addiction Flashcards
Drugs of abuse MOA
increase dopamine release in the shell of the nucleus accumbens. Also affects motivational systems and reward (ventral tegmental area to nucleus accumbens), frontal regions involved in learning, cognitive control or inhibition (prefrontal cortex), and regions involved in mood and stress reactivity.
Why are adolescents more vulnerable to addiction than adults
The nucleus accumbens is mature in early adolescence but the pre-frontal cortex is not.
What is response reversal learning
Behavior is rewarded, then change to stimulus and elicit punishmnet. Patients with substance abuse have harder time with response reversal learning.
Describe assessment and screening tools for substance abuse
MAST – Michigan Alcoholism Screening Test, CAGE Questionnaire, Substance Abuse Subtle Screening Inventory (SASSI), TWEAK, Self Administered Alcoholism Screening Test (SAAST), AUDIT – Alcohol Use Disorder Identification Test
What is considered “at risk” drinking
Men ≥ 5 standard drinks in a day or > 14 per week. Women ≥ 4 in a day or > 7 per week
What is the single question that can be asked to screen for alcohol abuse
“How many times in the past year have you had 4/5 or more drinks in a day?” (4 for women and 5 for men, ≥1 time is considered positive) 88% sensitivity and 67% specificity
“How many times in the past year have you had 4/5 or more drinks in a day?” (4 for women and 5 for men, ≥1 time is considered positive) 88% sensitivity and 67% specificity
“How many times in the past year have you had 4/5 or more drinks in a day?” (4 for women and 5 for men, ≥1 time is considered positive) 88% sensitivity and 67% specificity
Diagnosis of substance abuse
Mild = 2-3 symptoms, Moderate = 4-5 symptoms, Severe = 6+ symptoms
Which neurotransmitters/receptors do the following affect? Alcohol, opioids, nicotine, cocaine, amphetamines, sedative-hypnotics, THC, PCP, hallucinogens, inhalants
Alcohol: Multiple (GABA) Opioids: Opioid (i.e. μ) Nicotine: Nicotinic Cocaine: dopamine (t) Amphetamines: dopamine (t) Sedative-hypnotics:GABA THC :Cannabinoid PCP: NMDA Hallucinogens: Multiple Inhalants:Multiple (NMDA) Alcohol: Multiple (GABA) Opioids: Opioid (i.e. μ) Nicotine: Nicotinic Cocaine: dopamine (t) Amphetamines: dopamine (t) Sedative-hypnotics:GABA THC :Cannabinoid PCP: NMDA Hallucinogens: Multiple Inhalants:Multiple (NMDA) Alcohol: Multiple (GABA) Opioids: Opioid (i.e. μ) Nicotine: Nicotinic Cocaine: dopamine (t) Amphetamines: dopamine (t) Sedative-hypnotics:GABA THC :Cannabinoid PCP: NMDA Hallucinogens: Multiple Inhalants:Multiple (NMDA)
meds for alcohol abuse
Antabuse (disulfiram), Revia and Vivitrol (naltrexone), Campral (acamprosate
•Antabuse/disulfiram reaction
Flushing,Headache, Nausea, Dizziness, Tachycardia
antabuse dosing
b Load 500mg PO QD for 5 days, 250mg PO QD or 500mg M-W-F, Some patients require higher doses to have disulfiram reaction
antabuse side effects
Metallic taste, Headaches, Drowsiness or fatigue, Optic neuritis, Peripheral neuropathy, Hepatitis, Rash, A few cases of psychotic symptoms (i.e. metronidazole)
antabuse interactions
Metronidazole - Psychosis/confusion Amitriptyline - Psychosis/confusion Phenytoin - Phenytoin toxicity Diazepam- Sedation Perphenazine- Breakthrough Isoniazid - Nausea/lethargy/ataxiaMetronidazole - Psychosis/confusion Amitriptyline - Psychosis/confusion Phenytoin - Phenytoin toxicity Diazepam- Sedation Perphenazine- Breakthrough Isoniazid - Nausea/lethargy/ataxiaMetronidazole - Psychosis/confusion Amitriptyline - Psychosis/confusion Phenytoin - Phenytoin toxicity Diazepam- Sedation Perphenazine- Breakthrough Isoniazid - Nausea/lethargy/ataxia
antabuse contraindications
Risk for MI, risk for CVA, cognitive dysfunction (cant remember what will happen if drinks), pregnancy category C
Naltrexone MOA
Blocks mu opioid receptors. Blocks euphoria from alcohol and blocks effects of heroin.
