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
In regards to the criteria for a substance use disorder, how many equal no diagnosis?
0-1
In regards to the criteria for a substance use disorder, how many equal a mild diagnosis?
2-3
In regards to the criteria for a substance use disorder, how many equal a moderate diagnosis?
4-5
In regards to the criteria for a substance use disorder, how many equal a severe diagnosis?
6 or more
What are the criteria for a substance use disorder?
- using more than intended
- unsuccessful quit attempts
- too much time
- failure to fulfill major obligations
- continued use despite knowledge of problems
- giving up activities
- use despite physical hazards
- continued use despite social or interpersonal problems
- tolerance
- withdrawal
- craving
What are the ABC’s of a poisoned patient?
Airway Breathing Circulation/Cessation seizure/C-spine Decontamination/Diagnostics Enhanced elimination Specific antidotes
What are the effects seen with opiates?
- depressed respiration
- increased pleasure
- blocked pain
- pinpoint pupils
Coma, respiratory depression, and pinpoint pupils are suggestive of the ___ toxidrome.
opiate/narcotic
Hypertension, tachycardia, increased temperature, dilated pupils, and anxiety are suggestive of the ___ toxidrome.
Sympathomimetic
Confusion or coma, respiratory depression, hypotension, decreased temperature, and variable pupillary changes are suggestive of the ___ toxidrome.
sedative or hypnotic
Tachycardia, dilated pupils, diarrhea, abdominal cramps, and piloerection are suggestive of the ___ toxidrome.
withdrawal
Salivation, lacrimation, urination, defecation, gastric cramps, emesis, killer B’s (bradycardia, bronchorrhea, bronchoconstriction) are suggestive of the ___ toxidrome.
cholinergic
Fever, ileus (lack of intestinal movement), flushing, tachycardia, urinary retention, myoclonus, hallucinations are suggestive of the ___ toxidrome.
anticholinergic
The antidote for CO poisoning is ___.
O2
The antidote for opiate poisoning is ___.
naloxone
The antidote for anticholinergic poisoning is ___.
physotigmine
The antidote for organophosphates poisoning is ___.
atropine, pralidoxime
The antidote for acetaminophen poisoning is ___.
N-acetylcysteine
The antidote for methanol/ethylene glycol poisoning is ___.
ethanol, fomepizole
The antidote for cyanide poisoning is ___.
nitrites/lilly kit
The antidote for digoxin poisoning is ___.
digibind
The antidote for betablocker poisoning is ___.
glucagon
The antidote for Ca2+ channel blocker poisoning is ___.
calcium, glucagon
The antidote for iron poisoning is ___.
deferoxamine
The antidote for Pb/Cu/Cd/Zn poisoning is ___.
calcium EDTA
The antidote for As/Au/Hg inorganic poisoning is ___.
BAL
The antidote for heparin poisoning is ___.
protamine
The antidote for coumadin poisoning is ___.
Vitamin K
The antidote for isoniazid poisoning is ___.
Vitamin B6
A BAC of 20-50 is associated with ___.
feeling good, loss of inhibitions, buzz
A BAC of 50-100 is associated with ___.
impaired judgment and coordination
The legal BAC limit is ___.
80
A BAC of 100-150 is associated with ___.
difficult with gait and balance
A BAC of 150-250 is associated with ___.
lethargy, difficulty sitting upright
A BAC of 300 is associated with ___.
coma in the naive drinker
A BAC of 400 is associated with ___.
respiratory depression
A BAC of 600 is associated with ___.
death
What is the appropriate treatment intervention for precontemplation?
feedback
What is the appropriate treatment intervention for contemplation?
psychotherapy to deal with ambivalence
What is the appropriate treatment intervention for preparation?
menu of treatment options
What is the appropriate treatment intervention for action?
let patient choose
What is the appropriate treatment intervention for maintenance?
relapse prevention
___ is the most effective pharmacotherapy option because it reduces cravings and relapse.
Naltrexone
Chantix functions
- decreases cravings and withdrawal
- blocks nicotine binding to reduce reward
What are the effects of cocaine?
- euphoria
- talkativeness
- decreased sleep
- decreased appetite
- sexual stimulation
- irritability
- anxiety
- restlessness
- paranoia (chronic user needs lower and lower does for this to happen)
Faster onset and faster wearing off of drug makes it __.
more addictive
What is a cocaine metabolite? How long is it detectable in the urine?
Benzoylecgonine (BE); 48 hours
Cocaine tolerances
- complete tolerance to euphoria
- incomplete tolerance to increased HR
- reverse tolerance to paranoia and seizures
Effects of marijuana
- stimulation (^ BP, P, RR, appetite, decreased executive function)
- sedation (dry mouth, slurred speech, uncoordinated movements, anti-emetic)
- anesthesia (pain relief, memory and judgment loss)
- hallucinogen (mild euphoria, visual, delusion, paranoia)
Methamphetamine symptoms
- sympathetic discharge (stimulation, flight of ideas, insomnia)
- hyperthermia
- sweating
- flushing
- tachypnea
- tachycardia
- hypertension
- seizures
- long term memory/IQ impairment
Psuedoaddiction definition
misinterpretation of relief seeking behaviors as drug seeking behavior
Hyperalgesia definition
condition in which opioid use results in hypersensitivity to pain
What are the levels of managed care for treatment and referral of SUD?
- outpatient treatment
- intensive outpatient program (day/evening, partial hospitalization)
- medically monitored program (freestanding or hospital based)
- medically managed program (hospital based)
What is the lifetime prevalence for SUD in males and females? Incidence?
Prevalence
- 15% in males
- 5% in females
Incidence
6-8% in males
2-3% in females
What are alcohol concerns specific to women?
- BAC gets 50% higher
- greater incidence of hepatic disease
- greater cerebral atrophy
What are the types of alcoholism? Who is at risk for each?
Type I - late onset - functional and intermediate groups
Type II - early onset - antisocial and severe/chronic groups
What are the neurobiologic susceptibilities for alcoholism?
- temperamental deviations
- prefrontal-midbrain neuroaxis dysfunction
- serotonin deficit
- D2 dopamine receptor gene mutation
- lower baseline plasma beta-endorphins
What are the symptoms of nicotine withdrawal?
- nicotine craving
- irritability, anger, impatience
- restlessness
- difficulty concentrating
- insomnia
- anxiety
- depressed mood
- increased appetite
What does CAGE assess?
- felt the need to CUT DOWN drinking
- people ANNOY you by criticizing drinking
- felt GUILTY
- had an EYE OPENER first thing in morning
What is the most sensitive indicator of alcohol relapse?
Carbohydrate-deficient transferrin (CDT)
What are the biomarkers used to measure long-term drinking?
- CDT
- GGT
- MCV
- liver function - AST, ALT, alkaline phosphate
- CAMP
What are the direct tests used to measure immediate drinking?
- BAC
- Ethyl glucuronide (EtG)
- phostphatidyl ethanol (Peth)
