Alcohol, Opioids + Other Drugs B&B Flashcards
what % of untreated delirium tremens cases are fatal? what is a preceding sign? what is the cause of death?
delirium tremens (DTs) = severe alcohol withdrawal, ~20% untreated are fatal
preceded by seizure —> death due to autonomic instability
what is the dopamine system that is active in brain reward/ substance abuse?
mesolimbic dopamine system - from ventral tegmental area (VTA) to nucleus accumbens (NA) to prefrontal cortex
which of the following is NOT schedule IV?
a. ketamine
b. benzodiazepines
c. zolpidem
a. ketamine is schedule III
schedule I = high abuse potential, no medical use
schedule II = high abuse potential, medical use
schedule III = less potential
schedule IV = low potential
schedule V = lowest potential for abuse
what is considered at risk drinking for men vs women?
men = 4+ drinks/day or 14/week
women = 3+ drinks/day or 7/week
what is the CAGE criteria
C: ever felt you should cut down on drinking?
A: people are annoyed by your drinking?
G: ever felt guilty about your drinking?
E: have had an eye opener drink in the morning?
2 positive responses = positive test
what is a really good lab marker for alcohol abuse?
GGT - liver function test that is very specific for heavy drinking (>35)
what is the tx for alcohol withdrawal?
benzodiazepine taper (4-6 days) - prevent seizures, sedate patient so they’re more comfortable
antiseizures (carbamazepine, phenobarbital) can also be used, but won’t act as relaxants
+ fluid/ electrolytes (Mg+, K+)
what is the MOA and clinical use of disulfiram?
aka Antabuse, treats alcohol use disorder
inhibits acetaldehyde dehydrogenase —> causes withdrawal symptoms due to accumulating acetaldehyde
what are the 3 options for medication assisted treatment (MAT)?
- methadone = agonist
- buprenorphine (Suboxone) = partial agonist
- naltrexone (Vivitrol) = antagonist
to which receptors do endorphins vs enkephalins vs dynorphins bind?
endorphins —> mu R
enkephalins —> delta R
dynorphins —> kappa R
what happens following activation of opioid receptors?
coupled to G proteins, binding causes:
1. closure of presynaptic Ca2+ channels —> reduce NT release
2. opening of postsynaptic K+ channels —> hyperpolarization
altogether causes decreased NT activity, esp. glutamate (major excitatory NT)
which opioid does NOT cause miosis (small pupils)?
meperidine
which opioid is most useful for the following problems?
a. acute pulmonary edema
b. cough suppression
c. diarrhea
d. shivering
a. acute pulmonary edema - IV morphine
b. cough suppression - codeine
c. diarrhea - loperamide
d. shivering (such as from infection, chemo) - meperidine (opioids cause skin flushing/warmth)
what are 3 unusual effects of opioid withdrawal?
- yawning
- rhinorrhea/lacrimation
- piloerection
Pt presents to ED for drug withdrawal of unknown cause. Their nose and eyes are running, and the hair is standing up on their arms. They are also yawning frequently. What type of drug are they using?
opioids - withdrawal causes yawning, rhinorrhea/lacrimation, piloerection (among more obvious signs)
which MAT is also used in alcohol abuse?
naltrexone: long-acting opioid antagonist, blocks effects of opioids if taken (prevents relapse)
what is the treatment for PCP (phencyclidine, “angel dust”) intoxication? (2)
- benzodiazepines - sedative
- haloperidol - rapid-acting anti-psychotic
what electrolyte imbalance can occur from ecstasy (MDMA) intoxication?
hyponatremia - NMDA causes increased fluid intake + secretion of ADH
may cause seizures/death
[MDMA = methylenedioxy-methamphetamine]
what is the presentation (3) of and treatment (1) for serotonin syndrome?
triad: Agitation + Autonomic hyperactivity (hyperthermia, tachycardia, diaphoresis) + NMJ hyperActivity (tremor, clonus, hyperreflexia, bilateral Babinksi)
tx: cyproheptadine (5-HT antagonist)
what is the MOA of morphine, oxycodone, hydrocodone, and fentanyl?
opioid full agonists at mu receptors
at presynaptic neuron, inhibit adenylyl cyclase-catalyzed formation of cAMP + close Ca2+ channels —> decrease NT release (esp. glutamate)
at postsynaptic neuron, open K+ channels —> hyperpolarization
what is the medical use of fentanyl?
regional anesthesia + used for palliative care (80-100x more powerful than morphine)
name 3 opioids which are NOT used for pain management that are full agonists at mu receptors
- methadone - opioid detoxification and maintenance
- codeine - cough suppressant
- dyhydrocodeine - cough suppressant
partial agonist at mu receptors
buprenorphine - combined with naloxone (Suboxone) or alone (Subutex) for opioid detoxification + maintenance
name 3 mixed agonist-antagonists of opioid receptors and describe their MOA
- pentazocine
- nalbuphine
- butorphanol
kappa agonist to produce analgesia; mu antagonist - treat mod-severe pain with decreased abuse potential (note, can precipitate withdrawal with antagonist activity)
