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Psychiatry SOH > Addiction and substance misuse > Flashcards

Addiction and substance misuse Flashcards

1
Q

What is addiction?

A

Criteria of dependence

Persistence of participation despite evidence of harm

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2
Q

What is the reward (mesolimbic) pathway?

A

Stimulus causes dopamine to be released -> this causes a motivating signal to the individual.
The more dopamine released, the more you want to do the behaviour.

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3
Q

The reward (mesolimbic) pathway is only involved in addiction, not normal pleasurable experiences. True or false?

A

False

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4
Q

What happens to the reward (mesolimbic) pathway if you repeatedly take substances?

A

Repeated dopamine release results in down regulation of dopamine receptors and tolerance develops.
This means more dopamine is needed to trigger a response of reward.

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5
Q

What is the role of the pre-frontal cortex in the reward (mesolimbic) pathway?

A

Modulates the powerful effects of the pathway and “puts the brakes on it” to ensure that we are making sound decisions.

keeps emotions and impulses under control to achieve long term goals.

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6
Q

In addiction, pre-frontal cortex is normal/dysfunctional?

A

Dysfunctional

- so that we are not making sound decisions and it is not modulating the effects of the reward pathway

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7
Q

What is the most popular opiate that is misused?

A

Heroin

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8
Q

What is heroin derived from ?

A

Poppy seeds

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9
Q

What is heroin?

A

Diamorphine

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10
Q

What happens when you take heroin?

A

Rapidly absorbed and crosses the BBB

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11
Q

If you carry out a drug screen on a patient and detect 6-mono-acetyl morphine, what is it indicative of?

A

Heroin use

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12
Q

If you carry out a drug screen on a patient and detect morphine, what is it indicative of?

A

Can’t say for certain

  • could be a variety of things
  • this is why detection of 6-mono-acetyl morphine is beneficial
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13
Q

Features of heroin use?

A 
Euphoria 
Analgesia 
Respiratory depression
Constipation
Reduced consciousness 
Pupillary constriction
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14
Q

Heroin withdrawal symptoms

A 
Cravings 
Agitation
Tachycardia, hypertension
Diarrhoea, N+V
Dilated pupils
Joint pains 
Yawning
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15
Q

Heroin causes psychosis. True or false?

A

False

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16
Q

Management of opiate misuse - opiate substitution therapy

A

Replace short acting opiate with long acting opiate

17
Q

Name 2 long acting opiates that can be used in opiate substitution therapy

A

Methadone
Buprenorphine

initially taken under supervision

18
Q

Management of opiate misuse -opiate detoxification

A

Gradually give them reducing doses of the drug until they are not on any opioids all together

19
Q

There is a huge risk of dying following opiate detoxification. Why is this?

A

The patient is still psychologically dependent on the substance so often the patient relapses.

20
Q

What is used to reverse an opiate overdose?

A

Nalaxone

21
Q

Name 2 complications of IV drug misuse

A

Infection

Thrombotic/embolic

22
Q

1 unit of alcohol = __ ml alcohol

A

10 ml

23
Q

Alcohol addiction causes up-regulation/down-regulation of glutamate receptors?

A

Up-regulation

- excess glutamate activity

24
Q

Alcohol withdrawal - clinical features

A 
Restlessness
Tremor
Sweating 
N+V
Loss of appetite
Insomnia
Seizures
Tachycardia
Hypertension 
Delirium Tremens
25
Q

How does delirium tremens present

A 
Gradually 
Night time confusion
Disorientation
Agitation
Visual and auditory hallucinations
26
Q

Alcohol withdrawal - management

A

Benzodiazepines

  • use long acting agents (diazepam)
  • reduce dose gradually over 7 days
  • only used in detoxification period
27
Q

Alcohol withdrawal - which vitamin is used?

A

Thiamine

28
Q

Why is thiamine given to a patient with alcohol withdrawal?

A

As a prophylaxis against wenches’ encephalopathy

29
Q

Alcohol withdrawal - relapse prevention - which drugs can be used?

A

Disulfiram (antabuse)
Acamprostate
Naltrexone

30
Q

How does Disulfiram (antabuse)

work?

A

Inhibits acetaldehyde dehydrogenase which stops the metabolism of alcohol into its end products

31
Q

How does acamprostate work?

A

Acts centrally on glutamate and GABA systems

Psychiatry SOH (19 decks)

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