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Addiction Boards > Foundations > Flashcards

Foundations Flashcards

1
Q

What is ASAM Level 0.5?

A

Early Intervention

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2
Q

What is ASAM Level 1?

A

Outpatient Treatment

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3
Q

What is ASAM Level 2?

A

IOP (9 hours) and Partial Hospitalization (20 hours)

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3
Q

What is ASAM Level 3?

A

Inpatient / Residential

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4
Q

What is ASAM Level 4?

A

Medically Managed Intensive Inpatient

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5
Q

What is at risk drinking?

A

Drinking more than recommended limits without meeting SUD criteria

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6
Q

How common AUD?

A

30% population

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7
Q

Percentage of people who need SUD Tx and actually receive?

A

10%

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8
Q

10 people with AUD with chronic severe form?

A

10%

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9
Q

Percentage of population that are abstainers?

A

25

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10
Q

Percentage of population with social use?

A

50

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11
Q

Percentage of population hazardous use?

A

15

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12
Q

Percentage of population AUD?

A

10

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13
Q

What is primary prevention?

A

Preventing initiation of something

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14
Q

What is secondary prevention?

A

Achieve early detection, diagnosis and treatment of affected individuals

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15
Q

What is tertiary prevention?

A

Diminish the incidence of complication of a disease

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16
Q

What is universal prevention?

A

Targets the whole population

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17
Q

What is selective prevention?

A

Targeting those at slightly higher risk

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18
Q

What is indicated prevention?

A

Targeting those who are already at high risk

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19
Q

What should you do when giving narcan?

A

Call 911

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20
Q

Enzyme induction by tobacco smoke?

A

CYP1A2

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21
Q

Enzymes induced by nicotine

A

CYP2D6
CYP2B6
CYP2E1

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22
Q

Drugs impacted by CYP2D6

A

TCA’s
SSRI/SNRIs
BB
Tramadol
Methadone

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23
Q

Drugs impacted by CYP2B6?

A

Bupropion
Cyclophosphamide
Efavirenz
IFosfamide
Methadone

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24
Q

Drugs impacted by CYP2e1

A

Inhalational anesthetics
Acetaminophen
Ethanol
Theophylline

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25
Q

What happens when you induce a CYP?

A

Decreases level of drug, if stabalized before starting to smoke, you may not need higher dose. If already smoking your initial dose would be higher than norm, but levels will elevated if you stop

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26
Q

Drugs impacted by CYP1A2

A

1 and SGAs
Clozapine
Fluvoxamine
Theophylline
Caffeine
R-warfarin

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27
Q

Symptoms methyl etoh intox?

A

home distilled/grapes, grains:
toxic optic neuritis - blindness
severe metabolic acidosis
ATN
renal failure

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28
Q

What is Isopropyl alcohol and risk?

A

Cleaning solvent:
- usually mild acidosis
- rarely severe
- risk kidney failure

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29
Q

What is Ethylene glycol and risk?

A

(antifreeze):
increased excretion Ca2+ oxalate crystals
severe metabolic acidosis; ATN,
renal failure

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30
Q

What does the following suggest:
- level of intoxication incompatible with BAC
- high anion gap (>15)
- lactic acid not
sufficient to explain anion gap

A

Intoxication with another etoh subtype

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31
Q

Rx for intoxication in non common etoh?

A

Fomepizole

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32
Q

What is Marchiafava-Bignami syndrome?

A

Italian red wine: damage to corpus callosum, psychosis, seizures,
paralysis

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33
Q

What is Alcohol-tobacco amblyopia?

A

Blurred and/or double vision, muscle weakness

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34
Q

What does Vick’s inhaler give falst positive for?

A

Meth - run isomer study

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35
Q

Which med is positive on opiate assay?

A

hydromorphone

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36
Q

How does ADA impact drug screening?

A

-Employers with >15 employees
-Cannot discriminate SUD if in treatment for or hx of SUD

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37
Q

FMLA and SUD screening?

A

-Public agencies and private employers >50
*Employees on job > 1 year and >1,250 hours in past 12 months
-12 weeks of unpaid, job-protected leave to address own health or of family member

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38
Q

Drug-Free Workplace Act of 1988?

A

-Most employers not required to have a drug-free workplace policy
-Any employer receiving federal grants or contracts must be drug-free
-Does not specifically allow for workplace drug testing

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39
Q

Civil Rights Act of 1964?

A
  • > 15 employees
    -Drug testing programs must be, Culturally competent, Fairly enforced, and Sensitive
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40
Q

National Labor Relations Act of 1935?

A

-Drug testing affecting unionized workers must be Negotiated with union
– Even when another federal required

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41
Q

Can schools drug test?

A

Only for extracurriculars

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42
Q

What does oxycodone break down to?

A

Oxymorphone

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43
Q

What does clonazepam break down to?

A

7 amino clonazepam

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44
Q

What are the OARS?

A

The Four Core Skills of Motivational Interviewing (MI):
1.Open Questions
2.Affirming
3.Reflective Listening
4.Summarizing

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45
Q

What is the spirit of MI?

A

PACE
Partnership
Acceptance
Compassion
Evocation

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46
Q

Four processes of MI?

A

EFEP
Engaging
Evoking
Focusing
Planning

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47
Q

What for of arrhythmia is torsades?

A

V tach

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48
Q

Prevalence NAS in MOUD?

A

-40-60%
-Less common & Severe with Bup

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49
Q

What can Combination METHADONE + COCAINE cause?

A

Toxic leukoencephalopathy - initial recovery, then mental status
changes led to lethal catatonia. MRI findings of leukoencephalopathy

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50
Q

Common causes false positive stimulants?

A

High doses of caffeine,
Decongestants: pseudephedrine, ephedrine, oxymetazolone, PPA

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51
Q

What does uspstf recommend for tobacco screening?

A

All adults and pregnant woman

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52
Q

How does nida define heady drinking for men?

A

5 day / 14 week

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53
Q

How does nida define heady drinking for men?

A

4 day / 7 week

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54
Q

How many questions in Audit? What does it screen for?

A

10, etoh, self administered
7 low risk
15 - dependence

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55
Q

Safe etoh level for pregnant?

A

0

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55
Q

What does S2Bi screen for?

A

Adolescent use placing into risk category

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55
Q

Etoh screeners for pregnancy?

A

Tweak - T Ace
- Tolerance and Cutdown score higher

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55
Q

What is DAST?

A

Adults and older use for SUD

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55
Q

What is TAPS?

A

Daults only, nicotine, etoh, others

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55
Q

Screeners for adolescents placing in risk groups?

A

S2BI

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56
Q

BSTAD?

A

Brief screener eoth tobac other drugs
- For youth

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57
Q

What is CRAFFT?

A

Screener for adolescents and peds

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58
Q

Strength SBIRT etoh adults?

A

Grade B

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59
Q

when do most relapse occur?

A

in the first 90 days after discharge from treatment (80%). actually first 30.

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60
Q

number avg attempts b4 year sobriety?

A

5-7

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61
Q

odds recurence if sober at five years?

A

15%

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62
Q

completion rate LT community?

A

10-25%

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63
Q

% inmates with SUD?

A

60%

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64
Q

Compliance in disulfarim with spousal contract?

A

90%

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65
Q

Most common psychiatric disorder with SUD?

A

MDD

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66
Q

Increased risk of SUD with BPD?

A

4x

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67
Q

Most common SUD in psychiatric illness?

A

Tobacco, highest in schizo

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68
Q

Personality disorder highest in SUD?

A

Antisocial

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69
Q

Increased risk suicide in dual diagnosis?

A

11x

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70
Q

% getting treatment for mental illness and SUD?

A

10%

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71
Q

pathophys of why schizo smokes more?

A

lower level nicotinic ach receptors, involved in cognition and memory activated by ach and nicotine

72
Q

Mortality decrease in MOUD?

A

2/3

73
Q

Risk of suicide no MOUD?

A

4x

74
Q

Stopping MOUD risk on suicide?

A

6x at two weeks

75
Q

Number 1 and two behavioral health diagnosis risk for AUD?

A
  1. Antisocial
  2. BPD
76
Q

What is the single model of treatment?

A

Single model of treatment: Treating primary psychiatric disorder and SUD will remit

77
Q

What is the Sequential model of treatment?

A

Treat each problem sequentially

78
Q

What is the Parallel model of treatment?

A

Treat both problems at different settings

79
Q

What is the Integrated model of treatment?

A

Treat both problems in same setting (preferred)

80
Q

What diagnosis is DBT helpful for?

A

Borderline

81
Q

How does DBT work?

A

Helps with affective regulation and reducing self-harm (e.g., suicidal attempts, thoughts, or urges;
cutting; drug use)

82
Q

What is Assertive Community Treatment (ACT)?

A

– Case management with emphasis on small case load, individualized approach, assertive outreach, close
contact, and team management
– An integrated treatment for severe mental illnesses

83
Q

What is the Most effective and least utilized psychosocial treatment for SUDs?

A

Contingency Management

84
Q

What is the Seeking Safety (SS)?

A

– Integrated present-focused therapy to learn skills for coping with trauma/posttraumatic stress disorder
AND substance use disorder
– Target trauma-related problems (including PTSD) and substance use disorder simultaneously

85
Q

What is * Integrated Group Therapy (IGT)?

A

– Adjunct to Rx and is based on CBT principles, integrated therapy for patients with BP & SUD
– Helps patients understand te relationship between disorders, and link between thoughts
/ behaviors, and how they contribute to recovery and relapse

86
Q

What is * Acceptance and Commitment Therapy (ACT)?

A

– Encourages embracing thoughts / feelings rather than fighting or feeling guilt
– Combines mindfulness with self-acceptance
– Help patients accept what is out of their control, and commit instead to actions that enrich lives
– Helpful for MH and SUD diagnoses and chronic pain

87
Q

Preferred med AUD BPD?

A

valproate

88
Q

Preffered med schizo SUD?

A

Clozapine

89
Q

What enzyme does disulfiram inhibit that can lead to psychosis?

A

Dopamine-β-hydroxylase
- Low does and close monitoring in schizo

90
Q

How does methadone prolong QT?

A

inhibits cardiac potassium channels

91
Q

What can naltrexone worsen?

A

Depression

92
Q

FDA approved meds for MTSD?

A

Sertraline and paroxetine

93
Q

Prevalence TUD with ADD?

A

50%

94
Q

What is cluster A?

A

Paranoid, schizoid, schizotypal

95
Q

What is cluster B?

A

Antisocial, borderline, histrionic, narcissistic

96
Q

What is cluster C?A

A

Avoidant, dependent, obsessive compulsive

97
Q

Rate of AUD/ SUD in eating disorder?

A

AUD: 25%
SUD: 20%

98
Q

cutoff at which to expect aws?

A

150: if showing intoxication at or below likely not tolerant

99
Q

when seizure hallucination in aws?

A

24-48h

100
Q

when DTs in AWS?

A

48-96

101
Q

standard drink?

A
  • 1.5 oz 80 proof spirits (40%)
  • 4-5 oz table wine (8%-12%) – Fortified wines may be up to 20%
  • 12 oz Beer (6%)
  • All these contain from 13-15 grams ethanol
102
Q

parenteral dose adjustmet benzos?

A
  • oral 50% first pass hepatic metabolism
  • use 1/2 dose adj if parenteral
103
Q

success rate cold turkey smoking?

A

5%

104
Q

What is the bioavailability of IV?

A

1

105
Q

How many half lives to reach steady state?

A

5

106
Q

What are zero order kinetics?

A

Rate of drug removal is constant: etoh

107
Q

What is first pass metabolism?

A

Happens before drug reaches systemic circulation. More prevalent in oral and lipid soluble drugs

108
Q

Main CYP in metahdone metabolism?

A

CYP3A4

109
Q

How do psychoactive substances work in the nucleus acumbens?

A

Increase dopamine here
- Naturally rewarding activities
also increase De release in
mesolimbic pathway from
VTA to NA

110
Q

What does acute administration of psychoactive drugs and dependence causes in the basal ganglia?

A

Increase in De transmission in basal ganglia

111
Q

What activates the VTA-nucleus accumbens pathway?

A
  • All psychoactive substances
    -This pathway is important not only in drug dependence but also in physiological behaviors such as
    eating, drinking, sleeping, sex
112
Q

3 regions of brain involved in activation of behavior?

A
  1. Prefrontal cortex
  2. Amygdala
  3. Nucleus accumbens
113
Q

Where do fear based behaviors live?

A

Amygdala

114
Q

Where do motivation based behaviors live?

A

Nucleus acumbens

115
Q

What does the VTA do?

A
  • Projections from VTA release De in circuit in response to motivationally relevant event
  • Facilitates cellular changes that establish learned associations with event
116
Q

Part of brain involved in choice?

A
  • Choice initiated in part by means of the PFC
  • Activation of PFC precedes behavior
117
Q

What is thought to be the final common pathway?

A
  • Strong linkage between PFC and drug-seeking behavior
  • Dysregulation in anterior cingulate cortex and orbitofrontal cortex is critically involved in difficulty
    experienced by addicted individuals in control over drug-seeking behavior
  • Hyperactivity of anterior cingulate and orbitofrontal cortex contributes to compulsive behaviors
118
Q

Effect of cocaine on NTs?

A

Inhibits monoamine reuptake transporters (MATs): reuptake of DA

119
Q

Effect amphetamines on NTs?

A
  • Inhibits MATs
  • Increase quantity of DA release
120
Q

Effects ETOH on NTs?

A
  • Stimulates GABAA receptor
  • Inhibits NMDA receptors
  • Stimulates opioid and cannabinoid receptors
121
Q

Effets nicotine on NTs?

A

Agonist at nicotinic acetylcholine

122
Q

Effects Cannabis on NTs?

A

Agonists at cannabinoid (CB)

123
Q

Effects hallucinogens on NTs?

A

Partial agonists at 5-HT2A

124
Q

Effects PCP on NTs?

A

Antagonist at NMDA glutamate

125
Q

What is Lofexidine?

A

α2-adrenergic agonist: produces cellular effects akin to OPR activation and lessens many of withdrawal symptoms/signs in humans

126
Q

Which NT has emerged as a potential new target to prevent
relapse, especially from alcohol cues?

A

Glutamate - might have large role in relapse

127
Q

What is Anandamide?

A

Neurotransmitter found in humans activating the cannabinoid receptors
CB1/CB2

128
Q

Can you establish risk from case / control?

A

NO

129
Q

What is a cohort study?

A

Investigators identify groups with and without exposure, then follow groups over time to compare incidence of disease
- Usually are prospective
- Risk can be established

130
Q

What is the incidence proportion?

A

Number new cases of disease during specified period / Size population at start of period

131
Q

What is incidence rate?

A

Number new cases during period /
Time each person observed totaled for all persons
- Can accommodate person coming into / leaving study (since person-time is calculated for each subject)

132
Q

Definition prevalence?

A

Total number cases during a given period / Population during time period

133
Q

What is the risk ratio (relative risk)?

A

Risk (cumulative incidence) in exposed group / Risk (cumulative incidence) in unexposed group

134
Q

Another name for risk ratio?

A

Relative Risk

135
Q

What does RR = 1 signify?

A

No difference in incidence among those with or without characteristic

RR < 1
Signifies a lower risk, which may indicate a protective effect
associated with the characteristic

136
Q

What does RR greater than one mean?

A

Increased risk disease associated with characteristic

137
Q

What does RR less that one mean?

A

Lower risk, may indicate protective effect associated with characteristic

138
Q

What is the NNT?

A

1 / Absolute risk reduction

139
Q

Definition sensitivity?

A

Number people w/ disease AND tested positive /
Number of people who have the disease

Number of people with no disease AND tested negative
Number of people with no disease

140
Q

Definition specificity?

A

Number of people with no disease AND tested negative / Number of people with no disease

141
Q

PPV?

A

True positive / True positive + False positive

142
Q

NPV?

A

True Negative / True Negative + False Negative

143
Q

What is the mean?

A

Average

144
Q

What is the median?

A

50th percentile

145
Q

What is the mode?

A

Number most frequent

146
Q

What happens to standard deviation if sample size increases?

A

Decreases

147
Q

Values that lie within various SDs?

A

As long as normal distribution, following rules apply:
– 68% lie within 1 SD of mean
– 95% lie within 2 SDs of mean
– 99.7% lie within 3 SDs of mean

148
Q

Main factors influencing power of a study?

A
  1. Effect size: as magnitude of difference increases, power increases
  2. Variability of outcome measure: as variability of outcome decreases, power increases
  3. Sample size: as size of sample increases, power increases
149
Q

Denition of power?

A

Probability of rejecting a false null hypothesis: likelihood a study will detect an effect when there is an effect there

150
Q

What is a null hypothesis?

A

There is no association between exposure of interest and outcome

151
Q

What is the P value?

A

Probability, under null hypothesis, of obtaining a result equal to or more extreme than what was observed

152
Q

What P value is significant?

A

Less than 0.05

153
Q

What is type 1 error?

A

Probability of rejecting null hypothesis when it is in fact true: saying you found something when you didn’t
- A false positive

154
Q

What is type II error?

A

Probability of accepting null hypothesis when it is false: not finding something when there was something there
- A false negative

155
Q

Gender risk AUD?

A

Males: 2:1

156
Q

Ethnic low and high risk AUD?

A

High: native american
Low: Asian American

157
Q

AUD more prevalent urban or rural?

A

Urban

158
Q

Do men or woman progress more quickly in their SUD?

A

Woman

159
Q

Increased death risk in woman AUD?

A

50%–100% higher than men, including deaths from suicides,
alcohol-related accidents, heart disease, stroke, and liver disease

160
Q

When AUD most prevalent?

A

19 years of age
- Earlier the first use the higher the risk

161
Q

Heavy drinking cutoff for men and woman?

A

Men: five drinks
Woman: 4 drinks

162
Q

Most commonly used illicit substance?

A

THC

163
Q

AUD vs. SUD prevalence?

A

AUD 2x more prevalent
- AUD: 30 percent lifetime
- Drug: 10% lifetime

164
Q

How many people use etoh in past month?

A

50%

165
Q

People die annually from etoh?

A

95k

166
Q

Percent TCH use in past year by young adults?

A

35%

167
Q

When smoked, how does nicotine compare in dependency?

A

Higher dependence liability than opiates, alcohol

168
Q

Highest risk factor for disease burden in world?

A

Smoking, after hypertension

169
Q

Leading cause of preventable death in US?

A

Tobacco: 1/5 deaths

170
Q

Life expectancy of smoker?90

A

10 years less
- Quitting before 40 decreases that risk by 90%

171
Q

What % opiate users used pills?

A

90

172
Q

hcv rate ivdu?

A

1/3 positive in one year
-53% in five years

173
Q

example opiates?

A

Morphine
Codeine
Thebaine

174
Q

Semisynthetic opioids?

A

Heroin from morphine
Buprenorphine & oxycodone from thebaine

175
Q

2 common synthetic opioids?

A

Methadone and fentanyl

176
Q

where are opiods metabolized?

A

liver

177
Q

renal and hepatic impact opiods?

A

Impaired hepatic function could increase concentrations of opioids and impaired renal function could
cause accumulation of metabolites

178
Q

Effect based on neural binding site opiods?

A

Thalamus: produces analgesia
Cortex: impaired thinking/balance
Prefrontal cortex: decision about how important use of the drug is
VTA)/nucleus accumbens: euphoria

179
Q

Hyperactivity of nor-adrenergic neurons in locus coeruleus causes in opioid withdrawal?

A

– Increased BP, HR, respirations
– Increased sweating, diarrhea
– Clonidine & opiates reverse these effects

180
Q

Increased γ-Aminobutyric acid (GABA) effects in opioid withdrawal?

A

Reduced dopamine in the nucleus accumbens cause:
– Dysphoria, depression, craving
– Only opiates (methadone and buprenorphine) reverse these effects

181
Q

Time course withdrawal short acting?

A
  • Begins 6-12 hours after last dose
  • Peaks 36-72 hours, and lasts about 5 days
182
Q

Time course withdrawal long acting?

A

Methadone: 36-72 hours; may be as short as 20 hours in rapid metabolizers,
also a longer period before peak effects occur

183
Q

How long does narcan dose last?

A

1-4 hours

184
Q
A

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