Substance Abuse Disorders Flashcards
what is substance use disorder?
- important social, occupational, recreational activities given up or reduced
- use in hazardous situations
- tolerance
- withdrawal
- use despite physical or psychological problems caused by use
What does severity depend on?
-the # of symptoms that they have
Specifiers for early remission?
-no criteria for > 3months but < 12
Sustained remission
-no criteria for > 12 months (except craving)
Withdrawal
- substance specific syndrome problematic behavioral change due to stopping or reducing prolonged use
- no withdrawal: PCP; other hallucinogens; inhalants
What does DA get converted into?
- adrenaline!
- so, coke addicts will come in emaciated and complaining of being tired
Why do Native Americans have a higher alcoholism?
- they can burn through alcohol faster
- more efficient Alcohol dehydrogenase
Is AA good for treatment?
- no, it is a social experience
- there is no professional leading it
What does alcohol do with NT’s in our brain?
- raises GABA
- so, we compensate by increasing Glutamate
Does alcohol withdrawal sometimes require hospitalization?
- yes
- Delerium tremens is the really bad one that is life-threatening
What is the score for CIWA that they need to indicate more severe withdrawal?
->10
Benzodiazpines
- GABA agonist…. cross tolerant with alcohol
- reduce risk of SZ; provide comfort/sedation
Anticonvuslants
- reduce risk of SZand may reduce kindling
- helpful for portracted withdrawal
- carbamazepine or valproic acid
Thiamine supplementation
-risk thiamine deficiency (wernicke-korsakoff)
What meds will we use for alcohol t?
- disulfiram
- naltrexone
- acamprosate
what kind of prevention is disulfiram doing?
-tertiary prevention
Why would someone on disulfiram have rashes?
-they spray perfume on their skin… it’s that powerful
Do we ever use alprazolam for withdrawal?
- no!
- too short of a time of action
Which three benzos have no metabolites associated with them?
-oxazepam, lorazepam, and temazopam or something like that
Pinpoint pupils…. what do we think of ?
- opioid intoxitcation
- for withdrawal, their pupils go the other way
Meds for opiate use disorder
- methadone: opioid sub… no ceiling…
- naltrexone
- buprenorphine: ceiling effect
Neuroadaptation for amphetamines
- inhibit reuptake of DA, NE, SE…. greatest effect on DA
- all 3 of them have similar structures…. so we call them monamines sometimes
What enzyme metabolizes tobacco?
-CYP1A2
Neuroadaptation for tobacco?
-nAChR on DA neurons in VTA release DA in nAC
Meds for tobacco use
- bupropion
- varenicline
MDMA
- ectsasy
- enhanced empathy, personal insight, euphoria, increased energy
- tolerance develops really quickly
Neuroadaptation for MDMA
-affects 5HT, DA, NE, but predominantly 5HT2 receptor agonists
Psychosis from MDMA
- Hallucinations generally mild
- paranoia
PCP
- angel dust
- severe dissociative reactions, paranoid delusions, hallucinations, can become very agitated/violent with decreased awareness of pain
- cerebellar sx: ataxia, dyarthria, nystagmus*** this one is important
- they will have superhuman strength**
Tx for PCP
- antipsychotic drugs or BZD if required
- low stimulation environment
- acidify urine if severe toxicity/coma
