Addiction Flashcards
What is defined as hazardous drinking
Drinking above the level of 2-3 units/day for women and 3-4 units/day for men
What is defined as harmful drinking
Defined as a pattern of alcohol consumption causing health problems related to alcohol
What is defined as alcohol dependence
Behavioural syndrome of impaired control over alcohol use, with drinking becoming problematic and harmful
How to diagnose alcohol dependence
3 critieria met during 12 month period:
Tolerance.
Withdrawal symptoms/Alcohol withdrawl syndrome.
Use in larger amounts for longer periods than intended.
Time is spent obtaining alcohol or recovering from effects.
Social, occupational and recreational pursuits are given up/reduced.
Use is continued despite knowledge of alcohol related harm.
What screening tool can be used for alcohol use disorders
AUDIT
What happens in dependent drinkers
Lasting central nervous system changes take place which put people at long term risk of relapse
What laboratory investigations are useful in alcohol dependents
Gamma-glutamyl transferase which is a good biological marker of alcohol misuse.
Features of alcohol withdrawal
Sympathetic nervous system overactivity
Perceptual disturbances
Cognitive changes
Insomnia, GI distrubances and sometimes seizures
Symptoms of sympathetic nervous system overactivity
Raised pulse, raised blood pressure, sweating, tremor, raised temperature
Symptoms of perceptual disturbances
Visual, tactile or more rare auditory. Can be vivid dreams or hallucinations or llusions. Formication - sensation of feeling things crawling on the skin
Symptoms of cognitive changes
Anxiety, paranoia, delirium
What vitamin is lacking in alcohol dependents
Thiamine
What is the primary target for opioids
Mu opioid receptors and then dopamine
What are the other actions of opioids
Kappa and delta opioid receptors
What is the primary targey for cocaine
DAT and dopamine
What is the primary target for nicotine
Nicotinic ACh receptor and dopamine
What is the primary target for ethanol
GABA/glutamate, increasing GABA and decreasing glutamate
What is the primary target for benzodiazepines
GABA receptor, increasing GABA and dopamine
What is the primary target for cannabis
CB1 receptors with an effect on dopamine
Primary target for ecstasy
5-HT transporter which increases 5-HT and some DA
Primary target for ketamine/PCP
NMDA which decreased glutamate
Primary target for LSD
5-HT2 receptors which increased 5-HT
Full agonist of opiates in clinical pharmacotherapy
Methadone
Full agonist of cocaine in clinical pharmacotherapy
Buproprion
Full agonist of nictotine in clinical pharmacotherapy
Nictotine - patches, gum, ect
Full agonist of ethanol in clinical pharmacotherapy
Benzodiazepines, Baclofen
Full agonist of ecstasy in clinical pharmacotherapy
SSRIs
Antagonists of opiates in clinical pharmacotherapy
Naltrexone, buprenorphine
Antagonist of nicotine in clinical pharmacotherapy
Mecamylamine
Antagonist of ethanol in clinical pharmacotherapy
Naltrexone, nalmefene, flumazenil
Antagonist of ecstasy in clinical pharmacotherapy
SSRI
Antagonist of LSD in clinical pharmacotherapy
5-HT2
Top of heirachy for aims in treatment for drug addiction
Total abstinence
sseond in heirachy for aims in treatment of drug addiction
Reduce prescribed medication - methadone reduction
Third in hierachy for aims in treatment of drug addiction
Stop illicit drug use - by prescribing substitute medication
Bottom of hierachy of aims in treatment of drug addiction
Harm minimisation - vaccination for Hep B, needle exchange
Opioid withdrawal symptoms
Dilated pupils, tachycardia, increased BP, sweating, piloerection, sneezing, yawning, rhinorrhoea, psychomotor agitation
