Substance Disorders Flashcards
What are the 2 key brain structures that play the largest role in addiction?
Nucleus accumbens
Ventral tegmental area
DTs are most likely to develop how long after last alcoholic drink?
2-3 days
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
The symptoms associated with acute alcohol withdrawal are related to overactivity of which neurotransmitter.
Glutamate (major excitatory NT in brain)
If Werniicke’s encephalopathy is left untreated, pt develops anterograde amnesia and confabulation. What is the disorder?
Korsakoff syndrome
A patient has been drinking and develops ataxia + nystagmus + opthalmoplegia. What d/o are they struggling with and what is treatment?
Wernicke’s encephalopathy
TX: thiamine
What part of the brain is damaged in chronic alcoholics?
mamillary bodies
Which antabuse med inhibits metabolism of aldehyde dehydrogenase?
disulfiram
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
Which maintenance tx for opioid withdrawal is best first choice for adolescents?
Buprenorphine (partial mu agonist)
What are the pupils like in acute intoxication with alcohol/benzos/sedatives?
pupillary constriction (miosis)
If a teen comes in and has recently used a stimulant (ie cocaine, meth) and is in a hypertensive crisis, what medication would you treat them with?
B-blockers or nitroprusside
What is tx for someone who is intoxicated with hallucinogen/PCP who is having seizures or agitation ?
Diazepam
What is tx for someone who is intoxicated with hallucinogen/PCP who is having HTN ?
Phentolamine
What is tx for someone who is intoxicated with hallucinogen/PCP who is in panic, paranoia or psychosis ?
close observation in quiet room, benzos
Which illicit substance can potentially cause the following symptoms:
-sudden sniffing death syndrome (leads to withdrawal seizures)
-interfere with oxygen supply to vital tissues –> injury to RBC/anemia, hypoxia, cardiac arrhythmias, bone marrow injury, impaired immunologic fxn
-demyelination (symptoms similar to MS), brain atrophy
Inhalants
What is MDMA aka?
ecstasy
What NT does ecstasy cause release of and from where?
Serotonin release from raphe nucleus
Which illicit substance can lead to rhabdomylosis, sweating, hyperthermia, dehydration and involuntary jaw clenching and grinding?
Ecstasy
What are the stages of change?
precontemplation
contemplation
preparation/determination
action
maintenance
relapse
What drug is contraindicated in someone with cocaine-induced myocardial ischemia?
Using a nonselective beta-blocker (ie propranolol) can lead to unopposed alpha-1 receptor activation. This results in heightened peripheral vasoconstriction and can increase blood pressure and coronary artery vasoconstriction.
During intoxication with PCP will you see miosis or mydriasis?
miosis
Which substances align with these MOA?
1. Agonism at 5-HT2A receptors in the central nervous system (CNS)
2. NMDA receptor antagonists
3. Blockade of dopamine reuptake
4. Activation of cannabinoid receptors
- LSD
2.Ketamine or PCP - Cocaine, methamphetamines
- Cannabis
Pt p/w synesthesia (perceiving colors as tastes), altered perception of time, and hallucinations, along with signs such as tachycardia, hypertension, dilated pupils, and heightened tactile sensitivity has most likely taken what substance?
LSD
The classic triad of respiratory depression, altered mental status, and constricted pupils is indicative of toxicity of what substance?
opioid toxicity
C/f respiratory depression occurs in lieu of opioids when patient has RR is less than ___ bpm.
(above or below)
12 bpm
