Cooley Addiciton Flashcards
What is a good definition for addiction?
Primary, chronic disease of brain reward, motivation, memory and related circuits. Dysfunction in these circuits leads to characteristic biological, psychological, and behavioral dysfunction. The pursuit of the reward by whatever means, substance abuse and other behaviors, is the problem.
Reward deficiency syndrome is a result of what?
Dopamine system malfunction
Now, just because we say the dopamine system is malfunctioning, what are 2 other contributing structures and their relevance to addiction?
Hippocampus with memory and learning
Amygdala with emotional regulation
What is very different about tolerance and physical dependence?
These are normal physiological adaptations of the body in the presence of an opioid and even when people are taking it for a health condition. They are not sufficient to diagnose addiction
3 very common comorbidities in substance abuse?
Antisocial PD
Depression
Suicide
How do we classify mild, moderate, and severe substance use disorder?
Mild - 2-3 symptoms
Moderate - 4-5 symptoms
Severe 6 or more symptoms
5 diagnostic criteria for substance abuse?
- Disorder represents a clinically significant symptomatic presentation of a relevant mental disorder
- History, PE and labs show the disorder developed during or within 1 month of substance intoxication or withdrawal of a med and the med is capable of producing the mental disorder
- The disorder is not better explained by an independent mental disorder
- The disorder does not occur exclusively during the course of a delirium
- The disorder impairs the person every day life
What drug does intoxication not apply to?
What 3 drugs does withdrawal not apply to?
Tobacco
PCP, hallucinogens, inhalants
3 options of where to treat substance abuse?
Hospital
Residential treatment unit
Outpatient program
4 non pharm treatment options for substance abuse
Detox, motivational interviewing, alcoholics and narcotics anonymous, behavior therapy
What is the intoxication level of alcohol?
Intoxication signs?
Withdrawal signs?
0.08
Impaired judgement and poor coordination all the way to big time depressant of everything.
Early with anxiety, irritable, tremor, etc. to seizures to delirium
What is the most severe manifestations of alcohol withdrawal?
What is the hallmark of this manifestations?
When does it occur?
Delirium tremens
Global confusion and autonomic hyperactivity (sympathetic)
3-10 days after last drink
What total score on the clinical institute withdrawal assessment for alcohol indicates more severe withdrawal?
Over 10
3 pharm treatments alcohol withdrawal?
Benzos (gaba agonist)
Anticonvulsants, like carbamazepine and valproic acid
Thiamine
4 things for outpatient alcohol Use disorder treatment?
Alcoholics Anonymous
Disulfiram - more harmful then good
Naltrexone
Acamprosate
MOA of naltrexone and 2 effects?
Adverse effect?
MOA of acamprosate?
Adverse effect?
Mu antagonist which reduces euphoria and cravings
Liver toxicity
Normalize gaba and glutamate maybe
Kidney
How is benzo and barb intoxication different than alcohol?
What is common detox mistake with benzos?
What is the person is on short elimination benzo?
Taper guideline?
New evidence shows which drug combo works effectively?
Less cognitive/motor impairment
Tapering too fast
Convert a short acting benzo to long and then taper
Decarease dose every 1-2 weeks and not more than 5mg diazepam dose equivalent
Gabapentin and tizandine
What is unique about the benzos oxazepam, temazepam, and lorazepam?
Not affected by hepatic insufficiency
6 things to treat alcohol withdrawal?
Anti nausea, antacid, anti poop, muscle relaxant, NSAIDS, clonidine, and maybe benzo
3 medications to treat opiate use disorder?
Methadone
Naltrexone
Buprenophrine
3 dangers to remember about methadone?
Deadly with a benzo
QTC prolongation big time
Danger when used with another 3A4 substrate
MOA of naltrexone?
MOA of buprenophrine?
Opioid blocker
Partial mu agonist with a ceiling though
Clinical symptom of chronic intoxication of stimulants?
Withdrawal of symptoms can causes severe what?
Psychosis
Suicidal depression
MOA of cocaine?
Adverse effect?
Mainly prevents reuptake of DA
Vasoconstrictor, so watch MI and stoke
MOA of amphetamines?
What syndrome an it be fatal in?
Reuptake blocker of DA, NE, SE, but greatest effect on DA
Fatal in brudaga syndrome
What mental health disorder has almost of their patients smoking?
Schizophrenia
Drug interactions to know for tobacco?
3 symptoms of initial use of tobacco?
MOA in Brain?
CYP1A2
Dizziness, HA, nausea
Stimulate release of DA from VTA into NA
3 treatment options for tobacco use disorder?
Cognitive behavior therapy
Agonist substitution like gum, patch, etc.
meds, bupropion and varenicline
Intoxication symptoms of MDMA or ecstasy?
4 common short term problematic symptoms?
MOA?
2 withdrawal symptoms?
Senses are hyperactive, illusions, psychosis
Tachycardia, sweating, muscle spasms, and extremely high fever
Serotonin 5ht2 agonist
Sleepiness and depression
MOA of cannabis?
Teen males who regularly use have what risk increased?
Cannabis frequently worsens what?
Cannabis has profoundly impair what?
CB1 CB2 agonist and. Block uptake of GABA and DA
Risk of psychosis
Makes comorbid mental illness worse
Short term memory
2 treatments for cannabis disorder?
Detox and behavior therapy
What exactly is PCP?
What is the intoxication picture for PCP?
Big time symptom to know?
2 things to treat?
Dissociative anesthetic like ketamine
Dissociative reactions like paranoid, aggressive, violent
NYSTAGMUS, both vertical and horizontal
Antipsychotic or benzos and low stimulation environment
