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INTERGRATED STUDIES IN MENTAL HEALTH > addiction > Flashcards

addiction Flashcards

1
Q

What are the 2 ways addiction can occur?

A

Physiological and Psychological

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2
Q

What are process addictions?

A

Behaviours known to be addictive due to their mood altering nature.

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3
Q

When a drug is INTIALLY taken what are the 2 types of effects it can reinforce?

A

Rewarding or Withdrawal effects

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4
Q

What are some examples of drugs that cause a PHYSICAL DEPENDANCE (WITHDRAWAL)?

A

Opiates
Barbiturates
Alcohol

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5
Q

Explain how the negative reinforcement model works.

A

Individuals continue to use drugs, despite negative consequences.
This is due to the PHYSICAL DEPENDANCE (alleviates uncomfortable states including negative mood states, tension, arousal, craving, or withdrawal)

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6
Q

What are some examples of drugs that cause a POSIITVE INCENTIVE (REWARD)?

A

Cocaine
Amphetamine
Nicotine

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7
Q

Explain how the positive reinforcement model works.

A

Individuals take the drug as it triggers the reward pathway in brain and reinforces WANTING the drug.

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8
Q

What is the key difference in the Positive vs Negative reinforcement models?

A

In the negative the person NEEDS the drug in order to avoid withdrawal symptoms
In positive the person WANT’S the drug due to the positive effects.

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9
Q

What is the KEY trait in predicting the potential to become an addict and why?

A

Impulsivity= the tendency to act without thought/ lack of foresight and no consideration for the consequences shows structural and functional changes in the brain

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10
Q

What are the 4 neurotransmitters involved in the rewards pathway?

A

Dopamine
GABA
Glutamate
Opioid Peptides

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11
Q

Which areas of the brain release the dopamine neurotransmitter in the reward pathway?

A

Ventral Tegmental Area
Nucleus Accumbens

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12
Q

Which areas of the brain release the Opioid peptides neurotransmitter in the reward pathway?

A

Nucleus Accumbens
Amygdala
Ventral Tegmental Area

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13
Q

Which areas of the brain release the GABA neurotransmitter in the reward pathway?

A

Amygdala
Bed Nucleus of stria terminalis

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14
Q

Which areas of the brain release the Glutamate neurotransmitter in the reward pathway?

A

Nucleus Accumbens

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15
Q

Dopamine act on both the D1 and D2 receptors, what are their functions?

A

Function: Pleasure, Euphoria, Mood and motor functions.

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16
Q

Which receptor does serotonin act on?

A

5HT3

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17
Q

Which receptors do Cannabinoids act on and what are their functions once stimulated?

A

Receptors: CB1 and CB2
Function: Pain, Appetit and memory

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18
Q

What are the 2 types of Opioid Peptides?

A

Endorphins
Enkephalins

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19
Q

What are the four categories of drugs that are easily abused?

A

Narcotics
Hallucinogens
Depressants
Stimulants

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20
Q

Narcotics are drugs that are PHYSICALLY ADDICITNG, What are some examples?

A

Opiates: Morphine, Heroin
Opioids: Oxycodone, Hydrocodone, Codeine, Fentanyl

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21
Q

What are some drugs that are both physically and psychologically addcitive?

A

Hallucinogens
Stimulants

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22
Q

What are some examples of hallucinogens?

A

LSD
Psilocybin
MDMA
Mescaline
PCP
Marijuana

23
Q

What are some examples of depressants?

A

Alcohol
Benzodiazepines

24
Q

What are some examples of stimulants?

A

Dexedrine
Caffeine
Methedrine
Amphetamine
Cocaine

25
Q

What does DIRECT drug action mean?

A

Drug appears to have direct action on the DA receptor or DA transporter- this increases DA receptor activation.

26
Q

How does INDIRECT drug action work? (in relation to dopamine)

A

Drug of abuse may modulate dopamine via other receptor system and neurotransmitters that then modulate a different system.
Downstream effects on dopamine from above systems.

27
Q

How does indirect drug action work in relation to GABA?

A

Binds to sub receptors GABAA: Dopaminergic activity is eventually increased in the VTA by inhibiting GABAergic interneurons

28
Q

What is an indirect form of drug action

A
29
Q

What does withdrawal syndrome involve?

A

-disturbance of the autonomic nervous system
-activation of the thalamus
-release of corticotrophin releasing hormone (CRH)
-activation of the noradrenergic nucleus locus coeruleus (LC)

30
Q

What are some drugs used to treat alcohol dependence?

A

Naltrexone: blocks mu opioid receptor (reduces the rewarding effects of alcohol)
Acamprosate: inhibits the release of glutamate thus decreasing excitation (withdrawal) that occurs during withdrawal

31
Q

What drugs are used to treat Heroin dependence?

A

Methadone, Buprenorphine: activate opioid receptors

32
Q

What drugs are used to treat tobacco dependence?

A

Nicotine gum/patch: activate nicotinic receptors

33
Q

What novel medications are used to treat psychostimulant dependence?

A

Rimonabant: blocks cannabinoid receptors (CB1)

34
Q

What is the neurobiology of addiction?

A
  1. Anatomical areas of the brain involved in the reward pathway: nucleus accumbens, ventral tegmental area and the prefrontal cortex.
  2. Dopaminergic activity is the final chemical action involved in reward.
  3. Drugs of abuse work with receptors and transporters which directly/ indirectly influence dopaminergic activity.
    4.Withdrawal occurs following an abrupt cessation of drug of abuse following changes to the nervous system
35
Q

What are pharmacological strategies aimed to accomplish?

A
  1. treating acute withdrawal symptoms
  2. preventing relapse
  3. substitution therapy
36
Q

Which receptors does alcohol work on?

A
  1. GABA-A receptor
  2. NMDA receptor
37
Q

How does alcohol act on GABA-A receptors?

A

Alcohol has its own binding site on the GABA-A receptor complex to enhance the effects of GABA.

38
Q

How does alcohol act on NMDA receptors?

A

Acts as an indirect antagonist at glutamate NMDA receptors ===>blocks ion channel associated with the glutamate NMDA receptor
Chronic blockade of glutamate NMDA receptors by alcohol  upregulation of these receptors

39
Q

What are the consequences of upregulation of these receptors?

A

Consequences of the upregulation of glutamate NMDA receptors include tolerance to the effects of alcohol===>increase the risk of seizures during withdrawal.

40
Q

What are the withdrawal symptoms of alcohol?

A

nausea, emesis, tremor, tachycardia, restlessness, irritability, anxiety, insomnia, nightmares and transitory hallucinations

41
Q

What occurs during acute alcohol withdrawal?

A

Long-acting benzodiazepines, such as diazepam or chlordiazepoxide

42
Q

How is ethanol metabolised?

A

metabolised to acetaldehyde by the enzyme alcohol dehydrogenase to acetic acid by the enzyme acetaldehyde dehydrogenase ===> the acetic acid enters the Krebs cycle===>broken down into water and carbon dioxide.

43
Q

What is used in the prevention of relapse of alcohol?

A

Disulfiram
Naltrexone

44
Q

What is the MOA of disulfiram?

A

blocks the oxidation of ethanol at the aldehyde stage by inhibiting the enzyme aldehyde dehydrogenase===>
accumulation of acetaldehyde produce palpitations, throbbing headaches, hypotension, nausea, emesis, flushing, dizziness, chest pains and thirst.

45
Q

What is the dose and strength of disulfiram?

A

Taken orally at a dose of 500 mg per day for 2 weeks and then maintained at a dose of 250 mg per day.

46
Q

How does Naltrexone work?

A

πœ‡-opioid receptor antagonist that blocks the reinforcing effects of alcohol on the opioid system and reduce craving for alcohol

47
Q

What is the dose and strength of naltrexone?

A

Naltrexone is usually taken orally in doses of 50 mg/d for up to 12 weeks or given as an intramuscular injection in the gluteus muscle at a dose of 380 mg every four weeks.

48
Q

What are the main adverse effects of naltrexone?

A

The main adverse effects are nausea, vomiting, loss of appetite, abdominal pain, dizziness, anxiety and dysphoria.

49
Q

What is Acamprosate indicated for?

A

An anti-craving drug that is used to sustain abstinence in alcoholics after detoxification.

50
Q

What is the MOA of Acamprosate ?

A

Agonist activity at GABA-A receptors and antagonist activity at glutamate NMDA receptors====>mimics the actions of alcohol at these receptors.

51
Q

What is the basic MOA of heroin?

A

Heroin is a πœ‡-opioid receptor agonist and mimics the reinforcing effects of naturally released enkephalins in the brain.

52
Q

What are the withdrawal symptoms of heroin?

A

Symptoms that include restlessness, spasms of agonizing pain, involuntary twitching of the leg muscles, fever and sweating followed by hypothermia, vomiting and diarrhoea

53
Q

What type of agents are used to manage heroin dependence?

A

The agents that are recommended for substitution therapy are the partial πœ‡-opioid receptor agonists, methadone and buprenorphine.

54
Q

What is the MOA of methadone?

A

Long-acting πœ‡-opioid receptor partial agonist that is administered as an oral solution once daily.

The normal dose varies depending on the patient, but is in the range 15 to 40 mg. Methadone should be given eight hours after the discontinuation of heroin.

INTERGRATED STUDIES IN MENTAL HEALTH (16 decks)

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