Substance Flashcards
Signs of amphetamine intoxication
Dry mouth, hyperthermia, dilated pupils, tachypnoea, hypertension
Maybe chest pain & palpitations
Cannabis affects cognition and learning T/F
T
Amphetamines- mechanism of action
Catecholamine release (mostly dopamine) at the presynaptic terminal
Tics can be precipitated by stimulant use T/F
T
Mechanism of action of cocaine
Dopamine reuptake inhibition-
competitive blockade of dopamine reuptake by the dopamine transporter
Paranoid delusions can accompany amphetamine intoxication T/F
T
Antipsychotic use in alcohol withdrawal yes or no
No bcs it lowers the seizure threshold
What is the definition of early remission from stimulant use disorder?
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).
Definition of sustained remission from stimulant use disorder
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).
What is the contemplative stage in substance misuse?
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
What is the substance most commonly used in adolescents?
Alcohol
Higher or lower doses of methadone maintenance for better treatment retention and decreased illicit drug use?
Higher
Does pharmacological treatment of ADHD reduce future substance misuse?
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
What is the difference between naloxone and naltrexone?
They are both opioid antagonists. Naloxone is short acting and naltrexone is long acting and approved for treating opioid dependence as a result
Suspect intoxication with which drug in a patient with vertical nystagmus?
PCP
Naltrexone cannot be used w significant liver disease T/F
T
Monitoring with naltrexone
LFTs quarterly
Naltrexone and pregnancy
Contraindicated
Acamprosate in pregnancy
Contraindicated
Acamprosate and liver dysfunction
No
Acamprosate and carrying on drinking
No you need to be abstinent 5 days
Disulfiram and drinking
No
Disulfiram and pregnancy
Contraindicated
What is a standard drink of alcohol?
13.6gr of pure alcohol. 12oz beer, 5oz wine, one shot of spirits
Low risk drinking guidelines Canada
Men max 15/ week (max 3 day) women 10/week (max 2 day)
When do seizures and hallucinations start in ETOH withdrawal
8-24 hours
Naltrexone can be used with ongoing drinking T/F
T
Acamprosate is TID dosing T/F
T
Acamprosate a problem in renal impairment T/F
T
Disulfiram no psych sfx T/F
F, mood swings & psychosis
Which is the only non substance addiction disorder in DSM
Gambling
Action of Acamprosate
GABA agonist & glutamate antagonist
Action of naltrexone
Blocks mu opioid receptor
The first line treatments of alcohol use disorder
- Naltrexone
2. Acamprosate
Naltrexone can cause potentially fatal hepatitis T/F
T
Disulfiram interferes with dopamine metabolism T/F
T
Methadone reduces risk of death in opioid addiction T/F
T
Methadone has a short duration of action T/F
F
Methadone is assoc a a high risk of overdose early in treatment T/F
T
What is suboxone?
Buprenorphine + naloxone
Suboxone safer than methadone T/F
T overdose much less frequent
What are the approved pharmacological treatments for cannabis use disorder?
There aren’t any
Prevalence gambling disorder
1% (London)
Canadian Coalition for Seniors Mental Health: Low risk drinking guidelines for senior adults
Women: max 1 drink/day, 5/week. Men: max 1-2/day and 7/week
Prevalence of alcohol use in schizophrenia
40% K&S
Opioid withdrawal can present with delirium T/F
F
Benzo withdrawal is potentially lethal T/F
T
The most commonly abused substance in adolescence
Alcohol
What is the half life of alcohol
4-5 hours
What is type II alcoholism
It affects only the sons of alcoholic fathers & starts in adolescence
Clonidine is ised in opioid withdrawal T/F
T
Treatment for cocaine detox
No pharmacological agents. Symptoms are minor, its just craving. Treatment is relapse prevention
NT involved in opioid withdrawal symptoms
Noradrenergic
Hyperphagia is associated with no cocaine craving in cocaine use disorder T/F
T
Risk factors for developing DTs
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
Amantadine may be an effective treatment for cocaine-dependent patients with severe cocaine withdrawal symptoms T/F
T
How long do cocaine metabolites stay in the urine
96hours
Cannabis effects on cognition last how long
Up to 48 hours but prob a lot less 5-12 hours
Hyperreflexia is seen in which withdrawal states?
BDZ & alcohol
Addictive drugs activate which dopaminergic pathways?
Mesocortical and mesolimbic
A low dose of a substance can reactivate addiction via the D3 pathway T/F
T
Stress can reactivate addiction via increased amygdala activity (increased NE and CRF release) T/F
T
How is early remission defined in DSM V?
At least 3/12 but less than 12/12
What is the longest acting opioid antagonist and how long does it last?
Naltrexone 72 hours
Mechanism of action of Disulfiram
Inhibits acetaldehyde dehydrogenase
Define mild, moderate & severe alcohol use disorder as per DSM V
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
DSM V criteria for alcohol use disorder (including the time frame and how many criteria are required)
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.”
- Alcohol is often taken in larger amounts or over a longer period than was intended.
- There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
- A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
- Craving, or a strong desire or urge to use alcohol.
- Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
- Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
- Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
- Recurrent alcohol use in situations in which it is physically hazardous.
- 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.
- 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. - 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.
When do alcohol withdrawal symptoms typically begin?
4-12 hours after stopping/ reducing intake
How does alcohol contribute to the development of heart disease? (2)
- Low grade hypertension
2. Marked increase in triglycerides and LDL cholesterol
According to DSM V the large majority of individuals who develop AUDs do so by which age?
Late thirties
How much does the risk of AUD increase by in children of parents with AUDs?
3-4X
One year prevalence AUD in adolescents and adults
4.6% adolescents and 8.5% adults according to London course
The mental disorder with the largest substance use concurrent prevalence
ASPD 84% (London)
First line treatments for AUD
- Naltrexone
2. Acamprosate
Which psychosocial treatment best for AUD?
According to Project Match (1988-98):
MET = CBT = Twelve step
Naltrexone does what to people with AUD in terms of drinking habits?
Reduces heavy drinking
Naltrexone contraindications in AUD (3)
- Liver dysfunction
- Opioid use
- Pregnancy
Duration of action naltrexone
24-72 hours
Route of metabolism acamprosate
Renal
Number of days abstinent for alcohol for acamprosate
5
Effect of acamprosate
Maintains abstinence
Best pharmacological AUD therapy for a liver patient
Acamprosate
Abstinent for how long before starting disulfiram?
Two days
The Cochrane review 2020 said which psychosocial treatment is best for AUD in terms of abstinence?
12-step (42% at 12/12 cf 35% on CBT at 12/12)
Methadone reduces criminal behaviour T/F
T
Naltrexone is used in gambling disorder T/F
T but not much of an evidence base
Two NRTs together are better than one T/F
T
