PMHNP Board Review (2020)
Positive Romberg Sign - ✔✔(r/t etoh) loss of balance that occurs when closing the eyes
ETOH withdrawal delirium may result in? - ✔✔Seizures or death
DSM Severity for ETOH - ✔✔Mild = 2-3 sx
Moderate = 4-5 sx
Severe = >= 6 sx
DSM ETOH Remission Criteria - ✔✔Early = >3 mos & <12 mos
Substantial Remission = >12 mos
Screening & Early Intervention scale for SUD - ✔✔SBIRT Screening, Brief Intervention & Refereal to
Treatment
CAGE - ✔✔Cut down
Annoyed
Guilty
Eye-Opener
>=2 is clinically significant
Labs for AUD - ✔✔ETOH/SUD Blood & urine
BAC
Ele. AST, ALT, MCV, CDT (Carb deficit transfer)
Dec. Hgb, B12, folic acid
ETOH W/D Sx - ✔✔Most common = tremors (w/i hours of cessation)
Ele. b/p. tachy, n/v, poss. hyperthermia
,Sx of ETOH W/D Emergency - ✔✔Hallucinations = 7 - 48 hours
DTs - 48 - 72 hours, peaks on 4th day, can last for 2 weeks
CIWA - ✔✔Clinical Institute Withdrawal Assessment
0-8 Support &Monitoring w/o meds! (NO meds unless >=8)
8-14 = Pharm Intervention
15 = IMMEDIATE Pharm Int!
Disulfiram (Antabuse) Dosage for ETOH - ✔✔Usually 250 mg/day
NO perfumes or mouthwash!
Meds Used for ETOH W/D Sx including Seizures - ✔✔Benzos & Carbamazepine (Tegretol)
Vitamin to be given during ETOH detox - ✔✔Thiamine >300 mg/day
CRAFFT - ✔✔SUD screening tool for adolescents (12-21)
COWS - ✔✔Clinical Opiate Withdrawal Scale
5-12 = mild
13-24 = moderate
25-36 = moderately severe
>36 = severe withdrawal
Meds used for Opiod Detox & Maintenance - ✔✔Buprenorphine (Suboxone)
Naloxone (Naltrexone)
Methadone
Clonidine (use with care! may mask VS changes & inc. seizure risk!)
Phenobarbital
, Cannabis W/D Symptoms Timeline - ✔✔Sx begin w/in 24 - 48 hours
Peak 4 - 6 hours
Duration 1 - 3 weeks
Cannabis Treatment - ✔✔Motivational Enhancement Therapy (MET)
Best Tx is MET + CBT + Contingency Management
When to Start & Stop CIWA - ✔✔Start: Last ETOH w/i past 12 hours
Hx of: w/d sx, large amt of etoh over long time
Stop: When score is <10 after 3 consecutive assessments
CIWA Measurement Guideline - ✔✔N/V
Tremors
Paroxysmal Sweats
Anxiety
Agitation
Tactile, Auditory, Visual Disturbances
H/As or "fullness in head"
Orientation/Sensorium
Neurological Factors of Addiction - ✔✔"Feel good" rewards by Dopamine Pathways
Ele. Dopamine
Ele. Glutamate
Dec. GABA
Neurobiological Factor of Addiction Withdrawl - ✔✔Significant decrease in dopamine levels
Precautions w/Antabuse (disulfiram) - ✔✔May use >12 hours after last drink
NO mouthwash/perfume
Positive Romberg Sign - ✔✔(r/t etoh) loss of balance that occurs when closing the eyes
ETOH withdrawal delirium may result in? - ✔✔Seizures or death
DSM Severity for ETOH - ✔✔Mild = 2-3 sx
Moderate = 4-5 sx
Severe = >= 6 sx
DSM ETOH Remission Criteria - ✔✔Early = >3 mos & <12 mos
Substantial Remission = >12 mos
Screening & Early Intervention scale for SUD - ✔✔SBIRT Screening, Brief Intervention & Refereal to
Treatment
CAGE - ✔✔Cut down
Annoyed
Guilty
Eye-Opener
>=2 is clinically significant
Labs for AUD - ✔✔ETOH/SUD Blood & urine
BAC
Ele. AST, ALT, MCV, CDT (Carb deficit transfer)
Dec. Hgb, B12, folic acid
ETOH W/D Sx - ✔✔Most common = tremors (w/i hours of cessation)
Ele. b/p. tachy, n/v, poss. hyperthermia
,Sx of ETOH W/D Emergency - ✔✔Hallucinations = 7 - 48 hours
DTs - 48 - 72 hours, peaks on 4th day, can last for 2 weeks
CIWA - ✔✔Clinical Institute Withdrawal Assessment
0-8 Support &Monitoring w/o meds! (NO meds unless >=8)
8-14 = Pharm Intervention
15 = IMMEDIATE Pharm Int!
Disulfiram (Antabuse) Dosage for ETOH - ✔✔Usually 250 mg/day
NO perfumes or mouthwash!
Meds Used for ETOH W/D Sx including Seizures - ✔✔Benzos & Carbamazepine (Tegretol)
Vitamin to be given during ETOH detox - ✔✔Thiamine >300 mg/day
CRAFFT - ✔✔SUD screening tool for adolescents (12-21)
COWS - ✔✔Clinical Opiate Withdrawal Scale
5-12 = mild
13-24 = moderate
25-36 = moderately severe
>36 = severe withdrawal
Meds used for Opiod Detox & Maintenance - ✔✔Buprenorphine (Suboxone)
Naloxone (Naltrexone)
Methadone
Clonidine (use with care! may mask VS changes & inc. seizure risk!)
Phenobarbital
, Cannabis W/D Symptoms Timeline - ✔✔Sx begin w/in 24 - 48 hours
Peak 4 - 6 hours
Duration 1 - 3 weeks
Cannabis Treatment - ✔✔Motivational Enhancement Therapy (MET)
Best Tx is MET + CBT + Contingency Management
When to Start & Stop CIWA - ✔✔Start: Last ETOH w/i past 12 hours
Hx of: w/d sx, large amt of etoh over long time
Stop: When score is <10 after 3 consecutive assessments
CIWA Measurement Guideline - ✔✔N/V
Tremors
Paroxysmal Sweats
Anxiety
Agitation
Tactile, Auditory, Visual Disturbances
H/As or "fullness in head"
Orientation/Sensorium
Neurological Factors of Addiction - ✔✔"Feel good" rewards by Dopamine Pathways
Ele. Dopamine
Ele. Glutamate
Dec. GABA
Neurobiological Factor of Addiction Withdrawl - ✔✔Significant decrease in dopamine levels
Precautions w/Antabuse (disulfiram) - ✔✔May use >12 hours after last drink
NO mouthwash/perfume
