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BPS: Additional > Substance Abuse Disorders > Flashcards

Substance Abuse Disorders Flashcards

1
Q

Physical dependence

A

Body adjusts to need drug. Not enough to be addiction by itself
Pts often become dependent when on opioids

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2
Q

Addiction

A

Chronic, primary disease of brain reward, motivation, memory, and related circuitry.

Individual is pathologically pursuing reward/relief via substance use/other behaviors

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3
Q

Reward deficiency syndrome

A

Dopamine system malfunction that is complicit in vulnerability to addiction

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4
Q

Besides the dopamine system, what other two areas in the brain are involved in addiction?

A

Learning and memory in hippocampus

Emotional regulation in amygdala

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5
Q

What is the ultimate common pathway for addictive behaviors?

A

Neurobiological circuitry of the CNS

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6
Q

What are some predisposing factors to being on the addictophrenia spectrum?

A

Genetic hx of: addictive disorders, intractable mood disorders, and personality disorder/habitual criminal behavior
Hx of: polysubstance abuse, trauma early in life, chronic psychosocial stressors early in life

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7
Q

What are some common co-morbid conditions in addicts?

A

~50% also have antisocial PD, depression, or suicidal thoughts

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8
Q

What are the 11 (i’m sorry) diagnostic criteria of substance abuse?

A
  1. using larger amts or for longer time than intended
  2. desire and unsuccessful attempts to cut down or control use
  3. Lots of time spent obtaining, using, or recovering
  4. Craving
  5. Failure to fulfill major roles in work, home, school
  6. Persistent social or interpersonal problems caused by substance abuse
  7. Important social, occupational, rec activities given up or reduced
  8. Use in physically hazardous situations
  9. Use despite physical or psychological problems causes by use
  10. Tolerance
  11. Withdrawal (not seen w PCP, inhalants, and hallucinogens)
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9
Q

What # of diagnostic criteria must be present for mild, moderate, and severe substance use disorder?

A

Mild: 2-3
Moderate: 4-5
Severe: 6 or more

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10
Q

What do the specifiers “in early remission”, “in sustained remission” and “in controlled envi” mean for substance use disorder?

A

Early remission - >3 months but <12 months
Sustained remission - no criteria for >12 months
In a controlled envi means they have restricted access to substances - like jail or rehab

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11
Q

Substance abuse mental disorders should have evidence of which two findings?

A
  1. Disorder developed w/in one month of substance intoxication or withdrawal or taking a med
  2. Involved substance is capable of producing the mental disorder
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12
Q

What are two findings that indicated a substance-induced mental disorder would be BETTER EXPLAINED by another diagnosis?

A
  1. Disorder preceded onset of severe intoxication or exposure to medication
  2. Full mental disorder persisted for substantial period of time after cessation of acute withdrawal/severe intoxication
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13
Q

Intoxication

A

Reversible substance-specific syndrome due to recent ingestion of substance

Has behavioral/psychological changes due to CNS effects

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14
Q

What are the two aspects of neuroadaptation that occur after repeated use of a drug?

A

Pharmacokinetic - adaptation of metabolizing system

Pharmacodynamic - ability of CNS to function despite high blood levels

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15
Q

What is tolerance of a substance?

A

When you need to increase the amt of substance to achieve desired affect OR when there is a markedly diminished effect w continued use of same amt of substance

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16
Q

When would you send a pt to the hospital for tx?

A

Drug OS, risk of severe withdrawal, medical co-morbidities, requires restricted access to drugs, suicidal ideation

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17
Q

When would you send a pt to a residential tx unit?

A

No intensive medical/psychiatric monitoring needs
Needs restricted environment
Partial hospitalization

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18
Q

When would a pt be sent to an outpatient program?

A

no risk of med/psych morbidity and a highly motivated pt

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19
Q

What BAC indicates intoxication?

A

0.08g/dl

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20
Q

What ways can alcohol be fatal?

A

Loss of airway protective reflexes, pulmonary aspiration, profound CNS depression

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21
Q

What are the early symptoms of alcohol withdrawal? (10)

A 
Anxiety
Irritability
Tremor
HA
Insomnia
nausea
tachycardia
HTN
hyperthermia
Hyperactive reflexes
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22
Q

What is seen 24-48 hrs into alcohol withdrawal?

A

Seizures - often grand mal

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23
Q

What is seen 48-73 hrs into alcohol withdrawal?

A

Withdrawal delirium (DTs) w altered mental status, hallucinations, marked autonomic instability. Can be life-threatening

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24
Q

What is delirium tremens?

A

Most severe symptom of alcohol withdrawal!!

3-10 days after last drink

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25
Q

What are the clinical manifestations of delirium tremens?

A

Profound global confusion is hallmark

Also have agitation, disorientation, hallucinations, fever, HTN, diaphoresis, autonomic hyperactivity

Can progress to cardiovascular collapse

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26
Q

How are benzos useful in alcohol withdrawal tx?

A

GABA agonist that is cross-tolerant with alcohol. Reduces risk of seizure and helps provide comfort/sedation

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27
Q

Anticonvulsants and alcohol withdrawal tx

A

Carbamazepine or valporic acid van help w reducing seizure risk and reducing kindling.

Helps w protracted withdrawal

28
Q

Thiamine supplementation and alcohol withdrawal

A

Helps reduce risk of Wernicke/Korsakoff

29
Q

Alcohol tx

A

Outpatient tx (AA), disulfiram (little evidence), naltrexone, acamprosate

30
Q

What organs should you test the function of before giving naltrexone and acamprosate, respectively?

A

Naltrexone - LFTs

Acamprosate - kidney

31
Q

What two qualities would make barb or benzos more addictive?

A

More lipophilic and shorter duration of action

32
Q

What are the symptoms of benzo withdrawal?

A 
Anxiety 
Irritability 
Insomnia 
Fatigue
HA
Tremor 
Sweating 
Poor concentration
33
Q

How can you avoid benzo withdrawal?

A

Switch from short acting to long acting benzo and then slowly taper down. decrease dose every 1-2 weeks

34
Q

Which two benzos should you consider if you want to do a rapid taper?

A

Carbamazepine or valporic acid

35
Q

What are the s/s of opioid intoxication?

A

Pinpoint pupils, sedation, constipation, bradycardia, hypotension, and decreased RR

36
Q

S/s of opioid withdrawal

A

Not life threatening! Dilated pupils, lacrimation, goosebumps, n/v, diarrhea, myalgias, arthralgias, dysphoria, agitation

37
Q

How do you tx opioid withdrawal?

A

Symptomatically w antiemetic, antacid, antidiarrheal, muscle relaxant, NSAIDs, clonidine, maybe Benzos

38
Q

What medications are tx options for opiate use disorder?

A

Methadone, naltrexone, buprenorphine

39
Q

What are some dangers of methadone?

A

Can be deadly if used w benzo, can cause QTC prolongation, and can’t use w other 34A substrates

40
Q

If a pt on methadone comes to the hospital and needs pain management, what are the options?

A

Other opioids, but not another 34A substrate

don’t use benzos and don’t use additional methadone

41
Q

What are the 11 psychological signs of stimulant intoxication?

A 
Euphoria
Enhanced vigor
gregariousness
Hyperactivity
Restlessness
Interpersonal sensitivity
Anxiety
Tension
Anger
Impaired judgement
Paranoia
42
Q

What are the 13 physical signs of stimulant intoxication

A 
Tachy
Papillary dilation
HTN
N/V
Diaphoresis
Chills
Weight loss
Chest pain
Cardiac arrhythmias 
Confusion 
Seizures
Come
Hyperthermia
43
Q

What are signs of chronic intoxication of stimulants?

A 
Affective blunting (reduced emotional activity)
Fatigue
Sadness 
Social withdrawal
Hypotension
Bradycardia
Muscle weakness
Psychosis sometimes
44
Q

What is one of the biggest risks of stimulant withdrawal

A

Suicidal depression

45
Q

What are some risks from cocaine use?

A

Vasoconstrictive effects can increase CVA and MI risk

Can get rhabdomyolysis w compartment syndrome from hyper-metabolic state

46
Q

What neuroadaptation is found in chronic cocaine use

A

Prevents re-uptake of DA

47
Q

What is a big risk from amphetamine use?

A

Psychosis that is permanent

48
Q

What neuroadaptation can take place w chronic amphetamine use?

A

Inhibits re-uptake of DA, NE, and SE but mainly DA

49
Q

What is a drug interaction tobacco users are at risk for?

A

induces CYP1A2 so can have interaction - ex would be olanzapine

50
Q

Neuroadaptation that takes place w tobacco use?

A

nAchR on DA neurons in VTA release DA into NA

51
Q

What are withdrawal sx of tobacco use?

A

Dysphoria, irritability, anxiety, decreased concentration, insomnia, increased appetite

52
Q

Tx for tobacco use disorder?

A

CBT
Agonist substitution therapy - gum, lozenge, patch
Medication - buproprion and varenicline (Chantix)

53
Q

What are some examples of naturally occurring hallucinogens?

A 
Peyote cactus (mescaline)
Magic mushroom (psilocybin)
54
Q

What are some synthetic hallucinogens?

A

LSD, DMT, STP, MDMA

55
Q

What are some s/s of MDMA (ecstacy) intoxication?

A 
Illusion
Hyperacusis
Sensitivity of touch
Taste/smell altered
Oneness w the world
Tearfulness
Euphoria
Panic
Paranoia
Impaired judgment
56
Q

What are some short term physical s/s of ecstacy use?

A

Tachy, sweating, muscle spasms, super high fever

57
Q

Severe MDMA toxicity can progress to -

A

Rhabdomyolysis, renal failure, seizures, DIC, cardiac arrhythmias, and deathf

58
Q

What is the predominant neuroadaptation w MDMA use?

A

5HT2 receptors

59
Q

Neuroadaptation of ~cannabis~

A

Affects CB1 and CB2 cannabinoid receptors in the brain and body

Decrease uptake of GABA and DA

60
Q

What are s/s of cannabis withdrawal?

A

insomnia, irritability, anxiety, poor appetite, depression, physical discomfort

61
Q

Risk of cannabis use?

A

Smoke seems to be more carcinogenic than tobacco

Can inhibit short term memory

62
Q

PCP intoxication s/s

A

Severe dissociative reactions - paranoid delusions, hallucinations, can become agitated/violent w decreased awareness of pain

63
Q

What are cerebellar symp of PCP use?

A

Ataxia, dysarthria, nystagmus

64
Q

Severe OD of PCP s/s?

A

Mute, catatonic, muscle rigidity, HTN, hyperthermia, rhabdomyolysis, seizures, coma, death

65
Q

Treating PCP

A

Low stimulation environment
Antipsych or BZD if needed
Acidifiy urine if there is severe toxicity/coma

66
Q

Neuroadaptation of PCP

A

Allosteric modulation of glutamate NMDA receptor

BPS: Additional (5 decks)

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