Addiction and Substance Misuse Flashcards
List the ICD-10 criteria for dependence
Strong desire to take the substance
Difficulty in controlling substance use
Withdrawal state
Neglect other pleasures
Persistence despite evidence of harm
Which dopaminergic pathway, associated with reward, is involved in addiction?
Mesolimbic pathway
What is the effect of dopamine release upon behaviour?
Motivates us to repeat behaviour
Involved in pleasurable experience
What effect do drugs like amphetamine and cocaine have on dopamine?
Increase release of dopamine
If dopamine receptors are repeatedly stimulated, what can eventually develop?
Tolerance
due to downregulation/decreased sensitivity of receptors
What is the consequence of developing tolerance in addiction?
Threshold for feeling reward is increased; normal pleasurable experience don’t evoke enough of a reward response
Frontal lobe areas associated with executive functioning develop before those areas associated with emotion. True/False?
False
Other way around!
Which parts of the brain are associated with memory learning?
Amygdala
Hippocampus
Which parts of the brain are associated with inhibitory motor control?
Prefrontal cortex
Anterior cingulate gyrus
Which parts of the brain are associated with motivation/drive?
Orbito-frontal cortex
Subcallosal cortex
Which parts of the brain are associated with reward?
Nucleus accumbens
Ventral pallidum
[mesolimbic pathway]
How many ml of alcohol = 1 unit?
10ml
What is the equation for calculating no. of units of alcohol?
[% x volume]/10
What are the current guidelines for low risk alcohol drinking?
No more than 14 units per week, ideally spread over 3 or more days
What are the parameters of increased risk alcohol drinking?
Regular consumption of 15-35 units a week
What are the parameters of high risk alcohol drinking?
Regular consumption of over 35 units a week
Which marker can be an indicator of alcoholic liver injury?
GGT
Which marker identifies men who have been drinking 5+ units of alcohol a day for a year or more?
Carbohydrate deficient transferin
What is the most common cause of a raised MCV?
Alcoholism
What effect does alcohol have on excitatory glutamatory ion channels?
Inhibits action of glutamate receptors
What effect does alcohol have on inhibitory GABA ion channels?
Potentiates action of GABA receptors
Alcohol withdrawal leads to less/more glutamate activity and less/more GABA activity
Alcohol withdrawal leads to more glutamate activity and less GABA activity
List clinical features of alcohol withdrawal
Restlessness, tremor
Sweating
Anxiety
Loss of appetite and sleep
Tachycardia
Seizure, delirium tremens
Which drugs are used to manage alcohol withdrawal?
Benzodiazepine
Thiamine (parenteral)
Which drug is the 1st line agent for alcohol detox relapse prevention?
Naltrexone
Which drug should be started as soon as alcohol detox is complete?
Acamprosate
Which alpha-2-receptor agonist can help with opiate detox?
Lofexidine
What are the 2 main detox agents used for opiate misuse?
Methadone
Bruprenorphine
What effect does mephedrone have on neurotransmitters?
Inhibits reuptake of serotonin, noradrenaline and dopamine
What are the user effects of taking mephedrone?
Feeling of ecstasy, openness
Increased confidence and desires
Taking mephedrone increases susceptibility to ladybird attacks. True/False?
True
What is sympathetic toxidrome and which drug is it related to?
Amphetamines
Range of toxic autonomic effects e.g. tremor, sweating, pain, confusion, vomiting etc.
What is serotonin syndrome?
Excess serotonin causes hypomania, agitation, myoclonus and hyperactive autonomic state
What effect on neurotransmission does methamphetamine have?
Inhibits reuptake of noradrenaline and dopamine
Synthetic cannabinoids can be more potent than cannabis. True/False?
True
800x more potent!
Which legal high causes a detachment from reality, including depersonalisation and derealisation?
[dissociative]
Ketamine
