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Behavioral Dynamics > Substance abuse-Exam 2 > Flashcards

Substance abuse-Exam 2 Flashcards

1
Q

____ alcohol, tobacco, illicit drugs or improperly used medication

A

substance

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2
Q

_____ sporadic consumption with no major adverse consequences

A

substance use

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3
Q

______ consumption that risks major adverse consequences

A

at risk substance use

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4
Q

______ condition characterized by an individual who is significantly affected by another person’s substance use or addiction

A

codependency

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5
Q

Define substance abuse

A

maladaptive use causing impairment or distress over a 12-month period where 1+ has occurred:

Failure to fulfill major role obligations

Use of drugs in hazardous situations

Recurrent legal problems due to substance use

Continued drug use despite persistent social or interpersonal

problems because of use

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6
Q

_____ state of adaptation manifested by a substance class-specific withdrawal syndrome

A

dependence

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7
Q

What can dependence be produced by?

A

Rapid dose reduction or cessation of a substance

Administration of an antagonist

Tolerance to the substance

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8
Q

____ and ____ are both types of dependence that a patient can manifest

A

Psychological dependence

Physiologic dependence

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9
Q

______ primary, chronic, neurobiologic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations

A

addiction

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10
Q

What are the characteristic behaviors of addiction?

A

Impaired control over substance use

Compulsive substance use

Continued substance use despite harm

Craving for substance

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11
Q

What is the difference between substance use and dependence/addiction?

A

Substance use - pts retain control of their use

Dependence and Addiction - No longer have full control

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12
Q

Dependence/addiction you can ????? often predate the initial substance use, thought to be genetically predisposed. What is this thought to be due to?

A

Measurable brain abnormalities

changes that affect dopamine level in mesolimbic system

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13
Q

What are some examples of psychological dependence?

A

irritable, agitation etc etc

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14
Q

What are some examples of physiological dependence?

A

heart palpitations, HA, N/V

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15
Q

Substance use disorder is defined as maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by ___ of the following within a ____:

A

2+

12-month period

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16
Q

**Patients 12 yrs and up with any illicit drug use in the past 1 month: is _____

A

almost 1 in 5 (17%)

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17
Q

**______ that they have a substance abuse problem

A

Almost 95% are unaware

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18
Q

** ______ age at first use = _____ risk of later addiction

A

younger age

increased risk

aka the younger you are when you first use, the greater the chance of addiction later

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19
Q

What ethnicity has the highest rates of substance abuse?

A

alaskan native and native american

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20
Q

**Lifetime prevalence of ETOH - Almost ______ of pts 12+

A

4 out of 5 (78%)

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21
Q

**ETOH within past 12 months - almost ______

A

2 out of 3 (63%)

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22
Q

**ETOH within past 12 months, ages 12-20 - about _____

A

3 in 20 (15%)

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23
Q

**Cigarettes or vaping: ______ - Lifetime, pts 12 and up (2022)

A

Over 1 out of 2 pts (57%)

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24
Q

**Cigarettes or vaping ______ - Past 1 yr, pts 12 and up (2022). Is this statistic getting better or worse?

A

Over 1 out of 5 pts (28%)

no improvement and trending up

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25
Q

Young adults are more likely to use ______.

A

vaporized cigarettes (vapes)

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26
Q

**What are the top 3 most abused substances? Know which ones are illicit

A

1: Alcohol

#2: Marijuana
#3: Pain relievers

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27
Q

**_____ is the leading cause of preventable death in the US

A

Tobacco use

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28
Q

What are some substance abuse risk factors

A

Early onset tobacco use
Early experimentation with substances
Type of substance tried

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29
Q

_____ neurotransmitter involved in regulation of pain, appetite, memory, mood

A

Anandamide

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30
Q

Why do people abuse substances?

A

Chemical structure of many drugs is similar to neurotransmitters

Drugs of abuse affect the motivation and pleasure
pathways in our brain!

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31
Q

Drugs of abuse ____ dopamine levels, and affect ___ and _____ levels

A

increase dopamine

serotonin and glutamate levels

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32
Q

What are some common cognitive defects with addiction?

A

Short-term memory loss

Impaired abstract thinking

Impaired problem-solving strategies

Loss of impulse control

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33
Q

What are the three C of addiction?

A

Control
Compulsion
Chronicity: multiple relapses precede stable recovery

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34
Q

There is a strong link between mental illness and substance use, which of the two should be treated first?

A

Should treat both at the same time

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35
Q

What is the opponent-process theory?

A

Every process that is either pleasant or unpleasant has a secondary “opponent” (opposite) process that sets in after

With repetition, the primary process becomes weaker while the opponent process is strengthened

aka: less of high/rush with more of the withdrawal

aka: over time its less about getting high and more about avoiding the withdrawal

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36
Q

What are most of the substance abuse medication aimed at treating?

A

medications aimed at preventing the rush and helping with the withdrawal to not be so terrible

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37
Q

**About _____ US adults use alcohol in a risky manner and are at risk for substance use issues!

A

1 in 4

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38
Q

_____ repetitive use of alcohol, often to alleviate emotional problems

A

at-risk drinking

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39
Q

What is considered moderate drinking for men? binge drinking?

A

moderate drinking: 1-2 drinks/day
binge: greater than 4 drinks on a single occasion

more than 14/drinks/week on average

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40
Q

What is considered moderate drinking for women? binge drinking?

A

moderate drinking: 1 drink/day
binge drinking: more than 3 drinks on a single occasion

more than 7 drinks a week on average

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41
Q

**What equals 1 drink?

A
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42
Q

How long does it take the liver to process 0.5oz of alcohol?

A

1 hour

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43
Q

What are some telescoping factors in women that speed up the timeline from first drunk to alcohol dependence?

A

Lower EtOH dehydrogenase

Lower total body water

Smaller volume of distribution

Drink like partner

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44
Q

What enzyme breaks down alcohol?

A

EtOH dehydrogenase

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45
Q

What psych disorder is common in alcohol abuse? What gender is more likely to abuse alcohol?

A

depression

males

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46
Q

What is the 3rd leading cause of preventable death in the US?

A

excessive alcohol use

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47
Q

_____ recurrent use of alcohol despite disruption in social roles, alcohol-related legal problems, or taking safety risks

A

alcohol addiction

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48
Q

What are some risks factors for alcohol dependence?

A

Male gender

White or Native American

Younger age (18-29)

Being single

Lower income

Past exposure to adverse events (think military combat)

Genetic predisposition

Significant disability

Other psych disorders (SUD, depressions, BPD, personality disorders)

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49
Q

What is the CAGE questionnaire?

A

CUT DOWN on your drinking?
felt ANNOYED by someone criticizing your drinking?
felt GUILTY about your drinking?
ever needed an EYE-OPENER?

2+ yes: need an more in depth assessment
1 yes: is a red flag, possible substance abuse problem

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50
Q

_____ is the more in depth CAGE survey

A

Alcohol Use Disorders Identification Test (AUDIT)

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51
Q

What is the MOA of alcohol?

A

Crosses the blood-brain barrier

Acts as a sedative-hypnotic substance

Affects CNS receptors - GABA, NMDA (glutamate), 5HT-3 (serotonin)

Facilitates dopamine release

suppression of the inhibitory control system

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52
Q

What is delirium tremens?

A

extreme alcohol withdraw due to prolonged alcohol consumption, results in fewer GABA receptors

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53
Q

confusion, tremor, seizures, sensory hyperacuity, hallucinations, hyperreflexia
anxiety, agitation, panic attacks, paranoia
Diaphoresis, dehydration, electrolyte abnormalities

What am I?
What are the 2 major ones?

A

delirium tremens

**tremor and seizures

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54
Q

**What is the triad of Wernicke Encephalopathy? What is the treatment? Is it reversible?

A

Confusion, ataxia, ophthalmoplegia

Thiamine, other B vitamins

Often completely reversible with treatment

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55
Q

What are the signs of Korsakoff Psychosis? What is the treatment? Is it reversible?

A

Amnesia: anterograde and retrograde

Aphasia
apraxia (unable to perform movements when asked)
agnosia (unable to process sensory information)

Thiamine, other B vitamins

Only about 20% are reversible with treatment

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56
Q

What is a classic chronic alcohol abuse abdominal s/s?

A

Portal hypertension, varices, caput medusae

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57
Q

When does alcohol withdrawal tend to set in? When are the peak intensity of symptoms?

A

about 8-12 hrs after last drink

48-72 hours

58
Q

What is the mainstay treatment for alcohol withdrawal?

A

Medium to long-acting BZDs like diazepam (Valium), lorazepam (Ativan) usually preferred

consider adding on: clonidine or atenolol

B vitamins! (do NOT give IV glucose before giving thiamine supplementation)

Fluid replacement (if needed)

59
Q

_____ is used to help asses alcohol withdrawal severity. When does treatment begin?

A

CIWA Scoring

Tx often begins at score of 8-10 (mild) or higher

60
Q

What is the treatment for miild alcohol withdrawal?

moderate?

Severe?

A

short course of tapering BZD
e.g. - diazepam 20 mg orally on first day, then decrease by 5 mg/d

inpatient (hospital) treatment with regular BZD until stable
e.g. - diazepam orally 5-10 mg per hour depending on clinical need
Monitor vitals and electrolytes

inpatient (hospital) treatment, regular BZD until stable
e.g. - diazepam IV till sedated, then may give orally every 8-12 hrs
Reduce dose by 20% per 24 hrs - taper usually takes 1+ wks

social work and psych consult needed!!

61
Q

What is the first line medication for chronic alcoholism? What is the MOA?

A

Naltrexone (ReVia, Vivitrol)

Blocks the release of dopamine in the brain, better efficacy if given with behavioral therapy

62
Q

Can you start naltrexone while the patient is still drinking? What is the daily dose?

A

50 mg orally once daily - can start while person is still drinking

63
Q

What are the BBW for Naltrexone? What are the CI? What tests do you need to monitor?

A

hepatocellular injury, hepatotoxicity

hx of hypersensitivity, opioid dependence or current use of opiates

LFT

64
Q

_____ is first line therapy for chronic alcohol use and works to restore normal glutamate action. Interferes with glutamate release thereby stopping excitation that happens with withdrawal. Also affects GABA

A

Acamprosate (Campral)

65
Q

_____ 666 mg orally TID - often recommend to start after pt has been ABSTINENT

A

Acamprosate (Campral)

66
Q

What are the CI for Acamprosate (Campral)?

A

Severe renal impairment (CrCl < 30 mL/min)

aka good for bad livers but CI for bad kidneys

67
Q

____ is 2nd line therapy. Inhibits enzyme aldehyde dehydrogenase. Not proven long-term efficacy in alcohol abuse.Does not influence motivation/withdrawal directly

A

Disulfiram (Antabuse)

aka makes you feel very sick if you drink alcohol

68
Q

What are some other second-line therapies for alcohol abuse?

A

topiramate (Topamax), gabapentin (Neurontin)
baclofen, SSRIs, ondansetron

69
Q

**_____ is the #1 preventable cause of mortality. and causes ____ deaths

A

Smoking

1 out of 5

70
Q

What pt demo graphic has the highest risk for smoking?

A

male, AI/AN, multiracial, white, black, homosexual, low socioeconomic and education level

71
Q

____ have a slightly lower risk of cancer due to it not being inhaled as deeply into the lungs. _____ is passed through a water chamber before being inhaled

A

Cigars/Pipes

Hookahs

72
Q

____ is acute lung injury associated specifically with the use of vaping products.
Acute _____ reported after vape use

A

EVALI

eosinophilic pneumonia

73
Q

The average cigarette contains ____ of nicotine. Body absorbs about ___ per cigarette. ____ absorption with vape vs. smoke

A

10-15mg

1-2 mg per cig

2-3X more absorption with vaping

74
Q

____ stimulates nicotinic cholinergic receptors in the brain. Reaches brain in about ___ ; t½ about _____

A

nicotine

15 sec

1-2 hours

75
Q

**Tobacco tolerance is due to ???

A

due to upregulation of nicotinic (acetylcholine) receptors → develops rapidly

76
Q

What is the timeframe for tobacco withdrawal?

A

as early as 2 hrs after last cigarette, peaks in first 72 hrs, fades gradually over 3-4 weeks

77
Q

Nausea, salivation, pallor
Tachycardia, poor concentration
Decreased REM sleep

What am I?

A

acute toxic effects of tobacco

78
Q

Smokers on average die _____ earlier than non-smokers

A

10 years ealier

79
Q

What is the correlation between smoking and H. Pylori?

A

smoking increases the risks that abx prescribed for H. Pylori will not be effective

80
Q

Smokers will have an (increased/decreased) carbon monoxide level. What lab tests can you order to see if people have been smoking?

A

increased

Continine - nicotine metabolite (can be positive due to second hand smoke exposure)

Anabasine - present in tobacco and most vapes, not nicotine replacement

81
Q

What is first line for tobacco cessation?

A

Nicotine Replacement Therapy: need both long acting and short acting

82
Q

____ is the primary recommended treatment for adolescents who are smoking/vaping and wish to quit

A

Nicotine Replacement therapy

83
Q

____ is the most common SE of transdermal patch. What are two additional SE? What are two pt education points?

A

skin irritation

need to change location of the patch daily, do not sleep in patch

insomnia, vivid dreams

84
Q

_____ diminishes rather than stops nicotine withdrawal. What are the SE? What is the pt education?

A

Oral Nicotine Gum

N/V/D, HA, excess salivation, mouth irritation

Avoid acidic beverages before and during gum use
“Chew and park” method for 30 minutes

85
Q

What are the pt education points for oral nicotine lozenges? SE?

A

Does not need to be chewed; most nicotine content

Maximum - 5 lozenges every 6 hrs or 20 lozenges/day

mouth irritation, N/V/D, palpitations, HA, insomnia

86
Q

_____ absorbed through nasal mucosa - more rapid peak than oral

A

Nicotine Nasal Spray

87
Q

_____ blocks dopamine and norepinephrine reuptake (DNRI), antagonizes nicotinic cholinergic receptors. What are the SE?

A

Bupropion

insomnia, agitation, dry mouth, headache

88
Q

What are the CI to Bupropion?

A

epilepsy; high seizure risk; hx of anorexia or bulimia

89
Q

_____ partial agonist of nicotinic cholinergic receptors. Partial stimulation of receptor to decrease withdrawal. Blocks nicotine from binding to receptor, interfering with “reward”

A

Varenicline (Chantix)

90
Q

When ____ was first released there was concern about neuropsychiatric SE but the FDA has removed the BBW

A

Varenicline (Chantix)

91
Q

_____ recommended most commonly as back-up or adjunct to first-line medication

A

Nortriptyline

92
Q

The best success rates to quit smoking are achieved with plans that incorporate both ?????treatments.

A

pharmacologic and non-pharmacologic

93
Q

What do you think happens after someone quits smoking with regard to mood, cough and weight?

A

Mood- irritable
Cough- increased coughing
Weight- increased weight, usually around 10 lbs

94
Q

Opioid use during pregnancy can result in a drug withdrawal syndrome in newborns called _____

A

neonatal abstinence syndrome

95
Q

____ and ____ are natural opiates and are derived from poppy plant

What are the semi-synthetic ones?

Derived from ???

A

codeine, morphine

heroin, oxycodone, buprenorphine, oxymorphone, hydrocodone, hydromorphone.

Derived from opium (extract of poppy plant)

96
Q

What are the synthetic opiates?

A

meperidine, fentanyl, methadone

97
Q

____ acts on mu and noradrenergic/serotonin receptors

A

tramadol

98
Q

_____ acts on mu, kappa and delta opioid receptors in brain, digestive tract, spinal cord. What is each receptor responsible for?

A

Opioids

Mu – mediates pain, respiratory depression, constipation and physical dependence

Kappa – analgesia, diuresis, sedation , psychological dependence

Delta – analgesia, dependence, antidepressant

99
Q

What are some effects of opioids on the body?

A

Pupillary constriction
Constipation
Pinpoint pupils
Respiratory depression

100
Q

_____ is the short-acting opioid antagonist. What is the dosing for Cardiorespiratory arrest?

Spontaneous ventilations?

A

Naloxone (Narcan)

2mg

0.05mg IV

101
Q

**What does long term use of opioid do to your brain?

A

desensitization and downregulation of opioid receptors

102
Q

_____ opiates causes earlier development of tolerance

A

short-acting

103
Q

What is the opioid withdrawal symptoms scale? When do you need to treat?

A

Grade 0-4.

0 is no cravings/axiety and 4 is all the signs

Treat if grade 2 or higher

104
Q

What is the first line opioid agonist therapy?

A

Methadone or buprenorphine

Need to slowly taper up methadone to keep the symptoms at bay

buprenorphine 4-8 mg sublingually, IV, or IM

105
Q

____ are full agonist of the opioid receptors

___ are partial agonist

____ are antagonist

A

Opioids: aka fully activate the receptor

buprenorphine: partially activates

Naloxone: blocks

106
Q

What are some add on medications to give with opioid withdrawal?

A

Clonidine

Lofexidine: Associated with less hypotension than clonidine

BZD to help with agitation, ondansetron, loperamide

107
Q

_____ is an opioid antagonist and indicated for maintenance treatment. NOT ACUTE TREATMENT

A

Naltrexone (Revia, Vivitrol)

will cause withdrawal if used in acute treatment and risk of overdose with concurrent opioid use

108
Q

What is the BBW with Naltrexone (Revia, Vivitrol)? What is the MC SE?

A

hepatocellular injury

nausea

109
Q

_____ long acting opioid agonist and helps decrease withdrawal s/s and block “high” from acute opioid use. What is the initial and maintenance doses?

A

Methadone

Initial: 20-30mg, maintenance dose of 80-120 mg/d

110
Q

constipation, drowsiness, sweating, peripheral edema, reduced libido, erectile dysfunction

These are the SE of ____.

What test do you need to order to monitor on these patients?

What is the risk of overdose?

A

**Cardiac arrhythmias (QT prolongation) Need to order yearly EKGs

greater chance for lethal OD than with buprenorphine

111
Q

What are the criteria to qualify for methadone treatment?

A

Just needs to meet 1 criteria:

One year of continuous use or intermittent use for > 1 year

Have been on methadone maintenance within the past

2 years and show signs of imminent return to opioid dependence

Be recently released from hospital or prison and have hx of dependence and signs of imminent return to opioid dependence

Pregnant and opioid dependent

112
Q

Burpenorphine/nalozone is _____

A

Suboxone

113
Q

______ is available as a take home therapy due to the lower drug abuse potential and also has a long-acting implant available

A

Buprenorphine

114
Q

_____ cause release and block reuptake of dopamine, norepinephrine, serotonin. Give some examples of medication in this class

A

Psychostimulants

dextroamphetamine (Adderall), lisdexamfetamine (Vyvanse)
methylphenidate (Ritalin, Concerta)
Methamphetamines, MDMA (ecstasy), ephedrine

smoking/IV is the fastest effect then snorting, then oral

115
Q

What are some s/s of an acute amphetamine intoxication?

A

Euphoria
Psychosis
dilated pupils
increased HR and BP
weight loss
tooth decay

Severe:
Hypertensive crisis
Hyperthermia

116
Q

What is the treatment for amphetamine intoxication? What would you not want to give to a pt with amphetamine intoxication with hyperthermia?

A

IV BZD to control seizures

then treat s/s

no antipyretics (acetaminophen, ibuprofen, etc.)

117
Q

____ increased hyperactivity even when doses are spread out over weeks

A

sensitization

118
Q

Long term use of amphetamine can _____ in dopamine receptors in basal ganglia resulting in _____

A

decrease

motor deficit

119
Q

Long term use of amphetamine can _____ in metabolic rate in prefrontal cortex leading to ______

A

decrease

cognitive deficit which can develop into long-term psychosis

120
Q

_____ and ____ are recommended for chronic amphetamine use. Which is NOT safe to use on people taking opioids?

A

Naltrexone: not safe for opioid patients

Bupropion

121
Q

_____ is recommended for chronic amphetamine use if patients do not tolerate or respond to bupropion and naltrexone combo

A

Mirtazapine

122
Q

____ commonly abused by polydrug users but can be primary substance of abuse

A

BZDs

123
Q

_____ MOA enhance effect of GABA. What does chronic use do?

A

BZD

structural GABA receptor changes - ↓ affinity for BZD aka: BZD receptors will change shape

124
Q

**What does a BZD overdose alone look like? What other substance is commonly overdosed with it?

A

CNS depression with normal vital signs

alcohol

125
Q

____ is competitive antagonist of GABA receptor but is controversial do to precipitating BZD withdrawal seizures

A

Flumazenil

126
Q

What is the treatment for a BZD withdrawal? Is it life threatening? What is the goal?

A

long-acting BZD given IV and titrated to effect

YES! can be life-threatening

eliminate withdrawal s/s, avoid oversedation or respiratory depression then taper gradually over a period of months (6-12 months)

127
Q

____ may help to reduce BZD cravings during treatment

A

valproic acid, gabapentin, topiramate, lamotrigine

128
Q

____ primary effect blocks dopamine reuptake. What is it derived from?

A

Cocaine

coca plant

129
Q

Cocaine causes _____ of tissue. When used with ____ can produce more intense and longer-lasting effects

A

vasoconstriction

alcohol

130
Q

What are s/s of cocaine use?

A

Septal perforation
Spontaneous abortion
Placental abruption
Euphoria
Anxiety
Psychosis
Myocardial ischemia/infarction
Headaches/Migraines
Insomnia

131
Q

What are some s/s of cocaine withdrawal?

A

Craving
Sleep disturbances
Hunger
Severe fatigue
Severe depression

132
Q

What is the treatment for cocaine addiction? What do you give for acute withdrawal?

A

no set treatment regimen

dopamine agonist: Bromocriptine

133
Q

What is the first line long-term treatment for cocaine use?

A

Topiramate: Anticonvulsant - acts on GABA

134
Q

Marijuana is derived from ____. What is the primary psychoactive agent?

A

Cannabis sativa

Delta-9-tetrahydrocannabinol (THC)

135
Q

THC content has ???? over the years. What are the numbers

A

increased from 1-5% in 1960s to 10-15% currently

136
Q

Marijuana mimics ____ and increases _____ levels

A

anandamide

dopamine

137
Q

What are s/s of acute marijuana use?

A

Euphoria
Disinhibition
Hunger
Conjunctival injection
psychotomimetic

138
Q

N/V/D and abdominal pain
Hx of chronic _____ use (usually daily)
Relieved by hot showers/baths
Normal labs/GI work-up

What am I?
What is the treatment?

A

Cannabis hyperemesis syndrome

abstinence from cannabinoids, especially THC

139
Q

What is the goal of marijuana treatment? What is the treatment?

A

sustained abstinence rather than a controlled low level of continued use

therapy!!

No medication has yet been shown to cause extended abstinence or reduce severity of cannabis use disorder

140
Q

Cocaine is schedule ___
Ketamine and testosterone is schedule ____

A

2

3

141
Q

BZDS, tramadol and insomnia meds are schedule ___
Name some examples of schedule 5 drugs

A

4

cough preparations with less than 200mg of codeine per 100mL, Lomotil, Lyrica

142
Q
A

Behavioral Dynamics (16 decks)

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