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Psychiatry SB > Substance Misuse and Addiction > Flashcards

Substance Misuse and Addiction Flashcards

1
Q

what are the UK guidelines of drinking

A

men and women

- 14 units a week spread over 3 days

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2
Q

what is considered increased and higher risk drinking

A

increased risk
- 15 to 35 units per week

higher risk
- over 35 units per week

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3
Q

what is the definition of harmful use of alcohol

A

A pattern of psychoactive substance use that is causing damage to health. The damage may be physical or mental

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4
Q

what is alcohol dependence syndrome

A

Strong desire or sense of compulsion to take drug

Difficulty in controlling use of substance in terms of onset, termination or level of use

Physiological withdrawal state

Evidence of tolerance

Progressive neglect of other pleasures /interests because of use /effects of substance

Persistence with use despite clear evidence of harmful consequences

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5
Q

what does alcohol do in the brain

A

inhibits the action of excitatory NMDA-glutamate controlled ion channels
- chronic use leads to up regulation of receptors

Alcohol potentiates the actions of inhibitory GABA type A controlled ion channels

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6
Q

what does alcohol withdrawal lead to

A

excess glutamate activity (toxic to the nerve cell) and reduced GABA activity

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7
Q

what does acute alcohol withdrawal lead to

A

CNS excitability and neurotoxicity

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8
Q

what are the Sx of alcohol withdrawal syndrome

A

first Sx occur within hours and peak at 24-48 hours

restlessness, tremor, sweating, anxiety, n+v, loss of appetite and insomnia
tachycardia
systolic hypertension

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9
Q

what is the time line for alcohol withdrawal Sx

A

Sx = 6-12 hours

Seizures = 36 hours

Delirium tremens = 72 hours

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10
Q

how long do Sx last in alcohol withdrawal

A

5-7 days

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11
Q

what is features of delirium tremens

A

peak onset with 2 days of abstinence

often presents insidiously with night time confusion

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12
Q

Sx of delirium tremens

A 
Confusion
Disorientation
Agitation
Hypertension
Fever
Visual and auditory hallucinations
Paranoid ideation.
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13
Q

what is used during alcohol withdrawal

A

Benzodiazepines = Diazepam or Chlordiazepoxide

Thiamine

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14
Q

what is used in alcohol relapse prevention

A

Naltrexone
Disulfiram (antabuse)
Acamprosate

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15
Q

what are S.E. of Disulfiram

A

flushed skin, tachycardia, n+v, arrhythmias and hypotension

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16
Q

what is the criteria of dependence

A

A strong desire to take the substance

Difficulties in controlling substance use

A physiological withdrawal state

Tolerance - need a higher ‘dose’ to achieve the same effect

Neglect of alternative pleasures

Persistence despite evidence of harm

17
Q

what is the reward pathway

A

mesolimbic pathway:

VTA&raquo_space; nucleus accumbens&raquo_space; prefrontal cortex&raquo_space; release of dopamine

18
Q

what receptors are decreased by addiction

A

Dopamine D2 receptors

19
Q

what happens due to repeated dopamine release in addition

A

dopamine receptors down regulated&raquo_space; Threshold for rewards during abstinence is thus increased

20
Q

what part of the brain is our key creator of motivation to act

A

orbito-frontal cortex

21
Q

what is the role of the pre-frontal cortex

A

Helps intention guide behaviour

Modulates the powerful effects of the reward pathway

Sets goals, focuses attention

Makes sound decisions

Keeps emotions and impulses under control to achieve long term goals

22
Q

what does addictive drugs do to the prefrontal cortex

A

disrupts normal dopamine-related learning in the PFC

23
Q

what are the effects of dopamine release

A

Ability to update information within the PFC

Ability to select new goals

The ability to avoid compulsive repetition of a behaviour

24
Q

what parts of the brain are responsible for learning

A

Striatum – habit learning

Hippocampus – declarative learning

25
Q

what is one of the last parts of the brain to fully mature

A

prefrontal cortex

- is vulnerable whilst developing

26
Q

what is the medical intervention for opiate withdrawal

A 
Methadone
OR
Buprenorphine
OR
Diamorphine
27
Q

what can be added with buprenorphine

A

Naloxone

28
Q

what is used in opiate overdose

A

Naloxone

29
Q

what effects does cocaine have on the brain

A

serotonin, norepeniphrine, dopamine reuptake inhibitor

30
Q

what effects does amphetamine have on the brain

A

dopamine, norepinephrine release

31
Q

what effects does MDMA have on the brain

A

serotonin, norepinephrine, dopamine release

32
Q

what are negative effects of stimulants

A

increased BP, chest pain, agitation, sweating, headaches, insomnia

Jaw clenching, nausea, vomiting, paranoia, hallucinations

Craving, dependency

Psychiatry SB (23 decks)

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