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Therapeutics (Fall 2024) > Stimulant Use Disorder > Flashcards

Stimulant Use Disorder Flashcards

1
Q

What is the prevalence of SUD

A

Age 18-30 males, increasing use especially in BC and SK

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2
Q

Waht are the three cycles of SUD?

A

Binge,crash,repeat

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3
Q

Most stimulants are derivative of ___

A

AMpehtamines

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4
Q

What are considered weak stimulants?

A

Caffeine, nicotine

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5
Q

What are considered mild stimulants

A

Ephedrine, pseudoephendrine. dextromethorphan

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6
Q

What are considered moderate stimulants?

A

Ritalin, dextroamphetamine, vyvanse, modafininl, bupropion

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7
Q

What are considered strong stimulants?

A
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8
Q

What is the pharmacology/ MOA of stimulabts?

A

Increases CNS and Autonomic nervous system activity

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9
Q

All effect the reward pathway by increasing ____ at the ___

A

Dopamine, synapses

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10
Q

What is the duration of stimulants cocaine?

A

<1hr

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11
Q

What is the duraiton of ampehtamines?

A

Duration up to 12 hour depending on route and amount

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12
Q

WHat is cocaine?

A

Powder or rock form

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13
Q

What drug is used world wide and fastest growing drug in youth?

A

Meth

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14
Q

How is meth used?

A

Oral (3%)
Nasal 12%
Injecting 25%
Smoking 60%

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15
Q

What effects do stimulants have on the CNS?

A

Intense euphoria including

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16
Q

What affect do stimulants have on the autonomic nervous system?

A
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17
Q

What can overdoses of stimulants do?

A
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18
Q

What are the immediate complications of stimulants? (5)

A
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19
Q

What are the long term complications of stimulant use?

A
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20
Q

What are the three pillars of SUD management?

A
  • Acute intoxication
  • Acute withdrawal
  • Long term pharmacological management
    (withdrawal and cravings)
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21
Q

What are the acute intoxication symptoms of SUD?

A

Psychosis
Mania
Paranoia
Delirium
Increase blood pressure
Chest pain
Agitation
Sweating
Skin picking

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22
Q

What is the management of stimulant intoxication?

A

Supportive unless delusions or autonomic hyperactivity

Pharmacological agents only if overtly psychotic and agitated or medical crisis

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23
Q

What is the management for SUD agitation?

A

Lorazepam 2-4mg IM or po PRN q-30min to 6hr

24
Q

What is the management for psychotic symptoms?

A

Low dose antipsychotic such as risperidone 0.5-2mg/d, olanzapine 2.5-
7.5mg/d

25
Q

What are the cardiovascular complications management?

A

– arrhythmia: administer anti-arrhythmic agents

– Tachycardia (+/- hypertension): administer β-blockers (especially
labetalol/carvedilol), clonidine

26
Q

What are the seizure risk complications management

A

– anti-seizure meds if seizing (i.e. diazepam IV, midazolam IM)
– no role as a preventative

27
Q

What is the 1st stage of withdrawal

A

The initial crash

28
Q

When does the crash start?

A

Begins within hours and lastas 4-7 hours and lasts 4-7 hours

29
Q

What are the signs and symptoms of stage 1 SUD?

A

Crash

  • agitation
  • marked dysphoria
  • fatigue
  • hypersomnolence
  • Hyperphagia or anorexia
30
Q

What is Stage II withdrawal symptoms of SUD?

A

Begins after the first week and can last up to 10 weeks

31
Q

WHat happens during the first week of stage II?

A

– normal sleep
– euthymia
– little anxiety
– minimal craving

32
Q

What happens during the subsequent weeks of SUD in stage II?

A

– anhedonia
– ↑ anxiety & depression
– fatigue
– extreme craving

33
Q

What is anhedonia?

A

the inability to feel pleasure

34
Q

What are the non-pharm managements for SUD?

A

addictions counselling
support, community supports, rehab options, housing needs

35
Q

What are the post-acute hyperarousal/anxiety treatments for SUD withdrawal

A

– Continue benzos a little longer
– Mirtazapine (mixed results)

36
Q

What are the goals of therapy for long term management of SUD?

A
  • physical dependence? < psychological dependence
37
Q

Biggest factor leading to relapse and challenge to manage is

A

craving

38
Q

What is the rationale for using buproprion in SUD?

A

Rationale: 5-HT may attenuate reinforcing effects of amphetamine,
and 5-HT/NE counter withdrawal symptoms as depression

39
Q

If indicated what guidelines should we use the antidepressants in accordance to?

A

MDD guidelines

40
Q

What is the role of antipsychotics in SUD?

A

counterbalance excess DA activity and
restore NT pathways

No difference though

41
Q

What is the evidence of suing a prescribed stimulant?

A

Mixed results for long term benefit, may help with cravings.

42
Q

WHat is the issue with the usage of stimulants?

A

Our body de-regulates the dopamine receptors and therefore they will never achieve that ‘High”

43
Q

What is the rationale for dopamine agonists?

A

Chronic stimulant use leads to DA depletion

44
Q

What are 2 dopamine agonists?

A

Amantadine, bromocriptine

45
Q

What is modafinil?

A

INdicated for narcolepsy

46
Q

What evidence is there for modafinil?>

A
  • Mixed evidence of benefit: possibly useful to
    reduce cocaine use, but 2 neg trials and risk of
    ↑ effect of concurrent stimulant use
47
Q

What is the issue of using buproprion and naltrexone ER

A

Naltrexone ER not in Canada

48
Q

What is the non-pharm approach?

A

1st line = psychosocial approaches (CBT, contingency management,
addictions treatment)

49
Q

What is the major takeaway from SUD?

A

No established pharmacotherapy for stimulant use disorder

50
Q

What may long term users of stimulants appear as?

A

Traumatic brain injury to the patient. Since there brain has been depleted of dopamine they may appear like a Parkinson disease patient because of this.

51
Q

What is the issue with AP in SUD?

A

Increase negative symptoms and relapse possibly

Negative symptoms may increase and clinical sense that this could be promoting cravings

52
Q

What is the MOA of modafinil?

A
53
Q

What is the rationale for using naltrexone in SUD?

A

Endogenous opioids increase when high, therefore by blocking them we block the high

54
Q

Why may we use risperidone over olanzapine?

A

less sedation

55
Q
A

Therapeutics (Fall 2024) (11 decks)

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