Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Therapeutics III > Drug and Alcohol - Block 3 > Flashcards

Drug and Alcohol - Block 3 Flashcards

1
Q

What is drug abuse?

A

Use of an illicit drug causing harm to individual/society

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a pschoactive effects?

A

Action of drug in the CNS causing alterations in perception, reason for abuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is narcotic?

A

A drg that causes stupor and loss of sensibility or dulling of the senses

  • Any illicit and habit forming drug
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is reinforcing effects?

A

Promotes the compulsive ued of a drug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is rapidity?

A

Rate at which a drug reaches its receptors in the CNS and exerts its effects
* Positive reinforcement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is tolerance?

A

Decrease in drug’s effect as a consequence of repeated admin -> more drug for same effect
* Downregulation of dopamine rceptors secondary to repeated over and repeated exposue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is dependence?

A

The appearance of withdrawal syndrome when chronic admin of drug is halted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is addiction?

A

An abusive pattern of drug use characterized by an overwhelming involvement with the use of a drug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Categories of drugs of abus?

A

Opioids: heroin, morphine, meperidine, fentanyl
Psychomotor stimulants: Cocaine, amphetamines
MJ
Sedative hypnotics: Barbiturates, alcohol, BZD
Hallucinogens: LSD
Inhalants: Mitrous oxide, amyl nitrite, toulene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the characteristics of SUD according to DSM V?

A
  1. Taking substance in large amounts
  2. Wanting to cut down or stop but can’t
  3. Spending a lot of time with substance
  4. Cravings
  5. Not managing to do what you should
  6. Problems in relations or puts patient in danger
  7. Withdrawal sx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe the mechanism of limbic system?

A

Release dopamine and glutamate in response to stimulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe the reward system of the brain?

A
  1. Pleasurable event/stimuli=dopamine release in frontal cortex =euphoria
  2. The higher a stimuli’s place in the hierarchy, the stronger the compulsion to seek that stimuli
  3. Reward sytem reinforces survial behaviors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the driving forces of SUD?

A
  1. Cravings
  2. Rapidity
  3. Tolerance
  4. Withdrawals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the cause for cravings?

A

Overstim of reward circuit from dopamine leads to intense pleasurable high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the common formulations of cocaine?

A
  1. IV
  2. Smoking
  3. Intranasal
  4. PO
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How cn SUD lead to neurotoxicity?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the definition of SUD?

A

Maladaptve pattern of substance use -> clinically significant impairment or distress within a 12 month period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do we diagnose OUD?

A

At least two of the following should be observed within a 12-month period:
1. Recurrent opioid use resulting in a failure to fulfill responsibilities
2. Continued use -> social problems
3. Activites are given up
4. Recurrent opioid causes physical harm
5. Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the clinical presentation of OUD?

A
  1. Intoxication
  2. Withdrawal
  3. Dependence/Abuse
  4. Medical cmplications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the screening tools for SUD?

A
  1. Structured Clinical Interview (SCID)
  2. Questionnaires for screening drug problems
  3. Questionnaires for assessing the severity of drug problems
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the social complications of SUD?

A
  1. Loss in interest/motivation
  2. Criminal activity to support habit
  3. Transmission of HIV, Hep B and C
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the objectve of SUD tx? Goal of therapy?

A

Prevent medical and social ADR

Abstinence and harm prevention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Presentations of cocaine intoxication?

A
  1. Paranoid psychosis
  2. Chest discomfort/angina
  3. Sz, respiratory depression, acute HF, stroke, death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How do we treat cocaine intoxication?

A
  1. Buprenorphine/naltrexone to manage withdrawals
  2. Topiramate for relapse prevention
  3. Baclofen (reduce dopamine release)
  4. Tiagabine
  5. Disulfirum (makes high less pleasant)
  6. Modafinil
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are the non toxic physiological responses of amphetamines?
1. Loss of appetite 2. Euphoria 3. Mood elevation
26
Signs of amphetamine intoxication?
1. Sudden outbursts of aggression and violence 2. Paranoid delusions 3. Severe anorexia
27
Sx of amphetamine withdrawals?
1. Dysphoric 2. Fatigue 3. Aches and pains 4. Ax 5. Insomnia 6. Increased appetite 7. Vivid dreams
28
How do we manage amphetamine detox?
No tx, but med is beeficial for withdrawn sx: 1. Modafinil: reduce fatigue 2. Propranolol: Reduce anxiety 3. Bupropion: Help with unpleasant mood 4. Short term BZD, antipsychotics: control irritability and agitation
29
What are the signs of opioid withdrawals?
1. Opioid cravings 2. Restlessness, irritability, dysphoria 3. Hyperalgesia 4. Insomnia 5. Ax 6. Pupillary dilation 7. Sweating 8. N/V/D cramps 9. Hot flashes
30
What are the medical complications of opioids?
1. Constipation 2. Sexual dysfuntion
31
What are signs of opioid intoxication?
1. Euphoria 2. Respiratry depression 3. Nonarousable, unresponsive to stimulus 4. Limp, cyanosis 5. SLow heartbeat
32
COunseling points for naloxone?
1. Kicks off opioid from mu receptor 2. 1-8 minute onset 3. Readmin in 2 mins if no response 4. Duration of action is about 60 minutes, so make sure to call 911 and get patient to ER even if seem fine after administration  5. BZD prevents reversal
33
What is the difference between physical and psychological dependence?
**Physical:** tolerance, withdrawal, cravings, risk of OD and death **Psychological:** inability to cut down or control, increased amount of time spent, social withdrawal, opioid cause adverse consequences
34
What is the tx for OUD?
1. MAT 2. Methadone 3. Buprenorphine 4. Maltrexone 5. Tapering/weaning 6. Clonidine 7. Lofexidine (Lucemyra)
35
What is the MOA of methadone and buprenorphine?
1. Activtion of µ recepot 2. Inhibits activation of peripheral nociceptors 3. Prevent ascending transmission of pain signals
36
What is methdone's use for pain?
1. Not considered first line 2. Start 2.5 mg Q8H in opioid naive 3. Increase by 5 mg every 5-7 days 4. Effective dose can be as low 2.5mg TID  5. Effective duration 6 hours 
37
Methodone's use in OUD?
First line for IV abusers or high dose users: 1. Start dose 30mg increase by 5 based on symptoms to 50mg then by 10 2. Suppress withdrawal sx, cravings, and illicit opioid use, 60 mg QD or 80-85 mg
38
DDI of methdone and buprinorphine?
1. Antivirals decrease opioid 2. Antibiotic increase opioid 3. BDZ, barbs, alcohol 4. SSRI (sertraline): increase methadone
39
What is the use of naltrexone for OUD?
1. Antagonist of mu receptor 2. Required detox first, followed by 7-10 day wait perioid before initiation 3. Increased rate of OD after tx dropout -> loss in tolerance 4. Useful in concurrent BZD dependency 5. No risk for diversion
40
How should we taper opioids?
1. <50MME 2. Decrease 10% of original dose QW 3. Psychosocial support 4. Only reduce rate or pause taper but never reverse taper
41
Tx for pain during OUD tx?
NSAIDs, APAP
42
Tx for diarrea during OUD tx?
Loperamide (opioid as well though, so be careful)
43
Tx for constipation during OUD tx?
Laxative
44
N/V during OUD tx?
1. Prochloperazine 2. Halpeidol 3. Ondansetron
45
Ax, irritaility, cramps during OUD tx?
1. Hydroxyzine 2. Quetiapine
46
Insomnia during OUD tx?
Trazadone
47
Autonomic sx during OUD sx?
1. Cloniine 2. Reassess 3-7 days, taper upon sx resolution
48
What are the advantages of using clonidine for OUD?
1. decreases the noradrenergic hyperactivity associated with opioid withdrawal 2. Reduce withdrawal sx (n/v/d, cramps, sweating but doesn't reduce muscle aches, insomnia, cravings) 3. Doesn't produce opioid like tolerance or dependence or post methadone rebound in wd sx 0.1 mg TID
49
What is Lofexidine?
alpha-adrenergic agonist that is used for the mitigation of WD sx for up to 14 days during abrupt DC of opiiods * Expensive * Possible adverse effects & warnings:  Hypotension, bradycardia, syncope,  Somnolence, Dry mouth, QT prolongation * Increased risk of opioid overdose if resume using after withdrawal 
50
What is the mechanism of AUD?
During withdrawal, GABA levels decrease below normal capacity, which ultimately leads to hyperactivity of the nervous system * Alcohol activates opioid receptors -> pleasure of drinking
51
What are the complications of alcohol use?
1. Daages to liver, heart, nerves, CBC, GI 2. Impaired memory
52
What are sx of alcohol withdrawals?
1. SZ 2. Delirium tremens 3. Trembling 4. Ax
53
Differentiate the types of alcohol withdrawals
Onset of particular symptoms  and severity: **Mild:** sweating, agitation, tremor, NV, insomnia, Ax * 6-24H, peaks 24-36H **Major:** sz, increased BP, visual hallucinations * 12-48H, peak 24H **Withdrawal delirium (DT):** confusion, fever, tremor -> fatal * 48-96H
54
How do we screen for alcohol withdrawal?
Clinical Institute Withdrawal Assessment for Alcohol revised (CIWA-Ar)
55
How do we manage withdrawals?
1. Long and intermediate BZD is first line acute management * Lorazepam (good for elderly and live disease) * Diazepam * Chlordiazepoxide 1. Anticonvulsants (Valproate, carbamazepine, gaapentin) 2. Clonidine and atenolol: lower BP, HR, treors 3. Haloperidol: uncontrolled agitation 4. Penytoin-barb and propofol: refractory DT
56
What is nutritional suport for alcohol wthdrawal>
1. Folic acid 2. Thiamine 100mg QD to prevent Wernicke's encephalopathy 3. Magnesium to resolve AWS sx
57
What are anti crazing agents of for alcohol?
1. Acamprosate: decrease craving by GABA and glutamate 2. Naltrexone: reduce crazings and reinforcing properties of alcohol
58
Agents that deter patients from consuming alcohol?
Dilsulfiram: inhibits acetaldehyde dehydrogenase Support groups, AA, psychotherapy Meds to control comorbidities
59
Atibiotics that act similar to disulfiram?
1. Metronidazole 2. Ketoconazole
60
RF of BZD use disorder?
1. TDD used for 4-6 months 2. Dose exceeds 2-3x upper limit of TD used for 2-3 months 3. Withdrawal begins 12-48H after last use 4. Drugs with faster onset -> higher potential for dependence
61
What are your rapid BZDs?
1. Diazepam 2. Lorazepam
62
Intermediate BZDs?
1. Alprazolam 2. Lorazepam 3. Chlordiazepoxide 4. Clonazepam
63
Slow acting BZDs?
Oxazepam
64
BZDs that are most commonly abused?
1. Diazepam #1 2. Lorazepam and alprazolam (slightly) 3. Chlordiazepoxide (high)
65
Sx of BZD withdrawals?
1. Agitation, ax, irritability 2. Delirium, sz 3. Tremor
66
How do you tx BZD withdrawals?
1. Reduce BZD dose, taper, monitor using CIWA 2. Can decrease dose by greater percentage in the beginning of withdrawal 3. After reducing initial dose by 50%, may need to decrease dose deductions by 10% for patient comfort  Barbiturates Adj med for ax depression, insomnia Antipsychotics in cases of delirium
67
Adjuct tx for BZD withdrawal?
1. Hydroxyzine 2. Carbamazepine 3. Trazadone 4. Valproate 5. Imipramine 6. Pregabalin 7. Buspiron 8. Gabapentin 9. Flumazenil 10. Melatonin
68
What is Flumazenil? Disadvantages?
Revesal agent for BZD: 1. Induces sz 2. Ax, agitation, increased muscle tone 3. Respiratory depression 4. CV ADR 5. CNS effects **Requires careful monitoring for re-sedation**

Therapeutics III (40 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions