden Infant Death Syndrome (SIDS) Signup and view all the answers

What physiological system does nicotine primarily stimulate?

Both the sympathetic and parasympathetic nervous systems Signup and view all the answers

What characterizes the relationship between regular nicotine use and physical dependence?

Increased tolerance and physical dependence Signup and view all the answers

Which of the following can be a consequence of chronic nicotine use?

Chronic obstructive pulmonary disease (COPD) Signup and view all the answers

Which withdrawal symptom is specifically indicated for nicotine?

Increased appetite Signup and view all the answers

In terms of smoking prevalence among U.S. adults, what is the approximate percentage?

15% Signup and view all the answers

Which of the following effects can occur due to substance use?

Labile affect Signup and view all the answers

What is the main psychoactive component of cannabis responsible for producing a 'high'?

THC (tetrahydrocannabinol) Signup and view all the answers

What is the duration of effects typically associated with LSD use?

6-12 hours Signup and view all the answers

Which of the following statements is true regarding withdrawal symptoms of opiates?

They are not life-threatening. Signup and view all the answers

What may occur as a result of long-term LSD use?

Flashbacks later in life Signup and view all the answers

Which treatment is considered first-line for agitation in cases related to substance use?

Benzodiazepines Signup and view all the answers

What is a common experience reported during a 'bad trip' from hallucinogenic substances?

Marked anxiety and panic Signup and view all the answers

What physiological response is associated with substance use, including hallucinogens?

Tachycardia Signup and view all the answers

Which symptom is commonly associated with cannabis use?

Euphoria Signup and view all the answers

What is a notable effect reported during withdrawal from nicotine?

Increased appetite Signup and view all the answers

Which of the following symptoms can occur from LSD use?

Altered perceptual states Signup and view all the answers

What potential psychological experience is linked with the use of hallucinogens like LSD?

Flashbacks Signup and view all the answers

Which physiological response is associated with the use of stimulants like caffeine?

Tachycardia Signup and view all the answers

What symptom is commonly associated with alcohol withdrawal?

Tremulousness Signup and view all the answers

Which of the following is a symptom of opioid intoxication?

Pupil constriction Signup and view all the answers

What is a common withdrawal symptom seen in individuals withdrawing from barbiturates?

Hypertension Signup and view all the answers

Which of the following describes the post-use effects of amphetamines?

Severe depression Signup and view all the answers

What type of respiratory effect can occur with opioid intoxication?

Decreased respiratory rate Signup and view all the answers

What is a common psychological effect of cocaine use?

Psychomotor agitation Signup and view all the answers

Which condition is a risk associated specifically with opioid withdrawal?

Seizures Signup and view all the answers

What effect does PCP intoxication have on behavior?

Belligerence Signup and view all the answers

Study Notes

Substance Use Disorders

Characterized by a problematic pattern of substance use leading to functional impairment or distress.
Frequent use does not automatically indicate a disorder unless it causes problems.
Diagnosis requires at least two of the following criteria within a 12-month period:
- Using substance more than initially intended.
- Persistent desire or unsuccessful efforts to cut down on use.
- Significant time spent obtaining, using, or recovering from substance.
- Craving to use substance.
- Failure to fulfill obligations at work, school, or home.
- Continued use despite social or interpersonal problems due to substance.
- Limiting social, occupational, or recreational activities because of substance use.
- Use in dangerous situations (e.g., driving a car).
- Continued use despite subsequent physical or psychological problems (e.g., worsening liver problems).
- Tolerance (needing higher amounts for desired effect or diminished effects with same dose).
- Withdrawal (specific syndrome occurring when substance use stops or reduces).
Severity of disorder depends on number of criteria met (mild, moderate, or severe).
One-year prevalence of substance use disorder in the US is approximately 8%.
More common in men than in women.
Alcohol and nicotine are most commonly used substances.

Epidemiology

One-year prevalence of any substance use disorder in the US is approximately 8%.
More common in men than women.
Alcohol and nicotine are the most commonly used substances.

Psychiatric Symptoms

Mood symptoms are common in substance use disorders.
Psychotic symptoms can occur with some substances.
Personality disorders and psychiatric comorbidities (e.g., major depression, anxiety) are common.
It's often difficult to determine if psychiatric symptoms are primary or secondary to substance use (self-medication).

Acute Intoxication and Withdrawal

Diagnosis and treatment can be difficult due to simultaneous substance use.
Clinical presentation may be atypical.
Look for multiple substances.

Treatment of Substance Use Disorders

Behavioral counseling is essential.
Psychosocial treatments include motivational intervention (MI), CBT, contingency management, and individual/group therapy.
Residential ("rehab") programs (usually 28-day) are common for severe cases, with some choosing partial hospitalization or intensive outpatient programs.

Direct Testing for Substances

Table includes the substances and time they stay in the system. (e.g. Alcohol, Cocaine, Amphetamines, PCP, Sedative-hypnotics, Opioids, Marijuana)

Stages of Change

Stages to understand and manage any substance use disorder.
Includes precontemplation, contemplation, preparation, action, maintenance, and relapse.

Alcohol (EtOH)

Activates GABA, dopamine, and serotonin receptors, inhibiting glutamate receptors.
A potent CNS depressant
Metabolized to acetaldehyde then acetic acid (by alcohol dehydrogenase and aldehyde dehydrogenase respectively).
These enzymes are upregulated in heavy drinkers. Some populations may have less aldehyde dehydrogenase. This leads to flushing and nausea with alcohol consumption.
Important consideration for tolerance and withdrawal.
Common co-ingestant in overdose scenarios.

Alcohol Intoxication

Symptoms depend on blood alcohol level (BAL).
Higher BALs associated with more severe symptoms.
Includes impaired fine motor control, judgment, coordination, memory, lethargy, coma, respiratory depression, death.
Early monitoring key. Crucial to monitor airway, breathing, circulation, glucose, electrolytes, acid-base status.
Thiamine (vitamin B1) and folate necessary; thiamine must be given first, followed by glucose.

Alcohol Withdrawal

Dangerous condition after chronic use cessation.
Possible symptoms: autonomic instability, hallucinations (visual and tactile), seizures, delirium tremens (DTs), delirium.
Can be fatal if untreated.
Treatment focuses on stabilization and symptomatic relief with benzodiazepines (common choice: chlordiazepoxide [Librium] or lorazepam [Ativan]).

Wernicke's Encephalopathy

Caused by thiamine (vitamin B1) deficiency, often linked to poor nutrition.
Symptoms: ataxia, confusion, oculomotor symptoms (e.g., nystagmus, gaze palsies).
Note emergency condition requiring immediate treatment with high dose IV/IM thiamine, even before any glucose administration.

Cocaine

Blocks dopamine, noradrenaline, and serotonin reuptake; produces a stimulant effect.
Leads to increased dopamine in the brain reward pathways.
Can cause dangerous symptoms like hyperthermia, seizures, and cardiac arrhythmias.

Amphetamines

Block reuptake and release dopamine and norepinephrine, producing a stimulant effect.
Examples: various drugs (e.g. Dexedrine, Ritalin, methamphetamine).
Potential for high toxicity and adverse effects. Includes use in home labs and potential for severe overdose.

Phencyclidine (PCP)

Dissociative, hallucinogenic drug.
Antagonizes NMDA glutamate receptors and often causes stimulant or CNS depressive effects.
Risk of violence and dangerous behavior in intoxication.

Sedative-Hypnotics

Include benzodiazepines, barbiturates, zolpidem, zaleplon, and others, affecting GABA receptors and increasing chloride channel opening duration.
Risk of overdose and strong respiratory depression.
Risk of severe withdrawal in cases of prolonged ingestion or rapid cessation.

Opioids

Stimulates mu, kappa, and delta receptors, involved in analgesia, and dependence.
Examples: heroin, oxycodone, codeine, morphine etc.
High potential for overdose and severe respiratory depression.
Risk of high tolerance and significant withdrawal in cases of cessation.
Naloxone (an opioid antagonist) for overdose is crucial.

Marijuana

Primary active compound is THC (tetrahydrocannabinol).
Associated with cannabinoid receptors, influencing appetite increase, nausea and vomiting treatment, and chronic pain management.
Potential for respiratory issues and psychological effects.

Inhalants

A broad range of drugs inhaled and absorbed through the lungs, primarily by adolescents.
Includes solvents, glue, paint thinners, etc.
Toxic effects on various organ systems, leading to acute and chronic illnesses.

Caffeine

Adenosine antagonist, causing cAMP increase and excitatory neurotransmitter release.
Causes mild-moderate anxiety, insomnia, muscle twitching, etc. in cases of overdose.
Supportive care and symptomatic relief are crucial for withdrawal management.

Nicotine

Stimulates nicotinic receptors in the autonomic nervous system, leading to tolerance, dependence, and withdrawal effects.
Associated with significant health risks like COPD, cardiovascular diseases, and certain cancers.
Very addictive substance, and abrupt withdrawal can cause cravings and physical/psychological discomfort.

Gambling Disorder

Characterized by problematic gambling behavior.
Persistent, recurrent gambling causing significant impairment or distress (four or more criteria needed within a 12 month period).
Includes factors like preoccupation with gambling, increasing money amounts, unsuccessful attempts to quit/reduce, irritability/restlessness without gambling, gambling to relieve distress, lying, jeopardizing relations/job, relying on others.

Hallucinogens (LSD, PCP, Mushrooms)

Produce altered perceptions and hallucinations; can cause dangerous behaviors.

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Description

This quiz explores the critical features and criteria for diagnosing substance use disorders. Learn about the patterns of use, risk factors, and the implications of substance-related behaviors on daily functioning. Perfect for students and professionals interested in mental health and addiction studies.