SUBSTANCE ABUSE INFORMATION CARD OPIATE WITHDRAWAL
courtesy of DIVISION ON ADDICTIONS, Cambridge Health Alliance,
Early Signs (8-12 hrs): Diaphoresis, nausea, yawning, lacrimation,
an affiliate of Harvard Medical School
tremor, rhinorrhea, irritability, dilated pupils, resp. rate, pulse>90
Severe Signs (12-48 hrs): Insomnia, elevated T,P,R,& BP, nausea,
CAGE Test (adapted) to screen for Alcoholism/Drug Addiction:
vomiting, abdominal cramps, chills, diarrhea, muscle twitching,
1 + = high risk for addiction; full assessment recommended. Have you ever: • Cut back or Changed your drinking or (drug use) pattern?
Course: (1) Heroin: onset in 8-12 hrs, lasting 5-10 d, untreated.
felt Annoyed if people criticized your or (drug use) drinking?
(2) Methadone: onset in 24-48 hrs., lasting 2-4 wks.
felt Guilty about drinking or (drug use)?
needed a drink Early in the day to steady yourself?
Methadone-maintained pt - confirm dose w/methadone clinic.
Analgesics: pt is tolerant to opioids - analgesic Rx required for painmanagement. Methadone maintenance pts. may require higher
than conventional doses or increased frequency to attain analgesia.
Early Sxs (6-12 hrs.): Tremor, anorexia, nausea/vomiting, insomnia, anxiety,
Expect coping problems: Don’t dwell on dosage with pt.
irritability, diaphoresis, tachycardia, fever, mild hypertension, hallucino-
Monitor pulse, respiration, pupil size.
Later Sxs. (7-96 hrs): Seizures, Delirium Tremens
Timing: Earliest onset 6-8 hrs. after abstinence. Can be immediate or up 5 -
7 days. Some may present sxs. with a decrease in amount of use)
Untreated street addict: @ signs of w/drawal. Rx 20 mg po.
Rx: 1) Benzos to eleviate sxs.: Acute Medical Settings: lorazepam (ativan) at
Known heavy use: 30 mg po: Increase 5-10 mg q 2-4 hrs. to
least 1 mg q 4-6 hrs IV; titrate up or down holding the interval steady
stabilize. No more than 40 mg in 1st 24 hrs.
depending on patient status aiming for calm, but not oversedation .
Avoid doses >40 mg qd. unless enrolled in a licensed methadone
Dosage requirements vary widely. Decrease by no more than 10-20%
May use Clonidine 0.1mg. po tid with methadone or alone for
Note: Lorazepam preferred in acute medical settings (greatest
flexibility); Detox Setting: Chlordiazepoxide (Librium) 50-100 mg. po;titrate up and down as indicated
If NPO: ½ daily dose IM, divided q 12 hrs & restart prior full po
2) Thiamine 100 mg IM or IV qd x 3d; Folate 1 mg po qd.
3) Haloperidol (Haldol) .5-2.0 mg po or IM for severe agitation or
Course: Onset 30-60 m: peak levels 2-6 hrs: duration 24-36 hrs.
Side Effects: Reduce 5-10 mg prn lethargy:
Taper: If 1-14 d s/p admission, 10-20% qd. Expect distress.
DTs: Marked hypertension, tachycardia, fever, hallucinosis, agitation,
Discharge planning: initiate as quickly as possible.
confusion, combativeness, and seizures. Timing: 24-72 hrs. after abstinenceRx: ICU monitoring, restraints, IV fluids, IV benzos, antipyretics if
needed. Diazepam 5-10 mg or lorazepam (if liver disease) 1-2 mg
slowly IV q 15-20 min. until stabilized. Then q 2h prn. Detoxes:
Sx: Ataxia, nystagmus, ophthalmoplegia, confusion
Prevention: Thiamine 100 mg IM or IV prior to any glucose
Security guards present; Don’t show anger; Haloperidol 5 mg po or IM; Add
lorazepam 1-2 mg if needed; restraints if violent. Problem Gambling:
Sx: Generalized (focal gets a workup); often 2-6 closely spaced; status rare.
Timing: 7-48 hrs. after abstinence (late onset gets a workup).
DDX: R/O Trauma, metabolic causes (incl low Mg++), infection.
Rx: Benzos best. Protect from falls. This resource is intended solely for the use of medicalThis resource is intended solely for the use of medicalprofessionals and should not be used by the lay public.professionals and should not be used by the lay public.
VII ESA Congress, Cordoba, Spain, 15-18 July 2002 PYTHIUM SPP. AND TOTAL FUNGI RESPONSE TO GREEN MANURING. Manici L.M., Babini V., Caputo F. Research Institute for Industrial Crops. Via di Corticella 133- 40129 Bologna (ITALY) Introduction In recent years, interest has increased in the use of cover crops to enhance soil fertility (Elmer and LaMondia, 1999). This practice st
Neurohormonal consequences of APS Therapy Study carried out by : Prof. Dr. J.M.C. Oosthuizen MBCHB; DMEDSCI (Head of the Dept. of Physiology; University of the Free Prof. Dr. E.H. de Wet MBCHB; MMED; MD (Dept. of Physiology; University of the Free State) Beta-endorphin, the bodies endogenous analgesic, is a peptide consisting of 31 amino acids with properties similar to morphin