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Behavioral Medicine

who should detox as inpatients h/o seizure/delirium, medically unstable, psychosis, unstable environment, no support/transportation
who should detox as outpatients no seizure/delerium hx, med/psych stable, can return daily, has social support
CIWA stands for Clinical Institute Withdrawal Assessment
Easily administered, standardized rating scale to score withdrawal severity. CIWA
basing benzodiazepine dose on __ score allows more precise dosing, avoiding under and over medication CIWA
medical complications of cocaine coronary vasospasm, myocardial infarction, cardiomyopathy, arrhythmia, hypertension, stroke, seizures, delirium, placental abruption, fetal growth retardation, trauma, HIV/HCV/HBV, abscess, endocarditis, trauma
psychiatric complications of cocaine depression, mania/hypomania, anxiety, insomnia, irritability, sexual dysfunction, agitation, aggression, suicidal ideation, paranoia, psychosis, cognitive impairment
verbal consent is required for drug testing except __ in a medical emergency
__ is more useful than __ for drug testing except in acute overdose urine, blood
what must be followed to allow results of drug testing to be legally admissible chain of custody
use of drug testing in medical context initial evaluation for suspected use and to monitor ongoing treatment
what is in the standard "drugs of abuse panel" amphetamine, barbituates, cannabinoids, cocaine metabolite (benzoylecgonine), opiates(does not detect methadone or buprenorphine, +/- oxycodone), phencyclidine (PCP)
positive drug screen after __ is highly unlikely passive exposure
__ often triggers cocaine relapse alcohol use
supplanting crack as leading stimulant of abuse in rurual NC counties, especially in mountain regions methamphetamine
opioid dependence is infrequent with __ medical use for analgesia in patients without history of addictive behavior
characteristics of opioid overdose CNS depression progressing to coma, pinpoint pupils, resp depression, cardiovascular collapse, pulmonary edema (heroin), often lethal, rapidly reversible with IV naloxone
opioid withdrawal is __ but rarely __ in otherwise healthy individuals profoundly unpleasant, dangerous
symptoms of opioid withdrawal ab pain, N/V, diarrhea, piloerection, myoclonic jerks, lacrimation, rhinorrhea, anxiety, agitation, insomnia, irritability
severity of opioid withdrawal is scored using __ COWS (Clinical Opiate Withdrawal Scale)
treatment of opioid withdrawal clonidine (reduces adrenergic hyperactivity, sedating), NSAIDS, Loperamide (diarrhea), benzodiazepines (insomnia, irritability, agitation)
long acting synthetic opioid used as an opioid substitute methadone
how to administer methadone taper over several days in hospital, taper over several weeks for outpatient
__ blocks effect of self-administered opiates, but compliance is poor unless closely supervised oral naltrexone
most effective treatment for preventing relapse in opioid dependence methadone maintenance, buprenorphine maintenance
duration ranges of methadone maintenance months to decades
requires daily clinic visits for med administration methadone maintenance
opioid replacement that is initiated while patient is in withdrawal, safer than methadone during overdose, prescriptions are filled by pharmacies (no daily clinic visits after initial 2-day induction) buprenorphine maintenance
__ can trigger relapse of alcohol dependance and other addictions opioids
Created by: Adam Barnard Adam Barnard