Alcohol & Substance Abuse Flashcards
3 C’s that indicate alcohol use disorder
control, craving, consequences
alcohol is a CNS ___
depressant
how does alcohol have stimulatory effects
depression of inhibitory control mechanisms in the brain
alcohol targets which 4 systems to exhibit acute and chronic effects
GABA, DA, glutamate, and opioid peptide
ordered hierarchy of affected brain areas leading to CNS effects with alcohol
frontal cortex, cortex, cerebellum, diencephalon, brain stem/midbrain
sequence of response to alcohol (actual seen effects)
euphoria, impaired thought processes, decreased mechanical efficiency
acute effects of alcohol on GABA
enhances
acute effects of alcohol on glutamate
inhibits and reduces release
acute effects of alcohol on doapmine
increases firing rate
chronic effects of alcohol on GABA
reduces effectiveness (down regulates)
chronic effects of alcohol on glutamate
increases receptors (upregulates)
chronic effects of alcohol on dopamine
withdrawal decreases firing rate/release
which 2 organ systems are most affected by chronic alcohol use
CNS & liver
potential chronic CNS effects from alcohol
addiction, Wernicke’s, cortical atrophy, dementia
potential chronic liver effects from alcohol
steatosis/fatty liver, alcohol hepatitis, cirrhosis, pancreatitis.
how is alcohol absorption affected by food? changes in women?
food delays absorption
women have less breakdown before absorption so higher bioavailability
distribution of alcohol is equal to
total body water
alcohol follows __ metabolism via __ and is primarily __
zero order/capacity limited
alcohol dehydrogenase
oxidized
minor signs of alcohol withdrawal occur within
5-10 hours
symptoms of minor alcohol withdrawal
autonomic hyperactivity: tremulousness, hyperhidrosis, tachycardia, HTN, GI upset
anxiety, insomnia, vivid dreams, anorexia, diaphoresis, palpitations, HA
major alcohol withdrawal effects occur within
12-72 hours
symptoms of major alcohol withdrawal
hallucinations, seizures
when does delirium tremens occur with alcohol withdrawal
48-96 hours
symptoms of delirium tremens in alcohol withdrawal
disordered consciousness, hallucinations, disorientation, tachycardia, HTN, fever, agitation, elevated cardiac indices, hyperventilation, etc.
which agents are used for management/prophylaxis of alcohol withdrawal
thiamine, D5 & 1/2NS, multivitamins, diazepam, lorazepam, or other benzos
agents used to maintain sobriety from alcohol
naltrexone
acamprosate
disulfiram
baclofen
gabapentin
topiramate
used for alcohol sobriety and blocks opioid receptors, given IM or PO
naltrexone
AEs of naltrexone
nausea, HA, dizziness, insomnia, anxiety
which alcohol sobriety agent requires being opioid free? for how long
naltrexone, 7-10 days
alcohol sobriety agent that levels activity of GABA and glutamate
acamprosate
AE of acamprosate
diarrhea
alcohol sobriety agent that blocks acetylaldehyde dehydrogenase and the enzymes involved in DA metabolism
disulfiram
which alcohol sobriety agent required 12 or more hours abstinent from alcohol to use
disulfiram
do not use disulfiram if…
severe cardiac disease/occlusion, hepatic impairment, etc.
gold standard for drug tox testing
urine
creatinine normalized drug level =
(urine drug level) / (urine creatinine) x 100
increased response to a drug with repeated use
sensitization
behaviors displayed by a user when drug use ends
withdrawal
state of adaptation in which exposure to a drug induces changes that result in diminution of one or more of the drugs effects over time
tolerance
primary, chronic, neurobiologic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations
addiction
5 C’s of drug addiction
chronicity
impaired control
compulsive use
continued use despite harm
craving
maladaptive pattern of substance use characterized by repeated adverse consequences related to repeated use of it
drug abuse
the body adapts to the presence of a drug and needs it for homeostasis
dependence
drug classes that are depressants
sedative hypnotics (benzos, barbs)
GHB
DXM
Opiates
agent that can be used for a benzo overdose
flumazenil
how to manage benzo withdrawal
taper the dose
drug that activates opiate receptors on neurons
opiate agonist
drug that binds opiate receptors and blocks them
opiate antagonist
binds opiate receptors but not to the same degree as full agonists
partial opiate agonist
agent used for treatment of opiate overdose
naloxone
agents used for opiate withdrawal
methadone, buprenorphine, clonidine, lofexidine
agents used for opiate maintenance
methadone
buprenorphine
agent used for opiate abstinence maintenance
naltrexone
dosing scheme of methadone for withdrawal
follows a taper
brand names of buprenorphine containing naloxone
suboxone
zubsolv (tabs or film)
bunavail
buprenorphine is a major substrate of
cyp3a4
partial opioid agonist binding with high affinity to u and mu receptors causing analgesic effect
buprenorphine
which sub abuse drug is preferred for pregnancy? what is the alternative
methadone preferred
subutex alternative
objective of methadone for sub abuse maintenance
suppress s/s of withdrawal, extinguish craving, block reinforcing effect of illicit opiates
method of dosing for methadone maintenance
start low and go slow
can patients take methadone doses home?
only after a certain amount of time in the program with other factors considered
maintenance buprenorphine forms that are MONTHLY injections
sublocade, brixidi, naltrexone
maintenance buprenorphine form that is also a WEEKLY injection (& monthly)
brixidi
in order to receive sublocade patients must have received a transmucosal product for at least
7 days
BBW for sublocade
serious harm or death given IV due to formation of a solid mass upon contact with bodily fluids
brixidi is indicated for patients
receiving buprenorphine currently
naltrexone BBW
acute hepatitis, hepatocellular injury
how long must you be opiate free to take naltrexone
7-10 days
types of stimulant drugs
cocaine
amphetamines
methamphetamine
PCP
ketamine
types of hallucinogens
LSD
Psilocybin
mescaline
animal tranquilizer responsible for many OD deaths that targets a2 adrenergic receptors with no reversal agent
xylazine
