Addiction Flashcards
What is the immediate effect of most abused substances?
increase the availability of NTs that signal the nervous system to feel pleasure
Define substance abuse
a maladaptive pattern of substance use over at least 12 months that leads to impairment of occupational, physical, or social functioning. Substance abuse is not diagnosed when the patient meets the criteria for substance dependence.
Define substance dependence
substance abuse + withdrawal symptoms, tolerance or a pattern of compulsive use
Medical professionals look for 3 or more criteria from a set that includes 2 physiological and 5 behavioral pattherns over a 12-month period.
physiologic
1) tolerance 2) withdrawal
behavioral
1) being unable to stop once using starts
2) exceeding self-imposed limits
3) curtailing time spent on other activities
4) spending excessive time using or getting drugs
5) taking a drug despite deteriorating health
Define withdrawal
development of physical or psychological symptoms after the reduction or cessation of intake of a substance
Define cross-tolerance
development of tolerance to one substance because of using another substance
The most impt feel good NT is DA. Where is it produced, where does it project and when stimulated where is it released toward?
DA is produced in neurons of the mesolimbic dopaminergic tract in the VTA. These neurons project forward thru the medial forebrain bundle and when stimulated release DA toward the nucleus accumbens (NA) and frontal cortex
What is glutamate’s role in addictive behavior? How have drug companies used this to treat addiction?
Glutamate is associated specifically with the maintenance of addictive behavior. THerefore, agents that block glutamate’s activity can reduce drug cravings.
Patients with diagnoses of both mental illnesses and substance abuse are called?
mentally ill-chemically addicted (MICA) patients or dual diagnosis
What are the four classes of abused substances?
- sedatives
- opiods
- stimulants
- hallucinogens and related agents
What’s a useful strategy to see if a pt has a problem with alcohol?
Ask “CAGE” questions starting with “Do you ever…”
- try to CUT down on your drinking
- get ANGRY when someone comments on your drinking
- feel GUILTY about your drinking
- take a drink as an EYE-OPENER in the morning.
A positive ans to any two of the questions or just the last question –> alcohol problem
list the 3 frequently abused barbiturates
- amobarbital
- pentobarbital
- secobarbital
Benzodiazepines are safer than barbiturates except when?
taken with another sedative like alcohol.
In the sedatives group of abused substances, list the 3 substances
- alcohol
- benzodiazepines
- barbiturates
What is alcohol withdrawal delirium aka delirium tremens (DTs)? When is it observed? What else can cause DTs?
commonly observed on abt the 3rd day of withdrawal in pts who have been drinking heavily for at least 5 years. It is a life-threatening condition with a mortality rate of 20%. Withdrawal from benzodiazepines can also lead to the DTs.
How do you treat delirum tremens brought upon from alcohol withdrawal?
oral and IV fluids for dehydration as well as benzodiazepines (chlordiazepoxide, diazepam, and lorazepam)
List the 12 steps to recovery that the AA uses.
- admitted that we were powerless over alcohol
- came to believe that a power greater than ourselves could restore our sanity
- made a decision to turn our will and our lives over to GOD
- made a searching and fearless moral inventory of ourselves
- admitted to GOD, to ourselves, and to another human being that exact nature of our wrongs
- were entirely ready to have God remove all these defects of character
- humbly asked Him to remove our shortcomings
- made a list of all persons we had harmed and became willing to make amends to them all
- made direct amends to such ppl whenever possible, except when to do so would injure them or others.
- continued to take personal inventory and when we were wrong promptly admitted it
- sought thru prayer and meditation to improve our conscious contact with God
- having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs.
How does disulfiram prevent alcohol use?
It’s a daily ingestion that will block breakdown of alcohol and results in acetaldehyde accumulation –> intense nausea, headache, flushing.
T/F: psychotherapy alone has been very successful in treating alcoholism
False
All opiods have potential to cause physical and psychological dependence. Some can even improve mood. When compared with medically used opiods (morphine), abused opiods (heroin) have more what effects?
more europhic action and are more potent, can cross BBB more quickly and have a faster onset of action
What’s the classic clinical triad of opiod overdose? What are some other symptoms?
classic clinical triad: coma, respiratory depression, miosis (pinpoint pupils)
other symptoms: hypotension, bradycardia, hypothermia
What’s the most common cause of death from opiod overdose? How has this affected management?
respiratory arrest is the most common cause of death from opioid overdose. emergency treatment includes establishing an airway and supplying mechanical ventilation. Also, naloxone, an opioid receptor antagonist, is used to reverse respiratory suppression.
What are some physical withdrawal symptoms of opioids?
-flu-like effects (sweating, fever, rhinorrhea, muscle aches, autonomic instability)
Which is more dangerous: barbiturate (sedative) withdrawal or opioid withdrawal?
barbiturate b/c it can be fatal whereas opioid withdrawal is rarely fatal unless a serious underlying physical illness is present.
What’s the detoxification process of opioid addicts?
a synthetic opioid (methadone) can be given over a period of weeks in decreasing doses.
What’s an effective way to prevent a return to the dangers of heroin since most abusers end up abusing again (recidivism)?
substitution and continued use of legal opioids, such as methadone (full agonist replacement) or buprenorphine (partial agonist replacement)
List the 2 minor stimulants and the 2 major stimulants.
2 minor: caffeine + nicotine
2 major: amphetamine + cocaine
Which stimulant blocks the reuptake of DA? Which stimulates the release?
amphetamine stimulates the release of DA while cocaine blocks the reuptake of DA.
What are some symptoms of intoxication of too much caffeine, a minor stimulant?
restlessness, agitation, flushing of the face, and tachycardia
What is ecstasy?
combination of an amphetamine and a hallucinogen
What is speedballing?
users of heroin (or another depressant) counteract its sedating effect by mixing it with a stimulant like cocaine.
The “high” with cocaine is often followed by?
mood depression, a change that can occur in less than 1 hour
What are some psychotic symptoms that cocaine users feel?
-sensations of bugs crawling on the skin (cocaine bugs)