Final Exam Flashcards
Drug addiction
- aka substance dependence
- compulsive drug use despite adverse consequences for user
- may or may not include tolerance and physical dependence
Drug abuse
- pattern of drug use that produces recurrent and significant adverse consequences related to repeated use
- does not necessarily include tolerance or physical dependence
Tolerance
- reduction in effects of a specific dug due to repeated use
Brain circuits
- 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)
Nicotine
- target: nicotinic ACh receptors
- influx of Ca into cell => action potential
Amphetamine
- target: vesicular monoamine storage -> VMAT2 transporter substrate
- competes with DA for vesicles so DA levels build up and are released via DAT transporter
Cocaine
- target: DAT transporter antagonist
- reuptake blockade of dopamine
- homology between DAT transporters and NEPI and 5HT transporters
Cannabinoids
- target: CB1 and CB2 receptors
- receptors have high density throughout CNS
Barbituates and benzodiazepines
- target: allosteric sites of GABA-A receptor
- inhibit neurotransmission: activate chloride channels
- can also block GLU receptors
Hallucinogens and phencyclidine
- NMDA receptor and 5HT receptor
Inhalants and ethanol
- NMDA (negative) and GABA-A (positive) receptors
- disinhibits DA neurons in VTA
- withdrawal has opposite molecular effects
Opioids
- target: mu opioid receptor
- also release DA because receptor is expressed on VTA DA neuron
- G protein coupled receptor
- morphine, methadone, heroin
12 step program features
- misused substance is a symptom
- I am the problem (attitudes, reactions)
- there is a spiritual solution
- power through surrender
SMART recovery features
- 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
12 steps
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
SMART recovery 4 points
- Enhancing motivation to change
- Coping with urges
- Managing thoughts, feelings, and behaviors
- Lifestyle balance (emphasizing enduring satisfactions rather than immediate gratification)
Criteria for substance use disorder
- 11 criteria
- severity: 0-1 = no diagnosis; 2-3 = mild; 4-5 = moderate; 6+ = severe
Role of primary provider: prevention
- 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
Role of primary provider
- prevention
- screening
- assessment and diagnosis
- preliminary treatment plan
- treatment and referral
- follow-up
Blood alcohol concentrations (mg/dL)
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
Type I alcoholism
- late onset
- males and females
- after 25 years
- able to abstain
- anxious, depressed, passive-dependent
- 2/3 functional intermediate
Type II alcoholism
- early onset
- mainly males
- before age 25
- most unable to abstain
- antisocial, conduct disorder, impulsive
- 4/5 antisocial, severe/chronic
Neurobiological susceptibility to alcoholism
- prefrontal midbrain neuron is dysfunction: temperamental deviations
- pre-existing serotonin deficit
- D2 dopamine receptor gene mutation
- lower baseline plasma beta-endorphins
Stages of change
- pre-contemplation: give feedback
- contemplation: psychotherapy to deal with ambivalence
- preparation: menu of treatment options
- action: let patient choos
- maintenance: relapse prevention
Treating alcohol withdrawal
- anxiolytics and benzodiazepines (short and long acting)
Medications for managing alcoholism
- disulfiram: blocks action of aldehyde DH = nausea
- naltrexone: most effective; reduces cravings and relapse
- axamprosate
- ondansetron
- topiramate
Nicotine withdrawal symptoms
- nicotine craving
- irritability, anger, impatience
- restlessness
- difficulty concentrating
- insomnia
- anxiety
- depressed mood
- increased appetite
Smoking cessation treatment
- nicotine replacement
- bupropion SR
- varenicline
Physician intervention for smoking cessation
- ask (about smoking)
- advise (to quit)
- assess (readiness)
- assist (in attempt)
- arrange (follow-up)
Positive effects of cocaine
- euphoria
- garrulousness
- decreased sleep
- decreased appetite
- sexual stimulation
Negative effects of cocaine
- irritability
- anxiety
- restlessness
- paranoia
Local complications of cocain
- irritation/ulcers of nasal mucosa
- rhinorrhea
- nasal septal perforation
- pulmonary dysfunction
- dental/gum problems
Cardiovascular complications of cocaine
- MI
- ventricular dysrhythmias
- cardiomyopathy
- endocarditis
Neurological complications of cocaine
- hemorrhagic stroke
- ischemic stroke
- grand mal seizures
Cocaine metabolism
- metabolized by plasma cholinesterases
- metabolite is benzoylecgonine (BE); in urine up to 48 hours
Marijuana clinical effects
- 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
Amphetamines
- releases dopamine
- sympathetic discharge, hyperthermia, sweating, tachycardia, HTN
- releases serotonin: euphoria
- meth mouth, crank bugs, burns
Pseudoaddiction
- opiophobia
- misinterpretation of relief-seeking behaviors caused by under treatment of pain that is identified by clinician as inappropriate drug-seeking behavior
