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Psychiatric > Substance Abuse > Flashcards

Substance Abuse Flashcards

1
Q

Use

A

When one drinks, swallows, smokes, sniffs, inhales or injects a mind altering substance

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2
Q

Abuse

A

Use of alcohol or drugs for the purpose of intoxication, or, in the case of prescription drugs, for purposes beyond their intended use

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3
Q

Addiction

A

An irresistible psychological and/or physiological need to continue the substance use or behavior despite the harm it causes

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4
Q

Physical Dependence

A

Physiological requirement for the substance by the brain, as evidence by development of tolerance and withdrawal when use decreases or stops

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5
Q

Craving

A

An urgent desire for a substance or behavior to which one is addicted, often in response to triggers, that is very difficult to resist

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6
Q

Tolerance

A

patient need more of the substance to have the same affect

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7
Q

Cross tolerance

A

substances that are pharmacologically interchangeable in terms of how the body responds ( Ex: alcohol and most benzodiazepines )

  • can use this to treat dependence
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8
Q

Withdrawal

A

state characterized by adverse physical and psychological symptoms occurring when one ceases using a substance to which the brain is acclimated

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9
Q

Trigger

A

Anything which cues or prompts a response ex. seeing a bar may trigger a craving for alcohol

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10
Q

Detoxification

A

Safely withdrawing a person from an addictive substance, usually under medical supervision ( uses cross tolerance and gradually decreasing amounts )

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11
Q

Relapse

A

The recurrence of alcohol - or drug - dependent behavior in an individual after detoxication

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12
Q

Chemical Hook Theory

A

Once the brain has been exposed to the substance –> “the brain has to have it”

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13
Q

Alexander experiment

A

Conclusion, if we have what we need, we will not self medicate with drugs

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14
Q

Impaired response inhibition and salience attribution (iRSA)

A

With increasing exposure to rewarding activities/substances, the brain starts to focus more on the exposure to activities/substances

  • the brain becomes less and less able to control one’s response to cue ( ex: seeking cocaine after seeing white powder- the white powder is the cue)
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15
Q

Alcohol

A
  • CNS Depressant and euphoria
  • measure by blood alcohol level
  • prenatal use= Fetal alcohol syndrome
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16
Q

Alcohol abuse ( > 1 of the following in a year)

A
  • Recurrent use and hazardous situation’s.
    -Recurrent alcohol – related legal problems. - Recurrent use and failure to meet role obligations.
  • Continue use despite social or interpersonal problems.
17
Q

Alcohol Dependence ( > 3 of the following in a year)

A
  • Tolerance.
  • Withdrawal. Increase time spent in alcohol related activities.
  • Important activities given up or reduced.
  • Drinking more or longer than desired. Persistent desire or unsuccessful efforts to cut down on alcohol use.
  • Continue use despite knowledge of self harm.
18
Q

Biological response to Alcohol

A
  1. Increase GABA activity = causes relaxation and sedation
  2. Acute CNS, depression, and euphoria
  3. Long term: physical tolerance independence
  4. Wernicke’s Encephalopathy
  5. Korsakoff’s Syndrome
  6. Wernicke - Korasakoff Syndrome
19
Q

What is Wernicke’s Encephalopathy

A
  • Alcohol causes gastric irritation, reduce absorption of B vitamins, interferes with conversion of thiamine into thiamine pyrophosphate (bioactive form of thiamine)
  • Characterized By: acute onset of ocular motor dysfunction (eyes are misaligned) ataxia (impaired coordination), ptosis (drooping eye) and confusion (may have any or all of the symptoms.)
  • REQUIRES EMERGENCY TREATMENT = IV THIAMINE TO PREVENT PERMANENT DAMAGE
20
Q

what is Korsakoff’s Syndrome

A
  • Gradual onset of retrograde and anterograde amnesia w/sparing of intellectual function and some aspects of memory
  • Characteristic features: Apathy (lack of emotion), or increased talkativeness; confabulation ( created fictional stories about past events or present situation )
21
Q

Alcohol withdrawal ( when does it happen? S/SX?, Alcohol withdrawal syndrome)

A
  • Alcohol withdrawal can begin as soon as two hours after the last drink or dosage of last cross tolerance med
  • Early symptoms: tremors, diaphoresis, rapid pulse, elevated blood pressure and headache
  • Treatment of early sx
    • may feed pt
    • B-complex IM: multivitamis
    • Best treatment: prevention

ALCOHOL WITHDRAWAL SYNDROME
- early sx above worsen
- hallucination
- grand mal seizures
- changes in cognition

22
Q

Severe Alcohol Withdrawal : DELIRIUM TREMENS

A

MEDICAL EMERGENCY

  • ANS instability: tachycardia, HTN, pyrexia ( fever)

-MENTAL STATUS CHANGE: disorientation, reduced awareness of environment, delusions hallucinations, marked tremors agitation, and diaphoresis

  • Onset: 3-5 days after last drink
  • TREATMENT
    1. Replace thiamine, niacin, folate and magnesium – all IV
    2. Replace electrolytes- all IV
    3. Glycogen (D5W) - IV
    4. BENZODIAZEPINES - Sedative, increases GABA (used as cross tolerance)
    5. BACLOFEN- muscle relaxant, GABA agonist, REDUCES RELAPSE
    6. Antipsychotic
23
Q

Treatment for Alcohol Dependence

A

THE MEDS ARE USED TO REDUCE CRAVING AND OR REWARD FROM DRINKING

  1. NALTREXONE- bind to opioid receptors to block euphoric effectes of alcohol
  2. ACAMPROSATE- increases GABA ( used after detox )
  3. CITALOPRAM- SSRI
  4. ODANSTERONE- serotonin antagonist
  5. BACLOFEN- muscle relaxant, reduces craving, withdrawal
  6. GABAPENTIN- reduces relapse and amount of EtOH used.
  • Assure adequate nutrition and supplemental vitamins ( vitamin B and thiamine )
  • Omega 3 may limit neuro damage
24
Q

Cocaine

A
  • CNS stimulant that produces a euphoric rush of mental alertness and energy feelings of self-confidence,
  • Last for 10–20 minutes high followed by intense let down
  • Biological effects of cocaine= Paranoia, hallucinations tachycardia, hypertension, dilated pupils in increase temperature.
25
Q

Intoxication ( Cocaine )

A

CNS stimulant followed by depression,

-Increasing doses: restlessness –> tremors and agitation –> convulsions –> CNS depression

26
Q

Withdrawal ( cocaine )

A
  • Norepinephrine depletion causes a person to sleep for 12–18 hours.

Then sleep disturbances with rebound REM lethargy, decreased libido, depression, suicidality, anhedonia, poor concentration and cocaine craving

27
Q

Toxicity ( Cocaine )

A
  • Mydriasis ( pupils are enlarged), encephalopathy, seizures, decreased responsiveness, hypertension, rapid, and possible, irregular pulse, hyperpyrexia ( very high fever > 41.5 C ) , respiratory and cardiovascular failure.
28
Q

Meds for cocaine addiction

A
  1. METHYLPHENIDATE (ritalin)= may aid i self control and reduce craving ( but is abusable )
  2. GABAPENTIN (Neurotin)= may reduce tension, cravings
  3. VIGABATRIN (Sabril)= increases GABA and reduces cravings
  4. BACLOFEN (Gablofen, Lioresal)= reduces cravings
  5. N-ACETYLCYSTEINE (NAC)= seems to improve glutamate levels and reduce cravings
  6. NOCAINE= (experimental) mimics the effects of cocaine but at a weaker level but also blocks the effects of cocaine itself
29
Q

Amphetamines

A
  • blocks of norepinephrine and dopamine, not as strong effect on serotonin as cocaine has
    -Affects the peripheral nervous system
30
Q

Treatment for Tobacco Addiction

A
  • Is especially important in severe mental illness due to higher rates of smoking greater inhalation in
  1. Nicotine replacement via e-cigarettes
  2. BUPROPION (wellbutrin) = reduces cravings and weight gain associated with smoking cessation
  3. VARENICLINE= block nicotine receptors
31
Q

Caffeine

A
  • Stimulates cerebral cortex increases mental acuity.
  • 300 mg can cause tremors, poor motor performance, and insomnia.
    -POTENTIALLY FATAL
32
Q

Benzodiazepines

A
  • Causes CNS depression
  • Decreases the duration of REM Sleep
  • Withdrawal sx may begin as long as 8 days after last taken

Withdawal sx
- rebound anxiety and autonomic ( syncope, brain fog, N/V , etc. ), sensory excitement, motor excitement, cognitive excitation

Withdrawal tx = tapering

33
Q

Molly

A

Crystalline form of MDMA
- can cause severe dehydration and hyperthermia

34
Q

MDMA (ecstacy)

A

Can cause potential hyponatremia and hyperpyrexia

35
Q

GHB (rupies)

A
  • CNS depressant
  • “date rape drug”
  • Coma and seizures
36
Q

Opiate withdrawal sx

A

HYPEREXCITABILITY
- Autonomic: diarrhea, rhinorrhea, N/V, bradycardia
- CNS: sleeplessness, restlessness, agitation,
-Pain: adb cramping, bone pain, backache, and muscle aching
- Intense craving, erythema

37
Q

Meds use for Opiate Addiction

A
  1. LAAM ( L-alpha acetyl methadol )- every other day
  2. METHADONE- taken daily

1 & 2.) OPIOID AGONIST- intent is to replace other more disruptive and addictive opioids with meds that reduce craving
3. NALOXONE (narcan)
4. BUPRENORPHINE- ceiling action: blocks further effects of opioids when present in higher in amounts ( partial agonist/ antagonist)
5. BUPRENORPHINE/NALOXONE= naloxone blocks effect in med is crushed or ingested at higher doses in attempt to produce euphoria
6. NALMEFENE= blocks the effects of opioids

38
Q

Codependency ( signs)

A

staying in a abusive / unrewarding relationship, focusing on changing the other person while neglecting oneself

Psychiatric (12 decks)

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