Substance Related Disorders Flashcards
sporadic consumption of alcohol/drugs w/ no adverse consequences
substance use
frequency of alcohol/drug use may vary, there are adverse consequences experienced by the user
abuse
state of adaptation that is manifested by a drug class-specific withdrawal syndrome
physical dependence
a subjective need for a specific psychoactive substance, either for its positive effect or to avoid negative effects of its abstinence
psychological dependence
primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations
addiction
Leading cause of impotence in the US
drug use
How many positive responses to the CAGE questionairre do you need to diagnose alcohol dependence?
Two or more
Quantification of risky or hazardous drinking in men and women
men 14 drinks a week. women 7 drinks a week
Associated with failure to fulfill work obligations, use in hazardous situation, legal problems related to use, continued use despite interpersonal problems
alcohol abuse
a maladaptive patterns of use associated with 3 or more of the following, occurring at any time in the same 12-month period: tolerance, withdrawal, large quantities, desire to cut down, continues despite physical/psychosocial problems
alcohol dependence
Substance that leads to most substance-related deaths
alcohol
Quantification of moderate drinking
Men: 2 drinks or less a day
Women: 1 drink or less a day
Quantification of binge drinking
Men: 5 or more drinks in a row. Women: 4 or more drinks in a row
What happens when concentration of ETOH in stomach becomes too high?
mucus secretion and pyloric valve closure results in slowed absorption
catalyzes conversion of alcohol into acetaldehyde, which is toxic
alcohol dehydrogenase (ADH)
catalyzes conversion of acetaldehyde into acetate
aldehyde dehydrogenase (ALDH)
How long might the processes of ETOH metabolization continue to damage liver cells?
weeks to months. Clinical and chemical effects often become worse before disease resolves
What are the three patterns of hepatocellular injury?
fatty liver, alcoholic hepatitis, cirrhosis
Increased resistance to flow in portal venous system that manifests as ascites, splenomegaly, and through portosystemic shunts
portal hypertension
Where are the three portosystemic shunts located?
lower rectum, esophagus, umbilical veins
Occurs in persons who have been drinking heavily for many years—rare to see in persons younger then 35YO: Caused by thiamine deficiency due to poor nutrition/malabsorption
Wernicke-Korsakoff Syndrome
acute symptoms which are completely reversible when treated w/ high dose thiamine. Characterized by gait ataxia, vestibular dysfunction, confusion and ocular abnormalities
Wernicke’s encephalopathy
chronic condition where only 20% of patients recover—can be treated w/ po thiamine. Characterized by impaired recent memory and anterograde amnesia
Korsakoff’s Syndrome
Highest prevalence unemployed men in their 20s w/ only a high school education in urban areas. Use is highly associated with use of other legal and illegal substances
cocaine
2nd to cannabis most widely abused drug in the world. 5% of the U.S. population have used it
methamphetamine
Displaces epinephrine, norepinephrine, dopamine & serotonin into the synaptic cleft. Also inactivates neurotransmitter reuptake systems. Results in surge of adrenergic stimulation
methamphetamine
Appearance is malnourished, agitated, disheveled. They are tachycardic, HTN, hypercapnic, hyperthermic
methamphetamine intoxication
Biggest risk for meth intoxication
cardiovascular collapse
Blocks presynaptic reuptake pumps for dopamine, norepinephrine and serotonin. Also blocks voltage-gated membrane sodium ion channels
cocaine
increased energy, alertness, sociability; elation or euphoria; decreased fatigue, need for sleep and appetite; “total body orgasm”. tachycardia, pupil dilation, diaphoresis, nausea
cocaine intoxication
Psychoactive component—delta-9-tetrahydrocannabinol (THC). Most commonly used illegal substance worldwide
Cannabis
occur frequently in patients w/ cannabis disorders
mood and anxiety disorders
T/F There is substantial degree of heritability of cannabis dependence
True. 60%
Physiologic signs of use include: tachycardia, increased BP, increased RR, conjunctival injection, dry mouth, increased appetite
cannabis intoxication
substances whose primary effects include the alteration of sensory perception, mood & thought pattern
hallucinogens
acute intoxication w/ dysphoria, fear, agitation or other unwanted effects predominate
bad trip
recurrence of symptoms associated w/ hallucinogen after the effects of the acute intoxication have worn off, may occur months or years after the last use of the drug
flashback
Involves the interaction of numerous neurotransmitters. serotonergic activity may cause serotonin syndrome
hallucinogens
Neuropsychiatric symptoms, person remains oriented and aware their experience is drug-induced
LSD
OTC in cold and cough preparations. Anticholinergic delirium & acetaminophen toxicity have occurred
Dextromethorphan (DXM)
N/V often precede the onset of psychedelic effects. active ingredient in peyote cactus
mescaline
Dissociative anesthetic similar to ketamine. Commonly added to cigarettes, marijuana, or other herbs for smoking
Phencyclidine (PCP)
Distinguishing features of intoxication include: bizarre violent behavior, nystagmus, catatonic stupor/coma
Phencyclidine (PCP)
Wide variety of chemical structures mainly hydrocarbons, nitrites or nitrous oxide. Highly volatile, lipid soluble and absorbed from the pulmonary system. initial euphoria is followed by lethargy
inhalants
Most frequently used inhalants
glue, shoe polish, and toulene
Adverse effect of benzene use
can cause aplastic anemia and malignancy
Immediate effects: slurred speech, ataxia, disorientation, HA, hallucinations, violent behavior, seizures. Long-term: neurocognitive impairment, cerebellar dysfunction and peripheral neuropathy
inhalant intoxication
Agonist at nicotinic subtype of acetylcholine receptors. Activates the dopamine reward system. Increases circulation of norepinephrine and epinephrine
nicotine
activate specific transmembrane neurotransmitter receptors (mu, kappa, delta) that couple G proteins. Activation of CNS mu receptors results in euphoria, respiratory depression, analgesia and miosis
opiods
Features of intoxication includes depressed mental status, decreased respiratory rate, decreased tidal volume, miotic pupils
opiod toxicity
Vital signs of intoxication include low heart rate, mild hypotension, hypothermia
opiod toxicity
used to increase respirations to 12 or greater NOT to attain a normal level of consciousness
naloxone (opioid antagonist)
