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neuro psych & abuse exam 1 > Substance Abuse > Flashcards

Substance Abuse Flashcards

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1
Q

addiction definition

A

primary, chronic, neurobiological disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations

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2
Q

5 C’s

A

chronicity, impaired control over drug use, compulsive use, continued use despite harm, craving

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3
Q

drug abuse definition

A

maladaptive pattern of substance use characterized by repeated adverse consequences related to the repeated use of a substance

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4
Q

sensitization
ex?

A

inc response to a drug w repeated use ; shifting of dose-response curve to the left
cocaine-induced euphoria, movement, cataplexy and seizures

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5
Q

tolerance
types

A

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

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6
Q

risk factors for substance use disorders (SUDs)

A

dysfunctional childhood, abuse
ADHD, school problems, conduct disorder
early onset of substance absue (esp before 14yo)
personal hx SUD
genetic predisposition (+ FHx)

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7
Q

tests and how long drug stays detectable for

A

hair: 7d-3mo
urine: 1-30d
blood, saliva: 0-3d

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8
Q

synthetic opioids do/do not produce a + test for opiates?
ex)

A

do not
methadone, fentanyl

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9
Q

opiates that may not produce a positive test

A

oxycodone, benzos

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10
Q

benzo that may not produce a positive benzo test

A

clonazepam

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11
Q

OTC med that can make you test positive for amphetamines

A

pseudoephedrine

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12
Q

equation to determine drug concentration normalized to creatinine

A

[drug level in urine / creatinine] x 100

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13
Q

lab tests for SUD

A

vitamin D, B12, iron, folate, LFTs, thyroid, hematology, BMP, HIV, Hep C

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14
Q

Depressants

A

sedative hypnotics (benzos, barbs)
GHB
opiates
DM

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15
Q

benzos MOA
info

A

potentiate inhibitory actions of GABA at several CNS sites including the limbic system
rapid tolerance w chronic dosing

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16
Q

benzos effects

A

dec BP
memory impairment
confusion
drowsiness
anterograde amnesia
GI
urinary retention
bloodshot eyes
slurred speech
poor coordination
resp dep

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17
Q

three drugs w life-threatening withdrawal

A

alcohol
benzos
barbituates

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18
Q

benzo overdose tx

A

flumazenil 0.2mg/min up to 3mg max
good to taper so pt doesnt dip into withdrawal

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19
Q

flunitrazepam aka_______

A

roofies

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20
Q

barbituates effects

A

like EtOH intoxication
disinhibition
amnesia
poor judgement
mood liability
unsteady gait
nystagmus

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21
Q

barbituate wdrawal and tx

A

life threatening
taper off barb and add long acting (phenobarb), can subst anticonvulsant

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22
Q

GHB
what is it

A

gama-hydroxybutyrate
type of depressant
tx for narcolepsy
Xyrem is CIII

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23
Q

GHB effects vs toxicity

A

amnesia
hypotonia

toxicity is coma, seizures, resp dep, vomiting

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24
Q

GHB wdrawal

A

agitation, AMS, inc BP HR, tachy c

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25
Q

GHB overdose tx

A

supportive, vent, O2, intubate, fluids, thiamine

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26
Q

opiates MOA

A

binds opiate receptors in CNS, causing inhibition of pain pathways, altering the perception of and response to pain; generalized CNS depressants

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27
Q

opiates drugs

A

heroin, morphine, codeine, hydrocodone, hydromorphone, fentanyl, oxycodone, tramadol, tapentadol, meperidine

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28
Q

opioid overdose tx

A

naloxone 0.4-2mg IV/IM/SQ, 2 or 4mg nasal spray

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29
Q

methadone MOA
use
CYPs!

A

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

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30
Q

methadone and pregnancy

A

decreased halflife, may need increased dose

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31
Q

opioid wdrawal tx

A

methadone 20-80mg, taper by 5-10mg daily

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32
Q

methadone maintenance dose

A

<30-40mg a day

33
Q

buprenorphine MOA

A

u opiate receptors, partial mu agonis and weak kappa antagonist

34
Q

bup is a substrate of _______

A

3A4!

35
Q

bip inhibits ____

A

1A2, 2A6, 2C19, 2D6 all weakly

36
Q

buprenorphone has _______ so it can displace a ______

A

high affinity; full agonist

37
Q

bup can push someone into _____ w opiate on board

A

w drawal

38
Q

non-candidates for bup management

A

comorbid dependence on other CNS depressants
significant untx psych
active/chronic SI/HI
multiple tx relapses
poor response to suboxone
complex medical

39
Q

candidates for bup management

A

physically dependent as well as addicted
no CIs
interested
compliance is promising
willing to follow safety precautions
willing after review of tx

40
Q

probuphine candidates

A

on = 8mg suboxone or equiv / day
clinically stable

41
Q

probuphine dosing

A

74.2mg/implant x four implants at one time for 6 months

42
Q

probuphine vs SL bup

A

probuphine is non-inferior

43
Q

probuphine BBW

A

implant migration
protrusion
expulsion and nerve damage w insertion and removal of rod implants

44
Q

sublocade

A

SQ injection 100mg or 300mg

45
Q

which opioid addiciton tx have REMS

A

probuphine
sublocade

46
Q

clonidine MOA AE

A

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

47
Q

Lofexidine (Lucemyra) MOA AE

A

alpha 2 stimulator in brain stem, activates inhibitory neuron resulting in dec sympathetic outflow in CNS
AE: orthostatic hypot, bradyc, insomnia, dizziness, drowsy, xerostomia

48
Q

Wdrawal sx management: pain

A

NSAIDs, APAP, muscle relaxants, neuropathic agents

49
Q

wdrawal sx management: N/V

A

metoclopramide, zofran, anti-diarrheal

50
Q

wdrawal sx management: anxiety, sleep, restlessness

A

insomnia meds, muscle relaxants, hydroxyzine

51
Q

naltrexone po dosing
AE
BBW

A

25mg po qd x1wk then 50mg qd
AE: GI upset
BBW: acute hepatitis, hepatocellular injury

52
Q

what is vivitrol and who can receive it

A

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

53
Q

vivitrol (Naltrexone XR) exclusions

A

acute hepatitis or LF
in withdrawal
on opioid analgesics
current opioid dependence
+urine screen for opiate
known allergy
failed naltrexone challenge test

54
Q

naltrexone vs bup

A

no significant differences in relapse rates

55
Q

Ki
what can bump what

A

dec Ki –> can bump off higher Ki drug from R

56
Q

DXM is
MOA

A

dextromethorphan
potent NMDA receptor blocker
at high doses pharmacology is similar to PCP and ketamine

57
Q

DXM effects

A

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

58
Q

stimulants includes ______

A

cocaine, amphetamine, methamphetamine, PCP, ketamine

59
Q

cocaine effects

A

euphoria, elation, grandiosity
alertness
mydriasis
tachyc
sweat/chills
NV
insomnia
paranoia
aggression
motor agitation

60
Q

cocaine toxicity

A

cardiac arrest, MI, stroke, arrhythmia, seizures, hyperthermia, nasal septum ulceration, potentiate psychosis, hallucination

61
Q

cocaine wdrawal

A

depression, fatigue, nightmares, sleep disturbance, inc appetite, bradyarrhythmia, tremor

62
Q

cocaine overdose tx

A

supportive, lorazepam, haldol, antiarrhythmic agents prn cardio issues

63
Q

amphetamine MOA

A

blocks reuptake of DA, NE, inc release of DA and NE, MAOi

64
Q

amphetamine effects

A

dec fatigue
slert
dec appetite
in activity
inc resp
hypertherm
irritability
insomnia
confusion
tremor
convulsions
anxiety
paranoia
aggression
stroke, MI, arrhythmia
meth mouth

65
Q

amphetamine overdose tx

A

supportive, haldol, lorazepam

66
Q

MDMA aka____
effects

A

ecstacy, amphetamine derivative
empathy
relaxation
euphoria
dec inhibition
anxiety
pranoia
irrational
psychosis
touch
muscle tension
faint
chills. sweat
inc HR BP
hypertherm

67
Q

PCP moa

A

DA, 5HT, NE reuptake inibitor

68
Q

PCP effects at low vs high doses

A

low: sedation, ataxia, nystagmus, slurred speech, paresthesia
high: inc HR BP, temp, diaphoresis, muscle rigidity, seizure, coma

69
Q

ketamine MOA

A

releases endogenous catecholamines, produces cataleptic-like state via direct action on cortex and limbic system, reduces polysynaptic spinal reflexes

70
Q

ketamine effects

A

inc HR BP, hallucinations, vivid dreams, resp dep, hypertonia, dystonia, seizures, neuropathy, cardiac arrest, psychedelic effects

71
Q

hallucinogens includes

A

LSD, psilocybin, mescaline

72
Q

weed effects

A

euphoria, disinhibition, impaired cognition, short term memory loss, divided attention skills

73
Q

cocaine + EtOH =

A

cocathylene

74
Q

Q-ball =

A

quetiapine (Seroquel) + cocaine

75
Q

speedball =

A

heroine + cocaine

76
Q

krokodil componenets

A

desmorphoine, gasoline, lighter fluid, iodine, HCL, red phosphorous that causes skin erosions/ulcers and infections

77
Q

krokodil overdose s sx

A

slow shallow breathing, small pupils, slurred speech, pale face, blue lips/nails, choking/gurgline

78
Q

kratom vs morphone

A

13x more potent than morphine

neuro psych & abuse exam 1 (5 decks)

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