Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Psychopathology > Addiction Medicine > Flashcards

Addiction Medicine Flashcards

1
Q

diagnosis of substance use disorder

A

2+ in 12 months:
tolerance, withdrawal, more use than intended, craving, unsuccessful effort to cut down, spend excessive time in acquisition, give up activities to use, use despite negative effects, failure to fulfill roles, use in hazardous situations, use despite social problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

how to rate severity of substance use d/o

A

mild: 2-3 criteria
moderate: 4-5
severe: 6+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

3 C’s of addiction

A

craving
compulsion
loss of control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

diagnostic criteria for gambling disorder

A

4+ in 12 mos not explained by mania:
preoccupation w gambling, inc $ gambled, unsuccessful attempts to cut down/stop, irritability when trying to stop, use to escape problem, continue to try to break even after losing, lying to reveal extent, jeopardizing or losing relationship or career, relying on others for $ issue d/t gambling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

substance-induced disorders

A

intoxication, withdrawal, delirium, persisting dementia or amnestic d/o, psychosis, mood or anxiety d/o, sexual or sleep d/o, hallucination/ perception d/o

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

intoxication

A

reversible substance-specific syndrome d/t ingestion or exposure
maladaptive behavior or physiological change d/t effect of substance on CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

withdrawal

A

reversible substance-specific syndrome d/t decline in blood level of substance
causes clinically significant distress or functional impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

how to recognize substance-induced d/o

A

disturbance not better accounted for by non-substance-induced d/o (sx before substance or persist after cessation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

pathway affected by all addictive drugs except LSD

A

mesocorticolimbic dopaminergic reward thresholds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

components of addiction and relation to brain structures

A

reward pathway: mesolimbic DA circuit
VTA and NAcc - acute reinforcing effects of drugs
amygdala and hippo - memory and conditioned responses linked to craving

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

adolescent addiction screening

A 
CRAFFT
C = car intoxicated
R = relax/fit in/peer influence
A = alone
F = forget/blackouts
F = family/friends worry
T = trouble bc of use
If 1+, encourage to stop.
If 2+, screen for substance dependence.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

questions to ask about substance use

A 
TRAPPED
Tx history
Route of administration
Amount
Pattern (and change over time)
Prior abstinence
Effects (OD, withdrawal)
Duration of use (inc most recent and fam hx)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

medical detox goals

A

safe withdrawal
human withdrawal
prepare pt for ongoing tx of dependence
*does little to change long-term drug use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

impact of treatment on substance use

A

reduces drug use 40-60%
reduces crime 40-60%
*as successful as tx for DM, asthma, HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

5 stages of change

A

precontemplation (unaware or unwilling to change)
contemplation (aware of problem, no commitment to change)
preparation (intend to change)
action (*requires a lot of time and energy)
maintenance (prevent relapse, indefinite)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

motivational enhancement therapy

A

helps people recognize and change problem

useful for people ambivalent about change

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

importance of motivational interviewing

A

resolve ambivalence about changing behavior and instill ownership of change process in pt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

AA vs CBT

A

CBT is more effective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

detection in urine of THC, amphetamine, barbs, cocaine, methadone, PCP, opiates

A 
THC: 3-30 days
amph: 2-3 d
barb: 1-3 d
coke: 6h-3d
methadone: 7-9 d
PCP: 8 d
opiates: 1-3d
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

opiates not detected in UA

A

buprenorphine, oxycodone, hydrocodone, fentanyl

*can screen for these specifically

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

how to test for alcohol use

A 
short t1/2 in urine but detected up to 24 h
ethyl glucuronide (metabolite) may be detected up to 5d
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

best biomarker of alcohol relapse

A

CDT (carb-deficient transferrin) - synthesis disturbed by EtOH metabolites - elevated in 2 wk and normalizes in 2 wk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

12m and lifetime prevalence of EtOH and drug use d/o

A

EtOH: 13.9 and 29.1%
drug: 3.9 and 9.9%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

long-term abstinence rates with and w/o treatment

A

without: 20% chance
with: 50-66% chance of 1+ years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

sx alcohol withdrawal

A 
2+ of:
autonomic hyperactivity (inc HR, sweating), hand tremor, insomnia, n/v, transient hallucinations, agitation or anxiety, grand mal seizures (w/i 48 h)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

formication

A

tactile hallucinations seen ONLY in cocaine intoxication and EtOH withdrawal
ex: delusional parasitosis

27
Q

how to treat seizures in EtOH withdrawal

A

BZD not anti-convulsants!
OTL - “out the liver” - oxazepam, temazepam (not used), lorazepam
because glucuronidated not oxidized in liver - little functional liver needed

28
Q

delirium tremens

A

48-72 hours post EtOH cessation; 20% mortality
sympathetic hyperactivity: tachy, HTN, fever, diaphoresis, hallucinations, delusions
Tx: prevention, BZD, fluids, support

29
Q

predicting delirium tremens

A

hx of DT, early withdrawal sx (w/i 6h), use of sedative hypnotics (further decrease GABA-R), med problems (ID, hep, pancreatitis), withdrawal seizures on presentation, genetics

30
Q

Wernicke’s encephalopathy

A

acute amnestic d/o d/t EtOH
ataxia, nystagmus, ophthalmoplegia, confusion
rare in

31
Q

Korsakoff syndrome

A

chronic amnestic EtOH d/o
a/r-amnesia in responsive pt, +/- confabulation
tx: 3-12m thiamine (+ glucose)
21% completely recover, 25% significant recovery

32
Q

disulfiram

A

for EtOH dependence

inhibits ALDH = inhibits metabolism

33
Q

acamprosate

A

for EtOH dependence

glutamate receptors and transmission

34
Q

naltrexone MOA, and daily PO vs monthyl IM

A

for EtOH dependence
synthetic opioid antagonist
monthly = improved compliance

35
Q

acute cannabis use sx

A

euphoria, impaired motor coordination, sensation of slowed time, pupillary constriction and photophobia
2+ w/i 2 h of use: conjunctival injection, inc appetite, dry mouth, tachycardia

36
Q

spice MOA and dangers

A

full potent agonist of CB1 (vs. partial for THC)
often contaminated with b2-agonist -> sympathomimetic effects like tremor, tachy, anxiety
can also produce psychosis and paranoia

37
Q

chronic cannabis use sx

A

gynecomastia (relationship b/t CB1 and PRL receptors), reactive airway dz, dec sperm count, wt gain, lethargy

38
Q

cannabis intoxication sx

A

panic, delirium, psychosis

tx: antipsychotic med

39
Q

cannabis withdrawal diagnosis

A

3+ w/i 1 week of cessation:
irritable or aggressive, nervous/anxiety, sleep difficulty, dec appetite or wt loss, restless, depressed mood
1 of: stomach pain, shaky/tremor, sweating/fever, chills, headache

40
Q

stimulant intoxication sx

A

2+ of:
tachy or bradycardia, pup dilation, high/low BP, sweat or chills, n/v, wt loss, psychomotor agitation or retardation, mm weakness or resp depression, chest pain or arrhythmia
confusion, seizure, dyskinesia, dystonia, or coma

41
Q

cocaine or amphetamine intoxication vs schizophrenia

A

+ symptoms of SZ but no negative sx
reality testing intact
*if reality testing not intact, consider substance-induced psychotic d/o

42
Q

stimulant withdrawal sx

A

dysphoric mood + 2+ of fatigue, unpleasant dreams, in/hypersomnia, inc appetite, psychomotor retardation or agitation
*won’t kill pt (vs. EtOH w/d)

43
Q

life-threatening effects of amphetamines

A

hyperthermia, arrhythmias, renal failure

44
Q

long-term effects of MDMA

A

reduced brain 5HT and metabolites

reduced 5HT transporters and degenerating terminals

45
Q

managing stimulant intoxication

A 
HTN crisis d/t unopposed alpha - labetolol (a1 and b-blocker) to maintain CO
or phentolamine (a-blocker, less common) or nicardipine (2G CCB w high vascular selectivity and cerebral/coronary vasodilation)
agitation/sleep problems: short-acting benzo - no anti-psychotics because dec seizure threshold
46
Q

tx of stimulant dependence

A 
DA agonist (bromocriptine, amantadine) - inconsistent results
topiramate - ? glu-antagonist and GABA agonist
47
Q

opioid intoxication sx

A 
maladaptive behavior (euphoria -> apathy, dysphoria), pupillary constriction (dilation w anoxic brain injury)
constipation, bradycardia, hypoTN, resp depression
1+ of: drowsiness, slurred speech, impaired attn/memory
48
Q

opioid w/d sx

A

3+ of:
dysphoria, n/v/d, m ache (hamstrings), lacrimation/ rhinorrhea, pup dilation piloerection or sweating, yawning, fever, insomnia

49
Q

clonidine

A

a2-agonist to reduce opioid w/d signs by decreasing sympathetic outflow

50
Q

methadone

A

synthetic opioid agonist to help with withdrawal

safe for pregnancy

51
Q

buprenorphine/ suboxone

A

buprenorphine + naloxone
bup: long-acting potent partial mu agonist with mixed ag/antag kappa - dec risk resp dep and fewer autonomic sx
induces acute w/d - start when pt in w/d or clean
for opioid withdrawal
nal: antagonist

52
Q

drug interactions for suboxone (bup+nal)

A

azoles and protease inhibitors because metabolized by CYP 3A4

53
Q

hallucinogen intoxication sx

A

anxiety, fear of losing mind, paranoia
perceptual changes while awake and alert: depersonalization, derealization, illusion, hallucination, synesthesia
2+: pup dil, tachy, sweating, palpitations, blurred vision, tremor, incoordination

54
Q

physical effects of LSD/acid

A

hyperthermia, tachycardia, HTN, insomnia, loss of appetite

55
Q

PCP/ phencyclidine intoxication

A

unpleasant psychological effects (out of body, vivid dream), violence/ suicidality
2+ in an hour: nystagmus (v or h), HTN or tachy, numbness/ diminished pain, ataxia, dysarthria, mm rigidity, seizures or coma, hyperacusis
very similar to SZ (+ and - sx and reality testing not intact)

56
Q

ketamine

A

moderate version of PCP, odorless and tasteless

57
Q

MOA PCP

A

potent glutamate NMDA antagonist

58
Q

dextromethorphan

A

NMDA antagonist
less potent but similar effects to PCP and ketamine
sx: distorted visual perceptions to complete dissociation (for 6 h)

59
Q

tx hallucinogen/PCP

A

acute LSD: support
acute PCP: diazepam for seizure/agitation, phentolamine for HTN
chronic: discontinue use
OD (panic, paranoia, psychosis): BZD, observation in quiet room, no anti-ACh like phenothiazines (will worsen effect and seizure risk)

60
Q

why not to acidify urine in hallucinogen intoxication

A

although increased excretion of drug, risk of metabolic acidosis, rhabdomyolysis, etc.

61
Q

hallucinogen persisting perception d/o

A

“flashbacks” of experiences after discontinuation of hallucinogen use that is not d/t another medical condition

62
Q

inhalant intoxication sx

A

problematic behavior or psych changes (assault, belligerent, apathetic, impaired judgment) and 2+: dizzy, nystagmus, incoordination, slurred speech, unsteady gait, mm weakness, lethargy, euphoria, depressed reflexes, psychomotor retardation, tremor, blurred vision/ diplopia, stupor/coma

63
Q

MOA of inhalants

A

agonist of GABA-R, glut-blocker

*can cause dementia d/t this (like EtOH, BZDs)

Psychopathology (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions