Exam 4 Principles of Addiction and Drugs of Abuse Flashcards
What factors increase the potential for abuse?
1) Potency of the drug= greater potency = more likely to abuse
2) Quick/rapid onset of action
3) Inexpensive
4) Easy to obtain/distribute
What is drug abuse?
When drugs are used in a manner or ant inconsistent with medical or social patterns of a culture
What is Physical dependence?
-Changes that have occurred in the body after repeated use of a drug that necessitates the continued administration of a drug to prevent a withdrawal syndrome
- NOT an addiction (can exist without addiction)
- Addicts are usually physically dependent on drug they are abusing
-pt’s who use opiates for chronic pain management are likely to be physically dependent
What is Psychologic dependence?
- Perceived “need” or “craving” for a drug
- often feel that they cannot function w/o continued use of that substance
- Physical dependence disappears w/in days or weeks after drug use stops, but psychological dependence can last much longer
- Psychological dependence is primarily reason for relapse (initiation of drug use after period of abstinence).
What is Tolerance?
- **With repeated dosing, the dose of drug must be increased to produce same effect
- -or w/ consecutive dosing, same dose of drug produces less of an effect
- Need a HIGHER dose to produce the desired effect
- *Psychoactive drugs produce “central” tolerance (function or behavioral)
- definite decrease in the response of brain tissue to constantly increasing amounts of the drug
- NOT the same as metabolic tolerance (as we discussed in basic principles) caused by accelerated rate of metabolism of drug
- -insignificant factor in tolerance observed in humans to most psychoactive drugs
What is withdrawal syndrome?
–factors?
-Can range from mildly unpleasant to life-threatening
- -dependent on a number of factors:
1) drug being used
2) dose and route of administration
3) concurrent use of other drugs
4) frequency and duration of drug use
5) age, sex, health and genetics of the individual user
What is addiction?
- Compulsive drug-seeking behavior where acquiring and using a drug becomes most important activity in user’s life
- loss of control regarding drug use
-Continued use despite serious medical and/or social consequences
w/ addiction, there is always psychological dependence
What are the Behavioral signs of addiction?
1) preoccupation with obtaining the drug
2) compulsive use in spite of adverse consequences
3) relapse following periods of abstinence
4) anal retentive
5) obsessive compulsive
6) controlling
7) manipulative
What is Habituation?
physiological tolerance to or psychological dependence on a drug, short of addiction
What is enabling?
-The behavior of others (e.g. family and friends) who are associated w/ drug addict, results in continued drug abuse
–this is an inappropriate coping mechanism by the “enabler” that negatively reinforces that addict’s behavior
–often requires family counseling
What is abstinence?
- The state of being free of drugs
- -goal of drug treatment programs
What is abuse?
- non-sanctioned use of controlled substances
- use of legal pharmaceuticals outside of the scope of sound medical practice
All controlled substances substances have abuse potential or are immediate precursors to substances with abuse potential what can they alter?
abused to alter:
1) mood
2) thoughts
3) feelings
4) actions on CNS
5) alleviate pain, anxiety, depression, induce sleep, energize
What is the Treatment: for Abuse?
1) Multifactorial approach
- counseling for behavioral change
- education
- self-help groups
2) Individual must have the desire to stop for best chance of success
Drug abuse in Kids?
- Access to store medications at home
- -contributing factor to prescription medication abuse
- -especially problematic for children and teenagers
-a leading cause of visits to the ER due to accidental or intentional overdose
What are the Considerations for Children:
- many drugs must be given to children in doses that are smaller than the adult dose
- children have increased membrane permeability
- allows drugs to be absorbed more quickly and more easily
- doses are determined by the manufacturer
- dosing is based on the weight of the child
- typically, children receive half of the adult dose
What are the Trends for abuse?
1) more children are abusing prescription drugs than cocaine, heroin, hallucinogens and Ecstasy combined
2) Opiates cause more overdoses in adolescents than cocaine and heroin combined
What is misuse?
-misuse of a drug differs from abuse, as misuse implies that drug is being used inappropriately for patient’s disease state
–using the wrong drug for wrong problem, or the wrong dose for a longer period that prescribed
What is Chemical dependency for abuse?
-a primary, chronic, progressive, relapsing disease process with genetic, psychosocial and environmental factors influencing its development and manifestations
-progressive nature of addiction
■ experimental→ social use → abuse → addiction
■ majority of “social users” will become addicted
What are the gateway drugs?
Nicotine and Alcohol
- caution w/ dental patients who report a history of this disease
- remember: relapsing disease
- NO opiates, benzodiazepines, or nitrous oxide
- could make a recovered patient w/ alcoholism relapse
How do you determine? Drug choice
- Strength and efficacy of a given drug play important roles in whether a drug is selected by the drug abuser
- Effects vary significantly (largely dependent on dose and route of administration)
- concurrent use of other drugs is common
- boost desired effects or counter unwanted effects
Basic principles:
- when comparing drugs in the same group, the time required to produce physical dependence is _________with a rapidly metabolised drug and _________ with a slowly metabolized drug
- The time course of withdrawal reactions is related to the ___________of the drug
- shorter the half life, the __________the withdrawal occurs
- shortest
- longest
- half-life of the drug
- quicker
What are the common reasons for relapse following treatment for drug addiction?
- Primary reason = psychological dependence
- perceived “need” or “craving” for a drug, often feel that they cannot function w/o continued use of substance
-Physical dependence disappears w/in days or weeks after drug use stops, but psychological dependence can last much longer
- Caution w/ dental patients who report a history of disease (chemical dependency)
- -No opiates, benzodiazepines or nitrous oxide - could make a recovered patient w/ alcoholism relapse
What is the cardiovascular considerations for treating children who abuse inhalants?
-Difluoroethane - contains halogenated hydrocarbons
- -INCREASES heart muscle sensitivity to epinephrine
- -Can lead to sudden death
- Irregular heartbeat
- Heart attack
- Sniffing correction fluid can stop your heart
What are the consequences of IV drug abuse?
- IV injection of opioid drugs often results in:
- -Hepatitis B
- -HIV infection
- -TB
- -Damaged heart valves (IV drug users require antibiotics premed prior to receiving any dental treatment)
- Never provide treatment to patients who are under the influence
- Use good infection control and PPE when treating
What is the Poison Prevention Act of 1970s?
1) to prevent accidental drug intoxication in children
2) prescription must be dispensed in child-resistant containers
3) Exceptions= arthritis patients
What are the trends in children?
- More children are abusing prescription drugs than cocaine, heroin, hallucinogens + Ecstasy combined.
- Opiates cause more overdoses in adolescents than cocaine and heroin combined
Inhalants are ______ to abuse. “huffing” out of can or sniffing or bagging.
They are readily ___________
Manufacturers of difluroethane add _______ to discourage use.
easiest
accessible
bitterants
What are the harmful effects of inhalants?
1) Permanent brain damage memory loss
2) hearing loss
3) nose bleeds loss of smell
4) slurred speech
5) suffocation sudden death
6) irregular heart beat and heart attack (death)
7) nausea and vomiting
8) liver/kidney damage
9) muscle weakness and cramping
10) abdominal pain
11) involuntary passing of urine and feces
12) bone marrow depression
What are the causes of death of inhalants?
1) suffocation
2) respiratory depression
3) **Hepatotoxicity = cumulative damage
4) sudden sniffing death
What are other OTC drugs abused by children?
1) cough meds w/ dextromethorphan (DXM)
2) robotripping
3) Coricidin HBP (w/o acetaminophen) “Triple C” skittles
4) Energy and diet drinks
What are the conclusions of monitoring the future study?
- alcohol use continues to decline (41%)
- binge drinking declined (12%)
- Cigarette use reached historical lows in 2014
- Increasing peer disapproval
- E-cigarettes surpass tobacco cigarettes among teens
- illicit drug use declined (synthetic marijuana)
- Most students do NOT recognize synthetic marijuana as a dangerous drugs
- Bath salts = amphetamine-like sim
What are the Symptoms of withdrawal from opiate analgesics?
1) insomnia
2) nausea/vomiting
3) restlessness
4) diarrhea
5) cold flashes
6) muscle spasms
7) tremors
8) tachycardia
9) anxiety
10) sweating
11) muscle/bone pain
What is the treatment of opiate addiction?
1)** naloxone (Narcan)
■ used to reverse respiratory depression, pinpoint pupils and coma
■ oral surgeons have this drug in office emergency
■ Used for acute narcotic overdose
2) methadone
■ **long-acting opioid that can replace heroin then be gradually withdrawn
■ **physiologically equivalent drug to heroin that is used during long-term rehabilitation
What are the Dental implications of opioid users?
- They may require higher levels of pain meds to get desired effect
- Watch for drug-seeking behaviors: pts will ask for potent meds
**IV drug users require ABX premed prior to receiving dental treatment
What are the signs of acute opioid overdose?
1) Fixed, pinpoint pupils (miosis)
2) Depressed respiration
3) Hypotension
4) Shock
5) Slow or absent reflexes
6) Drowsiness
7) coma
* *know these
What are the important drugs used as antidotes to manage opiate overdose?
1) naloxone (Narcan)
2) methadone
What are the important drugs used as antidotes to manage BDZ overdose?
1) flumazenil
■ BDZ antagonist = “blocker” drug
■ Will not block CNS effects from alcohol, barbiturates, general anesthetics or opiates
■ May not reliably reverse respiratory depression/hypoventilation
● Establish airway
● Provide ventilation
2) BDZ reversal may cause seizures = be prepared to manage
What its the Pharmacology of alcohol?
- Most frequently abused drug
- Ethyl alcohol is rapidly and completely absorbed from the GI tract
- Oxidized in the liver to acetaldehyde, which is then metabolized to CO2 + H2O
- Excreted in lungs + urine
- Eliminated by zero order kinetics
- -a constant amount of alcohol is metabolized and eliminated per unit of time regardless of how much alcohol has been ingested - 1g per hour
- Excessive intake of alcohol can produce a prolonged effect
What are the signs of Intoxication?
1) Impaired judgment
2) Emotional instability
3) Nystagmus
4) Slurred speech
5) Dilated pupils
6) Ataxia
What are the signs of Severe Intoxication?
1) Seizures
2) Coma
3) Death
What are the Oral complications of alcoholism? (know these!)
1) Glossitis
2) Loss of tongue papillae
3) Angular cheilitis
4) Fungal infections
5) Bleeding (from liver damage)
6) Oral cancer (squamous cell)
7) Leukoplakia and ulceration of lateral borders of the tongue
What are the Considerations of alcohol use in older adults?
1) **Decreased body water and lean body mass
- Higher concentration of alcohol, 20% increase in peak blood level
2) **Decline in liver and kidney function
3) Malnutrition/weight loss (caused by cirrhosis, heart disease, pancreatitis, pancreatic carcinoma)
4) Injuries/falls
The elderly more sensitive to the alcoholic effects of what ?
1) **Metabolize alcohol more slowly
2) Alcohol stays in body longer
3) **Decreased body water = alcohol more concentrated
4) Aging lowers body’s tolerance
5) ***Older people develop problems with alcohol even if drinking habits have not changed
What are the consequences of chronic alcoholism in elderly individuals?
1) Biological brain disorder
2) Systemic health problems
3) Fatigue, weight loss
4) Worsening of existing conditions
5) Psychological
What are the Biological brain disorder associated with chronic alcoholism in the elderly ?
- simple withdrawal
- DTs (Delirium tremens)
- Seizures
- Organic hallucinations
- Psychosis
- Dementia
What are the Systemic Health problems associated with chronic alcoholism in the elderly ?
- liver damage/cirrhosis
- peripheral neuropathies
- damaged organs
- increased risk for certain cancers and immune disorders
What is the fatigue, weight loss of chronic alcoholism in the elderly caused by?
- cirrhosis
- heart disease
- pancreatitis
- pancreatic carcinoma
What is the worsening of existing conditions of chronic alcoholism in the elderly caused by?
- diabetes
- hypertension
- CHF
- liver probs
- memory probs
