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Neuro III > Biological Basis of Addiction > Flashcards

Biological Basis of Addiction Flashcards

1
Q

What is the term for:

inappropriate use of a drug, for a non-medical purpose

A

drug abuse

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2
Q

What is the term for:

uncontrolled & compulsive use of a drug

A

addiction

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3
Q

What is the term for:

increased dose requirement of hte same effect

What are the two kinds?

A

tolerance

pharmacokinetic- metabolism increased

phamacodynamic - changes in signaling

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4
Q

What are the two types of dependence?

A
  • physical
    • stopping or decerased administration cauees a withdrawl syndrome
  • psychological
    • cravings
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5
Q

What are the 3 features that overlap dependence with addiction?

A

impulsive

cravings

anxiety over withdrawl (dependence)

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6
Q

What is the term for:

the use of prescription drugs for recreational purposes

A

diversion

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7
Q

What are the drugs that are commonly diverted?

A

opiates, pseudoephedrine, benzodiasepines

amphetamine & methylphenidate

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8
Q

What does schedule I mean & what are the important drugs in this category?

A

no accepted medical use & a high potential for abuse

heroin, marijuana

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9
Q

What does schedule II mean & what are the important drugs in this category?

A

high potential for abuse, severe psychological or physical dependence

cocaine, methamphetamine, methadone, oxycodone, methylphenidate

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10
Q

What does schedule IVa mean & what are the important drugs in this category?

A

a low potential for abuse & low risk of dependence

xanax, ambien

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11
Q

What does schedule V mean & what are the important drugs in this category?

A

lower potential for abuse than Schedule IV & consist of preparations containing limited quantities of ceratin narcotics

antidiarrheal, antitussive, & analgesic purposes

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12
Q

What are the predisposing factors for drug addiction?

A

genetic

environment

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13
Q

How can drug addiciton have a physiological impact?

A

alters the nervous system

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14
Q

What are the 9 types of substance use disorders classified by the DSM-5?

A
  1. alcohol
  2. caffeine
  3. cannabis
  4. hallucinogens
  5. inhalants
  6. opiods
  7. sedatives, hypnotics, or anxiolytics
  8. stimulants
  9. tobacco
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15
Q

What are the behavioral indicators of substance use disorder?

A
  • impaired control & function
  • social impairment
  • risky use
    • DUI, HIV, hepatitis C, meth effects
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16
Q

What are the pharmacological indicators of substance use disorder?

A
  • tolerance
  • withdrawl
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17
Q

How does cocaine create a short circuit in the reward circuit?

A

block dopamine reuptake

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18
Q

How does amphetamines create a short circuit in the reward circuit?

A

stimulate dopamine, norepinephrine & serotonin release

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19
Q

What is the most imporant projection in the reward circuit?

Involves what neurotransmitter?

What is the name of this pathway?

A

VTA -> Nucleus accumbens (releases dopamine)

mesolimbic pathway

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20
Q

What pathway is activated most by addictive drugs?

A

mesolimbic

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21
Q

What are the imporant functions of the nucleus accumbens?

A
  • feelings of pleasure
  • critically important in addiction
22
Q

Wha is the most common form of administration for the following drugs:

heroin

cocaine

methamphetamine

marijuana

alcohol

A
  • heroin
    • oral opiates < smoking or IV heroin / fentanyl
  • cocaine
    • tea from coca leaves < nasal administration < smoking free base & crack
  • methamphetamine
    • oral < nasal administration < smoking
  • marijuana
    • smoking plant < hashish
  • alcohol
    • beer, wine < distilled beverages
23
Q

What are the medical complications that occur for heroin when injested via popping or IV?

A
  • popping
    • skin infections
  • IV
    • heart valve infection
24
Q

What are the medical complications that occur from nasal cocaine use?

A

nasal septum damage

25
Q

What are the medical complications that occur from alcohol use?

A

increase risk of oral cavity & esophageal cancer

liver cirrhosis & cancer

26
Q

What is the medical indication for opiates?

Which drugs are approved for this use?

A

analgesia

  • hydromorphone, oxymorphone, morphine, meperidine
  • fentanyl, others (iv for surgery, analgesic patches)
  • codeine, oxygodone (acetamenophen or ibuprofen)
27
Q

Which opiate is schedule I?

A

heroin

28
Q

Which is the most potent opiate?

A

fentanyl

50-100x more potent than morphine

29
Q

Answer the following questions for Opiates:

MOA

AE

Specific concerns?

A
  • mu opiate receptor agonist
  • AE
    • constipation – itching
    • sedation, addiction, respiratory depression, overdose death
    • withdrawl (usually not life threatening - dehydration & CV collapse)
  • Tolerance
30
Q

What drugs are used for Opiate overdose treatment?

A
  • naloxone - mu opiate compt. antagonist
  • naltrexone - opiate competitive antagonist
31
Q

What are the drugs approved for treatment of opiate addiction?

A

methadone

buprenorphine

32
Q

What is a non-opiate related use of naltrexone?

A

alcohol addiction

may block reward pathways in the limbic system

33
Q

What are the risk factors for heroin addiction?

A
  • previous abuse of prescription opiates
  • over prescription of opiates
  • use of other drugs of abuse
  • increased availability
  • low price
34
Q

What are the medical comorbidities seen in IV heroin use?

A
  • respiratory depression
  • sharing needles
    • Hep B, C, HIV
  • Venous sclerosis (collapsed veins)
  • Bacterial infections from non-sterile syringes, drugs
  • Infection of heart lining & valves
35
Q

What opiate problem is shown in the provided image?

A

necrotizing ulceration d/t skin popping heroin

36
Q

Methadone MOA?

Who can prescribe?

A

long lasting mu opiate receptor agonist

mu opiate receptor partial agonist

37
Q

Buprenorphine MOA

Who can presecribe?

A

mu opiate receptor partial agonist

qualified physicians, treatment centers

38
Q

What is the benefit of prescribing a buprenorphine/naloxone combination?

A

naloxone is not orally available - but it is active via injection

so, if they patient takes the drug orally, they will recieve the benefits of buprenorphine with no effect from naloxone

if the patient injects the combination, they will not receive the benefits of buprenorphine because nalaxone acts as a mu opiate receptor antagonist

39
Q

What are the benefits of using Buprenorphine compared to Methadone?

A
  • lower potential for misuse
  • diminish the effects of physical dependency to opioids, such as withdrawl symptoms & cravings
  • partial agonist
  • increased safety
  • less respiratory depression
  • can be dispensed by physicians
    • requires training
40
Q

What steps has the DEA taken in response to the opiate crisis?

A

from schedule III to schedule II

abuse deterrence (extended-release; gel)

changing guidelines

41
Q

What groups are excluded from the recomendations for primary care clinicians who are prescribing opioids?

A

active cancer treatment, palliative care, end-of-life care

42
Q

What are the major CDC guidelines for guiding opioid treatment?

A
  • effectiveness of non-pharmacologic & non-opioid pharmacologic therapy
  • benefits & harms of opioid therapy
    • patient assessment / evaluation mental health
    • treatment agreement
  • PDMP (prescription drug monitorying program)
  • highlighs regarding substance abuse disorder
    • pt using benzodiazepines at increased risk addiction & overdose
    • pt with substance abuse history
    • offering naloxone to high-risk patients
43
Q

What are the Sedative / Hypnotic drugs that have potential for abuse?

A

Benzodiazepines, Barbiturates, Ethanol

44
Q

What are the serious withdrawls effects of barbiturates & alcohol?

A

seizures

45
Q

Ethanol:

MOA?

Effects?

AE?

A
  • MOA
    • GABA release & GABAA receptors
    • increase ACh in ventral tegmental area w/ subsequent increase in dopamine in NA
    • inhibit NMDA & Kainate receptors
    • ion channels
  • Effects
    • complex, decreased inhibition, increased sedation
  • AE
    • accidents
    • cancer risk
    • Wernicke’s encephalopathy
    • Korsakoff’s psychosis, ehtanol toxicity & thiamine (B1) deficiency
    • coma / death
46
Q

Kinetics of ethanol elimination?

A

zero order

can eliminate ~ 1 drink / hr

47
Q

Drugs for alcohol addiction?

MOA?

A
  • Naltrexone
    • mu opiate receptor antagonist
    • may block reward pathway in limbic system
  • Acamprostate
    • unknown MOA
  • Disulfiram
    • inhibits aldehyde dehydroenase
    • acetaldehyde toxicity
48
Q

What are the medical indications for stimulants?

Which are approved?

MOA?

A

low dose - ADHD & cocaine is local anesthetic too

  • Amphetamines, methamphetamine, and cocaine
    • enhance dopaine & norepinephrine release
    • block dopamine reuptake (+ methylphenidate)
    • cocaine blocks dopamine reuptake
49
Q

Amphetamines, methamphetamine & cocaine are what schedule drugs?

Effects?

AE?

A
  • schedule 2
  • stimulant, euphoria
  • AE
    • addictive
    • physical dependence
    • unemployment, crime
    • mouth problems, skin infections, psychosis
50
Q

Epinephrine should not be administered if patients have used what drug in the past 24 hrs?

A

(local anesthetic should be administerred without epinephrine) -

methamphetamine

51
Q

What are the Tier 1 drugs?

A
  • opiates / heroin
  • methamphetamine
  • alcohol
  • cocaine
  • benzodiazepine
  • barbiturates

Neuro III (14 decks)

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