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MSII - Behavioral Science > Addiction Day > Flashcards

Addiction Day Flashcards

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1
Q

explain the neurobiology of addiction

A

chronic, progressive behavioral disorder whose central feature is compulsive drug use despite adverse consequences
-pathophysiology involves brain reward system and alterations that reward enhancing drugs effect on this system

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2
Q

how is the ventral tegmental area involved in addiction?

A

location of dopamine cell bodies that projects to nucleus accumbens (reward center) and prefrontal cortex (executive control)
-dopamine is made and stored here (barn)

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3
Q

how is the nucleus accumbens area involved in addiction

A

“reward center” of the brain

  • integrates VTA (dopamine) and PFC (glutamate) inputs to determine motivational output
  • -incentive (appetite)
  • -reward (consummatory)
  • excitement (horses)
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4
Q

how is the prefrontal cortex involved in addiction?

A

exerts executive control over midbrain structures

  • judgement
  • cost-benefit analysis
  • consider further PFC delination next
  • “rein in” excitement (wranglers)
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5
Q

how are the DLPFC, VMPFC, OFC, and ACC involved in addiction?

A

DLPFC: statistical analysis, prioritizing, top-down control center –> failure to assess risks of a behavior)

VMPFC: assigns emotional valiance –> drinking feels good, less stress, more social

OFC: impulse prevention –> can beat up, grope, or drive w/o consequence

ACC: vigilance –> scanning environment for next hit

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6
Q

decision making is done via?

A

glutamate driven via PFC structures

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7
Q

what is limbic drive due to?

A

dopamine driven

  • D3 receptors govern static levels of DA neuronal activity to allow homeostatic wakefulness, alertness, etc.
  • D2 receptors are pulsatile depending on motivation, derive, reward expectations, etc
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8
Q

what does chronic use of drugs lead to?

A

reward circuitry changes that promote more future drug use

  • increased limbic function
  • decreased PFC function
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9
Q

how does the limbic drive actually work? in addiction?

A
  1. VTA barn supplies DA to the nucleus accumbens
  2. NA receives input and chooses which horse to use
  3. amygdala assigns a pleasure, threat, or emotional value to linkage between 1 and 2
  4. 1 through 3 are limbic addiction pathways that are excessive in addictive behavior
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10
Q

how does cortical control actually work? in addiction?

A
  1. OBF should suppress doing dangerous or addictive things
  2. VMPFC should attach positive feelings to not doing dangerous things
  3. DLPFC should calculate true risk/benefit ratio of doing addictive things
  4. this system is overridden in addiction
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11
Q

what happens to frontal lobe structures in addiction?

A

become less active due to less glutamate

-may even atrophy, allowing increasing, maladaptive addictive (more DA) behaviors to occur

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12
Q

what does alcohol intoxication look like? Rx?

A
  • anxiolysis
  • dishinbition
  • slurred speech
  • ataxia
  • sedation/stupor
  • respiratory suppression
  • coma
  • death

Rx: support, restraint, protect airway, ventilate

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13
Q

what does alcohol withdrawal look like? Rx?

A
  • agitation
  • insomnia
  • tremor
  • GI upset
  • increased pulse, HR, BP
  • seizures
  • hallucinations
  • delirium
  • death

Rx: benzodiazepines (X-reactive) until vital signs and withdrawal symptoms normalize

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14
Q

what does benzodiazepine or barbiturates intoxication look like? Rx?

A
  • anxiolysis
  • slurred speech
  • ataxia
  • sedation/stupor
  • respiratory suppression
  • coma
  • death

Rx: support, restraint, protect airway, ventilate
-reverse with flumazenil for benzodiazepines, but may cause seizures

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15
Q

what does benzodiazepine or barbiturate withdrawal look like? Rx?

A
  • agitation, insomnia
  • tremor
  • GI cramps
  • hypereflexia
  • increased HR
  • seizures
  • hallucinations
  • delirium
  • death

Rx: benzodiazepine replacement until vital signs and withdrawal symptoms normalize

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16
Q

what do stimulants do to D2?

A

block dopamine reuptake, may reverse it

-more DA availability in mesolimbic system allows increased CNS arousal and excitability

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17
Q

what does stimulant intoxication look like? Rx?

A
  • elevated mood/esteem
  • irritability
  • insomnia
  • appetite loss
  • dilated pupils
  • racing heart
  • increased BP, elevated temperature
  • hyperreflexia
  • psychosis
  • cardiac arrest due to hypoxic brain injury
  • seizure

Rx: support, use meds to reverse specific intoxication symptoms

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18
Q

what does stimulant withdrawal look like? Rx?

A
  • fatigue
  • anhedonia
  • depression
  • increased sleep (crash) or decreased sleep
  • increased appetite

Rx: slowly stimulate D uptake

19
Q

what exactly is an opiod and where does it bind?

A

opiods are anything that bind and occupy receptors in the brain, exerting certain activities

20
Q

what are the receptors affected by opiates? what do these cause?

A
  • Mu (OP3, MOP) reduce pain, increase positive emotion
  • Kappa (OP2, KOP), delta (OP1, DOP) allow mild analgesia
  • -GPCR, causing neuronal hyperpolarization via cAMP reduction and increased K+ influx and decrease Ca++ efflux
  • -increase descending midbrain pain inhibitory paths –> increase serotonin and enkephalin firing
21
Q

what are many prescription narcotic pain meds?

A

naturally occuring alkaloids (poppy) or synthetic

-activate Mu, OP3, MOP receptors to control pain and improve emotional state associated with said pain

22
Q

what does opiate intoxication look like? Rx?

A
  • elevated mood
  • pupil constriction
  • respiratory suppression=gag reflex loss
  • low HR, BP
  • constipation

Rx: support, protect airway and use naloxone to reverse

23
Q

what does opiate withdrawal look like? Rx?

A
  • restless/agitated
  • watery eyes
  • yawning
  • dilated pupils
  • goose flesh/flushing
  • runny nose/sneezing
  • increased HR and BP
  • GI distress
  • GI cramps
  • muscle craps

Rx: methadrone (full agonist replacement) or buprenorphine (partial agonist replacement)

24
Q

what are hallucinogens?

A

PCP (phencyclidine), LSD (lysergic acid), mescaline, peyote, psilocybin

25
Q

what is hallucinogen intoxication? Rx?

A
  • perceptual distortion
  • hallucinations
  • depersonalization
  • vertical nystagmus
  • tremors
  • hyperreflexia
  • racing heart
  • flashbacks
  • paranoia

Rx: supportive

26
Q

what is cannabis intoxication? Rx?

A
  • elevated mood
  • expansive thought
  • sedation
  • pupil constriction
  • red conjunctiva
  • increased appetite
  • panic
  • paranoia
  • forgetfulness

Rx: questionable

27
Q

what is required for someone to want to change?

A

ready (timing is right)
willing (their own choice)
able (have the tools)

28
Q

what are the 5 stages of change?

A
  1. precontemplation (not at all thinking about it)
  2. contemplation (thinking about pros and cons)
  3. preparation (varying stage length; getting tools ready)
  4. action (actually doing it)
  5. maintenance (may falter, but keeps going through with it)
29
Q

what is the first process of change?

A

precontemplation to contemplation

  • consciousness (education) rising
  • emotional arousal/dramatic release
  • social liberation/environmental reevaluation
30
Q

what is the second process of change?

A

contemplation to preparation

-self re-evaluation

31
Q

what is the third process of change?

A

preparation to action

-self-liberation and commitment

32
Q

what is the fourth and last process of change?

A

action to maintenance

  • countering/counterconditioning
  • environmental control
  • rewards
  • helping relationships
  • may have 4-5 relapses in 4-5 years, but must learn from mistakes
33
Q

what is addiction abstinence?

A

must stop all drugs, and never use at all

-include the 12 steps based on AA

34
Q

what is the COPD-related way smokers die?

A

pasting over of alveolar capillary membrane with dirt, “air trapping” caused by particles plugging bronchioles

35
Q

what is the arterial damage-related way smokers die?

A

heart, brain, pudental artery

36
Q

what are smoking-related cancers?

A

irritation locally and via blood to pancreas, kidney, bladder, bone marrow

37
Q

what are methods to get people to quit smoking?

A
  1. Socrative teaching (tell them about what can go wrong)
  2. clarification/reflexive listening (ask them why they do things)
  3. confrontation/double sided reflection (more guilt-trips; educate in top-down approach)
38
Q

what is a step-by-step method for “healthier smoking”?

A
  1. eat breakfast, then smoke and enjoy the cigarette
  2. set a max allotment and don’t go any higher
  3. stop smoking the cigarette when it starts tasting bitter
39
Q

how does bupropion help smoke cessation?

A

NDRI slow-release antidepressant

  • blocks neuronal reuptake/recycling of NE and DA to improve alertness, attention, concentration, motivation
  • these nt build up in synapses and activate neurons in the area
  • -desensitize DA reward circuitry, so cigarette based ACTIVATION is not missed
  • -provide alertness, energy, and better cognition/mood, so cigarette effects are not missed
40
Q

what is Varenicline? mechanism? side effects/

A

most effective pill for smoking cessation

  • partial nicotine receptor agonists replaces full agonist of nicotine
  • stabilizes Na channel in less frequently open slats, and not desensitized
  • as it’s a small opening, it’s only a small rush
  • avoid most of the withdrawal, and provide some of the nicotine benefits w/o harm
  • ASE: insomnia, vomit, constipation, headache, abnormal dreams
  • -agitation, depression, suicidal behavior, and CVD not reduced (may even increase)
41
Q

what is the definition of drug abuse?

A

pattern of substance use that causes someone to experience harmful consequences

  • if in a 12 month period, a person is in 1+ of following:
  • -failure to meet obligations, such as missing work or school
  • -engaging in reckless activities, like driving while intoxicated
  • -encountering legal troubles, like getting arrested
  • -continuing to use despite personal problems
42
Q

what is the definition of substance dependence?

A

3+ criteria from a set that includes 2 physiological factors and 5 behavioral patterns in a 12 month period

  • physiological:
  • -tolerance
  • -withdrawal
  • behavioral:
  • -being unable to stop once using starts
  • -exceeding self-imposed limits
  • -curtailing time spent on other activities
  • -spending excessive time getting or using drugs
  • -taking a drug despite deteriorating health
43
Q

what is tolerance?

A
  • a person needs more of a drug to achieve intoxication

- markedly diminished effect with continued use of same amount

44
Q

what is withdrawal?

A
  • experience mental or physical symptoms after stopping drug use
  • same or closely related substance is taken to relieve or avoid withdrawal symptoms

MSII - Behavioral Science (18 decks)

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