Addiction Flashcards
What pathway acts on pleasure/ motivation?
Mesolimbic pathway mediated by release of dopamine
Ventral tegmental area > Nucleus accumbens
what pathway acts on goal setting/ descicion making?
Prefrontal cortex
True/ False Prefrontal cortex can override the mesolimbic pathway
True- prefrontal cortex can override the mesolimbic pathway
-drugs can disrupt the frontal cortex
mesolimbic pathway- motivation and pleasure using dopamine
prefrontal cotex- descicion making and goal setting
what part of the brain is the creator of motivation to act?
orbitofrontal cortex
what part of the brain is overactive in cravings/ addicts?
Orbitofrontal fortex is overactive in cravings/ addicts
-it is the creator of motivation to act
role of hippocampus in addiction?
stores memory of pleasure and learned drug associations
what dopamine pathway do addictive drugs act on?
Addictive drugs act on the mesolimbic pathway
(pathway that controls pleasure/motivation)
VTA >NA (mediated by dopamine)
what can chronic drug use and overstimulation of the mesolimbic pathway lead to?
-reduces dopamine receptor expression and results in tolerance
-the body eventually depends on drug dopamine stimulation to feel normal (negative reinforcement)
recommended units a week- alcohol?
14 units/ week
what is classed a hazardous drinking?
> 14 units/ week
-increases risk of harm
what harm can hazardous drinking (>14 units a week) cause?
Cancer- breast, GI (oesophagus, bowel, oral), liver
Wernicke’s encephalopathy
Korsakoff syndrome
Cardiovascular problems
what cancer can hazardous drinking (>14 units a week) cause?
Breast, GI (oesophagus, bowel, oral) and liver
what is Wernickes encephalopathy
Acute thiamine (aka B1) deficiency caused by hazardous drinking (usually >14 units/week)
Alcoholic develops ataxia, nystagmus and confusion
-what?
Acute thiamine (B1) deficiency
-Wernicke’s encephalopathy
what is Korsakoffs syndrome?
Chronic thiamine (B1) deficiency caused by alcohol use
Alcoholic presents with dementia and confabulation (false lies/ think they are telling the truth)
-what is this
Korsakoff syndrome
what CV SE are there to hazardous drinking (>14 units a week)?
Dilated cardiomyopathy
-stroke, hypertension
what is considered harmful drinking?
> 35 units/ week (women)
50 units/week (men)
what medication can be given for alcohol detoxification?
benzodiazepine (gradually withdraw) + vitamin supplementation (to prevent thiamine deficiency)
MofA benzodiazepines?
increase the affects of GABA (so more inhibation/ drowsiness)
inhibits glutamate (excitatory)
what can be done as relapse prevention in alcoholics?
should not use benzodiazepines beyond detoxification period
1st line= Naltrexone
-Disulfram
-Acamprosate
MofA Nalrexone?
(used 1st line in relapse prevention of alcoholics)
Opiod anatagonist and reduces rewards from alcohol
MofA- dilsulfram?
-acetaldehyde dehydrogenase inhibitor
(acetaldehyde build up with alcohol ingestion causing alcohol intolerace)
MofA Acromprosate?
Acts centrally (GABA/glutamate)
-reduces cravings
-good to use alongside psychotherapy
when is peak incidence of delirium tremens?
symptoms start 6-12 hours (tremor, sweating, tahcycardia, anxious)
seizures 36 hours
Peak incidence of delirium tremens 48-72 hours (coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia)
peak incidence of seizures?- delirium tremens
36 hours after last drink
when do delirium tremens symptoms start?
6-12 hours after last drink
-tremor
-sweating
-tachycardia
-anxiety
treatment of delirium tremens?
long acting benzodiazepine:
-diazepam
OR
-chlordiazepoxide
MofA- delirium tremens?
-Chronic alcohol consumption enhances GABA mediated inhibition in the CNS (similar to benzodiazepines) and inhibits NMDA-type glutamate receptors
-Alcohol withdrawal is thought to be lead to the opposite (decreased inhibitory GABA and increased NMDA glutamate transmission)
what is treatment of opiod dependance?
Opioid replacement therapy:
-Methadone (solution)
-Buprenorphine (oral tablet)
Patient has pinpoint pupils, respiratory depression or is unconscious. Have a history of opioid use
-how will you manage them?
Drug reversal= IV naloxone
Symptoms of drug toxicity= unconsciouss, respiratory depression, pin point pupils
