Exam 1 Flashcards
What is the definition of drug addiction/substance dependence?
Compulsive drug use, despite adverse consequences that interfere with normal activities and may include tolerance and dependence
What is the definition of drug misuse?
A pattern of drug use that produces recurrent and significant adverse consequences related to repeated use of the drug (doesn’t involve or result in physical addiction)
What is the neuroadaptive mechanism for long term drug use?
long term potentiation
Almost all substances of misuse release ___ in the ___.
dopamine in the nucleus accumbens
Withdrawal is linked to decreased dopamine in the ___.
nucleus accumbens
Stimulation of the ___ leads to dopamine release
ventral tegmental area (VTA)
What is the drug reward accelerator loop?
GABA inhibition of a second GABA neuron leads to increased dopamine, which then stimulates the cycle further
glutamate (prefrontal cortex) –> GABA (nucleus accumbes) –| GABA (ventral pallidum) –> dopamine (VTA) –> glutamate (prefrontal cortex)
What are the drug reward brakes?
glutamate (prefrontal cortex) –> GABA (nucleus accumbens) –| dopamine (VTA)
dopamine (VTA) –> GABA (nucleus accumbens) –| dopamine (VTA)
What is the target of nicotine?
nicotinic acetylcholine receptors –> stimulation
What is the target of amphetamine?
DAT transporter and VMAT2 transporter –> competes with dopamine for storage –> higher cytoplasmic dopamine levels –> dopamine leakage into extracellular space
What is the target of cocaine?
DAT transporter antagonist –> results in blockade of dopamine reuptake
What is the target of morphine?
µ opiate receptor (metabotropic, G-protein linked receptor)
What is the target of cannabinoids?
CB1 and CB2 receptors (G-protein linked receptors; CB1 receptor has the highest density in CNS out of drug receptors)
What is the target of barbiturates and benzodiazepines?
allosteric sites of GABA-A receptor –> inhibition of neurotransmission
What is the target of hallucinogens and phencyclidine?
NMDA receptor
What is the target of inhalants?
NMDA and GABA-A receptors
What are the targets of ethanol?
- disinhibition of VTA dopamine neurons –> euphoria
- positive modulator of GABA-A receptor + negative modulator of NMDA receptor –> inhibition of neurotransmission
profile of most stressed physician
- less than 48 years old
- female
- 100% solo practice
- increased work hours and hours in direct patient care
- few vacation days
contributors to burnout, substance misuse, and mental illness
- dysfunctional families
- inherent personality structure
- self imposed demands
- long hours
- caring for chronically ill patients
- isolation
- accessibility
- overall stress of job
contributors to substance use disorders
- stress
- isolation
- accessibility
- genetic predisposition
- chronic mental illness
What are the first 3 steps of AA?
acknowledge powerlessness and relinquish control
What is the 4th step of AA?
make an inventory (especially of resentments)
What is the 5th step of AA?
admit wrongdoing
What is the 6th step of AA?
be ready to change
What is the 7th step of AA?
humbly ask God to remove shortcomings
What is the 8th step of AA?
make list of harm caused
What is the 9th step of AA?
make amends
What is the 10th step of AA?
continue personal inventory
What is the 11th step of AA?
improve connection with God
What is the 12th step of AA?
spiritual awakening
What are the 4 points of the SMART program?
- enhance motivation to change
- cope with urges
- manage thoughts, feelings, behaviors
- lifestyle balance (emphasizing enduring satisfactions rather than immediate gratification)
What are the 5 alcohol use clusters?
- young adult
- functional
- intermediate familial
- young antisocial
- chronic severe
What is correct treatment for someone with a substance use disorder and mental illness?
mental health services + specialty substance use treatment (less than 12% of people receive this)
What are the primary care provider roles in addiction?
- patient education
- screen for high risk patients
- prevention of progression and reduction of morbidity and mortality when SUD does exist
How many ounces is 1 drink of beer?
12 oz
How many ounces is 1 drink of malt liquor?
8.5 oz
How many ounces is 1 drink of table wine?
5 oz
How many ounces is 1 drink of fortified wine?
3.5 oz
How many ounces is 1 drink of cordial, liqueur, or aperitif?
2.5 oz
How many ounces is 1 drink of hard alcohol?
1.5 oz