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ICM > 1: Substance Use Disorders > Flashcards

1: Substance Use Disorders Flashcards

1
Q

common drugs of abuse: sedative hypnotics

A
  • benzodiazepines
  • barbiturates
  • meprobamate gamma-hydroxybutyrate (GHB)
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2
Q

common drugs of abuse: stimulants

A
  • cocaine
  • amphetamines
  • methylphenidate
  • ephedrine
  • caffeine
  • MDMA (ecstasy)
  • bath salts (substituted cathinones)
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3
Q

common drugs of abuse: hallucinogens

A
  • LSD
  • mescaline
  • peyote
  • psilocybin
  • MDA (designer)
  • DMT (designer)
  • DOT (designer)
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4
Q

common drugs of abuse: dissociative anesthetics

A
  • PCP

- ketamine

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5
Q

common drugs of abuse: inhalants

A
  • solvents
  • nitrous oxide
  • alkyl nitrates
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6
Q

common drugs of abuse: anabolic

A

androgenic steroids

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7
Q

epidemiology of alcohol dependence (prevalence, incidence, gender)

A
  • lifetime prevalence of 12-15%
  • annual prevalence of 4-6%
  • men 4-5x more than ladies
  • incidence highest in younger ages then falls after 40 y/o
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8
Q

epidemiology of drug abuse (prevalence, incidence, gender)

A
  • lifetime prevalence ~6%
  • male > female, but less of a difference than alcohol
  • incidence also declines with age, starting at earlier age than alcohol
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9
Q

neurobiology of addiction

A
  • mesolimbic dopamine system
  • nucleus accumbens “reward center” - dopamine

all drugs act either directly (stimulants) or indirectly (others) to increase dopaminergic activity in the mesolimbic areas of forebrain

‘you are what you expose your brain to’

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10
Q

genetics of alcoholism: what things are different in alcoholics vs. non-alcoholics

A

genetic component indicated, but unknown what exactly

  • initial sensitivity to alcohol
  • increased tolerance
  • metabolism differences (ADH)
  • event related potentials in EEGs after stimulus
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11
Q

mechanisms of alcoholism

A
  • indirectly stimulates dopamine release in nuc accumbens
  • directly stimulates GABA-a receptor (disinhibits)
  • inhibits NMDA receptor (for Glu - excitatory)
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12
Q

mechanisms of cocaine**

A
  • blocks reuptake of dopamine in mesolimbic system (inhibits dopamine transporters)
  • stimulates norepi release in peripheral system
  • blocks Na channels
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13
Q

mechanisms of amphetamines**

A

-directly stimulates dopamine release in mesolimbic system

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14
Q

mechanisms of opiates

A
  • bind to mu, sigma, kappa receptors central and peripheral

- indirectly stimulate dopamine release in VTA

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15
Q

what class of drugs induces the strongest withdrawal symptoms?

A

opiates!

opiates don’t die, but are absolutely miserable
alcoholics are miserable and also can die

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16
Q

definition of an alcohol use disorder

A

maladaptive pattern of substance use leading to clinically significant impairment/distress w/i 12 mo:

  • 2-3 criteria = mild
  • 4-5 criteria = moderate
  • 6 or more criteria = severe
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17
Q

the C’s of substance use disorder

A

Continued use despite consequence
Control
Compulsion and Craving

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18
Q

what are the 11 criteria for alcohol use disorder?

A
  1. alcohol taken in larger amts/longer time than intended
  2. persistent desire/unsuccessful effort to cut down
  3. long time spent to obtain/use/recover from effects
  4. craving
  5. recurrent use -> failure to fulfill major role obligations
  6. continued use despite persistent/recurrent social probs
  7. important social/work/rec activities given up for prob
  8. recurrent use in physically hazardous situations
  9. use continued despite knowledge of problem
  10. tolerance
  11. withdrawal
19
Q

how is tolerance defined?

A

a need for markedly increased amts of the substance to achive intoxication or desired effect

markedly diminished effect with continued use of the same amount of the substance

20
Q

how is withdrawal defined?

A

the characteristic withdrawal syndrome for the substance

the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms

21
Q

what qualifies as AUD remission?

A

early: b/w 3-12 mo without use
sustained: at least 12 mo without use

22
Q

making the AUD diagnosis: CAGE

A

C- have you ever CUT down on your drinking? or been CRITICIZED?

A-have you ever been ANNOYED by drinking criticism?

G- ever felt GUILTY about things done while drinking?

E- do you ever have an EYE opener?

23
Q

3 ways to make AUD diagnosis

A
  • CAGE
  • AUDIT = AUD identification test
  • two question screen
24
Q

opioid misuse behaviors

A

loss of control

  • lost prescriptions
  • early refills
  • doctor shopping

use despite negative consequences - family or financial

physical dependence

25
Q

physical exam manifestations of AUD

A
  • smell of alcohol
  • parotid gland enlargement
  • liver enlargement
  • stigmata of chronic liver disease
  • mental status
  • track marks
  • weight loss
  • withdrawal symptoms
  • pupil size
26
Q

lab test results of AUD

A
  • BAL (blood alcohol level)
  • liver transaminases elevated (AST, ALT, GGT)
    • usually AST > ALT
    • usually mild elevations (100s)
    • GGT more sensitive (induced by alcohol)
  • MCV (mean corpuscular volume) elevation > 100
  • urine and serum drug testing
27
Q

how much does 1 beer raise BAL?

A

0.25

28
Q

how fast does the body metabolize beer?

A

1 beer/hour

29
Q

what are some factors that affect BAL between individuals?

A
  • stomach contents
  • body fat
  • male vs. female
  • carbonation
30
Q

where can drug remnants show up which can be tested for drug use?

A
  • urine
  • blood
  • saliva
  • hair
  • sweat
  • tissue
31
Q

urine drug testing

A
  • screening (ELISA) vs. confirmation (chromatography)

- a single (+) urine does not make the diagnosis, but can confirm the diagnosis

32
Q

relative sensitivity of urine drug testing for certain drugs: alcohol, marijuana, cocaine, amphetamines, opioids, benzodiazepines, designer drugs, hallucinogens

A

alcohol = marijuana = cocaine = amphetamines > opioids = benzodiazepines > designer drugs, hallucinogens

33
Q

relative specificity of urine drug testing for certain drugs: alcohol, marijuana, cocaine, amphetamines, opioids, benzodiazepines, designer drugs, hallucinogens

A

cocaine > opioids > alcohol = marijuana = designer drugs, hallucinogens > benzodiazepines > amphetamines

34
Q

comments on urine drug testing for the following drugs:

alcohol, marijuana, cocaine, amphetamines, opioids, benzodiazepines, designer drugs, hallucinogens

A
  • alcohol: too sensitive
  • marijuana: long excretion rate
  • cocaine: very short half-life
  • amphetamines: false positives
  • opioids: false negatives
  • benzodiazepines: many false positives and negatives
  • designer drugs/hallucinogens: not even detected on most UDS
35
Q

stages of change in overcoming substance addiction

A
  1. Pre-contemplation (not yet acknowledging the problem)
  2. Contemplation (acknowledging, but not ready to change)
  3. Action (changing)
  4. Maintenance (continuing the changed behaviors)
  5. Relapse (returning to old behaviors)
36
Q

treatment of substance use disorders

A
  • manage withdrawal
  • behavior therapy (CBT, motivational, group, education, fam)
  • treatment of co-existing mental health issues
  • pharmocologic
37
Q

what drugs require a detox?

A
  • alcohol
  • sedative hypnotics
  • opiates
38
Q

withdrawal symptoms of alcohol

A
  • tremors
  • diaphoresis
  • elevated BP
  • seizures
  • DTs
39
Q

withdrawal symptoms of sedative hypnotics

A
  • anxiety
  • myoclonus
  • seizures
40
Q

withdrawal symptoms of opiates

A
  • diarrhea
  • pain
  • cramps
  • anxiety
41
Q

pharmacologic targets for substance use disorders

A
  • detox agents
  • aversion (disulfram)
  • anti-craving (naltrexone, wellbutrin, acamprosate)
  • replacement (methadone, nicotine)
  • underlying disease (anti-anxiety, antidepressants)
42
Q

disulfram: mechanism of action, side effects

A
  • inhibits aldehyde DH -> accumulate aldehyde
  • results in disulfram-ethanol rxn: flushing, nausea, low BP

-hepatotoxicity

43
Q

naltrexone: mechanism of action, side effects

A
  • blocks U receptor (opioid antagonist)
  • believed to decrease reinforcing properties of alcohol
  • may decrease risk and length of prolapse
  • hepatotoxicity
  • blocks opioid pain meds
44
Q

methadone and buprenorphine: mechanism of action, other info

A
  • replaces heroin/opiates that patient is addicted to
  • given in controlled setting
  • combined w/ counseling and other interventions
  • most successful treatment available for heroin ***

ICM (26 decks)

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