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CLINICAL TOXICOLOGY > MANAGEMENT OF SUBSTANCE USE DISORDERS > Flashcards

MANAGEMENT OF SUBSTANCE USE DISORDERS Flashcards

1
Q

What is substance use disorder

A

Persistent use of substances illegal or illicit despite substantial harm and adverse consequences
OR
Problematic pattern of use leading to significant impairment or distress

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2
Q

What is drug abuse

A

Inappropriate and usually excessive self-administration of a drug for non-medical purposes

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3
Q

Common combinations of drugs of abuse

A

Alcohol and Heroin
Nicotine and alcohol
Cocaine and Heroin
Cocaine and Benzodiazepines
Heroin and Barbiturates

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4
Q

Why is therapeutic index reduced by tolerance to a drug

A

The toxicity and lethality profile does not shift to the same magnitude or doesn’t shift at all

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5
Q

What is tolerance

A

Reduced reaction to a drug following repeated use

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6
Q

Types of tolerance

A

Innate tolerance
Acquired tolerance

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7
Q

Types of acquired tolerance

A

Pharmacokinetic
Pharmacodynamic

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8
Q

Types of pharmacodynamic adaptations that cause tolerance

A

Short term
Long term adaptation or synaptic plasticity

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9
Q

What is cross tolerance

A

Acquiring tolerance to a drug ad requiring higher than normal doses of a second drug to have its effects.

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10
Q

What causes cross tolerance

A

Enzyme induction

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11
Q

What is sensitization

A

Non associative Progressive amplification of response to a drug on repeated administration

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12
Q

What is sensitization

A

Non associative Progressive amplification of response to a drug on repeated administration

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13
Q

What is sensitization

A

Non associative Progressive amplification of response to a drug on repeated administration

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14
Q

What is a non associative process

A

Non-associative learning is when an individual’s response to a stimulus changes in the absence of new stimuli. It is based on frequency

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15
Q

Types of drug dependence

A

Physiological dependence or Physical dependence
Psychological dependence or addiction

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16
Q

What type of dependence is responsible for withdrawal syndrome

A

Physical dependence

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17
Q

What type of dependence is responsible for withdrawal syndrome

A

Physical dependence

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18
Q

Explain physiological dependence

A

Resetting of homeostatic mechanisms in response to repeated drug use
Drug is needed to maintain near normal function of organs or systems

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19
Q

Which type of dependence causes pleasurable sensations that cause the user to continually seek for the substance or activity

A

Psychological dependence

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20
Q

Drug addiction or substance dependence is a chronically relapsing disorder characterized by ………………..,………..,……..

A
  1. Compulsion to seek and take drug
  2. Loss of control in limiting intake
  3. Emergence of a negative emotional state when access to drug is prevented
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21
Q

Addiction is a chronic relapsing disorder with roots both in …………

A
  1. Impulsivity
  2. Compulsivity
  3. Neurobiological problems
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22
Q

Examples of non-substance addiction they produces a rush or thrill

A

Gambling
Sex
Food
Internet
Mobile devices
Shopping

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23
Q

Four main dopaminergic pathways

A

Nigrostriatal pathway
Mesolimbic pathway
Mesocortical pathway
Tuberohypophyseal or tuberoinfundibular pathway

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24
Q

Describe the nigrostriatal pathway

A

Cell bodies largely in the substantia nigra whose axons terminate in the corpus striatum

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25
Q

Describe the mesolimbic pathway

A

Cell bodies in midbrain ventral tegmental area and fibers project via the medial forebrain to parts of the Lombok system, especially the nucleus acumbens and the amygdaloid nucleus

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26
Q

Describe the mesocortical pathway

A

Cell bodies in the VTA and axons which project via the MFB bundle to the frontal cortex

27
Q

Describe the tuberohypophyseal pathway

A

Neurons running from the ventral hypothalamus to the median eminence and pituitary gland

28
Q

Functions of the mesolimbic pathway

A

Reward and learned behaviors

29
Q

Function of the mesocortical pathway

A

Higher order cognitive functions like motivation, reward, emotion and impulse control

30
Q

Function of the nigrostriatal pathway

A

Regulation of movement

31
Q

Function of the tuberoinfundibular pathway

A

Regulates prolactin secretion

32
Q

Categories of dopamine receptors

A

D1-like (D1, and D5)
Gs coupled - activates adenylyl Cyclase and PKA

D2 like ( D2, D3, D4)
Gi/Go coupled- inhibits adenylyl cyclase, calcium and activates PLC and K

33
Q

Which dopamine receptors are implicated in addiction

34
Q

A example of a sigma receptor agonist

35
Q

Function of the sigma receptor

A

Plays a role in drug addiction

36
Q

What type of receptor is the sigma receptor

37
Q

Which pathway is linked to the sigma receptor

A

MAP kinase pathway

38
Q

What is another name for the brain reward pathway

A

Mesolimbic Dopaminergic pathway

39
Q

Which dopaminergic pathway does all drugs of abuse potential target

A

Mesolimbic pathway

40
Q

Ways in which drugs of abuse act

A

Increase dopamine release
Prevent dopamine reuptake
Prevent dopamine breakdown by enzymes
Stimulate dopamine receptors
Inhibit GABA pathways

41
Q

Class 1 drugs of abuse

A

Opioids
Tetrahydrocannabinol (THC)
Gammahydroxybutyrate (GHB)
LSD
Mescaline
Psilocybin
Act on GPCRs

42
Q

Class 2 drugs of abuse

A

Benzodiazepines
Nicotine
Ethanol
Ketamine
Phencyclidine
Act on channels

43
Q

Class 3 drugs of abuse

A

Cocaine
Amphetamine
Ecstasy
Act on transporters

44
Q

Major connections of the mesolimbic pathway and the functions

A

Locus ceruleus- Arousal and novelty
Amygdala- Stress and anxiety
Hippocampus - Context and memory
Prefrontal cortex- executive function, cognitive control
Orbitofrontal cortex - judgement and decision making

45
Q

How does punishments criticism or disappointment affect dopamine levels on the VTA

A

Decreases dopamine and increased GABA

46
Q

Functions of the ventral pallidum

A

Regulation of motivational salience, behavior and emotion

47
Q

How is the size of the VTA affected by addiction

A

Decreases in size

48
Q

Effect of addiction of dopamine receptors

A

D1 and D5 are downregulated, internalized and their transcription is reduced

49
Q

Effect of addiction of secondary messengers relays to dopamine receptors

A

Decoupling of second messenger relays to decrease effect size

50
Q

How is the size of the nuclei accumbens affected by addiction

A

Branches out and enlarges

51
Q

Effects of addiction on proinhibitory pathways

A

Upregulation of inhibitory receptors
Increased production of inhibitory neurotransmitters

52
Q

What is allostasis

A

Allostasis is defined as the process of maintaining homeostasis through the adaptive change of the organism’s internal environment to meet perceived and anticipated demands.

53
Q

………… forms one of the major reasons for relapse into drug use years after successful rehabilitation

A

Allostasis

54
Q

Three different Variables of drug addictions

A

Drug or agent factors
Host factors
Environmental factors

55
Q

Classification of drug addiction based on DSM V criteria

A

Mild 2-3 symptoms
Moderate 4-5 symptoms
Sever 6 or more symptoms

56
Q

Examples of narcotic or opioid analgesics

A

Heroin
Morphine
Codeine
Tramadol

57
Q

Examples of abused CNS depressants

A

Alcohol
Sedative/Hypnotics
Anxiolytics

58
Q

Examples of abused CNS stimulants

A

Cocaine
Methyxanthines
Nicotine
Amphetamines

59
Q

Other drugs of abuse

A

Psychedelics and Hallucinogens
Marijuana
Dissociative Anaesthetics
Anticholinergics

60
Q

Which drugs of abuse act on 5HT2A receptors

A

LSD
Mescaline
Psilocybin

61
Q

Drugs of abuse that antagonize NMDA receptors

A

Phencyclidine
Ketamine

62
Q

The five R’s for enhancing motivation to quit drug addiction

A

Relevance
Risks
Rewards
Roadblocks
Repetition

63
Q

Components of counseling a drug addict

A

Ask
Advise
Assess
Assist
Arrange

CLINICAL TOXICOLOGY (14 decks)

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