BMB 3 - Substance Abuse

Question 1

Substance abuse is responsible for ___ - ___% of healthcare costs.

Answer 1

Substance abuse is responsible for 20** - **30 % of healthcare costs

• (Although, 1% of healthcare dollars are spent on treatment of abuse and addiction.)*
• (60% - 80% of treatment happens in public sector.)*

Question 2

What percentage of those who need treatment for substance abuse/addiction actually get it?

Answer 2

10%

Question 3

Addiction is a _________ and not a chosen state.

Answer 3

Addiction is a disease and not a chosen state.

Question 4

Is detoxification treatment for substance abuse?

Answer 4

No.

(It does nothing to treat the actual underlying pathology of addiction.)

Question 5

True/False.

80% of persons between 18 and 21 years of age abuse substances

Answer 5

True.

Question 6

What percentage of the population develops an addiction during their lives?

Answer 6

10%

Question 7

Describe the diagnostic criteria for substance abuse disorders (think in terms of amounts, timeframes, efforts to quit, procurement, .

Answer 7

2 / 11 of the following:

Larger amounts than intended

Longer period than intended

Persistent desire or unsuccessful attempts to cut back

Large amount of time spent obtaining substance

Large amount of time spent recovering from use

Craving

Recurrent use inducing failure to meet major obligations

Continued use despite social drawbacks

Important social/recreational/occupational activities are given up

Physically hazardous and recurrent use

Continuance despite knolwedge of psychological or physiological repercussions

Question 8

How important is strict abstinance in the process of recovering from substance abuse?

Answer 8

It is crucial to the recovery process

Question 9

Name some of the major features of treatment that are common to all substance abuse disorders.

Answer 9

Abstinance

Social support

Life-long attendance

Question 10

What is ‘stinking thinking’ in regards to substance abuse disorders?

Answer 10

A neuroadaptation characterized by self-centeredness, external locus of control, loss of empathy, and loss of spiritual connectedness

Question 11

How can the ‘stinking thinking’ (self-centeredness, external locus of control, loss of empathy, and loss of spiritual connectedness) of substance abuse disorders be managed?

Answer 11

It resolves during abstinance

(but its presence indicates an increased likelihood of relapse)

Question 12

What major developmental issue can develop in adolescents who drink alcohol or use illicit drugs as a method of modifying their emotional reactions?

Answer 12

It can stunt emotional development

(adolescence is a process of learning how to feel bad and good appropriately)

Question 13

True/False.

Addictive dependencies on carbohydrates, gambling, religion, sex, aggression, stress, certain personality disorders, ADHD and novelty seeking are all associated with genetic predispositions.

Answer 13

True.

They may be evidences of a reward enhancement syndrome or reward deficiency syndrome.

Question 14

What use do medications have in treating neuroadaptations?

Answer 14

They stabilize the neuroadaptations so abstinance/recovery can help reverse them

Question 15

True/False.

For people with addiction involving the use of opioids the recovery rate is very high even without the use of medications.

Answer 15

False.

For people with addiction involving the use of opioids the recovery rate is very low without the use of medications.

Question 16

List the components of the ‘opioid triad.’

Answer 16

• Shallow breathing
• Pinpoint pupils
• Altered sensorium

Question 17

What medication is the go-to method of reversing opioid intoxication?

Answer 17

Naloxone

Question 18

What is the naloxone mechanism of action?

Answer 18

Opioid antagonism

Question 19

The short-acting benzodiazepines end in what suffix?

Answer 19

‘-Lam’

Question 20

The long-acting benzodiazepines end in what suffix?

Answer 20

‘-Pam’

Question 21

What is the mechanism of action of benzodiazepines?

Answer 21

GABA agonist

(increases frequency of Cl^- channel opening)

Question 22

Benzodiazepine withdrawal side effects are more likely to be seen in ______-acting drugs.

Answer 22

Benzodiazepine withdrawal side effects are more likely to be seen in short-acting drugs.

Question 23

True/False.

Stimulants such as amphetamines cause increases in Dopamine and other neurotransmitters.

Answer 23

True.

Question 24

When a patient begins taking a __________, they can develop a drug-induced psychosis that looks similar to schizophrenia (positive symptoms: due to the now excess dopamine in the body).

Answer 24

When a patient begins taking a stimulant, they can develop a drug-induced psychosis that looks similar to schizophrenia (positive symptoms: due to the now excess dopamine in the body).

Question 25

A 19-year-old patient presents with symptoms similar to those of schizophrenia. She has recently begun taking Adderall for her ADHD. What do you suspect?

Answer 25

Drug-induced psychosis

Question 26

The endocannabinoid system is a negative feedback system for \_\_\_\_\_\_\_\_\_\_.

Answer 26

The endocannabinoid system is a negative feedback system for **_glutamate_** *(the endocannabinoids acting as an 'auto-brake' of sorts)*.

Question 27

Endogenous endocannabinoids 2AG & AEA act on \_\_\_\_synaptic neurons, reducing the firing rate by activating presynaptic ____ receptors.

Answer 27

Endogenous endocannabinoids 2AG & AEA act on **_pre_**synaptic neurons, reducing the firing rate by activating presynaptic **_CB1_** receptors.

Question 28

Name two of the major endogenous endocannabinoids involved in regulating glutamate activity.

Answer 28

Endogenous endocannabinoids **_2AG_** and **_AEA_**

Question 29

Name the two cannabinoids which binds much longer and more strongly to the CB1 receptor than the endogenous endocannabinoids (resulting in a lot of downstream effects that aren’t fully known).

Answer 29

**THC** and **spice/k2**

Question 30

How can THC and spice/k2 be displaced from CB1 receptors without treatment?

Answer 30

They cannot.

Question 31

You come across an individual with pinpoint pupils and a pulse but who doesn't appear to be conscious or breathing. What do you administer, and what do you do next?

Answer 31

Naloxone Call EMS

Question 32

**True/False**. Nasal naloxone wears off more quickly than IV naloxone.

Answer 32

True.

Question 33

At low doses, cocaine's main effects involve \_\_\_\_\_\_\_\_\_\_\_s. At high doses, cocaine's main effects involve \_\_\_\_\_\_\_toxicity.

Answer 33

At low doses, cocaine's main effects involve **_neurotransmitter_**s *(norepinephrine, serotonin, dopamine)*. At high doses, cocaine's main effects involve **_cardio_**toxicity *(blocks cardiomyocyte Na⁺ and K⁺ channels)*.

Question 34

In what cases should cocaine-induced cardiotoxicity be treated with beta-blockers?

Answer 34

**Never**! | (Worsens vasospasms.)

Question 35

Name some of the effects of cocaine use on the body.

Answer 35

Euphoria, mydriasis, tremor, talkativeness, emotional instability, seizures, coma

Question 36

How should one treat acute cocaine use?

Answer 36

**Benzodiazepines** and **bicarbonate** + control of body **temperature** and monitor **glucose** levels

Question 37

**True/False**. Cocaine use and amphetamine use have similar presentations.

Answer 37

True. (Euphoria, talkativeness, energy, mydriasis, etc.)

Question 38

Which of the following mechanisms is used by amphetamines? ## Footnote **Weakly inhibits MAO** **Increases monoamine release from storage** **Competes with monoamine for reuptake**

Answer 38

**All three.**

Question 39

Describe the reverse-transporter-exchange mechanism of amphetamine use.

Answer 39

***Extra***cellular ***amphetamines*** are exchanged for ***intra***cellular ***monoamines*** (via DAT)

Question 40

Compare the strength of effects of amphetamines and methylphenidate on various neurotransmitter levels.

Answer 40

**NET** \> **DAT** (\>\> **SERT**)

Question 41

Compare the strength of effects of MDMA on various neurotransmitter levels.

Answer 41

SERT \> DAT (\>\> NET)

Question 42

MDMA mostly increases levels of which neurotransmitter(s)?

Answer 42

Dopamine Serotonin

Question 43

What is the mechanism of action of MDMA?

Answer 43

**5-HT2A**-**serotonin**-receptor and **D2**-receptor _agonists_ + **serotonin** and **dopamine** _reuptake inhibitors_

Question 44

A patient presents with euphoria, jaw clenching, teeth grinding, and increased empathy. She is also hyponatremic. What explains this hyponatremia?

Answer 44

**MDMA** **intake** | (and subsequent increase in **ADH** levels)

Question 45

Describe the mechanism of bath salts as recreational stimulants (inducing euphoria, hallucinations, etc.).

Answer 45

**Increased** **release** of _dopamine_ + **decreased reuptake** of _epinephrine_, _norepinephrine_, and _sertraline_

Question 46

What toxicities are associated with bath salt abuse?

Answer 46

Paranoia, violent behavior, suicidality (overdose-related deaths have also been reported)

Question 47

**True/False**. Both MDMA and bath salts are associated with potential hyperthermia as a result.

Answer 47

True.

Question 48

LSD is a partial agonist of what receptor(s)?

Answer 48

5-HT1; 5-HT2A

Question 49

What are the major effects of LSD use?

Answer 49

Hallucinations, enhanced sensory input, synesthesia; increased HR and BP

Question 50

What is mescaline?

Answer 50

A hallucinogenic derived from peyote cactus

Question 51

What is psilocybin?

Answer 51

A hallucinogenic derived from mushrooms

Question 52

Describe the mechanism of action of phencyclidine use in terms of receptor and neurotransmitter interactions.

Answer 52

**NMDA** _receptor agonism_; _inhibits reuptake_ of **dopamine**, **serotonin**, and **norepinephrine**

Question 53

Which recreational drug is a dissociative anesthetic and one of the most dangerous hallucinogens available?

Answer 53

Phencyclidine

Question 54

Describe the effects of phencyclidine on an individual.

Answer 54

**Euphoria**; **clinical signs**: hyperreflexia, catatonic posturing, seizures, nystagmus; **dissociation**: loss of contact w/reality, inability to communicate, aggression, amnesia, insensitivity to pain

Question 55

Marijuana acts by partial agonism of which receptors?

Answer 55

**CB1** and **CB2**

Question 56

What are the effects of marijuana use?

Answer 56

Giddiness, feeling of well-being, grandiosity, euphoria, relaxation, altered perception of passage of time, drowsiness, diminished coordination

Question 57

**True/False**. High-potency strains and/or some delivery methods of marijuana use are associated with acute psychosis.

Answer 57

**True**. ## Footnote *Marijuana use is associated with increased risk of schizophrenia in users (and also low-birth weights in their children).*

Question 58

**True/False**. Marijuana is a partial agonist of CB1 and CB2 receptors. Synthetic cannabinoids are full agonists of CB1 and CB2 receptors.

Answer 58

True.