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BRS Psychiatry > 1b// Substance use and Addiction > Flashcards

1b// Substance use and Addiction Flashcards

1
Q

Why may someone take drugs for recreational use?

A

Reduce anxiety
Get high
Escapism
Like it
Stay awake
Boredom
Feel better
To get sleep
To fit in
Curious
Everyone does
Rebel

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2
Q

Give some examples of drugs.

A
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3
Q

What are examples of positive and negative reinforcement of reasons of taking recreational drugs?

A
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4
Q

Describe the course of drugs use, harmful use and addiction.

A
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5
Q

Differentiate between harmful and hazardous substance use according to ICD-10.

A
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6
Q

Describe the ICD-10 diagnostic criteria for dependence syndrome.

A
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7
Q

Differentiate between addiction and dependence.

A
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8
Q

How does speed of brain entry affect addiction?

A
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9
Q

Describe the factors involved in alcohol/ drug use and addiction.

A
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10
Q

Describe the brain from use to addiction.

A
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11
Q

What are the acute and chronic effects of alcohol on the NS and neurotransmission.

A
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12
Q

Describe which neurotransmitter is dysregulated during alcohol withdrawal and what medications can be used.

A
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13
Q

What are the 3 models of addiction?

A
  1. Reward deficiency(positive reinforcement)
  2. Impulsivity/compulsivity
  3. Overcoming adverse state eg.withdrawal, anxiety (negative reinforcement)
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14
Q

Which chemical is involved in the pleasure-reward-motivation system and how does this relate to addiction? What is the key modulator in this system?

A
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15
Q

Describe the interaction between substances of abuse and dopamine, particularly relation to the actions of cocaine, amphetamines and alcohol, opiates and nicotine.

A
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16
Q

How can you predict reinforcing responses aka liking to psychostimulants in humans by brain dopamine D2 receptor levels?

A
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17
Q

how can you assess function in the reward pathway with fMRI? What can be concluded from this study?

A
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18
Q

Which regions of the brain are involved in different components of addiction?

A
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19
Q

Describe the change in reinforcement as addiction/ dependence develops.

A
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20
Q

What is the neuropharmacology and the brain regions associated with withdrawal and negative emotional states in addiction?

A
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21
Q

How do you assess amygdalar function with fMRI via emotional processing of aversive images?

A
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22
Q

Describe the key brain areas involved in impulsivity and compulsivity.

A
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23
Q

How can you assess neurocircuitry involved in inhibitory control with fMRI?

A
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24
Q

Outline the different clinical treatments.

A
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25
Q

Describe the calculation of alcohol units.

A
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26
Q

Describe some signs of harmful use/ dependence.

A
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27
Q

Describe some opiates withdrawal symptoms.

A
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28
Q

Describe the ICD-10 criteria for dependence syndrome.

A
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29
Q

Describe the ICD-10 criteria for harmful use.

A
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30
Q

Describe the DSM-5 classification changes.

A
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31
Q

Describe the DSM criteria for alcohol and opioid use disorder.

A
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32
Q

Outline the standard history and MSE, adjusted for substance use.

A
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33
Q

Describe the aspects of assessment specific to alcohol and opioids.

34
Q

Outline the alcohol assessment tools.

35
Q

What are the physical effects of alcohol on the body?

36
Q

Describe the features of and symptoms of alcohol withdrawal.

37
Q

What do opioids do?

38
Q

What are the 3 main types of opioids?

39
Q

Outline the signs of opiate overdose and how to reverse it.

40
Q

What medication is used for alcohol, opioids and G drugs/ benzos abstinence and detox regimes?

41
Q

What are G drugs?

42
Q

What is the course of alcohol/ drug use, harmful use, addiction?

43
Q

Does this make sense?

44
Q

Does this make sense?

45
Q

Does this make sense?

46
Q

Does this make sense?

47
Q

Does this make sense?

48
Q

Does this make sense?

49
Q

Does this make sense?

50
Q

Does this make sense?

51
Q

Does this make sense?

52
Q

Does this make sense?

56
Q

What is intoxication?

A

In both the DSM and ICD, intoxication is considered to be a transient syndrome due to recent substance ingestion that produces clinically significant psychological or physical impairment. These changes disappear when the substance is eliminated from the body

57
Q

What is withdrawal state?

A

This refers to a group of signs and symptoms that occur when a drug is reduced in dose or withdrawn entirely

58
Q

What is tolerance?

A

This is a state in which, after repeated administration, a drug produces a decreased effect. Increasing doses are therefore required to produce the same effect

59
Q

What is harmful use?

A

A pattern of psychoactive substance use that is causing damage to health (physical or mental)

60
Q

What is dependence syndrome?

61
Q

What is harmful use?

62
Q

What is dependence?

63
Q

What are the major causes of morbidity and mortality associated with substance abuse?

A

Trauma (e.g. broken bones from fights)
Road Traffic Accidents
Homicide
Suicide
Overdose (deliberate and accidental)

64
Q

What are common past medical history of patients with substance abuse?

A

Cirrhosis (Alcohol)
Endocarditis (IV use)
Abscesses (IV use)
BBV: Hepatitis B/C & HIV (IV use) (ask about vaccinations)

65
Q

What is the relevant pharmacology of alcohol? (absorption)

A

Alcohol is well absorbed from the mouth, stomach and small bowel and maximum blood concentration is reached within 60 minutes of ingestion. Alcohol absorption is slowed by food and sped up by the ingestion of effervescent drinks. It is hydrophilic and therefore widely distributed in all bodily tissues

66
Q

What is the relevant pharmacology of alcohol? (pharmacodynamics)

A

Alcohol enhances neurotransmission at GABA-A receptors (causing anxiolysis). It also stimulates dopamine release in the mesolimbic system (causing reward) and inhibits NMDA mediated glutamate release (leads to its amnesic effects)

67
Q

What is the relevant pharmacology of alcohol? (metabolism)

A

Ethanol is oxidised by alcohol dehydrogenase to acetaldehyde. This is oxidised by acetaldehyde dehydrogenase to carbon dioxide and water. 98% of alcohol metabolism occurs in the liver and 1 unit of alcohol (8g) can be metabolized per hour. Illicit brew may contain methanol which is broken down to formaldehyde and causes marked toxicity on the retina

68
Q

What are the aspects of alcohol assessment?

69
Q

What does alcohol withdrawal look like?

70
Q

What is an opiate?

A

Opiatesrefer to naturalopioidssuch as morphineandcodeine and heroin to some extent

71
Q

What is an opioid?

A

Opioidsrefer to all natural, semisyntheticandsyntheticopioids

72
Q

What are the types of opioids?

A

Natural (alkaloids)
Synthetic
Semi-synthetic

73
Q

Give examples of natural opioids?

A

Opium (3400 B.C.) – contains morphine, codeine, thebaine, papaverine
Morphine
Codeine
Thebaine

74
Q

Give examples of synthetic opioids?

A

Fentanyl (100x more potent than morphine)
Pethidine
Methadone
Tramadol

75
Q

Give examples of semi-synthetic opioids?

A

Heroin (1874) – 2x more potent than morphine
Hydrocodone
Oxycodone (Oxycontin)
Hydromorphone

76
Q

What do opioids do?

77
Q

What are the aspects of opioids assessments?

78
Q

What are the symptoms of opioid withdrawal?

A

Tachycardia
Sweating
Restlessness
Dilated pupils
Bone pain
Rhinorrhoea
Diarrhoea
Abdominal pain
Tremor
Yawning
Anxiety/Irritability
Gooseflesh skin

79
Q

What scale is used to measure opiate withdrawal?

A

COWS

clinical opiate withdrawal scale

80
Q

What happens during an opiate overdose?

81
Q

What do you give if someone has an opiate overdose?

A

Naloxone: inject into upper arm or thigh (400mcg), or nasal
spray (50% each nostril). If no response after 3 mins,
Repeat. Provide airway support, recovery position

82
Q

What are the treatments of opiate addiction?

BRS Psychiatry (11 decks)

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