Substance Abuse Disorders Flashcards
What explains the development of tolerance and physical dependence?
These are normal physical adaptations of the body in the presence of an opioid
How is addiction different from physical dependence?
Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry; dysfunction in these circuits leads to biological, psychological and behavioral dysfunction
What is the criteria for a diagnosis of substance use disorder?
- Using larger amounts or longer time than intended
- Persistent desire or unsuccessful attempts to cut down/control use
- Craving
- Fail to fulfill major roles
- Persistent social or interpersonal problems caused by substance use
- Important social, occupational, recreational activities have been given up on or reduced
- Use in physically hazardous situation
- Use despite physical or psychological problems caused by use
- Tolerance
- Withdrawal
of symptoms that classify substance use disorder as mild
2-3 symptoms
of symptoms that classify substance use disorder as moderate
4-5 symptoms
of symptoms that classify substance use disorder as severe
6 or more symptoms
Criteria for early remission from substance use disorder
No criteria for > 3 months but < 12 months
(except craving)
Criteria for sustained remission from substance use disorder
No criteria for > 12 months (except craving)
What differentiates a substance-induced mental disorder from a regularly classified mental disorder?
The disorder developed within 1 month of substance intoxication or withdrawal or taking a medication
and
The involved substance/medication is capable of producing a mental disorder
With which substances is withdrawal not seen?
PCP, certain hallucinogens (MDMA), inhalants
Define neuroadaptation
Underlying CNS changes that occur following repeated substance use such that persons develop tolerance and/or withdrawal
Define tolerance
The need to use an increased amount of a substance in order to achieve the desired effect
or
Markedly diminished effect with continued use of the same amount of the substance
Symptoms associated with alcohol intoxication include?
Mood lability
Impaired judgment,
Poor coordination
Neurologic impairment (dysarthria, amnesia, ataxia, obtundation)
Early signs of alcohol withdrawal
(first 8-24 hours)
Anxiety
Irritability
Tremor
HA
Insomnia
Nausea
Tachycardia
HTN
Hyperthermia
Hyperactive reflexes
What is typically seen 24-48 hours into alcohol withdrawal?
Seizures
(tend to be grand mal)
What condition develops 48-72 hours into alcohol withdrawal?
Delirium tremons (characterized by AMS, hallucinations, autonomic instability)
What is the hallmark of delirium tremens?
Profound global confusion
What is the typical treatment for alcohol withdrawal?
Benzodiazepines
Anticonvulsants, including Valproic acid or Carbamazepine
Thiamine supplementation to prevent wernicke/korsakoff
It is important to check LFTs to assess hepatotoxicity when a patient is taking what medication to treat alcohol use disorder?
Naltrexone
What is the treatment for alcohol use disorder?
Alcoholics anonymous!!!
Naltrexone
Acamprosate
???Disulfiram
Intoxication by what substance is similar to alcohol intoxication but with less cognitive/motor impairment?
Benzos & barbiturates
Symptoms associated with benzodiazepine withdrawal include?
Anxiety
Irritability
Insomnia
Fatigue and HA
Tremor
Sweating
Poor concentration
**time frame depends on half-life**
What common detox mistake often precipitates significant benzodiazepine withdrawal symptoms?
Tapering too fast
(symptoms worse at end of taper)
What pharmacologic therapies are helpful in treating benzodiazepine withdrawal?
Carbamazepine
Valproic acid
Gabapentin + Tizanidine
What benzodiazepines are metabolized only through glucuronidation in the liver and thus are not affected by age/hepatic insufficiency
Oxazepam
Temazepam
Lorazepam
Symptoms associated with opioid intoxication include?
Pinpoint pupils
Sedation
Constipation
HoTN
Decreased RR
Symptoms associated with opioid withdrawal include?
Dilated pupils
Lacrimation
Goosebumps
N/V/D
Myalgias and arthralgias
Dysphoria
Agitation
“Anxious, hot and moist”
What medications are used to treat opioid use disorder?
Naltrexone (antagonist)
Methadone (full agonist)
Buprenorphine (partial agonist)
Why is Methadone a high risk medication?
It can be deadly when used with a benzodiazepine
Frequently causes QTc prolongation which may lead to torsades depointe arrhythmia (fatal)
Dangers increase when used with other CYP3A4 substrates
Is methadone maintenance used to treat pain?
NO
Of the opioids, which is not a CYP3A4 substrate?
Morphine
Symptoms associated with acute stimulant intoxication include
Euphoria
gregariousness
hyperactivity
restlessness
anxiety, tensionl, anger
tachycardia, HTN, sweating
N/V
seizures, coma, hyperthermia
Symptoms associated with chronic stimulant intoxication include
Affective blunting
Fatigue
Sadness
Social withdrawal
HoTN and bradycardia
Muscle weakness
What is the main association with stimulant withdrawal?
Suicidal depression
Cocaine prevents the reuptake of what NT?
Dopamine
There is an increased risk of CVA and MI with what stimulant?
Cocaine
What two conditions are associated with cocaine use?
Rhabdomyolysis with compartment syndrome
Psychosis
What is the preferred treatment for stimulant use disorder?
Narcotics anonymous
Support, education, skills
Amphetamines can be fatal at lower doses in the setting of what syndrome?
Brugada syndrome
Amphetamines inhibit the reuptake of what NTs?
Greatest effect on which one?
DA, NE, and 5HT
Greatest effect on DA
Tobacco induces what cytochrome P450 enzyme?
What drugs are metabolized with this enzyme and thus should be monitored for interactions in smokers?
CYP1A2
Olanzapine, Ramelteon
Nicotine ACh receptors on DA neurons in the VTA release DA onto what area of the brain?
Nucleus accumbens
Symptoms associated with nicotine withdrawal include?
Dysphoria
Irritability
Anxiety
Decreased concentration
Insomnia
Increased appetite
Treatment options for Tobacco use disorder
CBT
Nicotine gum, patches, nasal spray
Bupropion
Varenicline (Chantix)
Commonly abused hallucinogens include
Mescaline
Psilocybin (shrooms)
LSD
DMT
STP
MDMA
Symptoms associated with MDMA intoxication include
*note MDMA = ecstasy/molly*
Illusions
Hyperacusis
Sensitivity to touch, taste, and smell
Euphoria
Panic/paranoia
Impaired judgment
What is a classic symptom that points to MDMA intoxication?
extremely high fever!!!
(38.5 to 43ºC)
MDMA affects 5-HT, DA and NE receptors, but what specific 5-HT?
5-HT2
What gender of adolescents who regularly use cannabis have a 7-fold increased risk of psychosis?
Males
Symptoms of PCP intoxication include?
Severe dissociative rxns (paranoid delusions, hallucinations, agitated/violent)
Nystagmus!!! (Vertical and horizontal)
Hyperthermia, rhabdomyolysis, seizures, coma and death with severe OD
Treatment for PCP intoxication includes
Antipsychotic drugs (SGAs are first line)
