Psychiatry IV Flashcards
What are intoxication and dependence of drug abuse?
Intoxication—>disturbances in various physiological levels
Dependence (tolerance)—>need to increase dose to achieve the same effect—>lead to withdraw
What are the criteria for substance use disorder?
- continue to use despite negative personal consequence
- can’t carry out normal work and school
- use in physically dangerous situation (like driving)
- continue to use even though experiencing social problems
- stop doing any social/recreational things
- using greater amount or over a longer period of time
- unable to cut down
- spend a lot of time getting the drug
- continue to use even though knowing its bad for him/her
- crave the drug
What are the score range for substance use disorder?
2-3—>mild
4-5—>moderate
6-7—>severe
Alcohol acts on ___ receptor just like Barbs
GABAa
Signs of alcohol withdraw
Agitation/tremor/insomnia/GI/vital signs go up/withdraw seizures
What to give for alcohol withdraw?
Lorazepam
What is the risk of flumazenil?
Seizure
Signs of benzo/barb withdraw
Agitation/tremor/insomnia/seizures
Chronic drug use increase activity in ___ and decrease in ___ part of the brain?
limbic/prefrontal cortex
3 parts of the brain that regulates mesolimbic reward?
VTA—(give DA)—>nucleus accumbens
Amygdala assigns a pleasure/threat to the link between the above 2
___ part of the brain control the reward system and the drug use
Prefrontal cortex
When you see dilated pupils you think what kind of drugs? what about miosis?
Stimulants/herion and opioids
Signs of withdraw from opioid
Restless/watery eyes/yawning/flushing
5HT/DA/NE and their metabolites?
5HT—>5HIAA
DA—>HVA
NE–>MHPG
What causes panic attack?
Sodium lactate
What is trazodone
Sedating TCA (low abuse)
Venlafaxine is for?
Social phobia
What are reflexive listening and double sided reflection when approaching smoking cessation?
(don’t tell them what to do)
Reflexive listening—>provide fact (what smoking do to ppl) and ask what they are thinking about it
Double sided reflection—>conflict of having a happy life and do drugs at the same time—>address this with the pt
The goal of 12 step of AA is to achieve?
Abstinence (no drinks at all)
What are the general ideas of AA?
Admit you need help—>superego function—>amend—->spirituality
What are stages of change (harm reduction)?
Precontemplation (not thinking about it)—>contemplation—>preparation—>action—->maintenance
Processes from pre to contemplation?
raise consciousness/pump him up/think about what would happen socially if you dont stop (wife will leave you if you dont stop drinking)
Processes from contemplation to preparation?
Do I have the tool to make a change?
Processes from preparation to action?
Believe in something large than yourself and commit
Processes from action to maintenance?
Give the life back to the pt
Pt comes in who is shooting up heroin, you teach him how to clean needles and prevent infection.
Put opioid pt on methadone maintenance.
Use patch or E-cig instead of smoking.
These incidents are examples of ___?
Harm reduction
What drug do we use for nicotine replacement therapy (NRT)?
Bupropion (replace DA)—>also counter the symptoms when you quit smoking (irritated/jittery/weight gain)
Nicotine patch
What is the best data for smoking cessation?
NRT (nicotine patch) + varenicline
What is varenicline?
Varenicline—>partial nicotine agonist—>avoid withdraw (side effect—>possible schizo)
