Addictions, Forensics, Sex & Paraphilia Flashcards
Tobacco smoking induces what liver enzyme activity?
P450 1A2. This leads to increase in the metabolism of certain psychotropic medications using this enzyme including clozapine, olanzapine, tri-cyclic antidepressants; which may lead to drug toxicity in patients who quit smoking.
currentpsychiatry.com
The dopaminergic neurons in the ventral tegmental area are particularly important in addiction. These neurons project to be cortical and limbic regions, especially the _____?
Nucleus accumbens
K&S page 387
In various studies, a range of 35 to 60% of patients with substance abuse or substance dependence also meet the diagnostic criteria for what personality disorder?
Antisocial PD
K&S page 387
How is alcohol metabolized?
Alcohol dehydrogenase (ADH) catalyzes the conversion of alcohol into acetaldehyde, which is a toxic compound; aldehyde dehydrogenase catalyzes the conversion of acetaldehyde into acetic acid. (K&S page 394)
How does alcohol effect sleep?
Decreases REM and deep sleep stage 4 and more sleep fragmentation, with more and longer episodes of awakening.
(K&S page 394)
Explain the classic timeline for the appearance of withdrawal symptoms from alcohol.
6-8 hrs - tremulousness
8-12 hrs - psychotic and perceptual symptoms
12-24 hrs- seizures
72 hours - delirium tremens
(K&S page 397)
The essential feature of Delirium tremens is delirium occurring within _________ after a person stops drinking or reduces the intake of alcohol?
One week.
Note: the syndrome usually develops on the third hospital day.
(K&S page 399)
Name 5 lab tests that are elevated in patients with alcohol-related disorders.
GGT MCV Uric acid Triglycerides AST ALT
(K&S page 395)
What are the symptoms and tx of Wernicke’s encephalopathy?
Acute, bilateral, reversible: ataxia, vestibular dysfunction, confusion, a variety of ocular motility abnormalities (horizontal nystagmus, lateral orbital palsy etc.)
Tx: thiamine 100 mg po bid or tid. Or 100 mg of thiamine per litre of IV glucose solution.
(K&S page 400)
What are the symptoms and tx of Korsakoff’s encephalopathy?
Chronic impaired mental syndrome (especially recent memory) and anterograde amnesia in an alert and responsive patient. +/- confabulation.
Tx: thiamine 100 mg po bid or tid for 3 to 12 months. Only about 20% recover.
(K&S page 400)
What is alcoholic pellagra encephalopathy?
Patients suffer from a niacin deficiency and tx is 50 mg po niacin qid.
These patients look afflicted with wernicke-korsakoff syndrome but do not respond to thiamine.
(K&S page 402)
What is the leading cause of mental retardation in the United States?
Fetal alcohol syndrome
K&S page 402
Which 3 prognostic signs combined, predict at least a 60% chance for 1 or more years of abstinence from alcohol?
- absence of preexisting antisocial PD or a dx of other substance abuse.
- life stability
- pt stays for the full course of initial rehab (perhaps 2-4 weeks).
What rare, but potentially fatal, adverse reaction to Disulfiram (Antabuse) should you be aware of?
Hepatitis; “monitor liver function tests periodically”.
K&S page 406
Acamprosate (Campral) is contraindicated in ______?
Severe renal impairment (CrCl less then or equal to 30 mL/min).
(K&S page 406)
The classic amphetamines produce their primary effects by causing the release of _____________, from the __________ terminals?
- Catecholamines (particularly dopamine)
- presynaptic
Note: designer amphetamines release catecholamines and serotonin).
(K&S page 408)
Opioid drugs, associated with abuse/dependence, are all prototypical u-opioid receptor ____________.
Agonists
K&S, p. 443
Name the primary effects of the following opioid receptors:
- mu
- kappa
- delta
Mu = analgesia, respiratory depression, constipation, dependence
Kappa = analgesia, diuresis, sedation
Delta = possibly analgesia
What is the difference between Cloninger et al (1981) Type 1 and Type II alcohol typologies?
Type I: both men & women; late onset; less family hx; anxious/shy; minimal criminality; environmental reactivity.
Type II: Men only; early onset; family hx; risk-taker; aggressive; ASPD
uOttawa 2014
List withdrawal symptoms from opioids
Severe muscle cramps, bone aches, diarrhea, abdo cramps, rhinorrhea, lacrimation, piloerection, yawning, fever, pupillary dilation, HTN, tachycardia, temperature dysregulation
What is the difference between Babor et al (1992) Type A and Type B alcohol typologies?
Type A: late onset; mild dependence; little drug use; promising prognosis, few risk factors.
Type B: early onset; many childhood risk factors; severe dependence; polydrug use; high psychopathology; poor prognosis.
uOttawa 2014
What is the clinical triad associated with opioid overdose?
Coma, pinpoint pupils, respiratory depression
K&S, p. 448
What drug is used to treat opioid overdose?
Naloxone (specific opioid antagonist)
- can administer IV at a slow rate, initially about 0.8 mg/kg.
K&S, p. 448
What is Cocaethylene?
The liver combines ETOH and cocaine and manufactures cocaethylene which intensifies cocaine’s euphoric effects, and is more toxic than either drug alone and increases the risk of sudden death. The mixture of ETOH and cocaine is the most common two-drug combo that results in drug-related death.
uOttawa 2014
