Substance & Addiction Flashcards
What illicit substance can cause persisting dementia?
Inhalants
What is PCP MOA?
potent NMDA receptor antagonist
Lets say a patient gets a a urine drug screen. Put the following drugs in order from shortest to longest duration of which they would still screen positive.
Heroin, amphetamines, alcohol, cannabis, PCP, cocaine, benzos
Alcohol - 12 hours
Amphetamine - 48 hrs
Cocaine: 3 days
Heroin- 72 hours
Benzos: 7 days
PCP - 8 days
Cannabis/MJ- 4 weeks
Elderly patient has a stroke and presents hypersexual, hyperorality, psychic blindness, super hungry and possibly can’t recognize faces. What syndrome are they suffering from and what area of the brain has been damaged?
Kluver-Bucy syndrome
Develops from b/l destruction of amygdaloid bodies which are in the medial temporal lobes
Carries of the genotype, COMT (Val158Met), are more vulnerable to what substance issues?
cannabis-induced psychosis
How does long-term cocaine use increase the risk of certain EPS symptoms?
Reduced number of D1 dopamine receptors in the striatal pathways
occurs in response to the chronic increase in synaptic dopamine caused by cocaine-induced inhibition of dopamine reuptake
Which substance use disorder are the following genes associated with?
A) AUTS2 (autism susceptibility candidate 2)
B) CHRNA 3, CHRNB 4, CHRNA 5
C) MOR
D) CHRNA 2
A) Alcohol use
B) Nicotine use (also for smoking related dx like lung cx & PAD
C) opioid use d/o
D) cannabis
Patient presents with anxiety, restlessness, insomnia, rhythmic intention tremor, dizziness, seizures, and psychosis (sorta mimicking mania). What is most likely diagnosis?
Barbiturate withdrawal syndrome
- normally occurs 2-4 days after stopping drug
The symptoms associated with acute alcohol withdrawal are related to overactivity of which neurotransmitter.
glutamate
Which inhalant affects Vitamin B12 metabolism and can lead to megaloblastic anemia?
Nitrous oxide
Which inhalant can lead to aplastic anemia?
benzene
T/F: Methadone is the treatment of choice for heroin-dependent pregnant women and for breastfeeding.
True
because of its long duration of action, which prevents the fetus from undergoing withdrawal
TRUE OR FALSE
P-450 2A6 gene polymorphisms have been shown to have a protective effect against nicotine use disorder.
TRUE
Preterm labor is most commonly associated with use of which substance?
opioid use
What NT is activated by nicotine in patients with tobacco use disorder?
dopamine
What are the 4 main criteria categories for substance use disorder?
- Impaired control
- Social impairment
- Risky use
- Physiologic change (tolerance/withdrawal)
What is the key reward structure for all addictive drugs?
nucleus accumbens
Compulsion and perseveration in relation to addiction are driven by what NT?
Dopamine
High levels of Carbohydrate-Deficient Transferrin (CDT) in the blood can be a marker of what?
heavy alcoholism
What is Ethyl Glucoronide (EtG) , which is found in urine, used as a biomarker to test for?
Tests for ethanol use, to monitor alcohol abstinence in situations where drinking is prohibited, only for last 5 days
Which antabuse med inhibits metabolism of aldehyde dehydrogenase?
Disulfiram
Which blood test can be used to monitor for alcohol use, particularly binge drinking or detection of heave alcohol use, for up to 4 weeks?
Phosphatidylethanol (PEth Testing), direct alcohol biomarker
Why would you order a gas chromatography/mass spectometry (GCMS)?
Gold standard/confirmatory test following POSITIVE urine test/immunoassay and can test for substances not detected by a screen
What gene gives you a 7x increased risk of developing psychosis from Marijuana use?
AKT1 gene
Benzoylecgonine (BE) is an inactive metabolite of what substance?
cocaine
Synesthesias is most associated with use of what substance?
Hallucinogens
What is the MOA of dextromethorphan?
NMDA receptor antagonist
What 2 brain changes may you notice in a chronic user of inhalants?
- brain atrophy
- demyelination
What is MOA of MDMA/ecstasy?
excessive serotonin release from the raphe nucleus
What are the stages of change?
precontemplation
contemplation
preparation
action
maintenance
relapse
When do heroin withdrawal symptoms peak?
36 to 72hrs
Exposure to what substance in-utero can lead to a baby with similar presentation to Fetal alcohol syndrome (growth retardation, microcephaly, micrognathia, small palpebral fissures, deep set eyes, low set ears, flat nasal bridge, and small fingernails)
Toluene (found in paints and organic compounds)
Which gene is primarily responsible for methadone’s metabolism in the body?
CYP3A4
T/F: Hydrocarbon users, have an increased risk of arrhythmias because of increased sensitization of the myocardium to catecholamines.
True – can lead to sudden sniffing death syndrome
What body system is most commonly affected by inhalation of hydrocarbons?
pulmonary system
Does crack cocaine or cocaine cause pathological lung findings?
crack cocaine
Solvent intoxication most closely resembles that produced by which other substance?
Alcohol-like
What are the screening tools used by PCP to assess for substance use in kids
A) 9-14y/o
B)15+ y/o
A) NIAA screen
B) CRAFFT screen
What is the most effective tool for the assessment of lower-prevalence (dependent, heavy, female, and minority) drinkers?
Alcohol Use Disorders Identification Test (AUDIT)
Self regulation-deficit predicted the development of what problematic behavioral disorder?
Video gaming vs. internet addition vs disordered gambling
Problematic video gaming
Hippuric acid found in someone’s utox is indicative that they have been using what substance?
sniffing glue (comes from toluene)
Which ligand and receptor is responsible for cannabis effects on the brain?
Full agonist activity of ______ on at CB-receptor ______ (1 or 2).
2AG
receptor 1
Polymoprhisms of P450 2D6 provide protection against non-medical use of what substance by modulating accumulation of toxic metabolites making further use undesired?
codeine
What is the important drug interaction between alcohol AND
1. meth
2. NSAIDS
- increased hepatotoxicity
- increased risk of gastric ulcers
A __________(decrease or increase) in expression of GLT-1(glutamate transporter 1) in the nucleus accumbens (NA) has been found to be the most consistent finding across substances of abuse.
decrease
Chronic inhalant use and their associated effects:
benzene, toluene, Dichloromethane, Nitrous oxide, Trichloroethylene
A) hematologic disorders ie aplastic anemia, agranulocytosis, myelodysplastic syndrome, multiple myeloma, leukemia, lymphoma
B) carbon monoxide poisoning
C) polyneuropathies secondary to dysregulation of vitamin B12 metabolism
D) generalized muscular weakness with metabolic acidosis in cases of chronic use
E) hepatotoxic in cases of chronic use.
A) benzene
B) Dichloromethane
C) Nitrous oxide
D) Toluene
E) Trichloroethylene
Which mu-receptor is responsible for the physical dependence of opioids?
Mu-2 receptor
Cocaine can lead to 2 different lung presentations after a few days of use: pair with correct one
acute eosinophilic pneumonia OR crack lung
A) rapid eosinophilic infiltration of the lung, chest x-ray/CT in this context typically shows ground-glass opacities, bronchoalveolar lavage demonstrating marked eosinophilia is typically diagnostic.
B) syndrome of diffuse alveolar damage and hemorrhagic alveolitis that occurs within 48 hours of smoking crack cocaine, chest x-ray and/or CT w/ nonspecific findings such as pulmonary hemorrhage or edema
A) acute eosinophilic pneumonia
B) crack lung
What drug can lead to embryopathy including growth retardation, microcephaly, micrognathia, small palpebral fissures, flat nasal bridge, deep-set eyes, low ears set, and small fingernails?
Toluene embryopathy
Which treatment for opioid use disorder would be most likely to result in the best maternal outcome and the lowest risk of neonatal abstinence syndrome for the newborn?
Buprenorphine
Morning glory seeds and catnip, taken in sufficient quantity, can mimic the intoxication produced by what substance?
LSD
What vitamin is affected by nitrous oxide and can lead to neurological issues such as polyneuropathy and psychosis.
Vitamin B12
T/F: CYP1A2 is correct because it is responsible for 90% of the metabolism of caffeine.
True
How long at a minimum should a patient be abstinent from alcohol before safely starting disulfiram?
48 hrs
What SSRI has several DDI and inhibits CYP4501A2 leading to accumulation of coffee in the body leading to progressive palpitations and jitteriness?
Fluvoxamine
Which medication for reflux/dyspepsia is found to produce false-positive results on the initial immunoassay used for the detection of cannabinoids?
Pantoprazole
Which do you see in initiation of addiction vs. chronic addiction drug users?
A) recruitment of the prefrontal cortex and switch from dopamine to glutamate based efferent to the accumbens (accumbens-thalamocortical circuitary)
B) Dopaminergic release in the nucleus accumbens
A) hallmark of chronic addiction seen in drug users
B) initiation of the addiction cycle.
Which substance leads to psychostimulatory effects thought to be caused by blockade of the A2A adenosine receptors and weak activation of extracellular signal-regulated kinase (ERK) in the striatum?
caffeine
___________ (substance) is metabolized into several components, out of which paraxanthines are the major (84%) active metabolite that mediates the psychostimulant effect.
Caffeine
Which substance has signs and symptoms of withdrawal caused by up-regulation of the adenosine system as chronic blockade of the A2A adenosine receptors would lead to up-regulation in these receptors?
caffeine
What substance increases cocaine bioavailability and toxicity?
Alcohol
Most of the benzodiazepine immunoassays are designed to detect what metabolite of the drug?
oxazepam
Alcohol increases what substances bioavailability and toxicity by eliminating its first pass metabolism?
Cocaine
Which medication can help with opioid withdrawal that has the following MOA:
central alpha2-agonist that binds to adrenergic receptors and decreases locus coeruleus activity resulting in reduction of withdrawal symptoms and anxiolytic properties by lowering the circulating noradrenaline.
Lofexidine
Which inhalant is associated with renal symptoms (ie kidney stones)?
Toluene
What is the most common complication of hydrocarbon intoxication?
Pneumonitis
What is the most common cause of death of hydrocarbon intoxication?
Dysrhythmias
Supportive measures should be taken first for the treatment of neuroleptic malignant syndrome, including fluids, cooling, and cardiac support.
The most common respiratory illness of chronic ______ (name substance) use is chronic bronchitis.
cannabis
Which opioid 2/2 its short half-life and its neurotoxic metabolite, which may accumulate, causes irritability, tremors, and, potentially, seizures?
Meperedine
What is the primary mechanism of action of hallucinogens such as lysergic acid diethylamide (LSD)?
5-HT (serotonin) receptor agonism
Which medication assisted treatment used for alcohol is associated with acute kidney failure?
Acamprosate
______ (women or men) have a more rapid progression from first-time cannabis use to the development of cannabis use disorder.
Women
Which receptor does alcohol act on GABA-A or GABA-B?
GABA-A
Maximum number of points of the CIWA is 67. Mild withdrawal is 8 or less on the CIWA; moderate withdrawal is 9 to 15; and severe withdrawal is 16 and over.
inhalation of nitrites can lead to acute acquired methemoglobinemia
