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Addiction
Behavioral Medicine
| Question | Answer |
|---|---|
| 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:
Abarnard
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