Addiction Day Flashcards
explain the neurobiology of addiction
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
how is the ventral tegmental area involved in addiction?
location of dopamine cell bodies that projects to nucleus accumbens (reward center) and prefrontal cortex (executive control)
-dopamine is made and stored here (barn)
how is the nucleus accumbens area involved in addiction
“reward center” of the brain
- integrates VTA (dopamine) and PFC (glutamate) inputs to determine motivational output
- -incentive (appetite)
- -reward (consummatory)
- excitement (horses)
how is the prefrontal cortex involved in addiction?
exerts executive control over midbrain structures
- judgement
- cost-benefit analysis
- consider further PFC delination next
- “rein in” excitement (wranglers)
how are the DLPFC, VMPFC, OFC, and ACC involved in addiction?
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
decision making is done via?
glutamate driven via PFC structures
what is limbic drive due to?
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
what does chronic use of drugs lead to?
reward circuitry changes that promote more future drug use
- increased limbic function
- decreased PFC function
how does the limbic drive actually work? in addiction?
- VTA barn supplies DA to the nucleus accumbens
- NA receives input and chooses which horse to use
- amygdala assigns a pleasure, threat, or emotional value to linkage between 1 and 2
- 1 through 3 are limbic addiction pathways that are excessive in addictive behavior
how does cortical control actually work? in addiction?
- OBF should suppress doing dangerous or addictive things
- VMPFC should attach positive feelings to not doing dangerous things
- DLPFC should calculate true risk/benefit ratio of doing addictive things
- this system is overridden in addiction
what happens to frontal lobe structures in addiction?
become less active due to less glutamate
-may even atrophy, allowing increasing, maladaptive addictive (more DA) behaviors to occur
what does alcohol intoxication look like? Rx?
- anxiolysis
- dishinbition
- slurred speech
- ataxia
- sedation/stupor
- respiratory suppression
- coma
- death
Rx: support, restraint, protect airway, ventilate
what does alcohol withdrawal look like? Rx?
- agitation
- insomnia
- tremor
- GI upset
- increased pulse, HR, BP
- seizures
- hallucinations
- delirium
- death
Rx: benzodiazepines (X-reactive) until vital signs and withdrawal symptoms normalize
what does benzodiazepine or barbiturates intoxication look like? Rx?
- 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
what does benzodiazepine or barbiturate withdrawal look like? Rx?
- agitation, insomnia
- tremor
- GI cramps
- hypereflexia
- increased HR
- seizures
- hallucinations
- delirium
- death
Rx: benzodiazepine replacement until vital signs and withdrawal symptoms normalize
what do stimulants do to D2?
block dopamine reuptake, may reverse it
-more DA availability in mesolimbic system allows increased CNS arousal and excitability
what does stimulant intoxication look like? Rx?
- 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
what does stimulant withdrawal look like? Rx?
- fatigue
- anhedonia
- depression
- increased sleep (crash) or decreased sleep
- increased appetite
Rx: slowly stimulate D uptake
what exactly is an opiod and where does it bind?
opiods are anything that bind and occupy receptors in the brain, exerting certain activities
what are the receptors affected by opiates? what do these cause?
- 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
what are many prescription narcotic pain meds?
naturally occuring alkaloids (poppy) or synthetic
-activate Mu, OP3, MOP receptors to control pain and improve emotional state associated with said pain
what does opiate intoxication look like? Rx?
- elevated mood
- pupil constriction
- respiratory suppression=gag reflex loss
- low HR, BP
- constipation
Rx: support, protect airway and use naloxone to reverse
what does opiate withdrawal look like? Rx?
- 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)
what are hallucinogens?
PCP (phencyclidine), LSD (lysergic acid), mescaline, peyote, psilocybin
what is hallucinogen intoxication? Rx?
- perceptual distortion
- hallucinations
- depersonalization
- vertical nystagmus
- tremors
- hyperreflexia
- racing heart
- flashbacks
- paranoia
Rx: supportive
what is cannabis intoxication? Rx?
- elevated mood
- expansive thought
- sedation
- pupil constriction
- red conjunctiva
- increased appetite
- panic
- paranoia
- forgetfulness
Rx: questionable
what is required for someone to want to change?
ready (timing is right)
willing (their own choice)
able (have the tools)
what are the 5 stages of change?
- precontemplation (not at all thinking about it)
- contemplation (thinking about pros and cons)
- preparation (varying stage length; getting tools ready)
- action (actually doing it)
- maintenance (may falter, but keeps going through with it)
what is the first process of change?
precontemplation to contemplation
- consciousness (education) rising
- emotional arousal/dramatic release
- social liberation/environmental reevaluation
what is the second process of change?
contemplation to preparation
-self re-evaluation
what is the third process of change?
preparation to action
-self-liberation and commitment
what is the fourth and last process of change?
action to maintenance
- countering/counterconditioning
- environmental control
- rewards
- helping relationships
- may have 4-5 relapses in 4-5 years, but must learn from mistakes
what is addiction abstinence?
must stop all drugs, and never use at all
-include the 12 steps based on AA
what is the COPD-related way smokers die?
pasting over of alveolar capillary membrane with dirt, “air trapping” caused by particles plugging bronchioles
what is the arterial damage-related way smokers die?
heart, brain, pudental artery
what are smoking-related cancers?
irritation locally and via blood to pancreas, kidney, bladder, bone marrow
what are methods to get people to quit smoking?
- Socrative teaching (tell them about what can go wrong)
- clarification/reflexive listening (ask them why they do things)
- confrontation/double sided reflection (more guilt-trips; educate in top-down approach)
what is a step-by-step method for “healthier smoking”?
- eat breakfast, then smoke and enjoy the cigarette
- set a max allotment and don’t go any higher
- stop smoking the cigarette when it starts tasting bitter
how does bupropion help smoke cessation?
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
what is Varenicline? mechanism? side effects/
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)
what is the definition of drug abuse?
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
what is the definition of substance dependence?
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
what is tolerance?
- a person needs more of a drug to achieve intoxication
- markedly diminished effect with continued use of same amount
what is withdrawal?
- experience mental or physical symptoms after stopping drug use
- same or closely related substance is taken to relieve or avoid withdrawal symptoms
