Substance abuse E4
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What are signs of long term physical issues with alcohol?
- depletion in B vitamin
- liver damage
- neuro-cognitive disorders such as Wernicke-Korsakoff
What is Korsakoff syndrome and what is it's cause?
Korsakoff syndrome is a chronic memory disorder caused by severe deficiency of thiamine (vitamin B-1). Korsakoff syndrome is most commonly caused by alcohol misuse, but certain other conditions also can cause the syndrome.
What tests will show someone has WKS?
Long term alcohol abuse is the common cause of wernicke-korsakoff sydrome.
It is linked to Vitamin B-1 deficiency. Liver and thiamine levels will be checked also.
What are symptoms of WKS?
- amnesia for events that happen after the onset of the disorder
- difficulty understanding the meaning of information
- difficulty putting words into context
exaggerated storytelling, or confabulation
What is the Alcohol AUDIT assessment scores show?
20+ is a high risk of alcohol abuse, while 0-7 is a low risk
Which NT does alcohol enhance that increases cravings and tolerance?
- GABA: gaba-alpha neuroreceptors have an inhibition effect.
- Chronic alcohol use leads to compensatory decrease in response
- This results in tolerance to effect of alcohol and desire to drink more for the same effect
Which NT does alcohol effect that causes withdrawal?
- Glutamate: this fits into the NMDA neuroreceptors
- NMDA receptors have an excitatory effect, but alcohol puts the brain to sleep.
- In chronic alcohol use, the NMDA receptors become very sensitive to small amounts of glutamate
- If the alcohol use suddenly stops, the brain becomes hyperexcitable
What symptoms will you see with someone going through alcohol withdrawal in the first 6-12 hours?
What symptoms will you see with alcohol withdrawal in the first 12-24 hours?
What symptoms will you see with alcohol withdrawals in 24-48 hours?
What is the cause of Delirium Tremens and what symptoms will it show?
After 48-72 hours of alcohol withdrawal: hallucinatioins (visual or auditory), disorientation, agitation
HTN, low graade fever, diaphoresis
What are the levels of care for each:
1. Low levels of withdrawal
2. Medium levels
3. High levels
- 1. Low: can be treated in an out-patient setting
- 2. Medium: can be treated using medications (Valium) in a psych unit
- 3. High: needs "medical detox" with IV Ativan in a hospital setting
What is the mg/dL BAL value that is considered incompatible with life?
- 400mg/dL = a BAL of 0.40%
- **Legal limit = 0.08%**
What are the stages of "Readiness for change" assessment? (6)
- 1. Pre-contemplation
- 2. Contemplation
- 3. Preparation
- 4. Action
- 5. Maintenance (6 months)
- 6. Relapse/recycling
How long does it usually take to change a habit in the maintenance phase?
What drug is used to treat an Opioid overdose?
What drug is used to maintain opioid levels and helps with withdrawals?
What is Naloxone used for?
What is Buprenorphine used for?
Opioid withdrawals and blocks other opioid euphoric effects
What drug is used to replace Heroin and prevents withdrawals?
What is Methadone used for?q
- Used to replace Heroin by preventing withdrawals and decreasing cravings (has a less therapeutic effect)
- Also effective in chronic pain
What is the COWS scale used for?
What are the life threatening risk of stimulant intoxication?
Death from cardiac issues
What are the two drugs that are standard meds for alcohol withdrawal?
Diazepam PO or Lorazepam IV
What does HALT stand for?
- for alcoholics
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