Exam 1: Substance Abuse Disorder Flashcards
Sensitization
increased response to a drug with repeated use
Dose vs response: shift left
ex: cocaine
Tolerance
adaptation, effect diminishes over time
dose vs response: shift right
2 types of tolerance
- metabolic-faster
(induction by liver enzymes) - cellular - over time (receptor downregulation)
Acute vs protracted tolerance
acute = after a single administration
Cross tolerance
tolerance to one drug leads to tolerance of others in the same class
ex: hydrocodone and oxycodone
Withdrawal
behaviors exhibited when drug use ends, typically opposite of drug effect
Induction of withdrawal
abrupt d/c
rapid dose reduce
decrease blood level of drug
giving antagonist
Addiction
primary chronic, neurobiological disease + genetic/psychosocial/environmental factors
5C’s of addiction
Chronicity
Control (impaired)
Compulsive use
Continued use despite harm
Craving
Drug abuse
maladaptive patterns of substance use w/ repeated adverse consequences related to repeated use
Dependence
body adapts to presence of drug - needs it to maintain homeostasis
Testing for drugs
Gold standard: urine (1-30days)
Hair: 7days - 3 months
Blood: 0-3 days (unless long half life)
Saliva: same as blood
Testing: drug interactions
Synthetic opioids = false negative for opiates
- methadone
- fentanyl
Some benzos (clonazepam) = false negative
OTC meds (sudafed) = false positive for amphetamine
short half life urine toxicology
meth
lorazepam
cocaine
heroin
(few days)
long half life urine toxicology
buprenorphine
cannabinoids
diazepam
methadone
(several days-few weeks)
Creatinine Normalizing equation
Creatinin - normal drug level = urine drug/urine creatinine *100
Repeated self administration
- pleasure
- classical conditioning
- incentive salience (craving, DA release from cues)
Risk factors for SuD
-dysfunctional childhood/abuse
-ADHD, school problems, conduct disorder
- early onset SU (before 14)
- personal hx of a SUD
- genetic predisposition (positive family hx)
Young patients & opioid use
- marijuana can be used as marker for those at risk for rx misuse
- use of opioids before high school graduation is associated with 33% increase in risk of later opioid misuse
Hair testing pro/con
pro: long observation period
Observable
con: need 150 strands, not many labs do this
- nape = recent
- crown = older
- scalp = most reliable
Urine testing pro/con
pro: reasonable detection limits, need creatinine normalize to follow levels
Limits: can falsify or alter sample, observeable
Blood testing pro/con
pro: can use if cant get urine/saliva
con: short detection time, more invasive, few labs do this
saliva testing pro/con
pro: can use if cant get urine/saliva
con: short detection time,
Benzodiazepines
Depressant
sedative hypnotics
potentiate GABA
Benzo intoxication
decreased BP
respiratory depression
memory impairment (ROOFIE, date rape drug flunitrazepam)
poor coordination
sleepiness, slurred speech
GI issues
Urinary retention
Benzo withdrawal
aniety
insomnia
restlessness
muscle tension
irritability
blurred vision
diaphoresis
nightmares
depression
paranoia
hallucinations
seizures
psychosis
Benzo overdose treatment
Flumazenil
contraindicated for TCA overdose or benzo dependent patients (withdrawal seizure)
Barbituates overdose tx
supportive care, o2/fluids
taper, change to long acting, substitute anticonvulsant
Barbituate effect
similar to alcohol
Disinhibition
Mood lability
Unsteady gait
Slurred speech
Nystagmus
Amnesia
Poor judgment
Barbituates withdrawal
Anxiety
N/V
Postural hypotension
Seizures
Delirium, insomnia
Hyperpyrexia
Taper, change to longer acting phenobarbital, substitute anticonvulsant
GHB effect
amnesia
hypotonia
Coma
Seizures
Respiratory depression
Vomiting
GHB treatment
supportive, o2 vent, fluids
GHB withdrawal
agitation
mental status change
Elevated HR and BP
Opiate effect
Euphoria
Dysphoria
Apathy
Motor retardation
Sedation
Slurred speech
Attention impairment
Miosis (pinpoint pupil)
Constipation
Opioid withdrawal
lacrimation, rhinorrhea, mydriasis, goosebumps, diaphoresis
Insomnia, yawning
Muscle ache/pain
Opioid overdose treatment
naloxone
detox:
Methadone
Buprenorphine
Clonidine
Lofexidine
Maintenance:
methadoone
buprenorphine
abstience:
naltrexone PO or IM
DXM intoxication
Heightened sense of perceptual awareness
Altered time perception
Visual hallucinations
Hyperexcitability
Lethargy
Ataxia
Slurred speech, sweating
Hypertension
Nystagmus
DXM PKPD
Major 2D6 substrate
Minor 2C9,2C19,2E1 substrate
Inhibits 2D6 weakly
DXM overdose
Seizures
Loss of conciousness
Brain damage
Irregular heartbeat
Death
Xylazine
tranquilizer
central a2 agonist
severe skin necrosis
Xylazine withdrawal
agitation, severe anxiety
Cocaine intoxication sx
Euphoria, elation, gradiosity
Loquacity
Alertness
Mydriasis
Change BP
Tachycardia
Sweat.chhills
N/V
Decreased fatigue
Paranoia, aggression
Motor agitation
Cocaine withdrawal
Depression
Fatigue
Nightmares
Sleep disturbances
Increased appetite
Bradyarryhtmias
Tremor
Cocaine overdose
Cardiac arrest
Myocardial infarction
Stroke
Arrhythmia
Seizures
Hyperthermia
Nasal septum ulceration
Kindling = potentiate psychosis/hallucinations
Cocaine treatment
Lorazepam, haldol, antiarrythmics, supportive
off label: Bromocriptine 2.5 mg tid
