abuse 2 BM2

Heavy drinking =

8 or more alcoholic beverages per week for women or 15 or more alcoholic beverages per week for men.

gabapentin

: Presumed reduction of post-acute withdrawal symptoms such as anxiety, insomnia, craving Used in conjunction with Naltrexone (especially in first 6 weeks) for alcohol withdrawal

topiramate

Topamax Anticonvulsant reduction in heavy drinking days

stimulant effects

elevated mood, increased temp, HR, BP decreased appetite withdrawal- depression, fatigue, anxiety

pH alterations

may indicated added substance but may also indicate infection or diet issues

hallucinogens

-LSD · PCP · MDMA (Ecstacy) · Marijuana · Mescaline · Psilocybin

Delirium Tremens

After 1-4 days, a person withdrawing from alcohol may experience _______________________, which is a rapid onset of disorientation, agitation and hallucinations. Delirium tremens are concerning because they are signified by autonomic hyperactivity such as tachycardia and hypertension. They occur in 5-10% of alcoholics and carry with them a 5% mortality risk

PCP MOA

Blocks reuptake of norepinephrine and dopamine creating sympathomimetic effects -highest rates of emergency room visits

Reasonable approaches to tobacco use disorder include:

Brief interventions such as Ask, Advise and Refer.

acamprosate

Campral - abstinence maintenance, decrease anxiety in alcohol withdrawal

Buprenorphine/Naloxone Film or Tablet (4:1 combination)

Ceiling Effect with lower opioid overdose risk First FDA approval in 2002 for OUD treatment - helps limit diversion Partial opioid agonist, Schedule 3

The following are all classified as stimulants:

Cocaine Methamphetamine MDMA (Ecstasy, Molly, or X-Colorful tablets) Prescription stimulants - amphetamine salts, methylphenidate Nicotine Caffeine

Which of the following is used in the treatment of cannabis use disorder?

Cognitive behavioral therapy

Psilocybin

Found in certain types of mushrooms Onset of hallucinations at 20 minutesLasts about 6 hours

hallucinogen abuse co occurrence

Frequently found with other substances including opioids (i.e. fentanyl)Risk of overdose with one single pill

Which of the following is true about the newer strains of cannabis that are available?

It is more likely to lead to cannabis use disorder

treatment for intoxication of halllucinogen

Mostly supportive For anxiety and psychosisBenzodiazepines (i.e. diazepam, lorazepam) If severe hypertensionNicardipine or NitroprussideDO NOT use beta blockers - may worsen hypertension

The NIAAA defines Excessive Alcohol Use as:

No more than 4 drinks per day for men.

Which of the following statements is not true regarding the tobacco withdrawal syndrome?

Non-nicotine treatments (varenicline and bupropion) are ineffective for treating tobacco withdrawal symptoms.

Oral and Extended Release (XR) Naltrexone

Opioid antagonist: blocks all opioid receptors Both require the patient to be fully abstinent from opioids Short acting opioids = 5-7 days abstinent Long acting opioids = 7-10 days abstinent Confirm opioid abstinence with urine drug test and/or naloxone challenge

first 36 hours.

People who are withdrawing from alcohol are experiencing tremors, diaphoresis, anxiety and insomnia as well as nausea and vomiting in the_________

symptoms of intoxication of hallucinogens

Pupil dilation Tachycardia / Palpation Diaphoretic Hypertension Blurred vision

benzodiazepines intoxication

Sedation Decreased respiratory rate Ataxia Confusion Syncope Bradycardia withdrawal is opposite

reasons for benzo abuse

Self-treat anxiety Treat insomnia from opiate withdrawal May be initially prescribed, but then become a use disorder

how to discontinue benzo

Taper dose slowly over period of weeks to months Substitute with lower abuse potential Benzodiazepine long half life (e.g. clonazepam or chlordiazepoxide) Oxazepam is a good choice if there is substantial liver impairment Anticonvulsants (e.g. phenobarbital, carbamazepine, pregabalin) may be useful as adjuncts to taper

Depending on gender, the following lab tests are commonly included for screening of patients first seen with opioid use disorder.

Urine drug screening, HIV, HCV, HBV, CBC, liver enzymes, urine pregnancy.

disulfiram

Used in tx of alcohol cessation. Inhibits acetaldehyde dehydrogenase-->increased acetaldehyde when drinking (toxic)-->N/V-->incentive not to drink abstain from alcohol for at least 12 hours before use

Bupropion

Wellbutrin, Zyban, varenicline are the 1st line treatment in tobacco use disorder

cannibis use disorder treatment

centered on behavioral therapy

stimulant abuse treatment

cognitive behavior therapy and support groups

Not recommended

combination therapy with vernicline and NRT

MDMA (ecstasy)

designer drug that can have both stimulant and hallucinatory effects Has complex effects, interacting with dopamine, norepinephrine, acetylcholine, and β2-adrenergic and serotonin type 2A receptors and affecting the release of several hormones

3 FDA approved drugs for AUD

disulfiram acamprosate naltrexone

barbiturates

drugs that depress the activity of the central nervous system, reducing anxiety but impairing memory and judgment alters sensory cortex, used for seizures, sedation and alcohol withdrawal

short term effects of weed

enhanced sensory perception and euphoria, slowed reaction time, altered coordination, increased heart rate and appetite, difficulty with learning and memory, and anxiety so withdrawal is opposite- irritable, anxious, decrease appetite

opioid use disorder medication

methadone buprenorphine naltrexone

Alprazolam

most commonly abused bc of short half life and a more rapid high

LSD

most potent mood changing hallucinogen

naltrexone

opioid antagonist no abstinence requirement for alcohol shows greater reduction in relapse and fewer heavy drinking days

Varenicline (Chantix)

prevents withdrawal without surges of dopamine release in tobacco cessation

adultering

use of masking agent in drug testing (make a small impure)

There are four classes of sedatives:

· 1Alcohol · 2Benzodiazepines · 3Barbiturates · 4Sedative-hypnotics

How many hours of training must PAs and NPs complete to receive a waiver to prescribe buprenorphine in office-based settings?

· 24

Which of the following benzodiazepines have the highest risk of abuse?

· Alprazolam

Naloxone is combined with which of the following drugs to reduce the risk of diversion while treating patients with opioid use disorder?

· Buprenorphine

Which of the following statements is true regarding tobacco use disorder?

· Bupropion is more effective in smokers with a past family history of major depression.

Some newer benzodiazepines have a structure that makes it difficult to show up on urine toxicology assays. Which of the following benzodiazepines needs a lower threshold for detection?

· Clonazepam

Which of the following substances is known to cause vasoconstriction and ischemia?

· Cocaine

Of the following alcohol withdrawal symptoms, which symptom tends to emerge 1-4 days after the initial onse of withdrawal?

· Delirium Tremens

A patient is acutely intoxicated with a hallucinogen. The patient is tachycardic, agitated, and visually hallucinating. To treat the patient now, which of the following medications would be most appropriate?

· Diazepam

Which of the following neurotransmitters is responsible for the pleasurable high experienced after using marijuana?

· Dopamine

Which of the following neurotransmitters is increased by stimulant use?

· Dopamine · Norepinephrine · Serotonin · All of the above.

Which of the following drugs comes in colorful tablets with imprinted designs and often contains other substances such as ketamine, and heroin?

· Ecstasy

Which of the following is considered both a stimulant and a hallucinogen?

· Ecstasy

Which of the following symptoms is experienced shortly after smoking cannabis?

· Enhanced sensory perception

Which of the following statements is true regarding opioid use disorder?

· From 1999-2017, almost 400,000 people died from an opioid overdose.

Which of the following statements about cannabis is true?

· It is the most commonly used illicit drug.

Which of the following is most accurate in regard to hallucinogens?

· It is uncommon that use becomes dependence.

Which of the following hallucinogens is most abused?

· LSD

Which form of opioid use disorder treatment can only be provided in an opioid treatment program under the Controlled Substances Act?

· Methadone

Which of the following statements is true about cocaine and methamphetamine use?

· Methamphetamine has a longer duration of action than cocaine.

Which of the following is most accurate about sedatives?

· Opiate overdoses often have co-occurrence of benzodiazepine use

A 35-year-old man admits to substance abuse during an annual physical exam. He indicates that use uses LSD at least once weekly. You would like to educate him about consequences. Which of the following would be the most likely long term effect?

· Perceptual distortions

DSM5 criteria for Alcohol disorder include:

· Persistent desire or unsuccessful attempts to cut down. · Giving up important social or recreational activities. · Continued use despite knowledge of medical or psychological consequence(s). · Withdrawal. · All of the above.

Which providers were given permanent waiver eligibility to prescribe buprenorphine for the office-based treatment of opioid use disorder in the SUPPORT for Patients and Communities Act?

· Physician assistants and nurse practitioners

A patient presents to your emergency department for "altered mental status." Which of the following signs or symptoms would support hallucinogens as a cause versus an organic condition?

· Pupil dilation

A patient is finishing his pills early and getting illicit sedatives for "anxiety and sleep." You diagnose a patient with benzodiazepine use disorder. Which of the following methods would be most effective in getting them off the medications?

· Taper over a few months