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Therapeutics > Alcohol & Substance Abuse > Flashcards

Alcohol & Substance Abuse Flashcards

1
Q

3 C’s that indicate alcohol use disorder

A

control, craving, consequences

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2
Q

alcohol is a CNS ___

A

depressant

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3
Q

how does alcohol have stimulatory effects

A

depression of inhibitory control mechanisms in the brain

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4
Q

alcohol targets which 4 systems to exhibit acute and chronic effects

A

GABA, DA, glutamate, and opioid peptide

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5
Q

ordered hierarchy of affected brain areas leading to CNS effects with alcohol

A

frontal cortex, cortex, cerebellum, diencephalon, brain stem/midbrain

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6
Q

sequence of response to alcohol (actual seen effects)

A

euphoria, impaired thought processes, decreased mechanical efficiency

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7
Q

acute effects of alcohol on GABA

A

enhances

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8
Q

acute effects of alcohol on glutamate

A

inhibits and reduces release

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9
Q

acute effects of alcohol on doapmine

A

increases firing rate

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10
Q

chronic effects of alcohol on GABA

A

reduces effectiveness (down regulates)

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11
Q

chronic effects of alcohol on glutamate

A

increases receptors (upregulates)

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12
Q

chronic effects of alcohol on dopamine

A

withdrawal decreases firing rate/release

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13
Q

which 2 organ systems are most affected by chronic alcohol use

A

CNS & liver

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14
Q

potential chronic CNS effects from alcohol

A

addiction, Wernicke’s, cortical atrophy, dementia

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15
Q

potential chronic liver effects from alcohol

A

steatosis/fatty liver, alcohol hepatitis, cirrhosis, pancreatitis.

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16
Q

how is alcohol absorption affected by food? changes in women?

A

food delays absorption
women have less breakdown before absorption so higher bioavailability

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17
Q

distribution of alcohol is equal to

A

total body water

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18
Q

alcohol follows __ metabolism via __ and is primarily __

A

zero order/capacity limited
alcohol dehydrogenase
oxidized

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19
Q

minor signs of alcohol withdrawal occur within

A

5-10 hours

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20
Q

symptoms of minor alcohol withdrawal

A

autonomic hyperactivity: tremulousness, hyperhidrosis, tachycardia, HTN, GI upset
anxiety, insomnia, vivid dreams, anorexia, diaphoresis, palpitations, HA

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21
Q

major alcohol withdrawal effects occur within

A

12-72 hours

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22
Q

symptoms of major alcohol withdrawal

A

hallucinations, seizures

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23
Q

when does delirium tremens occur with alcohol withdrawal

A

48-96 hours

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24
Q

symptoms of delirium tremens in alcohol withdrawal

A

disordered consciousness, hallucinations, disorientation, tachycardia, HTN, fever, agitation, elevated cardiac indices, hyperventilation, etc.

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25
Q

which agents are used for management/prophylaxis of alcohol withdrawal

A

thiamine, D5 & 1/2NS, multivitamins, diazepam, lorazepam, or other benzos

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26
Q

agents used to maintain sobriety from alcohol

A

naltrexone
acamprosate
disulfiram
baclofen
gabapentin
topiramate

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27
Q

used for alcohol sobriety and blocks opioid receptors, given IM or PO

A

naltrexone

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28
Q

AEs of naltrexone

A

nausea, HA, dizziness, insomnia, anxiety

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29
Q

which alcohol sobriety agent requires being opioid free? for how long

A

naltrexone, 7-10 days

30
Q

alcohol sobriety agent that levels activity of GABA and glutamate

A

acamprosate

31
Q

AE of acamprosate

A

diarrhea

32
Q

alcohol sobriety agent that blocks acetylaldehyde dehydrogenase and the enzymes involved in DA metabolism

A

disulfiram

33
Q

which alcohol sobriety agent required 12 or more hours abstinent from alcohol to use

A

disulfiram

34
Q

do not use disulfiram if…

A

severe cardiac disease/occlusion, hepatic impairment, etc.

35
Q

gold standard for drug tox testing

A

urine

36
Q

creatinine normalized drug level =

A

(urine drug level) / (urine creatinine) x 100

37
Q

increased response to a drug with repeated use

A

sensitization

38
Q

behaviors displayed by a user when drug use ends

A

withdrawal

39
Q

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

A

tolerance

40
Q

primary, chronic, neurobiologic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations

A

addiction

41
Q

5 C’s of drug addiction

A

chronicity
impaired control
compulsive use
continued use despite harm
craving

42
Q

maladaptive pattern of substance use characterized by repeated adverse consequences related to repeated use of it

A

drug abuse

43
Q

the body adapts to the presence of a drug and needs it for homeostasis

A

dependence

44
Q

drug classes that are depressants

A

sedative hypnotics (benzos, barbs)
GHB
DXM
Opiates

45
Q

agent that can be used for a benzo overdose

A

flumazenil

46
Q

how to manage benzo withdrawal

A

taper the dose

47
Q

drug that activates opiate receptors on neurons

A

opiate agonist

48
Q

drug that binds opiate receptors and blocks them

A

opiate antagonist

49
Q

binds opiate receptors but not to the same degree as full agonists

A

partial opiate agonist

50
Q

agent used for treatment of opiate overdose

A

naloxone

51
Q

agents used for opiate withdrawal

A

methadone, buprenorphine, clonidine, lofexidine

52
Q

agents used for opiate maintenance

A

methadone
buprenorphine

53
Q

agent used for opiate abstinence maintenance

A

naltrexone

54
Q

dosing scheme of methadone for withdrawal

A

follows a taper

55
Q

brand names of buprenorphine containing naloxone

A

suboxone
zubsolv (tabs or film)
bunavail

56
Q

buprenorphine is a major substrate of

A

cyp3a4

57
Q

partial opioid agonist binding with high affinity to u and mu receptors causing analgesic effect

A

buprenorphine

58
Q

which sub abuse drug is preferred for pregnancy? what is the alternative

A

methadone preferred
subutex alternative

59
Q

objective of methadone for sub abuse maintenance

A

suppress s/s of withdrawal, extinguish craving, block reinforcing effect of illicit opiates

60
Q

method of dosing for methadone maintenance

A

start low and go slow

61
Q

can patients take methadone doses home?

A

only after a certain amount of time in the program with other factors considered

62
Q

maintenance buprenorphine forms that are MONTHLY injections

A

sublocade, brixidi, naltrexone

63
Q

maintenance buprenorphine form that is also a WEEKLY injection (& monthly)

A

brixidi

64
Q

in order to receive sublocade patients must have received a transmucosal product for at least

A

7 days

65
Q

BBW for sublocade

A

serious harm or death given IV due to formation of a solid mass upon contact with bodily fluids

66
Q

brixidi is indicated for patients

A

receiving buprenorphine currently

67
Q

naltrexone BBW

A

acute hepatitis, hepatocellular injury

68
Q

how long must you be opiate free to take naltrexone

A

7-10 days

69
Q

types of stimulant drugs

A

cocaine
amphetamines
methamphetamine
PCP
ketamine

70
Q

types of hallucinogens

A

LSD
Psilocybin
mescaline

71
Q

animal tranquilizer responsible for many OD deaths that targets a2 adrenergic receptors with no reversal agent

A

xylazine

Therapeutics (20 decks)

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