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Psychiatry > Substance > Flashcards

Substance Flashcards

1
Q

Signs of amphetamine intoxication

A

Dry mouth, hyperthermia, dilated pupils, tachypnoea, hypertension

Maybe chest pain & palpitations

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2
Q

Cannabis affects cognition and learning T/F

A

T

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3
Q

Amphetamines- mechanism of action

A

Catecholamine release (mostly dopamine) at the presynaptic terminal

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4
Q

Tics can be precipitated by stimulant use T/F

A

T

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5
Q

Mechanism of action of cocaine

A

Dopamine reuptake inhibition-

competitive blockade of dopamine reuptake by the dopamine transporter

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6
Q

Paranoid delusions can accompany amphetamine intoxication T/F

A

T

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7
Q

Antipsychotic use in alcohol withdrawal yes or no

A

No bcs it lowers the seizure threshold

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8
Q

What is the definition of early remission from stimulant use disorder?

A

After full criteria for stimulant use disorder were previously met, none of the criteria for stimulant use disorder have been met for at least 3 months but
for less than 12 months (with the exception that Criterion A4, “Craving, or a strong desire or urge to use the stimulant,” may be met).

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9
Q

Definition of sustained remission from stimulant use disorder

A

After full criteria for stimulant use disorder were previously met, none of the criteria for stimulant use disorder have been met at any time during a period of 12 months or longer (with the exception that Criterion A4, “Craving, or a strong desire or urge to use the stimulant,” may be met).

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10
Q

What is the contemplative stage in substance misuse?

A

Contemplation (“getting ready”) – People are beginning to recognize that their behaviour is problematic, and start to look at the pros and cons of their continued actions

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11
Q

What is the substance most commonly used in adolescents?

A

Alcohol

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12
Q

Higher or lower doses of methadone maintenance for better treatment retention and decreased illicit drug use?

A

Higher

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13
Q

Does pharmacological treatment of ADHD reduce future substance misuse?

A

Stimulant use prevents reduces future substance use

- at least in youth stimulants reduce SUD by 50% (Faraone meta analysis 2003) to close to levels of general pop

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14
Q

What is the difference between naloxone and naltrexone?

A

They are both opioid antagonists. Naloxone is short acting and naltrexone is long acting and approved for treating opioid dependence as a result

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15
Q

Suspect intoxication with which drug in a patient with vertical nystagmus?

A

PCP

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16
Q

Naltrexone cannot be used w significant liver disease T/F

A

T

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17
Q

Monitoring with naltrexone

A

LFTs quarterly

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18
Q

Naltrexone and pregnancy

A

Contraindicated

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19
Q

Acamprosate in pregnancy

A

Contraindicated

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20
Q

Acamprosate and liver dysfunction

A

No

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21
Q

Acamprosate and carrying on drinking

A

No you need to be abstinent 5 days

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22
Q

Disulfiram and drinking

A

No

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23
Q

Disulfiram and pregnancy

A

Contraindicated

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24
Q

What is a standard drink of alcohol?

A

13.6gr of pure alcohol. 12oz beer, 5oz wine, one shot of spirits

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25
Q

Low risk drinking guidelines Canada

A

Men max 15/ week (max 3 day) women 10/week (max 2 day)

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26
Q

When do seizures and hallucinations start in ETOH withdrawal

A

8-24 hours

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27
Q

Naltrexone can be used with ongoing drinking T/F

A

T

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28
Q

Acamprosate is TID dosing T/F

A

T

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29
Q

Acamprosate a problem in renal impairment T/F

A

T

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30
Q

Disulfiram no psych sfx T/F

A

F, mood swings & psychosis

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31
Q

Which is the only non substance addiction disorder in DSM

A

Gambling

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32
Q

Action of Acamprosate

A

GABA agonist & glutamate antagonist

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33
Q

Action of naltrexone

A

Blocks mu opioid receptor

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34
Q

The first line treatments of alcohol use disorder

A
  1. Naltrexone

2. Acamprosate

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35
Q

Naltrexone can cause potentially fatal hepatitis T/F

A

T

36
Q

Disulfiram interferes with dopamine metabolism T/F

A

T

37
Q

Methadone reduces risk of death in opioid addiction T/F

A

T

38
Q

Methadone has a short duration of action T/F

A

F

39
Q

Methadone is assoc a a high risk of overdose early in treatment T/F

A

T

40
Q

What is suboxone?

A

Buprenorphine + naloxone

41
Q

Suboxone safer than methadone T/F

A

T overdose much less frequent

42
Q

What are the approved pharmacological treatments for cannabis use disorder?

A

There aren’t any

43
Q

Prevalence gambling disorder

A

1% (London)

44
Q

Canadian Coalition for Seniors Mental Health: Low risk drinking guidelines for senior adults

A

Women: max 1 drink/day, 5/week. Men: max 1-2/day and 7/week

45
Q

Prevalence of alcohol use in schizophrenia

A

40% K&S

46
Q

Opioid withdrawal can present with delirium T/F

A

F

47
Q

Benzo withdrawal is potentially lethal T/F

A

T

48
Q

The most commonly abused substance in adolescence

A

Alcohol

49
Q

What is the half life of alcohol

A

4-5 hours

50
Q

What is type II alcoholism

A

It affects only the sons of alcoholic fathers & starts in adolescence

51
Q

Clonidine is ised in opioid withdrawal T/F

A

T

52
Q

Treatment for cocaine detox

A

No pharmacological agents. Symptoms are minor, its just craving. Treatment is relapse prevention

53
Q

NT involved in opioid withdrawal symptoms

A

Noradrenergic

54
Q

Hyperphagia is associated with no cocaine craving in cocaine use disorder T/F

A

T

55
Q

Risk factors for developing DTs

A

Risk factors for developing delirium tremens (DTs) include the following:
Prior ethanol withdrawal seizures
History of DTs
Concurrent illness
Daily heavy and prolonged ethanol consumption
Greater number of days since last drink
Severe withdrawal symptoms at presentation
Prior detoxification
Intense craving for alcohol

56
Q

Amantadine may be an effective treatment for cocaine-dependent patients with severe cocaine withdrawal symptoms T/F

A

T

57
Q

How long do cocaine metabolites stay in the urine

A

96hours

58
Q

Cannabis effects on cognition last how long

A

Up to 48 hours but prob a lot less 5-12 hours

59
Q

Hyperreflexia is seen in which withdrawal states?

A

BDZ & alcohol

60
Q

Addictive drugs activate which dopaminergic pathways?

A

Mesocortical and mesolimbic

61
Q

A low dose of a substance can reactivate addiction via the D3 pathway T/F

A

T

62
Q

Stress can reactivate addiction via increased amygdala activity (increased NE and CRF release) T/F

A

T

63
Q

How is early remission defined in DSM V?

A

At least 3/12 but less than 12/12

64
Q

What is the longest acting opioid antagonist and how long does it last?

A

Naltrexone 72 hours

65
Q

Mechanism of action of Disulfiram

A

Inhibits acetaldehyde dehydrogenase

66
Q

Define mild, moderate & severe alcohol use disorder as per DSM V

A

mild AUDs – defined as the presence of 2-3 criteria
moderate AUDs – defined as the presence of 4-5 criteria
severe AUDs – defined as the presence of 6 or more criteria

67
Q

DSM V criteria for alcohol use disorder (including the time frame and how many criteria are required)

A

DSM-5 Alcohol Use Disorder Criteria
According to the DSM-5, alcohol use disorder is “a problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following [criteria], occurring within a 12-month period.”

  1. Alcohol is often taken in larger amounts or over a longer period than was intended.
  2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
  3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
  4. Craving, or a strong desire or urge to use alcohol.
  5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
  6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
  7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
  8. Recurrent alcohol use in situations in which it is physically hazardous.
  9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
  10. Tolerance, as defined by either of the following:
    a need for markedly increased amounts of alcohol to achieve intoxication or desired effect, or a markedly diminished effect with continued use of the same amount of alcohol.
  11. Withdrawal, as manifested by either of the following: the characteristic withdrawal syndrome for alcohol, or alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid alcohol withdrawal symptoms.
68
Q

When do alcohol withdrawal symptoms typically begin?

A

4-12 hours after stopping/ reducing intake

69
Q

How does alcohol contribute to the development of heart disease? (2)

A
  1. Low grade hypertension

2. Marked increase in triglycerides and LDL cholesterol

70
Q

According to DSM V the large majority of individuals who develop AUDs do so by which age?

A

Late thirties

71
Q

How much does the risk of AUD increase by in children of parents with AUDs?

A

3-4X

72
Q

One year prevalence AUD in adolescents and adults

A

4.6% adolescents and 8.5% adults according to London course

73
Q

The mental disorder with the largest substance use concurrent prevalence

A

ASPD 84% (London)

74
Q

First line treatments for AUD

A
  1. Naltrexone

2. Acamprosate

75
Q

Which psychosocial treatment best for AUD?

A

According to Project Match (1988-98):

MET = CBT = Twelve step

76
Q

Naltrexone does what to people with AUD in terms of drinking habits?

A

Reduces heavy drinking

77
Q

Naltrexone contraindications in AUD (3)

A
  1. Liver dysfunction
  2. Opioid use
  3. Pregnancy
78
Q

Duration of action naltrexone

A

24-72 hours

79
Q

Route of metabolism acamprosate

A

Renal

80
Q

Number of days abstinent for alcohol for acamprosate

A

5

81
Q

Effect of acamprosate

A

Maintains abstinence

82
Q

Best pharmacological AUD therapy for a liver patient

A

Acamprosate

83
Q

Abstinent for how long before starting disulfiram?

A

Two days

84
Q

The Cochrane review 2020 said which psychosocial treatment is best for AUD in terms of abstinence?

A

12-step (42% at 12/12 cf 35% on CBT at 12/12)

85
Q

Methadone reduces criminal behaviour T/F

A

T

86
Q

Naltrexone is used in gambling disorder T/F

A

T but not much of an evidence base

87
Q

Two NRTs together are better than one T/F

A

T

Psychiatry (27 decks)

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