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Post Midterm > Substance Abuse > Flashcards

Substance Abuse Flashcards

1
Q

Psychoactive drugs

A
  • Regulated by fed gov, due to abuse potential and safety risk; Reg’d under the Controlled Substances Act (CSA)
  • Doctors can prescribe most controlled substances after special registration with the DEA.
  • Schedule 1- 5 drugs
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2
Q

Schedule 1 drugs

A
  • Drugs with a high harm risk and NO safe, accepted medical use:
  • Examples- heroin, marijuana, LSD, and ecstasy
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3
Q

Schedule 2 drugs

A
  • Drugs with a high harm risk but with safe and accepted medical use; these drugs are highly addictive
  • Examples: most opioids and stimulants and some barbiturates.
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4
Q

Schedule 3, 4, 5

A
  • drugs with a harm risk less than schedule 2 drugs with safe and accepted medical uses in the US
  • Schedule 3- several barbiturates, anabolic steroids, codeine (Tylenol 3)
  • Schedule 4- most benzodiazepines
  • Schedule 5- liquid codeine preparations (eg Robitussin)
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5
Q

Abuse of controlled prescription drugs is

A

Rising; more deaths from opioids that are prescribed to someone than there are deaths related to heroin and cocaine (street drugs).

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6
Q

Sedatives

A
  • CNS depressants
  • Alcohol, Benzo’s (diazepam,and lorazepam) Barb’s (phenobarbital, secobarbital)
  • Barbiturates , specifically, have a low safety margin and high abuse potential.
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7
Q

Sedative intoxication

A

Key symptoms:

  • Sedation, sleepiness, decreased anxiety
  • Disinhibition , impaired judgement
  • slurred speech, incoordination
  • stupid or coma
  • reduced respiratory drive

Other potential effects:

  • Anticonvulsant and anesthetic effects
  • disrupted sleep architecture- decreased slow wave sleep and R.E.M. Sleep- resulting in un refreshing sleep.
  • Alcohol-related brain damage (ARBD)(e.g Korsakoff’s amnesia)
  • Cross tolerance to other sedatives- i.e drinking alcohol chronically, being prescribed a benzo and not responding to initial dose due to developed tolerance from EtOH use.
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8
Q

Sedative withdrawal

A 
Key Symptoms: marked by ANS hyperactivity, can be fatal . 
Extreme panic reaction: 
- Agitation, insomnia, and anxiety
-ANS hyperactivity 
-N/v
-hand tremor 
Also: 
-transient hallucinations- can occur in any sensory modality including tactile (ie Formication- sensation of bugs crawling under skin); can occur as the main symptoms of withdrawal without physical sx's , as is the case in Alcohol Hallucinosis.
-Seizures
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9
Q

Extreme form of Sedative withdrawal

A

Delirium Tremens (DT’s): confesional state as part of sedative withdrawal:

  • Severe and uncommon
  • Seen after chronic heavy use of a sedative , esp alcohol
  • associated with high mortality rate.
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10
Q

Pharmacological Tx for ALCOHOL

A
  1. Disulfiram (Antabuse)- inhibits the enzyme that break down acetaldehyde; after EtOH is consumed, acetaldehyde. *USE FOR THE SHORT TERM
  2. Naltrexone, Revia: an opioid receptor blocker the reduces the pleasurable effects of alcohol. Helps avoid full relapse.
  3. Acamprosate (Campral): an NMDA receptor anatagonist the reduces cravings for EtOH by decreasing uncomfortable feelings of protracted abstinence.
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11
Q

Disulfram (Antabuse)

A
  1. Disulfiram (Antabuse)- inhibits the enzyme that break down acetaldehyde; after EtOH is consumed, acetaldehyde accumulates causing toxic run, nausea for 30-60 minutes.
    * USE bc of poor compliance, DISULFIRAM (ANTABUSE) is typically given short term if person into a known high risk situation; knowing the toxic effect is DISINCENTIVE to take first drink.
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12
Q

Major Stimulants

A
  1. Amphetamines - methamphetamines, MDMA, Adderall
  2. Amphetamine like drugs- methylphenidate aka Ritalin
  3. Cocaine
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13
Q

Major Stimulant Intoxication

A 
Psychological - may mimic sx's of schizophrenia and/or BP1 manic episodes. --use Drug screen to distinguish. 
- Euphoria and grandiosity 
-Psychomotor acceleration and stereotypical 
-Paranoia and hallucinations 
Physical 
-Elevated HR and BP -- life threatening
-Appetite and loss of insomnia
-Mydriasis; dilated pupils 
-Seizures
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14
Q

Major stimulant withdrawal

A

Key symptoms: Maybe mimic MDD with atypical features

  • dysphoric mood
  • fatigue and psychomotor slowing
  • Hypersomnia with vivid unpleasant dreams
  • Increased appetite

*non life threatening and relatively mild, more so uncomfortable/unpleasant , but not deadly

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15
Q

Ecstasy (MDMA)

A
  • Schedule 1 Drug; Classified as a stimulant PLUS mild hallucinogenic effects (perceptual alterations)
  • commons things look more interesting
  • empathogensis
  • Concern about neurotoxicity
  • other health consequences, hyperthermia
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16
Q

Bath Salts

A

-Stimulant Designer drug containing, in part, amphetamine-like chemical (mdpv)

ACUTE TOXICITY

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17
Q

Minor stimulants

A
  1. Nicotine
  2. Caffeine
    - Cause improved mood, increased alertness/attention and decreased appetite.
    - DSM-5 does not recognize a category for nicotine intoxication
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18
Q

Nicotine Withdrawal

A 
Dysphoric mood
Restlessness, anxiety
Difficulties concentrating 
Irritability, anger
Increased appetite 
Decreased heart rate
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19
Q

Caffeine intoxication and withdrawal , NOT use disorder

A
  • occurs after a dose much greater than 250 mg of caffeine
  • Key symptoms:
    Increased energy , restlessness, insomnia, nervousness, rambling thoughts, tachycardia, dieresis, GI disturbance, muscle twitches.

Caffeine withdrawal: headaches, dysphoric, fatigue, decreased concentration

20
Q

Hallucinogens and Related Substances

A

A. Classic hallucinogens : LSD, Mescaline. (Peyote Cactus), Psilocybin(shrums)
B. Cannabis: Marijuana , Hashish
C. Dissociative anesthetic: PCP, Ketamine

21
Q

Commonalities between Hallucinogens and related substances

A
  1. These drugs are known for their PERCEPTUAL ALTERING ABLITIES
    - Classic Hallucingoen (LSD, Mescaline, Shrums/Psilocybin)- Hallucinations
    - Cannaboids- Distortions
    - Dissociative Anesthetics (PCP, Ketamine)- depersonalization
  2. Mind calming effects, despite having sympathomimetic effects ; nonetheless, they can be associated with agitation/paranoia.
22
Q

Concern between Hallucinogens and related substances

A

Concerns (largely unproven_ exists that these drugs CAUSE a persisting psychotic state (schizophrenia, psychosis)

23
Q

a) Classic hallucinogens

A
  • “Flashbacks”: Hallucination persisting perception disorder- DSM 5 dx
24
Q

b) Cannabis

A

-Gateway drug alongside prescription opioids
-most commonly used illegal substance
Rarely causes hallucination, unless INGESTED– perhaps having to do with metabolism
-shorter acting than LSD (2-4 HRS of cannabis vs. 8-12 hours of LSD), unless ingested– may last longer if cannabis is ingested.
-Associated with “amotivational syndrome”

25
Q

Eating Cannabis can cause

A
  • hallucination and longer acting time (longer than 2-4 hours)
26
Q

Cannabis intoxication-key sx’s

A

PSYCHOLOGICAL
-perceptual distortions (e.g intensification of senses ( base of the song is heightened, noticing things that not normally noticed - edges of potatoe chips?)
-perception of slowed time
Physical
-Conjunctival injection
-Increased appetite
-dry mouth - hearing smacking of lips while talking.

27
Q

Cannabis withdrawal

A 
Key symptoms
- "Agitation"---oppposite of mellow 
Psychological 
-Irritability and nervousness 
-dysphoric mood
-sleep disturbance 
-decreased appetite

Physical
-headaches, nightsweats, stomach cramping, shakiness.

28
Q

Federal status of Cannabis

A

Schedule 1

29
Q

c)dissociative anesthetics (PCP) sx’s of intoxication

A
  • Depersonalizations
  • agitation, belligerence , and confusion, impulsitivity and unpredictability (naked guy running naked, directing traffic)
  • Nystagmus, hyperacusis
  • Decreased responsiveness to pain- due to depersonalizations, pain is there but person is distracted from sensation of pain
  • Ataxia, muscle rigidity , seizures, coma

*Considered a psychiatric emergency bc of violent and unpredictability ebeahviors

30
Q

Treatment of acute intoxication of PCP

A

No recognized withdrawal symptoms

  • benzodiazepines/antipsychotics
  • reduced environmental stimulation
  • restraints maybe be needed

*allow time to pass

31
Q

OPIOIDS(narcotics)

A

Main medical use of opioids- analgesia

  • additional notable effects- euphoria in varying intensities
  • Heroin: Produces intense euphoria (highly addictive); Can be smoked/snorted/ so users dont always have needle track marks.
32
Q

Main medical use of opioids

A

Analgesia

33
Q

Heroin

A

Opioid, narcotic

Can be injected, snorted or smoked, so not necessarily have needle tracks.

34
Q

OPIOD Intoxication

A

Key sx’s

  • Initial intense rush followed by EUPHORIA and DROWSINESS, DYSPHORIA as the high dissipates –thus the craving for more.
  • miosis “PIN-POINT PUPILS”
  • unconscious
  • respiratory depression
35
Q

Opioid Overdose

A

-Can be lethal from respiratory depression
-Treatment of overdose : Naloxone (Narcan)
Nalaxone (Narcan)- is a short acting opiod receptor anatagonist ; used for ACUTE OVERDOSE, but not opioid addiction therapy.

36
Q

Naltrexone (REVIA)

A
  • Opioid receptor blocker that reduces the pleasurable effects of alcohol

USE– to help pt stop drinking when “slip” does occur, after several beers/drinks they will notice that they are just not getting anything out of it, so they discontinue drinking, e.g naltrexone will prevent a “full relapse”.

37
Q

Naloxone (NARCAN)

A

A short acting opioid receptor anatagonist

-used for acute overdose but not opioid addiction therapy.

38
Q

Acamprosate (CAMPRAL)

A

An nm daughter receptor blocker that reduces craving for alcohol by decreasing the uncomfortable feelings associated with relapsing. Make you feel good, euphoria.

39
Q

OPIOID withdrawal

A

KEY SYMPTOMS—FLU LIKE SYMPTOMS, you feel like u want to die, but withdrawal is usually not deadly.

  • dysphoria
  • nausea, vomiting, diarrhea,muscle aches, lacrimation, and rhinorrhea
  • piloerection, sweating, fever
  • yawning
  • pupillary dilation
40
Q

Treatment Approaches: Opioids

A
  1. Abstinence-bASED THERAPY

2. Replacement therapy (RT), more successful than abstinence based therapy

41
Q

Abstinence based Therapy

A
  1. Abstinence-bASED THERAPY
    - Requires patient to be completely abstinent from opiod drugs
    - Often involves use of NALTREXONE ( a long acting opioid receptor blocker) to black opioids effects it relapse occurs
    - tends to be unsuccessful
42
Q
  1. Replacement therapy
A

Involves giving the patient a safer opioid drug (methadone or buprenorphine)
-tends to be more successful than abstinence based therapy

43
Q

Rationale for RT

A

-Chronic , heavy opioid use results in

Anhedonia , hypodaminergic state

44
Q

Methadone

A

> Schedule 2 opioid drug
When used for addiction treatment, methadone:
- Is only available at an official federally-regulated opioid treatment program (OTP)
- Cannot be prescribed by doctors

45
Q

Buprenorephine

A

> Schedule 3 opioid drug - less scheduled
When used for addiction:
-available from doctors office after approval by the DEA
-Can be “prescribed” , “administered”, or “dispensed” from a doctor’s office.
-Can reach MORE addicts than with Methadone

46
Q

Suboxone

A

Buprenorphine + Naloxone (Narcan)
Used if patient is abusing medications, i.e crushing pills to snort or smoke–> in such cases, the burprenorphine is inhibited by the short acting opioid anatagonism of the Narcan.

47
Q

Duration and Benefits of Replacement therapy

A
  • Usually continues for at least 1-2 years

- Benefits of RT: oral administration, stable drug level,

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