Term
| DSM5 Criteria for Substance Abuse Disorder |
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Definition
(RIPS)
-Risky Use of Substance
-Impaired control
-Pharmacological Criteria
-Social Impairment
Severity is based on # of symptoms criteria endorsed:
-Mild: 2-3 symptoms
-Moderate: 4-5 symptoms
-Severe: > or = 6 symptoms |
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Term
| DSM5 criteria for Alcohol Withdrawal Syndrome |
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Definition
Cessation of (or reduction in) alcohol use that has been heavy and prolonged
> or = 2 of the following symptoms within several hour to a few days after cessation/reduction:
-Autonomic hyperactivity
-Hand tremor
-Insomnia
-N/V
-Transient visual, tacile, auditory hallucinations
-Psychomotor agitation
-Anxiety
-Seizures |
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Term
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Definition
-GABA agonist
-inhibits NMDA receptors which decrease glutamate |
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Term
| Prolonged exposure to alcohol |
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Definition
-Upregulation of NMDA receptors
-Down regulation of GABA receptors
-Tolerance |
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Term
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Definition
-Enhanced NMDA receptor fxn
-Reduced GABAergic transmission
-enhanced dopamine neurotransmission -->hallucinations
-Increased noradrenergic activity causing sympathetic overdrive |
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Term
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Definition
-Delirium
-Tremens (tremors)
-Auntonomic hyperactivity (tachycardia, hyperpyrexia, HTN)
-usually after 3-5 days after last drink
-persists for 5-10 days
Treatment: BZDs
-Diazepam & chlordiazepoxide (long t1/2)
-Lorazepam & oxazepam (good for elderly and with hepatic dysfunction)
Administered either:
1) Fixed schedule: specific intervals
2) Symptom triggered: only given if CIWA>10 |
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Term
| Questions for Alcohol Dependence |
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Definition
(CAGE)
Can you CUT down on your drinking?
Are you ANNOYED when asked to stop drinking?
Do you feel GUILTY about your drinking?
Do you need an EYE-OPENER drink when you get up in the morning? |
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Term
Blood Alcohol Content (BAC)
Legal limit & Tolerant |
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Definition
Legal limit: = 0.08%
Tolerance: No signs of intoxication and BAC > 0.15% or BAC >0.3% at any time |
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Term
| Carbohydrate-deficient transferrin |
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Definition
CDT
Increases after 1-2 weeks of heavy alcohol drinking
Normalizes if you abstain for 2-3 weeks
%CDT> 2.6% indicative of heavy alcohol use
NOT INFLUENCED BY LIVER DISEASE |
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Term
| Gamma glutamyl transferase |
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Definition
GGT
Modest elevation or normal-high levels (>35) units = heavy drinking
Increases after 4-8 weeks of heavy drinking
Normalizes after 2-3 weeks from abstinence
NON SPECIFIC BIOMARKER (other things will increase this level besids alcohol abuse) |
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Term
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Definition
Best indicator of heavy alcohol consumption
Increases after daily alcohol consumption >40g (3 drinks)
Normalizes in 2-3 weeks |
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Term
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Definition
Non-specific
AST/ALT >2 suggestive of alcoholic etiology in liver disease patients |
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Term
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Definition
MCV
Normal: 80-100
>100 can indicate heavy drinking
NON SPECIFIC
~2-4 months to normalize after abstienence |
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Term
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Definition
(b) Antabuse
ALCOHOL DETERRENT
MOA: blocks aldehyde dehydrogenase and prevents alcohol metabolism
Do NOT use any alcohol products while taking or for 14 DAY AFTER USE |
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Term
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Definition
(b) ReVia
MOA: Mu opioid antagonist that reduces cravings and reward
Decreases heroin use in combo with psychological counseling
MUST be opioid free for 7-10 days BEFORE initiating
BLACK BOX WARNING: Hepatotoxicity |
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Term
| Naltrexone ER Injectable (g) |
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Definition
(b) Vivitrol
Indicated for opioid and alcohol dependence
380MG Q 4 weeks in GLUTEAL injection |
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Term
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Definition
(b) Campral
Indicated form maintenance for alcohol abstinence
Dose is 666mg, but may give in 2 pills of 333mg so patient is more comfortable with number
SEs: Dose related diarrhea & rare suicidal ideation |
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Term
| Opioid Detoxification Methods |
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Definition
1) Abrupt treatment: opioid antagonist (naltrexone, naloxone)
- can use clonidine to reduce withdrawl symptoms
2) Tapering: replacement opiod agonist (buprenorphine or methadone) |
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Term
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Definition
(b) Dolphine
MOA: synthetic mu opioid agonist (CII)
FIRST LINE TREATMENT
SEs: QT Prolongation
BLACK BOX WARNING: Repiratory depression
Interactions: Antiretrovirals can decrease methadone levels |
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Term
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Definition
(b) Subutex
MOA: synthetic prtial mu opiois agonist & kappa antagonist. Bidns irreversibly (CIII)
CEILING EFFECT REACHED AROUND 16-20mg/DAY |
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Term
| Buprenorphine/Naloxone (g) |
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Definition
(b) Suboxone
Only works if taken Sublingually
Tagrt dose: 16mg/day |
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