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

Substance Abuse Disorders Flashcards by Madison Bompard

What explains the development of tolerance and physical dependence?

These are normal physical adaptations of the body in the presence of an opioid

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

of symptoms that classify substance use disorder as mild

2-3 symptoms

How well did you know this?

Not at all

Perfectly

of symptoms that classify substance use disorder as moderate

4-5 symptoms

How well did you know this?

Not at all

Perfectly

of symptoms that classify substance use disorder as severe

6 or more symptoms

How well did you know this?

Not at all

Perfectly

Criteria for early remission from substance use disorder

No criteria for > 3 months but < 12 months

(except craving)

How well did you know this?

Not at all

Perfectly

Criteria for sustained remission from substance use disorder

No criteria for > 12 months (except craving)

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

With which substances is withdrawal not seen?

PCP, certain hallucinogens (MDMA), inhalants

How well did you know this?

Not at all

Perfectly

Define neuroadaptation

Underlying CNS changes that occur following repeated substance use such that persons develop tolerance and/or withdrawal

How well did you know this?

Not at all

Perfectly

Define tolerance

The need to use an increased amount of a substance in order to achieve the desired effect

Markedly diminished effect with continued use of the same amount of the substance

How well did you know this?

Not at all

Perfectly

Symptoms associated with alcohol intoxication include?

Mood lability

Impaired judgment,

Poor coordination

Neurologic impairment (dysarthria, amnesia, ataxia, obtundation)

How well did you know this?

Not at all

Perfectly

Early signs of alcohol withdrawal
(first 8-24 hours)

Anxiety
Irritability
Tremor
HA
Insomnia
Nausea
Tachycardia
HTN
Hyperthermia
Hyperactive reflexes

How well did you know this?

Not at all

Perfectly

What is typically seen 24-48 hours into alcohol withdrawal?

Seizures
(tend to be grand mal)

How well did you know this?

Not at all

Perfectly

What condition develops 48-72 hours into alcohol withdrawal?

Delirium tremons
(characterized by AMS, hallucinations, autonomic instability)

How well did you know this?

Not at all

Perfectly

What is the hallmark of delirium tremens?

Profound global confusion

How well did you know this?

Not at all

Perfectly

What is the typical treatment for alcohol withdrawal?

Benzodiazepines

Anticonvulsants, including Valproic acid or Carbamazepine

Thiamine supplementation to prevent wernicke/korsakoff

How well did you know this?

Not at all

Perfectly

It is important to check LFTs to assess hepatotoxicity when a patient is taking what medication to treat alcohol use disorder?

Naltrexone

How well did you know this?

Not at all

Perfectly

What is the treatment for alcohol use disorder?

Alcoholics anonymous!!!

Naltrexone

Acamprosate

???Disulfiram

How well did you know this?

Not at all

Perfectly

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**)