Addiction Medicine Part 3 Flashcards
What are Sedatives
CNS Depressants such as
•Alcohol
•Benzodiazepines (e.g., diazepam, lorazepam) •Barbiturates (e.g., phenobarbital, secobarbital)
Note: Barbiturates have a low safety margin and high abuse potential.
What are consequences of sedatives
There are 9
➢Intoxication
• sedation, sleepiness, decreased anxiety
• disinhibition, impaired judgment
• slurred speech, incoordination
• stupor or coma
• respiratory depression*due to the stupor or coma
•Anticonvulsant and anesthetic effects
•Disrupted sleep architecture resulting in unrefreshing sleep (more S2 and less S3)
•Alcohol-related brain damage (ARBD) (e.g., Korsakoff’s amnesia)
•Cross tolerance to other sedatives
What are symptoms of Sedative Withdrawal
There are 6
The first three together are considered what
agitation, insomnia and anxiety
• ANS hyperactivity*
• nausea or vomiting*
• hand tremor*
These first three together are called “Extreme Panic Attack”
• transient hallucinations (see next slide) • seizures
*The ANS hyperactivity can be fatal.
Hallucinations
•Can occur in any sensory modality, including tactile:
■Formication— sensation of bugs crawling under the skin
•Can occur as the main symptom of withdrawal without physical symptoms (“alcohol hallucinosis”)
Delirium Tremens (DTs)
►A delirium (a confusional state) may also occur as part of sedative withdrawal:
• severe and uncommon
• seen after chronic heavy use of a sedative (esp. alcohol)
• associated with high mortality rate
What are the three drug treatments for Alcoholism
and when do you use each one? What are the effects?
- Disulfiram (Antabuse) inhibits the enzyme that breaks down acetaldehyde.
•After alcohol use, acetaldehyde accumulation causes a toxic reaction (e.g., nausea) for 30-60 min.
►USE: Due to poor compliance, disulfiram is given only short-term if person will be in a high risk situation. Knowing about toxic effect is disincentive to take first drink. - Naltrexone (Revia): An opioid receptor blocker that reduces the pleasurable effects of alcohol.
►USE: This drug helps a person stop drinking after a few drinks when a “slip” occurs (i.e., this helps to avoid a full relapse). - Acamprosate (Campral): An NMDA receptor antagonist that reduces the anhedonia of protracted abstinence, and thereby decreases the craving for alcohol
►USE: Because acamprosate causes the person to feel euthymic, it help to prevent the “slip” from happening in the first place
What are Inhalants
What age commonly is associated
What are the signs
Substances with psychoactive vapors (e.g., glues, paints)
•Similar to sedative intoxication
•Teenage experimentation is common
- Signs: rashy, red, and runny nose, chemical smell, face discoloration
- Associated with morbidity (organ failure)/mortality (“sudden sniffing death”)
What are major Psychostimulants
•Amphetamines
(e.g., methamphetamine, MDMA, Adderall)
•Amphetamine-like drugs (e.g., methylphenidate [Ritalin])
•Cocaine
What is Psychological and Physical Intoxication
Psychological:
• euphoria and grandiosity
• psychomotor acceleration & stereotypies
• paranoia & hallucinations
Physical: • *elevated heart rate & bp (life threatening) • appetite loss and insomnia • mydriasis (pupils blown wide open) • seizures
What’s the difference between Meth and Cocaine
Both are especially addictive due to direct action on the reward pathway, producing an intense “rush” followed by euphoria.
• Effects of cocaine shorter lasting than meth: ▪ Half life= 30 min (cocaine) vs 12 hrs (meth) ▪ Cocaine use is thus more frequent.
• Physical changes with methamphetamine
(“Meth mouth” and “Meth face”)
What is ECSTASY
What’s its other name
Methylene-dioxymethamphetamine= MDMA
Symptoms
The feel good drug
►Stimulant effects PLUS mild hallucinogenic effects (perceptual alterations):
• common things look more interesting • empathogenesis
• concern about neurotoxicity
• other health consequences (e.g., hyperthermia)
• reputation as a safe drug despite Schedule I status
What are Bath Salts
What are 4 other names for them
Symptoms
Ivory Wave, Purple Wave, Vanilla Sky, Bliss
Designer drug containing, in part, amphetamine-like chemicals (MDPV)
▪Agitation ▪Paranoia ▪Hallucinations ▪Chest pain, tachycardia, hypertension ▪Suicidality
What are the two differentials for stimulant intoxication and what is needed to distinguish?
schizophrenia and/or bipolar I (manic) episodes.
- both disorders may be clinically indistinguishable from stimulant use
- a drug screen is needed.
What are withdrawal symptoms from major stimulants?
what’s another term for them?
what must be seen?
Are these life threatening?
Are there drugs approved for addiction?
dysphoric mood MUST BE SEEN
- fatigue and psychomotor slowing
- hypersomnia with vivid unpleasant dreams • increased appetite
AKA MDD with atypical features
No
No
What are Minor Psychostimulants
What do they cause you to feel
- Nicotine (from tobacco cigarettes and smokeless forms of tobacco)
- Caffeine (coffees, teas, chocolate, some OTC medications)
Both nicotine and caffeine cause improved
mood, increased alertness/attention and
decreased appetite.
Does DSM-5 recognize a category for nicotine intoxication?
What are withdrawal symptoms
No
▪ dysphoric mood ▪ restlessness, anxiety ▪ difficulties concentrating ▪ irritability, anger ▪ increased appetite ▪ decreased heart rate
What are treatments for Nicotine Use Disorder
•Nicotine Replacement Therapies (e.g., gum)
▪These contain low amounts of “healthy” nicotine to decrease craving.
•Buproprion (Zyban) & Varenicline (Chantix)
▪There is a black box warning on these drugs due to reports of suicidal, erratic behavior for both drugs.
