ABPM Addiction Medicine flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

DSM-5 SUD severity thresholds

Mild = 2–3 criteria, moderate = 4–5, severe = 6 or more of 11 criteria met within a 12-month period.

AUDIT-C positive cutoff

Score ≥4 in men or ≥3 in women suggests unhealthy alcohol use; a brief three-item screen for hazardous drinking.

CIWA-Ar threshold for treatment

Scores of about 8–10 or higher generally prompt symptom-triggered benzodiazepine dosing in alcohol withdrawal management.

Alcohol withdrawal timeline

Tremor and autonomic symptoms begin 6–24 h after last drink; seizures peak 12–48 h; delirium tremens occurs 48–96 h.

Thiamine before glucose

Give thiamine 100 mg IV or orally before or with glucose in at-risk patients to prevent Wernicke encephalopathy.

Early vs sustained remission

Early remission is 3–12 months without SUD criteria (except craving); sustained remission exceeds 12 months.

Motivational interviewing OARS

Core skills are Open questions, Affirmations, Reflections, and Summaries; the approach elicits and strengthens the patient's own change talk.

Naltrexone opioid-free interval

Patients must be opioid-free for roughly 7–10 days before starting naltrexone to avoid precipitated withdrawal.

Opioid overdose triad

Pinpoint pupils, respiratory depression, and decreased level of consciousness characterize opioid toxicity; naloxone reverses it.

Naloxone dosing and duration

Give 0.4–2 mg IV/IM/IN and repeat every 2–3 minutes; naloxone's effect may be shorter than the opioid, so observe for re-sedation.

Maddrey discriminant function

A score ≥32 indicates severe alcoholic hepatitis and supports corticosteroid treatment such as prednisolone 40 mg daily for 28 days.

Wernicke encephalopathy triad

Ophthalmoplegia, ataxia, and confusion; the full triad occurs in a minority, so treat empirically with parenteral thiamine.

Cannabis hyperemesis syndrome

Recurrent vomiting with compulsive hot bathing in chronic cannabis users; symptoms resolve with sustained cannabis cessation.

Neonatal opioid withdrawal syndrome

Finnegan scoring guides treatment; first-line pharmacotherapy is morphine or methadone, with rooming-in and breastfeeding as nonpharmacologic foundation.

Right-sided endocarditis risk

Injection drug use, especially with unsterile technique, is strongly associated with right-sided (tricuspid) infective endocarditis.

Stimulant intoxication management

Supportive care with benzodiazepines for agitation and active cooling for hyperthermia; no specific antidote exists for stimulant overdose.

Alcohol withdrawal seizure timing

Withdrawal seizures typically occur 12–48 hours after the last drink and are managed with benzodiazepines.

Combination nicotine replacement

Using a nicotine patch plus a short-acting form (gum, lozenge, spray) is more effective than a single form for smoking cessation.

Varenicline for smoking cessation

A partial nicotinic agonist and the most effective single cessation medication; monitor for neuropsychiatric symptoms though risk is low.

Acamprosate indication

Used for alcohol use disorder maintenance of abstinence; preferred when hepatic impairment is present but requires normal renal function.

Disulfiram mechanism

Inhibits aldehyde dehydrogenase, causing acetaldehyde accumulation and unpleasant reactions to alcohol; best for supervised, motivated patients.

Benzodiazepine taper rate

Reduce roughly 5–10% every 2–4 weeks (slower for long-term users) to avoid withdrawal seizures and rebound anxiety.

PDMP checking frequency

Prescription drug monitoring programs should be reviewed before starting controlled substances and at least every three months during chronic opioid therapy.

Naloxone co-prescribing threshold

Consider co-prescribing naloxone at ≥50 MME/day or with other overdose risk factors such as concurrent benzodiazepines or prior overdose.

Contingency management

A behavioral intervention providing tangible reinforcers for verified abstinence; the most effective treatment for stimulant use disorder.

CRAFT for family members

Community Reinforcement and Family Training teaches family to reduce enabling and reward non-use; roughly 60–70% of users enter treatment.

Enabling behaviors

Family actions that shield the person from consequences of use, such as paying substance-related debts or minimizing the problem.

Al-Anon and Nar-Anon

Mutual-help groups for family and friends of people with alcohol or drug problems; attendance is associated with reduced family distress.

Codependency concept

A descriptive pattern of excessive caretaking and self-sacrifice by family members; it is not a DSM diagnosis and lacks standardized criteria.

Behavioral couples therapy

A conjoint treatment for SUD that improves both substance outcomes and relationship satisfaction compared with individual therapy alone.

Children of parents with SUD

These children have elevated adverse childhood experiences and later mental health and substance use risk; screening and support are indicated.

Family framing of relapse

Educating families that relapse is a common clinical event rather than moral failure reduces shame and improves treatment engagement.