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Undeleted > Addiction > Flashcards

Addiction Flashcards

1
Q

general def. of dependence

A

patient find the drug so pleasurable and reinforcing that they have difficulty controlling their use of the substrance

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2
Q

what is neurobio explanation

A
  • in nucleaus accumbens and medial forebrain, DA is transmitter
  • tied with memory and executive function
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3
Q

what does DA drive

A

survival benefits - food, sex, nurturing

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4
Q

how do drugs tie into these pathways

A
  • cocaine directly blocks DA reuptake

- other drugs do so via other neurotransmitters

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5
Q

5 things that give a drug addictive potential

A
  1. rapid onset of action
  2. high potency at receptor
  3. short duration of action
  4. tolerance
  5. withdrawal
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6
Q

2 ways tolerance is increased

A
  1. # of receptors and sensitivity

2. levels of neurotransmitters

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7
Q

what does rate of tolerance developlment depend on

A

the effects - for opiods

  1. pain is slow
  2. sedation is fast
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8
Q

what happens in withdrawal

A

receptors that resist the drugs are now unoppsed - get opposite effects

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9
Q

how do genes inflence alc.

A

for naive drinkers

  1. fewer adverse effects
  2. greater tolerance
  3. more pos. effects
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10
Q

2 psychiatric risk factors

A
  1. use releives negative mood states

2. have other mental disorders

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11
Q

4 social risk factors

A

nothing to do, nothing to lose

  1. lack of meaningful life
  2. lack of social support
  3. cultural attitudes towards
  4. peer influences
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12
Q

6 clinical features of dep

A
  1. drug becomes main focus of time and life
  2. neglects major responsiblities
  3. continued use despite consequences
  4. try to quit but relapse
  5. tolerance, withdrawal
  6. cravings
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13
Q

4 Cs

A

Compulsive use
Cut down (unable)
Cravings
Consequences

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14
Q

steps to a substance use Hx

A 
IPTARRR
Initiation
Pattern
Treatment hx
Abstinence
Relapse
Risk assessment
Readiness to change
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15
Q

why is it important to address smoking

A
  • killa

- smoking cessation counselling is one of the most cost-effective interventions available

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16
Q

benefits to quit

A
  • breathe easier in 24hr
  • cough better in 2 weeks
  • risk of CAD down 50% in one year
  • risk of stroke normalizes in 5 years
  • risk of dying normalizes in 15 years
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17
Q

4 effects of nicotine

A
  1. psychoactive effects - chamelon
  2. CV effects - incre HR, output, BP
  3. app suppresion
  4. incr. metabolic rate
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18
Q

pharma of nicotine

A

binds to ACH receptor in nuleaus accumbens

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19
Q

why so addictive

A
  • rapid onset
  • 200 puffs a day
  • easy to self regulate
  • very reinforcing - hardest to quit
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20
Q

what is withdrawal timing of nicotine

A

24hr - beings - irritable, anxiety, depressed mood
5day - severe withdrawal last
months - still have the urge

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21
Q

4 general types of intervention

A
  1. init. smoking cessions
  2. counselling
  3. pharma
  4. combo - more effective than either alone
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22
Q

5 As of smoking cessation

A
  1. ask - do you smoke
  2. advise - clear and strong
  3. assess - within 30 days
  4. assist - START
  5. arrange follow up
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23
Q

what is START for assisste

A 
Set a quit date
Tell friends/fam
Anticipate and plan for challenges
Remove all cigs
Talk to doc
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24
Q

4 meds

A
  1. nicotine replacement
  2. buproprion
  3. varenicline
  4. combo therapy
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25
Q

what is effect of meds

A

double chance

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26
Q

2 types of NRTs

A

patch - good in first 2 weeks

gum - good for breakthrough cravings

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27
Q

what is buproprion

A

atypical antidep - elevates DA levels

- 1-2 weeks to work

28
Q

what is veranacline

A

champix

- partial nictotine agonist - give effect and blocks other nictoine

29
Q

5 effective public health strategies

A
  1. incr. cost
  2. pass clean air leg.
  3. create effective anti-smoking
  4. ban tobacco advertising
  5. provide cessation aids
30
Q

what is alc. epi

A

80% men and 60% of women use at some time
30-50% have an adverse effect
15% chance of disorder

31
Q

what is psych effect of alc

A

CNS depressent
low dose - anxiolytic, pleasure, disinbi
high dose - sedative/hyponotic

32
Q

2 main transmitters in alc

A

GABA - CNS inhibition

glutamate - CNS exitatation

33
Q

what happens in acute, chronic and withdrawal of alc

A

acute - GABA dominant
chronic - equal
withdrawal - glut dominante - autonomic arousal

34
Q

2 Sx with 6-24hrs of withdrawal

A
  1. tremor

2. diaphoresis

35
Q

Sx at 8-254hrs

A

hallucinations

36
Q

sx at 24-48 hours

A

seizures

37
Q

sx of 72+ hours

A

DTs - can be high mortality

38
Q

what are DTs

A
  • tahcy
  • tremor
  • diaphoresis
  • fever
  • disorientation
39
Q

goals of detox

A
  • manage sx of withdrawal
  • prevent serious events
  • bridge to treatment
40
Q

main treatment of withdrawal

A

benzos

41
Q

5 stages of alc intervention

A
  1. ID
  2. intervention
  3. detoxification
  4. rehabilitations
  5. prevention
42
Q

what is SBIRT

A

Screening, Brief Intervention, Referral to Treatment

43
Q

3 important things to ask about

A
  1. all patients
  2. weekly amount
  3. maximum in a day over last month
44
Q

CAGE

A

Cut down
Annoyed
Guilt
Eye-opener

45
Q

what is brief screen

A

in past year how often have you have 5 or 4 drinks in one sitting

46
Q

what is safe drinking

A

men - 15/wk and max 3/day
women 10/wk and max 2/day
can have an extra on special occasions

47
Q

what is FRAMES brief intervention

A 
Feedback
Responsibilty is on patient
Advice to change
Menu of options
Empathic style
Self-efficacy
48
Q

3 drugs for alc. and mech

A

naltrexone - opiod antagonist - don’t get high
acamproate - enhances GABA to releive sub-acute withdrawal
disulfram - ALDH inhib - get toxic buildup and feel bad

49
Q

what is effect of opiods

A

act on mu opiod receptors and get sense of peace/happiness

50
Q

why don’t all pts become addicted

A

most don’t have the reinforecing effects

51
Q

3 keys for doctors when prescribing opiods

A
  1. select patients carefully
  2. titrate doses slowly and carefully
  3. watch for “aberrant behavior”
52
Q

what is opiod withdrawal

A
  • flu-like sx

- psych sx predominate

53
Q

how does methadone work

A

has slow onset and long half-life

- releives sx without sedation or euphoria

54
Q

what is buprenorphine (suboxone)

A
  • sub-lingual partial agonsit
  • binds tigtly and displaces other opiods
  • ceiling effect so can’t OD
55
Q

what is contingency mgmt

A
  • daily dispensing, supervised
  • gradual introduction of take home doses as well
  • urine screens
56
Q

compications of THC

A
  • poor social funct.
  • depression
  • addiction
  • MVA
  • drug-induced psychosis
57
Q

who to be concerned about with THC

A

more than a joint/day

58
Q

what is THC use in pain

A
  • weak evidence

- contains carconogens

59
Q

what is cocaine effect

A

blocks re-uptake of DA

- most reinforceing drug

60
Q

5 therapies of substance use

A 
MI
CBT
AA
contingency mgmt
family therapy
61
Q

what is MI

A
  • collaborative! and conversational
  • use PT strengths
  • style is as a guide
  • need to also be empathic
62
Q

3 keys to CBT

A
  1. recognize triggers
  2. avoid high risk situations
  3. cope with cravings
63
Q

what is AA programs

A

12 steps

  • alc. is medical and spiritual disease
  • abstinence based
  • accept loss of control
  • need a sponsor
64
Q

what is contingency mgmt

A

based on operant conditioning

  • reward abstience
  • punish drug use
65
Q

what does contingency mgmt look like

A
  • find target bahev. (eg drugs in urin)
  • clear consequences of success and failure
  • immediate reinforcement
  • incentives and punishments immediate
66
Q

what is family therapy

A

rewards and focus on abstinent behavior while retoring family system

67
Q

what is addiction among physician

A

lifetime 8-14%
M>F 7:1
more alc, opiods, sedatives

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