Behavioral Medicine
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| who should detox as inpatients | h/o seizure/delirium, medically unstable, psychosis, unstable environment, no support/transportation
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| who should detox as outpatients | no seizure/delerium hx, med/psych stable, can return daily, has social support
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| CIWA stands for | Clinical Institute Withdrawal Assessment
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| Easily administered, standardized rating scale to score withdrawal severity. | CIWA
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| basing benzodiazepine dose on __ score allows more precise dosing, avoiding under and over medication | CIWA
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| 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
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| psychiatric complications of cocaine | depression, mania/hypomania, anxiety, insomnia, irritability, sexual dysfunction, agitation, aggression, suicidal ideation, paranoia, psychosis, cognitive impairment
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| verbal consent is required for drug testing except __ | in a medical emergency
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| __ is more useful than __ for drug testing except in acute overdose | urine, blood
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| what must be followed to allow results of drug testing to be legally admissible | chain of custody
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| use of drug testing in medical context | initial evaluation for suspected use and to monitor ongoing treatment
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| 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)
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| positive drug screen after __ is highly unlikely | passive exposure
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| __ often triggers cocaine relapse | alcohol use
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| supplanting crack as leading stimulant of abuse in rurual NC counties, especially in mountain regions | methamphetamine
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| opioid dependence is infrequent with __ | medical use for analgesia in patients without history of addictive behavior
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| 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
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| opioid withdrawal is __ but rarely __ in otherwise healthy individuals | profoundly unpleasant, dangerous
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| symptoms of opioid withdrawal | ab pain, N/V, diarrhea, piloerection, myoclonic jerks, lacrimation, rhinorrhea, anxiety, agitation, insomnia, irritability
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| severity of opioid withdrawal is scored using __ | COWS (Clinical Opiate Withdrawal Scale)
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| treatment of opioid withdrawal | clonidine (reduces adrenergic hyperactivity, sedating), NSAIDS, Loperamide (diarrhea), benzodiazepines (insomnia, irritability, agitation)
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| long acting synthetic opioid used as an opioid substitute | methadone
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| how to administer methadone | taper over several days in hospital, taper over several weeks for outpatient
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| __ blocks effect of self-administered opiates, but compliance is poor unless closely supervised | oral naltrexone
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| most effective treatment for preventing relapse in opioid dependence | methadone maintenance, buprenorphine maintenance
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| duration ranges of methadone maintenance | months to decades
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| requires daily clinic visits for med administration | methadone maintenance
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| 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
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| __ can trigger relapse of alcohol dependance and other addictions | opioids
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