Substance Abuse Flashcards
addiction definition
primary, chronic, neurobiological disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations
5 C’s
chronicity, impaired control over drug use, compulsive use, continued use despite harm, craving
drug abuse definition
maladaptive pattern of substance use characterized by repeated adverse consequences related to the repeated use of a substance
sensitization
ex?
inc response to a drug w repeated use ; shifting of dose-response curve to the left
cocaine-induced euphoria, movement, cataplexy and seizures
tolerance
types
state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug’s effect over time
shifting dose response curve to the right
metabolic and cellular types
risk factors for substance use disorders (SUDs)
dysfunctional childhood, abuse
ADHD, school problems, conduct disorder
early onset of substance absue (esp before 14yo)
personal hx SUD
genetic predisposition (+ FHx)
tests and how long drug stays detectable for
hair: 7d-3mo
urine: 1-30d
blood, saliva: 0-3d
synthetic opioids do/do not produce a + test for opiates?
ex)
do not
methadone, fentanyl
opiates that may not produce a positive test
oxycodone, benzos
benzo that may not produce a positive benzo test
clonazepam
OTC med that can make you test positive for amphetamines
pseudoephedrine
equation to determine drug concentration normalized to creatinine
[drug level in urine / creatinine] x 100
lab tests for SUD
vitamin D, B12, iron, folate, LFTs, thyroid, hematology, BMP, HIV, Hep C
Depressants
sedative hypnotics (benzos, barbs)
GHB
opiates
DM
benzos MOA
info
potentiate inhibitory actions of GABA at several CNS sites including the limbic system
rapid tolerance w chronic dosing
benzos effects
dec BP
memory impairment
confusion
drowsiness
anterograde amnesia
GI
urinary retention
bloodshot eyes
slurred speech
poor coordination
resp dep
three drugs w life-threatening withdrawal
alcohol
benzos
barbituates
benzo overdose tx
flumazenil 0.2mg/min up to 3mg max
good to taper so pt doesnt dip into withdrawal
flunitrazepam aka_______
roofies
barbituates effects
like EtOH intoxication
disinhibition
amnesia
poor judgement
mood liability
unsteady gait
nystagmus
barbituate wdrawal and tx
life threatening
taper off barb and add long acting (phenobarb), can subst anticonvulsant
GHB
what is it
gama-hydroxybutyrate
type of depressant
tx for narcolepsy
Xyrem is CIII
GHB effects vs toxicity
amnesia
hypotonia
toxicity is coma, seizures, resp dep, vomiting
GHB wdrawal
agitation, AMS, inc BP HR, tachy c
GHB overdose tx
supportive, vent, O2, intubate, fluids, thiamine
opiates MOA
binds opiate receptors in CNS, causing inhibition of pain pathways, altering the perception of and response to pain; generalized CNS depressants
opiates drugs
heroin, morphine, codeine, hydrocodone, hydromorphone, fentanyl, oxycodone, tramadol, tapentadol, meperidine
opioid overdose tx
naloxone 0.4-2mg IV/IM/SQ, 2 or 4mg nasal spray
methadone MOA
use
CYPs!
binds opiate receptors in CNS, causing inhibition of pain pathways, altering the perception of and response to pain; generalized CNS depressants
detox or maintenance
substrate of CYP 3A4, 2C9, 2C19, 2D6
inhibits 2D6, 3A4
methadone and pregnancy
decreased halflife, may need increased dose
opioid wdrawal tx
methadone 20-80mg, taper by 5-10mg daily
methadone maintenance dose
<30-40mg a day
buprenorphine MOA
u opiate receptors, partial mu agonis and weak kappa antagonist
bup is a substrate of _______
3A4!
bip inhibits ____
1A2, 2A6, 2C19, 2D6 all weakly
buprenorphone has _______ so it can displace a ______
high affinity; full agonist
bup can push someone into _____ w opiate on board
w drawal
non-candidates for bup management
comorbid dependence on other CNS depressants
significant untx psych
active/chronic SI/HI
multiple tx relapses
poor response to suboxone
complex medical
candidates for bup management
physically dependent as well as addicted
no CIs
interested
compliance is promising
willing to follow safety precautions
willing after review of tx
probuphine candidates
on = 8mg suboxone or equiv / day
clinically stable
probuphine dosing
74.2mg/implant x four implants at one time for 6 months
probuphine vs SL bup
probuphine is non-inferior
probuphine BBW
implant migration
protrusion
expulsion and nerve damage w insertion and removal of rod implants
sublocade
SQ injection 100mg or 300mg
which opioid addiciton tx have REMS
probuphine
sublocade
clonidine MOA AE
alpha 2 stimulator in brain stem, activates inhibitory neuron resulting in dec sympathetic outflow in CNS
AE: drowsy, dizzy, xerostomia, HA, orthostatic hypot,fatigue, abdominal pain, bradyc
Lofexidine (Lucemyra) MOA AE
alpha 2 stimulator in brain stem, activates inhibitory neuron resulting in dec sympathetic outflow in CNS
AE: orthostatic hypot, bradyc, insomnia, dizziness, drowsy, xerostomia
Wdrawal sx management: pain
NSAIDs, APAP, muscle relaxants, neuropathic agents
wdrawal sx management: N/V
metoclopramide, zofran, anti-diarrheal
wdrawal sx management: anxiety, sleep, restlessness
insomnia meds, muscle relaxants, hydroxyzine
naltrexone po dosing
AE
BBW
25mg po qd x1wk then 50mg qd
AE: GI upset
BBW: acute hepatitis, hepatocellular injury
what is vivitrol and who can receive it
naltrexone XR
approved for opioid dependence in pt who meet DSM criteria for opioid dependence, recently received opioid detox and opioid free for at least 7d
vivitrol (Naltrexone XR) exclusions
acute hepatitis or LF
in withdrawal
on opioid analgesics
current opioid dependence
+urine screen for opiate
known allergy
failed naltrexone challenge test
naltrexone vs bup
no significant differences in relapse rates
Ki
what can bump what
dec Ki –> can bump off higher Ki drug from R
DXM is
MOA
dextromethorphan
potent NMDA receptor blocker
at high doses pharmacology is similar to PCP and ketamine
DXM effects
hyperexcitability, hallucinations, lethargy, ataxia, slurred speech, sweating, HTN, nystagmus, altered time perception
abuse can cause death, brain damage, seizure, loss of consciousness, and irregular HR
stimulants includes ______
cocaine, amphetamine, methamphetamine, PCP, ketamine
cocaine effects
euphoria, elation, grandiosity
alertness
mydriasis
tachyc
sweat/chills
NV
insomnia
paranoia
aggression
motor agitation
cocaine toxicity
cardiac arrest, MI, stroke, arrhythmia, seizures, hyperthermia, nasal septum ulceration, potentiate psychosis, hallucination
cocaine wdrawal
depression, fatigue, nightmares, sleep disturbance, inc appetite, bradyarrhythmia, tremor
cocaine overdose tx
supportive, lorazepam, haldol, antiarrhythmic agents prn cardio issues
amphetamine MOA
blocks reuptake of DA, NE, inc release of DA and NE, MAOi
amphetamine effects
dec fatigue
slert
dec appetite
in activity
inc resp
hypertherm
irritability
insomnia
confusion
tremor
convulsions
anxiety
paranoia
aggression
stroke, MI, arrhythmia
meth mouth
amphetamine overdose tx
supportive, haldol, lorazepam
MDMA aka____
effects
ecstacy, amphetamine derivative
empathy
relaxation
euphoria
dec inhibition
anxiety
pranoia
irrational
psychosis
touch
muscle tension
faint
chills. sweat
inc HR BP
hypertherm
PCP moa
DA, 5HT, NE reuptake inibitor
PCP effects at low vs high doses
low: sedation, ataxia, nystagmus, slurred speech, paresthesia
high: inc HR BP, temp, diaphoresis, muscle rigidity, seizure, coma
ketamine MOA
releases endogenous catecholamines, produces cataleptic-like state via direct action on cortex and limbic system, reduces polysynaptic spinal reflexes
ketamine effects
inc HR BP, hallucinations, vivid dreams, resp dep, hypertonia, dystonia, seizures, neuropathy, cardiac arrest, psychedelic effects
hallucinogens includes
LSD, psilocybin, mescaline
weed effects
euphoria, disinhibition, impaired cognition, short term memory loss, divided attention skills
cocaine + EtOH =
cocathylene
Q-ball =
quetiapine (Seroquel) + cocaine
speedball =
heroine + cocaine
krokodil componenets
desmorphoine, gasoline, lighter fluid, iodine, HCL, red phosphorous that causes skin erosions/ulcers and infections
krokodil overdose s sx
slow shallow breathing, small pupils, slurred speech, pale face, blue lips/nails, choking/gurgline
kratom vs morphone
13x more potent than morphine
