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701 > Exam 1: Substance Abuse Disorder > Flashcards

Exam 1: Substance Abuse Disorder Flashcards

1
Q

Sensitization

A

increased response to a drug with repeated use

Dose vs response: shift left

ex: cocaine

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2
Q

Tolerance

A

adaptation, effect diminishes over time

dose vs response: shift right

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3
Q

2 types of tolerance

A
  1. metabolic-faster
    (induction by liver enzymes)
  2. cellular - over time (receptor downregulation)
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4
Q

Acute vs protracted tolerance

A

acute = after a single administration

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5
Q

Cross tolerance

A

tolerance to one drug leads to tolerance of others in the same class
ex: hydrocodone and oxycodone

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6
Q

Withdrawal

A

behaviors exhibited when drug use ends, typically opposite of drug effect

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7
Q

Induction of withdrawal

A

abrupt d/c
rapid dose reduce
decrease blood level of drug
giving antagonist

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8
Q

Addiction

A

primary chronic, neurobiological disease + genetic/psychosocial/environmental factors

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9
Q

5C’s of addiction

A

Chronicity
Control (impaired)
Compulsive use
Continued use despite harm
Craving

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10
Q

Drug abuse

A

maladaptive patterns of substance use w/ repeated adverse consequences related to repeated use

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11
Q

Dependence

A

body adapts to presence of drug - needs it to maintain homeostasis

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12
Q

Testing for drugs

A

Gold standard: urine (1-30days)
Hair: 7days - 3 months
Blood: 0-3 days (unless long half life)
Saliva: same as blood

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13
Q

Testing: drug interactions

A

Synthetic opioids = false negative for opiates
- methadone
- fentanyl
Some benzos (clonazepam) = false negative
OTC meds (sudafed) = false positive for amphetamine

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14
Q

short half life urine toxicology

A

meth
lorazepam
cocaine
heroin
(few days)

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15
Q

long half life urine toxicology

A

buprenorphine
cannabinoids
diazepam
methadone
(several days-few weeks)

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16
Q

Creatinine Normalizing equation

A

Creatinin - normal drug level = urine drug/urine creatinine *100

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17
Q

Repeated self administration

A
  1. pleasure
  2. classical conditioning
  3. incentive salience (craving, DA release from cues)
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18
Q

Risk factors for SuD

A

-dysfunctional childhood/abuse
-ADHD, school problems, conduct disorder
- early onset SU (before 14)
- personal hx of a SUD
- genetic predisposition (positive family hx)

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19
Q

Young patients & opioid use

A
  • 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
20
Q

Hair testing pro/con

A

pro: long observation period
Observable
con: need 150 strands, not many labs do this
- nape = recent
- crown = older
- scalp = most reliable

21
Q

Urine testing pro/con

A

pro: reasonable detection limits, need creatinine normalize to follow levels
Limits: can falsify or alter sample, observeable

22
Q

Blood testing pro/con

A

pro: can use if cant get urine/saliva
con: short detection time, more invasive, few labs do this

23
Q

saliva testing pro/con

A

pro: can use if cant get urine/saliva
con: short detection time,

24
Q

Benzodiazepines

A

Depressant
sedative hypnotics
potentiate GABA

25
Q

Benzo intoxication

A

decreased BP
respiratory depression
memory impairment (ROOFIE, date rape drug flunitrazepam)
poor coordination
sleepiness, slurred speech
GI issues
Urinary retention

26
Q

Benzo withdrawal

A

aniety
insomnia
restlessness
muscle tension
irritability
blurred vision
diaphoresis
nightmares
depression
paranoia
hallucinations
seizures
psychosis

27
Q

Benzo overdose treatment

A

Flumazenil
contraindicated for TCA overdose or benzo dependent patients (withdrawal seizure)

28
Q

Barbituates overdose tx

A

supportive care, o2/fluids
taper, change to long acting, substitute anticonvulsant

29
Q

Barbituate effect

A

similar to alcohol
Disinhibition
Mood lability
Unsteady gait
Slurred speech
Nystagmus
Amnesia
Poor judgment

30
Q

Barbituates withdrawal

A

Anxiety
N/V
Postural hypotension
Seizures
Delirium, insomnia
Hyperpyrexia
Taper, change to longer acting phenobarbital, substitute anticonvulsant

31
Q

GHB effect

A

amnesia
hypotonia
Coma
Seizures
Respiratory depression
Vomiting

32
Q

GHB treatment

A

supportive, o2 vent, fluids

33
Q

GHB withdrawal

A

agitation
mental status change
Elevated HR and BP

34
Q

Opiate effect

A

Euphoria
Dysphoria
Apathy
Motor retardation
Sedation
Slurred speech
Attention impairment
Miosis (pinpoint pupil)
Constipation

35
Q

Opioid withdrawal

A

lacrimation, rhinorrhea, mydriasis, goosebumps, diaphoresis
Insomnia, yawning
Muscle ache/pain

36
Q

Opioid overdose treatment

A

naloxone

detox:
Methadone
Buprenorphine
Clonidine
Lofexidine

Maintenance:
methadoone
buprenorphine

abstience:
naltrexone PO or IM

37
Q

DXM intoxication

A

Heightened sense of perceptual awareness
Altered time perception
Visual hallucinations
Hyperexcitability
Lethargy
Ataxia
Slurred speech, sweating
Hypertension
Nystagmus

38
Q

DXM PKPD

A

Major 2D6 substrate
Minor 2C9,2C19,2E1 substrate
Inhibits 2D6 weakly

39
Q

DXM overdose

A

Seizures
Loss of conciousness
Brain damage
Irregular heartbeat
Death

40
Q

Xylazine

A

tranquilizer
central a2 agonist
severe skin necrosis

41
Q

Xylazine withdrawal

A

agitation, severe anxiety

42
Q

Cocaine intoxication sx

A

Euphoria, elation, gradiosity
Loquacity
Alertness
Mydriasis
Change BP
Tachycardia
Sweat.chhills
N/V
Decreased fatigue
Paranoia, aggression
Motor agitation

43
Q

Cocaine withdrawal

A

Depression
Fatigue
Nightmares
Sleep disturbances
Increased appetite
Bradyarryhtmias
Tremor

44
Q

Cocaine overdose

A

Cardiac arrest
Myocardial infarction
Stroke
Arrhythmia
Seizures
Hyperthermia
Nasal septum ulceration
Kindling = potentiate psychosis/hallucinations

45
Q

Cocaine treatment

A

Lorazepam, haldol, antiarrythmics, supportive
off label: Bromocriptine 2.5 mg tid

701 (16 decks)

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