Substance Abuse Flashcards by Joel Glotfelty

The most widely used substances

Alcohol and tobacco

How well did you know this?

Not at all

Perfectly

1 cause of death in the US

Tobacco

How well did you know this?

Not at all

Perfectly

Cigarette smoke has more than 7000 compounds. What are 4?

Acetone, cyanide, carbon monoxide, and formaldehyde

How well did you know this?

Not at all

Perfectly

What is the criteria for the following degrees of substance use disorders?

) Mild
) Moderate
) Severe

) 2-3 symptoms
) 4-5 symptoms
) 6 or more symptoms

How well did you know this?

Not at all

Perfectly

Schedule I controlled substances are high potential for abuse with no medical use. What are 5 examples?

MDMA, Heroin, GHB, Marijuana, and LSD

How well did you know this?

Not at all

Perfectly

Have high potential for abuse and medical use

Schedule II controlled substances

How well did you know this?

Not at all

Perfectly

What do we consider at risk drinking for men?

More than 4 drinks/day or 14 per week

How well did you know this?

Not at all

Perfectly

What do we consider at risk drinking for women?

More than 3 drinks/day or 7 per week

How well did you know this?

Not at all

Perfectly

What is the CAGE questionnaire screening test?

Cut down, Annoyed, Guilty, Eye opener

How well did you know this?

Not at all

Perfectly

In the CAGE assessment test, what do we consider a positive test?

2 positive responses (1 is at risk)

How well did you know this?

Not at all

Perfectly

One drink contains about

14 grams of pure alcohol

How well did you know this?

Not at all

Perfectly

Has a male:female ration of 3:1 and typical onset is 16-30 years old

Alcohol use disorder

How well did you know this?

Not at all

Perfectly

Almost all heavy drinkers have

Usually asymptomatic
Reversible

Fatty Liver

How well did you know this?

Not at all

Perfectly

Alcoholic cirrhosis can lead to

Portal Hypertension, decreased androgens, spider angioma

How well did you know this?

Not at all

Perfectly

Has the classic findings of hepatosplenomegaly, caput medusae, esophageal varices, and hemorrhoids

Portal Hypertension

How well did you know this?

Not at all

Perfectly

Alcoholic cirrhosis can decrease albumin levels which can lead to

Ascites (abdominal edema)

How well did you know this?

Not at all

Perfectly

Alcoholic cirrhosis can decrease coagulation factors, making you more susceptible to bruising. This is called

Ecchymoses

How well did you know this?

Not at all

Perfectly

The liver functions to store

Thiamine, folate, and B6

How well did you know this?

Not at all

Perfectly

Lack of folate from chronic alcohol use causes

Macrocytic anemia

How well did you know this?

Not at all

Perfectly

B6 deficiency from chronic alcoholism causes

Pallor (anemia)

How well did you know this?

Not at all

Perfectly

A test we can order if we are suspicious of heavy alcohol use is

Carbohydrate deficient Transferrin

How well did you know this?

Not at all

Perfectly

What level of Carbohydrate Deficient Transferrin (CDT) indicates heavy drinking?

CDT > 20g/L

How well did you know this?

Not at all

Perfectly

The legal BAC limit is

0-100 mg/dL

How well did you know this?

Not at all

Perfectly

A good marker for heavy drinking is

-Normalizes after about ~5 weeks of abstinence

GGT (>35)

How well did you know this?

Not at all

Perfectly

An AST:ALT ratio of what is suggestive of alcohol? -Less sensitive than GGT

AST:ALT > 2:1

Caused by an acute drop in thiamine - Reversible - Results in confusion, ataxia, and opthalmoplegia (eye muscle paralysis)

Wernicke Encephalopathy

Cause by a chronic decrease in thiamine -non-reversible

Korsakoff’s syndrome

Results in impaired memory, confabulation, and retrograde/anterograde memory loss

Korsakoff’s syndrome

Wernicke-Korskoff syndrome shows bilateral degradation of

Mammillary Bodies

Decreases the GABA receptor sensitivity

Alcohol

Also serves as an NMDA receptor antagonist

Alcohol

Thus, alcohol withdrawal causes an

Excitation due to decreased GABA function and increased glutamate function

The peak severity is at 36 hours and is where 90% of alcohol withdrawal seizures occur

Stage I withdrawal

Occurs during stage III of alcohol withdrawal (72-105 hours)

Delirium Tremens

Classified as a medical emergency with 20% mortality if untreated

Delerium Tremens

Characterized by autonomic instability, perceptual disturbances, and hyperactivity to lethargy

Delerium Tremens

Delerium Tremens is preceded by a

Seizure

Used to treat alcohol withdrawal by increasing GABA function and decreasing seizures

Benzodiazepines

Characterized by seizure, delirium, hallucinations, and delirium tremens

Complicated Withdrawal

Long-acting oxycodone with delayed absorption -“abuse-resistant”

Oxycontin

Marketed heavily for non-cancer prescriptions

OxyContin

A schedule II synthetic opioid that is 0-100 times stronger than morphine

Fentanyl

Is being illicitly made and mixed with or sold as heroin -Can cause fatal OD

Fentanyl

What are two major forms of heroin associated morbidity?

Endocarditis and syphilis

If you crush it, sniff it, or inject it, it causes a massive euphoria that lasts for more than 8 hours

Oxycontin

Fatalities appear to be heroin ODs -Can only be correctly identified post-mortem

Fentanyl

Characterized as non responsive with pinpoint pupils, no respiration, hypotension, and bradycardia

Opioid overdose

The cause of death from opioid overdose is

Respiratory depression

The two most important risk factors for opioid overdose are

1. ) Higher dose | 2. ) Combination with sedatives (alcohol/benzodiazepines)

Used as a marker for fatal overdose of opiates

Morphine Milligram Equivalence (MME)

An MME of 50-99 mg/day had an increase in OD risk of

3.7X

An MME of greater than 100 mg/day had an increase in OD risk of

8.9X

Which opioids are full mu agonists

Morphine and oxycodone

Which opioids are partial mu agonists?

Buprenorphine

Which two opioids are mu antagonists

Naloxone and naltrexone

Bind to receptors but only activate them to a limited extent

Partial agonists

Prevents opiate withdrawal and blocks full agonists -No respiratory depression

Partial agonist

Causes full opiate activity with respiratory depression and analgesia

Full agonist

Shows no opiate activity -Used for OD reversal

Antagonist

FDA approved for alcohol dependence and opiate dependence

Naltrexone

Why is Naloxone added in combination with oral opiate antagonists if it is not affective orally?

Prevent people from diverting by crushing and snorting or shooting up

Bupenorphine with Naloxone that is given as a sublingual tablet

Suboxone

Have the effects of changes in thoughts, perceptions, and mood -Minimal sedation

Hallucinogens

Cause no change in memory or intellectual function -5-HT2 receptor action

Hallucinogens

PCP, angel dust, LSD, and ketamine are examples of

Hallucinogens

Are not associated with abstinence syndrome and do not need detoxification

Hallucinogens

Lethal overdose is rare, but are often accompanied by psychological dependence and compulsive use

Hallucinogens

Users can develop symptoms that look just like schizophrenia

PCP

A dissociative anesthetic that causes psychosis resembling schizophrenia, but is characterized by marked neurological signs like vertical nystagmus and ataxia

PCP

Characterized by hyperalertneess, restlessness/pacing, talkative/pressured speech, and aggression or elation

Cocaine intoxication

Characterized by agitation and restless behavior, depressed mood, fatigue, and generalized malaise

Cocaine Withdrawal

Cocaine withdrawal also causes vivid and unpleasant

Dreams

A schedule II stimulant used for narcolepsy and ADHD

D-Methamphetamine

Releases high levels of dopamine -causes increased wakefulness, physical activity, respiration, and HR

Methamphetamine

Chronic abusers have severe structural and functional changes in areas of the brain associated with emotion and memory

Methamphetamine