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PMHNP Board Review (2020)
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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...

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  • November 29, 2023
  • 20
  • 2023/2024
  • Exam (elaborations)
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  • pmhnp board review 2020

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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

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