Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Term 5: Behavioral Science > 6/17- Substance-Related and Addictive Disorders II > Flashcards

6/17- Substance-Related and Addictive Disorders II Flashcards

You may prefer our related Brainscape-certified flashcards:
Biology 101 flashcards
1
Q

Sedatives, hypnotics, and anxiolytics include what?

A
  • Barbiturates
  • Benzodiazepines
  • Prescription sleep meds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How is intoxication with sedative, hypnotic, or anxiolytic defined?

A
  • Recent use of sedative, hypnotic, or anxiolytic
  • Maladaptive behavioral or pscyhological changes 1 or more:
  • slurred speech
  • incoordination
  • unsteady gait
  • nystagmus
  • impaired attn/memory
  • stupor/coma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is withrdrawal from sedative, hypnotic, or anxiolytic defined?

A
  • Cessation (or reduction in) prolonged use of a sedative, hypnotic, or anxiolytic 2 or more (developing in hours-few days):
  • autonomic hyperactivity (diaphoresis, HR > 100)
  • hand tremor
  • nausea/vomiting
  • anxiety
  • insomnia
  • hallucinations (A/V, tactile)
  • pscyhomotor agitation
  • grand mal seizures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

List of some Barbiturates?

A
  • Phenobarbital (Luminal)
  • Butalbital (Fiorinal)
  • Secobarbital (Seconal)
  • Amobarbital (Amytal)
  • Phentobarbital (Nembutal)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Characteristics of Barbiturates?

  • Uses
  • Result from long-term use
A

Uses:

  • Sedatives/anxiolytics
  • Anticonvulsants

May have:

  • Tolerance
  • Dependence/withdrawal
  • Lethal in overdose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What has largely replaced the use of barbiturates?

A

Benzodiazepines (think: similar to transition of TCA -> SSRIs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

List of Benzodiazepines

A
  • Alprazolam (Xanax)
  • Lorazepam (Ativan)
  • Oxazepam (Serax)
  • Chlordiazepoxide (Librium)
  • Clonazepam (Klonopin)
  • Diazepam (Valium)
  • Temazepam
  • Triazolam
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Indications for Benzodiazepines?

A
  • Highly effective anxiolytics and sedatives
  • Muscle relaxants, anticonvulsants, amnestics
  • GAD, Panic Disorder
  • Insomnia
  • Increase affinity of GABAA receptor for endogenous GABA, bind to BZD binding site

May see,cross-tolerance with alcohol and barbiturates (alcohol-like effects; treat withdrawal symptoms)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Risks of Benzodiazepines?

A
  • Tolerance -> dose escalation
  • Abrupt discontinuation -> withdrawal
  • Requires gradual tapering of dose
  • Abuse potential
  • Low lethality in overdose, unless combined with other sedatives, then lethal !!!
  • Intoxication, confusion, falls: esp. in elderly
  • Paradoxical agitation - Disinhibition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some hypnotics? Used for?

A

Prescription sleeping medications

  • Zolpidem (Ambien)
  • Zaleplon (Sonata)
  • Eszopiclone (Lunesta)
  • Remelteon (Rozerem)
  • Chloral hydrate (Noctec)
  • Meprobamate (Miltown
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are opiates? What are opioids?

A

Opiates- opium and naturally-occurring derived drugs (morphine and codeine)

Opioid- class of substances that acts on opioid receptors, includes synthetic drugs that bear little resemblance to opium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some natural opiates?

A
  • Opium
  • Morphine
  • Codeine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some semi-synthetic derivatives of opioids?

A

- Heroin

- Hydrocodone

  • Hydromorphone
  • Meperidine - Oxycodone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are some synthetic opioids?

A

- Fentanyl

  • Meperidine

- Methadone

  • Propoxyphene
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

3 phenomena seen in the neurobiology of opiods?

A
  1. Euphorigenicity of the drugs
  2. Capacity to positively reinforce drug seeking
  3. Avoidance of aversive feelings (including withrawal)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the different opioid receptors?

Responsible for?

A

Mu

  • Opioid drugs (morphine is prototypic agonist)
  • Analgesia, respiratory depression, mood elevation, constipation, immuno-suppression, physical dependence

Delta

  • similar to mu

Kappa

  • Dysphoria (endogenous dynorphins)

OFQ/N

  • Analgesic or pro-nociceptive ffects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which receptor do opioid drugs bind?

A

Mu opioid R

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is opioid intoxication?

A

Recent use of an opioid

Problematic behavior or psychological changes:

  • Initial euphoria followed by apathy, dysphoria
  • Psychomotor agitation or retardation
  • Impaired judgment & social/occupational fxn

Pupillary constriction and 1 or more:

  • Drowsiness/coma
  • Slurred speech
  • Impaired attention/meory
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is opioid withdrawal?

A
  • Cessation of or reduction in prolonged opioid use (or administration of an antagonist)

3 or more:

  • Dysphoric mood
  • Nausea/vomiting
  • Muscle aches
  • Lacrimation/rhinorrhea
  • Diarrhea
  • Pupillary dilation/piloerection/diaphoresis
  • Yawning
  • Fever
  • Insomnia (everything runs)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Opioid Intoxication vs. Withdrawal?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Treatment of opioid intoxication?

A

Naloxone (Narcan): IV, IM, SC, ET

  • Treatment of acute opioid overdose (0.4-2.0 mg Q 2-3 min prn)
  • Diagnosis of physical dependence via relief upon reception
  • Poor PO absorption (wouldn’t be able to take it by mouth at this point anyway)
  • Rapid parenteral metabolism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Treatment of opioid withdrawal: detoxification?

A

Often done inpatient b/c so distressing

  • Clonidine (Catapres)
  • Methadone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Characteristics of opioid withdrawal treatment with Clonidine

A

Clonidine (Catapres)

  • Alpha 2 adrenergic agonist and anti-HTN
  • Suppresses autonomic Sx of opiate wd
  • Allows for more rapid etox
  • Monitor for hypotension
  • SE: hypotension, sedation, limits outpt use
  • Lethargy, restlessness, anxiety, insomnia, cravings, not well relieved

Benzodiazepines for anxiety

Low-dose propranolol for restlessness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Characteristics of opioid withdrawal treatment with Methadone

A

Methadone

  • Mu receptor agonist
  • Commonly used drug to treat withdrawal Sx
  • Detox over several days inpatient
  • 6 mo outpatient
  • Morphine: methadone equivalency varies widely (2.5:1 to 14:1)
  • Careful not to overdose
  • More rapid with clonidine
  • Outpatient taper very gradual
25
Q

Characteristics of opioid withdrawal treatment with Buprenorphine?

A

Buprenorphine

  • Partial agonist at mu receptors
  • Becoming more widely used for detox
26
Q

Characteristics of opioid withdrawal treatment with Ultrarapid detoxification?

A
  • General anesthesia, antagonist therapy
  • Efficacy and safety being studied
27
Q

Treatment of opioid use disorder?

A

Agonist replacement:

  • Methadone maintenance
  • Buprenorphine maintenance

Opioid antagonists:

  • Naltrexone- only antagonist currently used
28
Q

Characteristics of opioid use disorder with Buprenorphine?

A
  • Mu-receptor agonist
  • Decreased acute euphoric effects
  • Readily absorbed orally
  • 4 hrs to peak concentration
  • Large extravascular reserve (not much withdrawal if weaned off)
  • T1/2 of 1-2 days
  • Cytochrome P450 CYP3A4
29
Q

Characteristics of opioid use disorder with methadone maintenance therapy?

A
  • High doses alleviate craving, induce cross tolerance, blocks heroin-induced euphoria
  • Theory: no need for heroin or associated maladaptive behaviors with obtaining the drug
  • Proven efficacy in reducing: heroin use, other drug use, health problems, crime
  • Controversy: primary purpose crime reduction? trading one addiction for another?
30
Q

Characteristics of opioid use disorder with Buprenorphine?

A

Partial agonist at mu opioid recpetors (kappa antagonist)

  • High affinity for mu receptors (can precipitate w/d)
  • Dissociates very slowly from receptors (long duration of action: 24-48 hrs, reduced capacity to produce withdrawal Sx)
  • Ceiling effect, low risk of overdose, no respiratory depression Less effective for those with larger opioid habits
31
Q

Formulations of Buprenorphine?

A

Subutex: SL buprenorphine tabs

  • Office based treatment of opiate dependence

Suboxone: SL buprenorphine/naloxone tabs (naloxone there to prevent abuse; for safety)

  • Okay for take home dosing
  • Naloxone has no activity PO; full antagonist if injected
  • Minimizes risk of diversion Buprenex: IM buprenorphine
  • FDA approved for pain
  • Inpatient detox protocols exist
32
Q

Characteristics of opioid use disorder with Naltrexone (ReVia)?

A
  • Opioid antagonist
  • Treatment of opioid addiction
  • Orally effective and long acting
  • Initiate after drug free (7 days heroin, 10 days methadone)
  • Better in populations with established careers, family support, high motivation
  • SE: decreased energy, hepatotoxicity
33
Q

What are some common stimulants?

A
  • Amphetamine-type substances
  • Cocaine
  • Other stimulants
34
Q

How is stimulant intoxication defined?

A
  • Recent use of a stimulant
  • Maladaptive behavioral or psychological changes: euphoria or affective blunting, changes in sociability, hypervigilance, interpersonal sensitivity, anxiety, tension, anger, sterotyped behaviors, impaired judgment

2 or more:

  • Pupillary dilation
  • Tachy/bradycardia
  • BP changes
  • Diaphoresis/chills
  • Confusion, seizures, dyskinesias, dystonias, coma
  • N/V
  • Psychomotor agitation, retardation
  • Weight loss
  • Muscle weakness, respiratory depression
  • Chest pain, cardiac arrhythmia

+/- Psychosis

35
Q

How is stimulant withdrawal defined?

A
  • Cessation of or reduction in prolonged stimulant use
  • Dysphoric mood
  • Withdrawal dysphoria- often severe (psychiatric emergency!)

2 or more:

  • Fatigue
  • Vivid, unpleasant dreams
  • insomnia or hypersomnia
  • Increased appetite
  • Psychomotor retardation or agitation
36
Q

What are some amphetamine substances/medications?

A
  • Methamphetamine
  • Amphetamine
  • Dextroamphetamine
  • Methylphenidate
  • Adderall
  • Dexedrine
  • Ritalin
  • Concerta
37
Q

Mechanisms of amphetamine activity?

A
  • Inhibits DA reuptake
  • Promotes DA release via DA transporter
  • Slow metabolism, effects last several hours longer than cocaine
38
Q

What is the natural source of cocaine?

A

Erythroxylon coca plant

39
Q

Characteristics (broad) of cocaine?

A
  • Indigenous to S. America
  • First used 2000 years ago
  • Chemically isolated in 1880s
  • Sigmund Freud impressed with “mood and work”
  • Involved in original Coca-Cola formula
40
Q

Forms and delivery of cocaine? Times of action

A

Snorting powdered cocaine (intranasal)

  • 2-3 min

Injecting dissolved cocaine (intravenous)

  • 15-30 sec

Smoking “crack” cocaine (inhalational)

  • 6-8 sec
41
Q

What are some of the reinforcing effects of cocaine?

A
  • Extreme euphoria in pure form
  • Hyperalertness
  • Grandiosity
  • Hypersexuality
  • Hypertalkativeness
  • Rapid onset of action
  • Rapid extinction of euphoria
  • Rapid tolerance
42
Q

Mechanisms of cocaine activity?

A

Immediate mechanism of action:

  • Increased NT levels (DA, NE, 5-HT)
  • Inhibition of reuptake

Mesolimbic dopamine system

43
Q

What is the natural origin of cannabis/marijuana?

A

Cannabis sativa plant

44
Q

Characteristics (broad) of cannabis?

A
  • Indigenous to Central Asia and China
  • Used by humans for > 4000 years-
  • “Gateway” or entry drug for many addicts
  • Most commonly abused illicit drug
  • “marijuana”, “hashish”, “kush”
45
Q

Cannabis has been legalized for medical use in treating what conditions?

A
  • Cancer
  • HIV
  • Glaucoma
46
Q

How is cannabis intoxication defined?

A
  • Recent use of cannabis
  • Problematic behavioral or psychological changes: impaired coordination, euphoria, ANXIETY, sensation of slowed time, impaired judgment, social withdrawal

2 or more:

  • Conjunctival injection - Increased appetite
  • Dry mouth
  • Tachycardia
47
Q

How is cannabis withdrawal defined?

A
  • Cessation or reduction in heavy and prolonged cannabis use (daily or almost daily/at least a few months)

3 or more (generally mild, flu-like Sx):

  • Irritability, anger, or aggression
  • Nervousness/anxiety
  • Sleep difficulty
  • Abdominal pain, tremors, sweats, fever, chills, headache
  • Restlessness
  • Depressed mood
  • Decreased appetite/wt loss
  • NAUSEA, vomiting
48
Q

Chronic adverse effects of cannabis?

A
  • Cognitive difficulties (concentration, memory)
  • Impaired motor function
  • Depression
  • Paranoia
  • Psychosis
  • Amotivational Syndrome
49
Q

What are some common hallucinogens?

A
  • Phenycyclidine (PCP)
  • Ergot
  • LSD
  • Mescaline
  • Psilocybin
  • MDMA (ecstasy)
50
Q

Characteristics (broad) of Phencyclidine (PCP)?

A
  • “Dissociative anesthetic”
  • 1960s: street use
  • “Angel dust”
  • PCP lace marijuana cigarettes
  • Surreptitiously mixed with other illicit drugs- economics
  • Inhalational, intranasal, IV
  • PCP binding site on NMDA receptors
51
Q

Characteristics of Ketamine?

A
  • Veterinary anesthetic
  • Club drug
  • “Special K”
  • PCP-like pharmacology
  • Inhalational, intranasal, IV, tablets
52
Q

How is Phencyclidine intoxication characterized?

A
  • Recent use of phenycyclidine (or pharmacologically-similar substance)
  • Problematic behavioral changes: belligerence, assaultiveness, impulsiveness, unpredictability, psychomotor agitation, impaired judgment

2 or more:

  • Nystagmus (vert or hor)
  • HTN or tachycardia
  • Numbness/decreased pain
  • Ataxia
  • Dysarthria
  • Muscle rigidity
  • Seizures or coma
  • Hyperacusis
53
Q

How is intoxication with other (non-PCP) hallucinogens characterized?

A
  • Recent use of a hallucinogen (other than PCP)
  • Problematic behavioral or psychological changes: anxiety/depression, IOR, fear of losing one’s mind, paranoia, impaired judgment
  • Perceptual changes in full wakefulness and alertness: intensification of perceptions, depersonalization, derealization, illusions, hallucinations, synesthesias (hearing colors, seeing sounds)

2 or more:

  • Pupillary dialtion
  • Tachycardia
  • Sweating
  • Palpitations
  • blurred vision
  • Tremore
  • Incoordination
54
Q

What is Hallucinogen Persisting Perception Disorder?

A

(Flashbacks)

Following cessation of use: re-experiencing of perceptual symptoms experienced while intoxicated with the hallucinogen

  • Geometric hallucinations
  • False perceptions of mvt in peripheral vision
  • Flashes of color
  • Intensified colors
  • Trails of images of moving objects
  • Positive afterimages
  • Halos around objects
  • Macropsia, micropsia (things appearing larger/smaller than they really are)
55
Q

What are some common inhalants?

A

Aliphatic and aromatic hydrocarbons

  • Gasoline, glue, paint thinner, spray paint

Halogenated hydrocarbons

  • Cleaners, typewriter correction fluid, spray can propellants

Toluene, benzene, acetone, methanol, others

“Huffing” and “Bagging”

56
Q

How is inhalant intoxication characterized?

A
  • Recent short-term, high-dose exposure to inhalants
  • Problematic behavioral or psychological changes: belligerance, assaultiveness, apathy, impaired judgment or function

2 or more:

  • Dizziness
  • Nystagmus
  • Incoordination
  • Slurred speech
  • Unsteady gait
  • Lethargy
  • Depressed reflexes
  • Psychomotor retardation
  • Tremor
  • Muscle weakness
  • Blurred vision/diplopia
  • Stupor or coma
  • Euphoria
57
Q

What are bath salts?

A
  • Synthetic cathinones (Catha edulis- “Khat”)
  • Mephedrone
  • Originally sold as “bath salts”
  • Labeled “not for human consumption”
  • No relation to Epsom salts
  • Amphetamine-like: DA, NE, 5-HT release
  • Psychosis and agitation
58
Q

What are characteristics of synthetic Cannabinoids?

A
  • Research compounds: designer drugs
  • Mixed with leaves from traditional herbs
  • Spice, K2, incense
  • Very little structural similarity to cannabis
  • Psychosis and agitation
59
Q

General Take Home Points:

  • Abuse:
  • Dependence:
  • New in DSM 5: Substance ______
  • Intoxication states are the opposite of withdrawal states
  • Common neurobiological addiction process across substances
A

General Take Home Points:

  • Abuse: maladaptive pattern of substance use
  • Dependence: behavioral (drug seeking and drug taking) and physiological (tolerance and withdrawal)
  • New in DSM 5: Substance Use Disorder (spectrum)
  • Intoxication states are the opposite of withdrawal states
  • Common neurobiological addiction process across substances

Term 5: Behavioral Science (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions