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Charis & Ellie VS Psych > Addiction, alcohol and Substance Misuse > Flashcards

Addiction, alcohol and Substance Misuse Flashcards

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1
Q

What is the reward pathway?

A

Mesolimbic pathway

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2
Q

What is amotivating signal?

A

Dopaminergic activity in mesolimbic pathway

-It incentivizes behaviour and is involved in normal pleasurable experiences

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3
Q

What activates mesolimbic pathway?

A

All drugs of abuse, therefore person can develop a want to seek these drugs continually

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4
Q

Concept of tolerance?

A

Repeated exposure to drug leads to down regulation of dopamine receptors meaning more is needed to get same response

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5
Q

What ‘puts brakes on’ mesolimbic pathway?

A

Prefrontal cortex, however it is not fully mature until 20s so is vulnerable whilst person is developing

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6
Q

What is dysfunctional in addicted people?

A

Prefrontal cortex

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7
Q

What other structures are implicated in development of addiction?

A

Hippocampus

Amygdala

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8
Q

Explain how stress plays a role in addiction?

A

Chronic stress leads to dampening of dopaminergic activity through the down regulation of D receptors, which reduces sensitivity to normal rewards encouraging exposure to highly rewarding behaviours

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9
Q

Criteria for dependance?

A
  • 3 or for at least 1 month:
  • Sense of compulsion
  • Craving
  • Physiological withdrawal
  • Preoccupation with substance use
  • Persistent use despite harmful consequences
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10
Q

What can criteria for dependence be used for?

A

Any addiction

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11
Q

What is hazardous drinking?

A

-Pattern of alcohol consumption that increases the harmful consequences for user

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12
Q

What is hazardous drinking defined as in women?

A

> 14 units but <35 units a week

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13
Q

What is hazardous drinking defined as in men?

A

> 14 units but <50 units a week

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14
Q

What is harmful drinking?

A

Pattern of alcohol consumption that is causing mental or physical damage

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15
Q

What is harmful drinking defined as in women?

A

> 35 units a week

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16
Q

Harmful drinking in men defined as?

A

> 50 units a week

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17
Q

Criteria for alcohol withdrawal?

A

Any 3 of:

  • Tremor of outstretched hands, tongue or eyelids
  • Sweating
  • Nausea, retching or vomiting
  • Tachycardia/HT
  • Anxiety
  • Psychomotor agitation
  • Headache
  • Insomnia
  • Malaise or weakness
  • Transient visual, tactile or auditory hallucinations or illusions
  • Generalized tonic clonic seizures
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18
Q

What is delirium tremens?

A

-Most serious withdrawal state- medical emergency

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19
Q

When does delirium tremens occur?

A

1-3 days after alcohol cessation

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20
Q

Presentation of delirium tremens/

A
  • Disorientation
  • Agitated
  • Marked tremor
  • Tactile visual hallucinations (insects etc)
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21
Q

Signs of delirium tremens?

A
  • Sweating
  • Tachycardia
  • Tachypnoea
  • Pyrexia
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22
Q

How can delirium tremens be treated?

A
  • Correct dehydration
  • Electrolyte abnormalities and thiamine replacement
  • Give chlordiazepoxide
23
Q

What does chlordiazepoxide help with?

A

Withdrawal

24
Q

What is included in Wernicke Korsakoff Syndrome?

A

Wernicke’s encephalopathy

Korsakoff syndrome

25
Q

What are WE and KS bothe due to?

A

Thiamine deficiency

26
Q

What causes Wernicke’s encephalopathy?

A

Acute thiamine deficiency

27
Q

What does acute thiamine deficiency result in?

A

Cytotoxic oedema in mamillary bodies

28
Q

Signs/symptoms of Wernicke’s encephalopathy?

A

Ocular dysfunction
Ataxic gait
Acute confusion

29
Q

Prevent progression of Wernicke’s syndrome to what and by doing what?

A

To Korsakoff’s

By thiamine replacement and early recognition

30
Q

What is Korsakoff’s due to

A

Chronic thiamine deficiency

31
Q

What is there in Korsakoff’s?

A

Cerebral atrophy

32
Q

How does Korsakoff’s present?

A

Profound anterograde and retrograde amnesia

  • Confabulation to fill in memory gaps
  • Generally lacks insight
33
Q

Key treatment for Korsakoff’s?

A

Abstinence and nutrition but generally chances of recovery are low

34
Q

Diagnostic markers of alcohol misuse in recent weeks?

A
  • Elevated GGT

- Elevated mean corpuscular volume

35
Q

Managemnet of alcohol withdrawal?

A
  • Reassure
  • Long acting Benzos alleviate symptoms
  • Vitamin supplementation
  • Thiamine prophylactically
36
Q

Why are long acting benzos used in alcohol withdrawal?

A

To help alleviate symptoms

-They are cross tolerant with alcohol due to action on GABA receptors, usually chlorodiazepoxide is used

37
Q

What happens to dose of chlordiazepide over 7 days?

A

Reduced

38
Q

Relapse prevention for alcohol dependence syndrome?

A
  • CBT
  • Motivational enhancement therapy
  • 12 step facilitation therapy
  • Behavioural self control therapy
  • Family and couple therapy
39
Q

Benzos and alcohol dependence syndrome?

A

-No place for benzos post detox

40
Q

1st line pharmacological treatment for alcohol dependence syndrome?

A

Naltrexone:

-Opioid antagonist that reduces reward for alcohol

41
Q

Other pharmacological treatments for alcohol dependence?

A
  • Acomprosate reduces cravings

- Disulfiram inhibits alcohol dehydrogenase leading to accumulation of acetaldehyde

42
Q

Side effects of disulfiram?

A

If alcohol is ingested it causes flushed skin, tachycardia, N&V, arrhythmias and hypotension

43
Q

Pharmacological management of opioid use?

A

Naloxene

-Methadone or buprenorphine: heroin substitute for withdrawal

44
Q

Why are methadone and buprenorphine good?

A

Methadone: orally
Buprenorphine: sublingual

Therefore less risk of non-sterile needles and also because taken once daily there are less peaks in opioid levels

45
Q

Tools used for alcohol screening?

A

FAST
AUDIT (Alcohol use ID test)
CAGE (Screens for dependence)

46
Q

Physiology of alcohol?

A

Alcohol inhibits action of excitatory NMDA glutamate controlled ion channels
-Alcohol potentiates actions of inhibitory GABA type A controlled ion channels

47
Q

Usual onset of delirium tremens?

A

Insidious with night time confusion

48
Q

Dopamine release effects?

A
  • Ability to update information within prefrontal cortex
  • Ability to select new goals
  • Ability to avoid compulsive repetition behaviour
49
Q

Who gets addiction?

A

About 50% is heritable

50
Q

Most common opioid?

A

Heroin (brown powder)

51
Q

What are natural opioids?

A

Morphine
Cocaine
Natural from opium poppy

52
Q

Semi synthetic opioids?

A

Hydrocodone

Hydromorphone

53
Q

Fully synthetic opioids?

A

Methadone

Tramadol

54
Q

Indications for when buprenorphine should be taken?

A

In front of community pharmacist

Charis & Ellie VS Psych (23 decks)

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