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Psychiatry > Substance Abuse > Flashcards

Substance Abuse Flashcards

1
Q

Neurobiology

A
  • Addictive substances activate reward pathway BUT even more dopamine release than normal
    • VTA (releases dopamine)—> nucleus accumbens —> OFC (shape actions toward desire) —> PFC (brake- stop action)
      +amygdala/hippocampus remember euphoria associated
  • Adaptation - need more and more b/c dopamine receptors become less responsive
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2
Q

4 Screening Tools

A
  • CAGE (cut down, annoyed when ppl ask, guilt, eye-opener)
  • AUDIT - alcohol use disorders screening test
  • S-MAST - short Michigan alcohol screening test
  • DAST- drug abuse screening tool
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3
Q

3 Drugs to Treat Alcoholism

A
  • Disulfarim - ADH inhibitor —> acetylaldehyde (toxic intermediate causes unwanted effects)
  • Naltrexone - opiate antagonist - block reinforcing pathway
  • Acamprosate - dec glutamate and inc GABA; restore balance to dec cravings
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4
Q

3 Drugs for Opiate Addiction

A
  • Methadone - mu-opioid agonst; only available in regulated programs (come to clinic ea day)
  • Buprenorphine (Suboxone) - partial mu agonist so can be given in office setting
  • Naltrexone too
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5
Q

3 Drugs for Tobacco Use

A
  • Nicotine replacement
  • Buproprion (NDRI - blocks NE and dopamine) to dec cravings
  • Varenicline (Chantex) - nicotinic acetylcholine partial receptor agonist
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6
Q

Therapies (5)

A
  • Motivational Enhancement Theory - application of MI to strengthen pt motivation
  • CBT - esp focus on relapse prevention skills
  • Contingency Management - provide incentives for clean drug tests
  • Self-Help Groups
    • Family Involvement
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7
Q

Signs of Intoxication & Withdrawal (alcohol)

A

I - Disinhibition, lethargy, ataxic, hypoglycemic

W - restless/anxious, inc BP/HR, hyper-reflexive, tonic clonic seizures, formication, alcohol withdrawal delirium (@ 48-72 hrs - fevers, agitated, disoriented, inc ANS)

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8
Q

Signs of Intoxication & Withdrawal (cannabis)

A

I -Euphoria, impaired judgment, slow reaction time, inc appetite, conjunctival injection (droopy and red), +/- anxiety and paranoid delusions

W- anxiety, depression, insomnia, poor appetite, restlessness

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9
Q

Signs of Intoxication & Withdrawal (stimulants)

A

I - Paranoia, pupil dilation, inc HR and BP, chest pain, nausea, seizures, psychomotor problems

W- Depressed, poor concentration, fatigue, poor sleep quality w/ vivid dreams, inc appetite

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10
Q

Signs of Intoxication & Withdrawal (opiates)

A

I- Initial euphoria then apathy, impaired judgment, drowsy, pinpoint pupils, respiratory depression, coma, death

W- Dilated pupils, sweating, tears, congestion, nausea, vomitting, ab cramps, goosebumps, insomnia, anxiety

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11
Q

Signs of Intoxication & Withdrawal (sedatives)

A

I - Somnolence, ataxia, resp depression (benzo use looks similar to alcohol)

W- Rebound insomnia, rebound anxiety, depression, seizure

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12
Q

Signs of Intoxication & Withdrawal (molly/ecstasy)

A

I - Euphoria, disinhibition, elevated BP/HR, hyperthermia, hyponatremia

W- Anxiety, depression, fatigue, poor conc

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13
Q

Opioid Epidemic Facts

A
    • corresponds to inc opioid prescription starting in late 1990s
      • Study of retrospective data said < 1% become addicted
      • Pain = 5th vital sign
      • 4X as many prescribed & 2X more deaths since
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14
Q

Opioid OD Risk Factors (7)

A
  • Using > 100 mg daily
  • Recent release from controlled environment (jail or treatment center)
  • Mixing w/ other depressants (benzos, alcohol, etc)
  • Medical conditions (renal, hepatic, pulmonary, HIV)
  • Age range 25-55
  • Highest among white non-Hispanic males
  • Using alone
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15
Q

Naloxone Pharmacology

A
  • Opioid antagonist w/ high affinity for mu receptor
  • Competes w/ and replaces bound agonist
  • Works w/in minutes
  • Last 20-90 min so may have to re-administer
  • No adverse effects if give to someone who is not overdosing
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16
Q

Naloxone Efficacy

A
  • IM and IN have similar outcomes after making a more concentrated IN formulation
    • Mean response time was about 8 min for both groups
  • No one released w/ AMA after being treated w/ naloxone died of OD in 12 hours following
  • Mass study showed 98% success rate of rescue attempts w/ naloxone and dec death rates inc communities that implemented opioid overdose prevention programs (syringe exchange and naloxone distribution)
17
Q

4 Forms of Naloxone

A
  • Intra-muscular
    • Traditional
    • Auto-injector
  • Intranasal
    • w/ MAD (off-label) - MAD may not be covered (costs $4-8 ea)
    • NARCAN nasal spray

Psychiatry (14 decks)

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