Drug Addiction Flashcards

1
Q

What is tolerance?

A

Loss of effect when taking the same dose, person increases dose to achieved desired effect

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2
Q

What is dependence?

A

Physiological and psychological need to keep using a drug

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3
Q

Why does dependence occur?

A

Physiological changes (alcohol)
Psychological factors (cravings and compulsions to the drug)

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4
Q

Why do you get withdrawal symptoms?

A

Physiological adaptions to the drug e.g. alcohol and benzodiazepines

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5
Q

What pathway is responsible for psychological addiction?

A

Mesolimbic pathway

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6
Q

What is the key neurotransmitter in the mesolimbic pathway?

A

Dopamine

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7
Q

What key structures are involved in the mesolimbic pathway?

A

Ventral tegmental area
Nucleus accumbens
Amygdala
Prefrontal cortex

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8
Q

How do addictive substances or behaviours activate the mesolimbic pathway?

A

Dopamine release in the pathway providing pleasurable reward

Repeated exposure to dopamine reduces number and sensitivity of receptors

Therefore stronger stimulus needed for same reward

Every day activities less rewarding, person seeks out the substance or behaviour to stimulate the reward pathway

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9
Q

Where are cues for substance of behaviour embedded?

A

Amygdala

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10
Q

What causes cravings?

A

Cues

People, events, places or objects can act as cues triggering a craving

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11
Q

What is a common trigger of a craving?

A

Stress

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12
Q

What do changes in the prefrontal cortex lead to?

A

Impaired function

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13
Q

What is the prefrontal cortex responsible for?

A

Executive functions

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14
Q

Give examples of executive function

A

Decision-making

Assessing risk

Impulse control

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15
Q

Complete the table

A
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16
Q

How is drug addiction managed?

A

MDT approach

Specialist drug and alcohol services available, usually with self-referral option

17
Q

What does drug addiction management involve?

A
  • Detoxification
  • Medication (to help maintain abstinence)
  • Psychological and behaviour therapies
  • Ongoing support
18
Q

What medication is used for opioid dependence?

A

Methadone (bind to opioid receptors)
Buprenorphine (bind to opioid receptors)
Naltrexone (prevents relapse)

19
Q

What medication is used for nicotine dependence?

A

Nicotine replacement therapy (patches, gum or lozenges)
Bupropion
Varenicline

20
Q

What do you give in acute heroin withdrawal?

A

Symptomatic treatment, dont give opioids

e.g. lofexidine (a2 agonist)

21
Q

What is malingering?

A

Fabrication or exaggeration of physical or psychological symptoms for personal gain or relief from duty or work

22
Q

What are the early signs of opiate withdrawal?

A

Early 12 hours
Rhinorrhoea
Sweaty clammy skin
Persistent yawning
Tachycardia
Restlessness
Dilated pupils
Lacrimation
Goosebumps

Late day 2-3
Nausea and vomiting
Diarrhoea
Insomnia
Abdominal cramps
Muscle pains

23
Q

What should be done before starting a patient on methadone prescription?

A
  • Check that they are being prescribed methadone
  • Urine drug screen
  • There’s time, more than 24 hours before withdrawal symptoms, so check
24
Q

How is methadone administered?

A

Methadone titration

Initial 20mg dose
If withdrawal symptoms persist, give further 10mg after 2 hours

Give total from day before next morning
Do not give more than 60mg unless prescribed already

25
Q

Why does methadone accumulate over the first few days of treatment?

A

Long half-life

26
Q

What is the aim of methadone treatment?

A

Stabilisation rather than detox

27
Q

What is buprenorphine?

A

Partial agonist
Must be in withdrawal to start