Substance Abuse Flashcards
A chronic disorder characterized by the compulsive use of substance resulting in physical, psychological, or social harm to be user and continued use despite the harm.
Addiction
Physiological adaptation to the effect of drugs so as to diminish effects with constant dosages or to maintain the intensity and duration of effects through increased dosage.
Tolerance
Reversible substance-specific syndrome
Due to recent ingestion or exposure to a substance
substance intoxication
what is the reward pathway in the brain
DA in mesocorticolimbic system
Increased response following repeated intermittent administration of a drug, in contrast to tolerance to drug effects that occur secondary to continuous exposure to a drug
Sensitization
CNS depressant
Works in a dose dependent fashion
Sedative, sleep, unconsciousness, coma, respiratory depression and CV collapse
alcohol
five or more drinks on the same occasion at least once in the past 30 days
Binge use
five or more drinks on the same occasion on at least 5 different days in the past 30 days.
heavy use
Major excitatory system in CNS
glutamate
what happens to NMDA pathway with alcohol intoxication
decrease glutamate activity
what GABA receptor is affected by alcohol
GABA A
what happens with chronic ethanol intoxication and GABA
down-regulation of GABA A which means they need more alcohol for the same effect
what causes the positive reinforcement and pleasurable effects of ethanol
dopamine (DA)
with alcohol If consciousness is impaired then ___________ should be given IV or IM for at least 3 days
thiamine
When a person’s maladaptive pattern of alcohol use lease to clinically important distress or impairment, as shown in a single 1-month period
Alcohol dependence
Acetaldehyde dehydrogenase (ALDH) inhibitor (irreversible)
Disulfiram
What happens if someone has alcohol while on sifulfiram
N/V, HA
SOB, sweating, etc
how long must patient have had to be abstinent from ETOH before starting disulfiram
12 hours
Competitive mu (µ) opioid receptor antagonist blocks ß- endorphin which stimulates dopamine release blocks ethanol-induced DA release in NAC
naltrexone
what is naltrexone used for
narcotic abuse
alcohol dependence
Approved to maintain abstinence after detoxification, works to restore balance between glutamate and GABA
acamprosate
main ADR w/ acamprosate
transient diarrhea
S/S of alcohol withdrawal
Tremor GI (nausea/vomiting) Mild diaphoresis Vital signs increase (mild) Sleep disturbance Hallucinations Seizures (7%)
what is the time course for major withdrawal symptoms
120-168 hours
scale to assess withdrawal from alcohol in patients
CIWA scale (t need additional meds)
drug to treat seizures from alcohol withdrawal
lorazepam
what 3 meds can be given if CIWA >8
Chlordiazepoxide 50-100 mg
Diazepam 10-20 mg
Lorazepam 2-4 mg
what type benzos is preferred therapy for benzos
long acting
chlordiazepoxide
diazepam
what benzo is best to use in patients w/ liver dz
short acting
lorazepam
oxazepam
what drugs may people in seizures/ DT needs to correct electorlyte imbalances
IV magnesium
IV thaimine
when is haloperidol given for DTs
only for severe agitation unresponsive to benzos
what is given for DTs
IV benzos
IV thiamine
simple taper for benzos
25% dose reduction per week until 50% reached
then decrease by 1/8 every 4-7 days
if benzo therapy is >8 weeks how long of a taper is recommended
2-3 weeks
if therapy if >6 month with benzo how long of a taper
4-8 week
what symptoms can occur w/ benzo withdrawal
Rebound anxiety
Recurrence or relapse of symptoms
Withdrawal symptoms
common bdz withdrawal symptoms
anxiety insomnia restlessness muscle tension irritability
signs of stimulant intoxication
Hyperthermia, Hypertension, Cardiac arrhythmias, Stroke
with stimulant withdrawal when are most of the symptoms
first 24 hours give benzos or antipsychotics
with intoxication patients presents with Euphoria Dysphoria Apathy Motor retardation Sedation Attention impairment Miosis
opioid
how can you reverse opioid intoxication
naloxone
what happens when chronic opiate users d/c using them
Leads to cyclic AMP in the adrenergic neurons becomes overactive
is opioid withdrawal fatal?
no, usually just discomfort
Alpha adrenergic autoreceptors
that helps with opioid withdrawal
help taper off heroin or methadone
clonidine
µ and ō opioid withdrawal agonist
Suppresses opioid withdrawal symptoms
Blocks effect of other opioids
methadone
ADRs of methadone
Constipation, sweating, urinary retention
Respiratory depression in intolerant individuals
µ receptor partial agonist and weak K receptor antagonist
Similar effects as methadone
Opioid antagonist at higher doses
safer than heroin
buprenoprhine
naltrexoine shouldn’t be initiated until patient is opioid free for how long?
7-10 days
what test assess nicotine dependence
fagerstrom test (>4 indicates dependence)
what are smoking cessation drugs
Buproprion
Varenicline
Clonidine
TCA’s
New name for sustained release buproprion approved by FDA for treatment of tobacco dependence
block NA and NE
Zyban
antagonizes and blocks nicotinic acetylcholine receptors
BBW for neuropsychiatric symptoms nad suicidality
Varenicline (Chantix)
can you combine multiple therapies for nicotine addiction
yes as long as risk/benefit ration is favorable
ex- cardiac dz and pregnancy
what TCA has been used as 2nd line for smoking cessation
nortriptyline (inhibit reuptake NE and 5-HT)
disadvantages= ACH burden, cardiac ADRs
