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Addiction Medicine > Final Exam > Flashcards

Final Exam Flashcards

1
Q

Drug addiction

A
  • aka substance dependence
  • compulsive drug use despite adverse consequences for user
  • may or may not include tolerance and physical dependence
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2
Q

Drug abuse

A
  • pattern of drug use that produces recurrent and significant adverse consequences related to repeated use
  • does not necessarily include tolerance or physical dependence
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3
Q

Tolerance

A
  • reduction in effects of a specific dug due to repeated use
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4
Q

Brain circuits

A
  • generalized memory and LTP
  • origin is ventral tegmental area (VTA), which releases DA in nucleus accumbens
  • withdrawal results in decreased DA release in NAcc
  • DA from VTA activates GABA neuron
  • GABA neuron inhibits DA in VTA (brake) OR disinhibits DA in VTA via Ventral Pallidum (accelerator)
  • VTA DA cells also stimulate GLU cells in prefrontal cortex
  • GLU cells can stimulate VTA DA cells (accelerator) or stimulate either GABA pathway in NAC (brake or accelerator)
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5
Q

Nicotine

A
  • target: nicotinic ACh receptors

- influx of Ca into cell => action potential

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6
Q

Amphetamine

A
  • target: vesicular monoamine storage -> VMAT2 transporter substrate
  • competes with DA for vesicles so DA levels build up and are released via DAT transporter
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7
Q

Cocaine

A
  • target: DAT transporter antagonist
  • reuptake blockade of dopamine
  • homology between DAT transporters and NEPI and 5HT transporters
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8
Q

Cannabinoids

A
  • target: CB1 and CB2 receptors

- receptors have high density throughout CNS

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9
Q

Barbituates and benzodiazepines

A
  • target: allosteric sites of GABA-A receptor
  • inhibit neurotransmission: activate chloride channels
  • can also block GLU receptors
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10
Q

Hallucinogens and phencyclidine

A
  • NMDA receptor and 5HT receptor
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11
Q

Inhalants and ethanol

A
  • NMDA (negative) and GABA-A (positive) receptors
  • disinhibits DA neurons in VTA
  • withdrawal has opposite molecular effects
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12
Q

Opioids

A
  • target: mu opioid receptor
  • also release DA because receptor is expressed on VTA DA neuron
  • G protein coupled receptor
  • morphine, methadone, heroin
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13
Q

12 step program features

A
  • misused substance is a symptom
  • I am the problem (attitudes, reactions)
  • there is a spiritual solution
  • power through surrender
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14
Q

SMART recovery features

A
  • disruptive thinking about misused substance is the problem
  • I can solve the problem
  • tools are learned to deal with situations
  • power through knowledge of techniques
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15
Q

12 steps

A

1-3: acknowledge powerlessness and relinquish control
4-7: introspective; reflect on behavior and affected relationships with others
8-9: make amends
10-12: maintenance and helping others

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16
Q

SMART recovery 4 points

A
  1. Enhancing motivation to change
  2. Coping with urges
  3. Managing thoughts, feelings, and behaviors
  4. Lifestyle balance (emphasizing enduring satisfactions rather than immediate gratification)
17
Q

Criteria for substance use disorder

A
  • 11 criteria

- severity: 0-1 = no diagnosis; 2-3 = mild; 4-5 = moderate; 6+ = severe

18
Q

Role of primary provider: prevention

A
  • primary: discussion with patients and families and evaluation of risk factors
  • secondary: assessment of high risk patients who have begun drug use but are not yet problematic
  • tertiary: prevention of progression and reduction of morbidity/mortality where substance use disorders exist
19
Q

Role of primary provider

A
  • prevention
  • screening
  • assessment and diagnosis
  • preliminary treatment plan
  • treatment and referral
  • follow-up
20
Q

Blood alcohol concentrations (mg/dL)

A

20-50: exhilaration, loss of inhibitions
50-100: impaired judgement and coordination
100-150: difficulty with gait and balance
150-250: lethargy, difficulty sitting upright
300: coma in non-habituated drinker
400: respiratory depression
600: death

21
Q

Type I alcoholism

A
  • late onset
  • males and females
  • after 25 years
  • able to abstain
  • anxious, depressed, passive-dependent
  • 2/3 functional intermediate
22
Q

Type II alcoholism

A
  • early onset
  • mainly males
  • before age 25
  • most unable to abstain
  • antisocial, conduct disorder, impulsive
  • 4/5 antisocial, severe/chronic
23
Q

Neurobiological susceptibility to alcoholism

A
  • prefrontal midbrain neuron is dysfunction: temperamental deviations
  • pre-existing serotonin deficit
  • D2 dopamine receptor gene mutation
  • lower baseline plasma beta-endorphins
24
Q

Stages of change

A
  • pre-contemplation: give feedback
  • contemplation: psychotherapy to deal with ambivalence
  • preparation: menu of treatment options
  • action: let patient choos
  • maintenance: relapse prevention
25
Q

Treating alcohol withdrawal

A
  • anxiolytics and benzodiazepines (short and long acting)
26
Q

Medications for managing alcoholism

A
  • disulfiram: blocks action of aldehyde DH = nausea
  • naltrexone: most effective; reduces cravings and relapse
  • axamprosate
  • ondansetron
  • topiramate
27
Q

Nicotine withdrawal symptoms

A
  • nicotine craving
  • irritability, anger, impatience
  • restlessness
  • difficulty concentrating
  • insomnia
  • anxiety
  • depressed mood
  • increased appetite
28
Q

Smoking cessation treatment

A
  • nicotine replacement
  • bupropion SR
  • varenicline
29
Q

Physician intervention for smoking cessation

A
  • ask (about smoking)
  • advise (to quit)
  • assess (readiness)
  • assist (in attempt)
  • arrange (follow-up)
30
Q

Positive effects of cocaine

A
  • euphoria
  • garrulousness
  • decreased sleep
  • decreased appetite
  • sexual stimulation
31
Q

Negative effects of cocaine

A
  • irritability
  • anxiety
  • restlessness
  • paranoia
32
Q

Local complications of cocain

A
  • irritation/ulcers of nasal mucosa
  • rhinorrhea
  • nasal septal perforation
  • pulmonary dysfunction
  • dental/gum problems
33
Q

Cardiovascular complications of cocaine

A
  • MI
  • ventricular dysrhythmias
  • cardiomyopathy
  • endocarditis
34
Q

Neurological complications of cocaine

A
  • hemorrhagic stroke
  • ischemic stroke
  • grand mal seizures
35
Q

Cocaine metabolism

A
  • metabolized by plasma cholinesterases

- metabolite is benzoylecgonine (BE); in urine up to 48 hours

36
Q

Marijuana clinical effects

A
  • stimulation: increase BP, P, RR, appetite; decrease executive function
  • sedation: dry mouth, slurred speech, uncoordinated movements, anti-emetic
  • anesthesia: pain relief, memory, & judgement loss
  • hallucinogen: mild euphoria, visual, delusional, paranoia
37
Q

Amphetamines

A
  • releases dopamine
  • sympathetic discharge, hyperthermia, sweating, tachycardia, HTN
  • releases serotonin: euphoria
  • meth mouth, crank bugs, burns
38
Q

Pseudoaddiction

A
  • opiophobia
  • misinterpretation of relief-seeking behaviors caused by under treatment of pain that is identified by clinician as inappropriate drug-seeking behavior

Addiction Medicine (1 decks)

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