4 - Substance Use Disorders Flashcards
Substance Use Disorder is defined as:
Continued use of a substance despite significant substance-related problems
How is SUD related to tolerance and withdrawal?
Tolerance and withdrawal are among the criteria for diagnosing/identifying SUD
BUT THEY ARE NOT necessary or sufficient by themselves for an SUD to exist
The pattern of drug use can exist in people who are not physically dependent on drugs and have not developed tolerance
BEING PHYSICALLY DEPENDENT ON A DRUG IS NOT THE SAME THING AS HAVING SUD
The major neurotransmitter in the reward circuit is ______
dopamine
Alcohol exerts its effects by interacting with three proteins on membrane phospholipids:
- GABA receptors
- Glutamate receptors
- 5-HT3 receptors
Why does alcohol depress the CNS?
When it binds with GABA receptors, it ENHANCES GABA mediated inhibition
When alcohol binds with glutamate receptors it BLOCKS glutamate-mediated excitation
How does alcohol activate the reward circuit?
Alcohol activates 5-HT3 receptors, which activates the reward circuit and triggers release of dopamine
Two neuropsychiatric syndromes are common in alcoholics:
Wernicke Encephalopathy
Korsakoff Psychosis
BOTH ARE CAUSED BY THIAMIN DEFICIENCY
Wernicke Encephalopathy is characterized by:
Reversible
Confusion, nystagmus, abnormal ocular movements
Korsakoff Psychosis is characterized by:
IRREVERSIBLE
polyneuropathy, inability to form long term memories, confabulation (unconsciously fill gaps in memory with fabricated facts and experiences)
How does alcohol abuse effect neuroanatomy?
Enlarged ventricles d/t cerebral atrophy
Why does alcohol feel like it has a warming effect?
It promotes vasodilation in the skin which feels warm, but actually promotes heat loss
Why does moderate drinking protect against heart disease?
It raises HDL levels
Which kind of alcohol prevents dementia?
Which kind is cardioprotective
Only red wine protects against dementia
But the cardiovascular effects are dose dependent, not isolated to a certain alcohol
Who benefits most from the cardioprotective effects of alcohol?
People who are NOT leading a healthy lifestyle
There’s no protective effect for people who are already leading a healthy lifestyle
Why does alcohol cause gastric ulcers?
Increases acid secretion AND attacks the mucus barrier directl
What is unique about alcohol metabolism?
It is metabolized at a constant rate, whether or not the serum concentration increases or decreases
Alcohol-induced hypotension results from:
Direct effect on peripheral blood vessels that CANNOT BE CONRRECTED WITH VASOCONSTRICTORS
What is usually the cause of death with alcohol overdoses?
Usually cardiovascular shock from profound hypotension. Usually not due to respiratory depression.
Why is naltrexone used in AUD?
blocks the reward circuit activation of alcohol by blocking dopamine release
IF THIS PATIENT IS TAKING OPIOIDS IT WILL CAUSE WITHDRAWAL
Why is antabuse given to treat AUD?
Causes Acetaldehyde Syndrome with mixed with alcohol
What are the symptoms of acetaldehyde syndrome?
N/V, blurred vision, hypotension
Can be life threatening!
What is the single greatest cause of preventable death in the US?
Cigarette smoking
How does nicotine impact nicotinic receptors?
Low doses activate nicotinic receptors
High doses block them
Cigarettes have relatively low doses, and therefor cause activation
The CV effects of smoking results from activating NN Receptors in the ______ and ______
Sympathetic ganglia
adrenal medulla
Stimulation leads to release of epinephrine and NE, causing CV s/s
