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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
What are the clinical manifestations of delirium tremens?
Profound global confusion is hallmark Also have agitation, disorientation, hallucinations, fever, HTN, diaphoresis, autonomic hyperactivity Can progress to cardiovascular collapse
26
How are benzos useful in alcohol withdrawal tx?
GABA agonist that is cross-tolerant with alcohol. Reduces risk of seizure and helps provide comfort/sedation
27
Anticonvulsants and alcohol withdrawal tx
Carbamazepine or valporic acid van help w reducing seizure risk and reducing kindling. Helps w protracted withdrawal
28
Thiamine supplementation and alcohol withdrawal
Helps reduce risk of Wernicke/Korsakoff
29
Alcohol tx
Outpatient tx (AA), disulfiram (little evidence), naltrexone, acamprosate
30
What organs should you test the function of before giving naltrexone and acamprosate, respectively?
Naltrexone - LFTs | Acamprosate - kidney
31
What two qualities would make barb or benzos more addictive?
More lipophilic and shorter duration of action
32
What are the symptoms of benzo withdrawal?
``` Anxiety Irritability Insomnia Fatigue HA Tremor Sweating Poor concentration ```
33
How can you avoid benzo withdrawal?
Switch from short acting to long acting benzo and then slowly taper down. decrease dose every 1-2 weeks
34
Which two benzos should you consider if you want to do a rapid taper?
Carbamazepine or valporic acid
35
What are the s/s of opioid intoxication?
Pinpoint pupils, sedation, constipation, bradycardia, hypotension, and decreased RR
36
S/s of opioid withdrawal
Not life threatening! Dilated pupils, lacrimation, goosebumps, n/v, diarrhea, myalgias, arthralgias, dysphoria, agitation
37
How do you tx opioid withdrawal?
Symptomatically w antiemetic, antacid, antidiarrheal, muscle relaxant, NSAIDs, clonidine, maybe Benzos
38
What medications are tx options for opiate use disorder?
Methadone, naltrexone, buprenorphine
39
What are some dangers of methadone?
Can be deadly if used w benzo, can cause QTC prolongation, and can't use w other 34A substrates
40
If a pt on methadone comes to the hospital and needs pain management, what are the options?
Other opioids, but not another 34A substrate don't use benzos and don't use additional methadone
41
What are the 11 psychological signs of stimulant intoxication?
``` Euphoria Enhanced vigor gregariousness Hyperactivity Restlessness Interpersonal sensitivity Anxiety Tension Anger Impaired judgement Paranoia ```
42
What are the 13 physical signs of stimulant intoxication
``` Tachy Papillary dilation HTN N/V Diaphoresis Chills Weight loss Chest pain Cardiac arrhythmias Confusion Seizures Come Hyperthermia ```
43
What are signs of chronic intoxication of stimulants?
``` Affective blunting (reduced emotional activity) Fatigue Sadness Social withdrawal Hypotension Bradycardia Muscle weakness Psychosis sometimes ```
44
What is one of the biggest risks of stimulant withdrawal
Suicidal depression
45
What are some risks from cocaine use?
Vasoconstrictive effects can increase CVA and MI risk | Can get rhabdomyolysis w compartment syndrome from hyper-metabolic state
46
What neuroadaptation is found in chronic cocaine use
Prevents re-uptake of DA
47
What is a big risk from amphetamine use?
Psychosis that is permanent
48
What neuroadaptation can take place w chronic amphetamine use?
Inhibits re-uptake of DA, NE, and SE but mainly DA
49
What is a drug interaction tobacco users are at risk for?
induces CYP1A2 so can have interaction - ex would be olanzapine
50
Neuroadaptation that takes place w tobacco use?
nAchR on DA neurons in VTA release DA into NA
51
What are withdrawal sx of tobacco use?
Dysphoria, irritability, anxiety, decreased concentration, insomnia, increased appetite
52
Tx for tobacco use disorder?
CBT Agonist substitution therapy - gum, lozenge, patch Medication - buproprion and varenicline (Chantix)
53
What are some examples of naturally occurring hallucinogens?
``` Peyote cactus (mescaline) Magic mushroom (psilocybin) ```
54
What are some synthetic hallucinogens?
LSD, DMT, STP, MDMA
55
What are some s/s of MDMA (ecstacy) intoxication?
``` Illusion Hyperacusis Sensitivity of touch Taste/smell altered Oneness w the world Tearfulness Euphoria Panic Paranoia Impaired judgment ```
56
What are some short term physical s/s of ecstacy use?
Tachy, sweating, muscle spasms, super high fever
57
Severe MDMA toxicity can progress to -
Rhabdomyolysis, renal failure, seizures, DIC, cardiac arrhythmias, and deathf
58
What is the predominant neuroadaptation w MDMA use?
5HT2 receptors
59
Neuroadaptation of ~cannabis~
Affects CB1 and CB2 cannabinoid receptors in the brain and body Decrease uptake of GABA and DA
60
What are s/s of cannabis withdrawal?
insomnia, irritability, anxiety, poor appetite, depression, physical discomfort
61
Risk of cannabis use?
Smoke seems to be more carcinogenic than tobacco | Can inhibit short term memory
62
PCP intoxication s/s
Severe dissociative reactions - paranoid delusions, hallucinations, can become agitated/violent w decreased awareness of pain
63
What are cerebellar symp of PCP use?
Ataxia, dysarthria, nystagmus
64
Severe OD of PCP s/s?
Mute, catatonic, muscle rigidity, HTN, hyperthermia, rhabdomyolysis, seizures, coma, death
65
Treating PCP
Low stimulation environment Antipsych or BZD if needed Acidifiy urine if there is severe toxicity/coma
66
Neuroadaptation of PCP
Allosteric modulation of glutamate NMDA receptor

BPS: Additional (5 decks)

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