Substance Use Flashcards
Early Remission vs Sustained Remision
Early: 3-12 months with nothing except cravings
Sustained remission: at leat 12 months without meeting criteria
Alcohol and CDT
CDT is a transferrin. Think of it as a deer with horns. In normal people, the horns have 4-5 branches. In alcoholics, they have 0-2 branches (carbohydrate Deficient transferrin) .
Ethyl Gulcuronide (EtG)
metabolite of ethanol which is formed din the body by glucouronidation usually from drinking. Lets you know if someone drank in the last 5 days. (pilots, etc)
What types of seizures happen in alcohol withdrawal?
Generalized Tonic clonic seizures
Peak incidence of alcohol withdrawal seizures after last drink?
24 hours
Benzos NOT metabolized by the liver?
‘out the liver’ : oxazepam, temazepam, lorazepam.
4 Symptoms of Wernicke’s Encephalopathy
confusion, ataxia, nystagmus, opthalmoplegia (paralysis of eye muscles)
What enzyme is inhibited by disulfiram?
Aldehyde dehydrogenase
Alcohol withdrawal is due to overabundance of what neurotransmitter?
glutamate
How is acamprosate metabolized?
Renally which defers it from naltrexone and disulfiram.
How does acamprosate work?
Leads to less glutamate transmission presynaptically, and also binds to post synaptic glutamate receptors. Helps to reduce hyperglutamatergic state in alcohol withdrawal .gg
When does acamprosate work?
Initiate as soon as possible after alcohol withdrawal when patient achieves abstinence. Maintain treatment if patient relapses. It increases the likelihood of abstinence.
What is the clonidine MOA?
Presynaptic noradrenergic a2 agonist
Methadone MOA
synthetic opioid AGONIST that is very long acting so it prevents the withdrawal sx. Keeps them comfortable and blunts cravings. Used for pregnant women.
Anandamide vs THC
Anandamide is the endogenous cannabinoid. THC has a much stronger and longer effect than anadamide on brain cells. THC interferes with Anandamide’s function of protecting neurons and keeping brain activity in balance.
THC and Hippocampal Neurons
THC suppresses activity of hippocampal neurons below the level needed to trigger memory formation. With chronic thc expsoure, neuron connections involved in memory are gradually lost due to continual suppression.
Marijuana Psychosis Gene
AKT1 gene governs an enzyme that affects Dopamine brain signaling, leading to psychosis (c/c is bad). Another is COMT gene which governs an enzyme that breaks down dopamine (val/val is bad).
Marijuana and collisions
2012 meta analyssis found marijuana use doubled collision risk.
NAC for cannabis use disorder
Modulates glutamate at 1200 mg bid. Side effects are vivid dreams, gi sx. No significant decrease i ncravings for cannabis .
Stimulant withdrawal dreams
unpleasant and vivid.
Cocaine MOA
Causes transient increase in extracellualr dopamine levels in dopaminergic pojections from the VTA area to the nucleus accumbens by binding to the dopamine transporter, thereby inhibiting dopamine reuptake.
Cocaine metabolite
BE (benzoylecgonine) is present in urine for ~48 hourspost use.
Off label disulfiram use in cocaine use disorder
It inhibits dopamin-beta-hydroxylase, plasma esterases, and aldehyde dehydrogenase involved in metabolism of cocaine . It will lead to anxiety, paranoi, and dysphoria after cocaine use which leads to less use overall.
Ketamine and vets
Ketamine used on animals. May have a vet or nurse who can access it.
Dextromethorphan MOA
NMDA receptor antagonist
Adverse events of inhalants
sudden cardiac death or seizures.
Pacifier at a rave party
Person is on MDMA which causes tooth grinding/bruxism.
Most common complication of hydrocarbon use?
Pneumonitis (sniffing paint thinner)
Biggest risk factor for developing cannabis use disorder
Early use of cannabis before 15 yo.
Naltrexone MOA
Full opioid antagonist.
LSD intoxication
mydriasis, tachycardia, hyperthermia, tremor, salivation, blurring of vision, marked anxiety or depression, paranoid ideation, depersonalization, derealization etc.
Endorphin Role
motor coordination, learning and memory, gastrointestinal function, the control of seizures, and the hormonal regulation of the reproductive system, yet are most often recognized for their role in the pain modulation
Toluene embryopathy and Fetal Alcohol Syndrome
Very similar (hydrocarbons) toluene embryopathy include and overlap symptoms seem in fetal alcohol syndrome - growth retardation, microcephaly, micrognathia, small palpebral fissures, deep set eyes, low set ears, flat nasal bridge, and small fingernails.
Which anti-alcohol med needs to be cautioned or CI in renal failure?
acamprosate
What metabolic abnormality can happen with toluene intoxication?
Distal or Type 1- Renal Tubular Acidosis classically described as hyperchloremic metabolic acidosis along with hypokalemia, is characterized by a lack of ability to reduce the pH of urine, despite minimal bicarbonate (HCO3-) wastage and severe academia
Alcoholic ketoacidosis comes from the person’s deficiency in what?
carbs
What CIWA score is associated with DT’s?
Severe, 16
Which substance is associated with the highest percentage of users who develop a use disorder?
nicotine
What do you give to reverse cocaine intoxication (sweating, tachy, fever)
Phenoxybenzamine
‘Chasing the dragon’
freebasing heroin on heated aluminum foil and breathing it in.
NIDA recommends pts on methadone should be on maintenance for a MINIMUM of how long?
National Institute on Drug Abuse (NIDA), notes that “For methadone maintenance, 12 months of treatment is the minimum, and some opiate-addicted individuals will continue to benefit from methadone maintenance treatment over a period of years.”
opioid short half life to long half life
Meperidine, morphine, methadone, buprenorphine
What should you look for in gasoline ingestion?
all patients presenting with suspicion of hydrocarbon exposure should immediately be placed on a cardiac monitor (because dysrhythmias are the most common cause of death) as well as pulse oximetry. A chest X-ray is indicated in any patient suspected of inhalation or aspiration of hydrocarbons.
Possible problem with IV drug use
Epidural abscess from bacterial seeding
Which disorders are likely to have a caffeine intoxication?
Depressive disorder
Bipolar disorder
Sleep disorder
Substance-use related disorder
MDMA intoxication can lead to what?
serotonin syndrome
Describe Wernicke-Korsakoff
Wernicke encephalopathy which is characterized by confusion, ataxia and ophthalmoplegia, and Korsakoff syndrome which is characterized by anterograde amnesia, but retrograde amnesia, disorientation and confabulation are also found in this syndrome.
What medication can you give to help with cocaine addiction?
bupropion
What does chronic alcohol intoxication do to GABA receptor sensitivity and to NMDA receptor number?
Decrease in GABA-receptor sensitivity and upregulation of NMDA-receptors
Sudden Sniffing Death syndrome can be caused by what medication combined with sniffing?
. Toluene increases the sensitivity of the myocardium to catecholamines, so they should be avoided in patients with inhalant use disorder to prevent death due to ventricular tachyarrhythmias (known as sudden sniffing death syndrome). Epinephrine is the correct answer, as it is a catecholamine classed as a non-selective agonist that acts on all adrenergic receptors.
What is a long term side effect of disulfiram?
Peripheral Neuropathy
Alcohol withdrawal timeline
- When can tremulousness happen?
- When can seizure happen after last drink?
- When can psychotic sx happen?
- How long is DT window?
Tremulousness is an initial stage of alcohol withdrawal, developing after 6 to 8 hours of abstinence. Psychotic and perceptual symptoms such as delusions and hallucinations can occur in 8 to 12 hours. Alcohol withdrawal seizures occur within the first 12 to 24 hours of abstinence, and can occur even while the blood alcohol level remains elevated and the patient remains partially intoxicated. Alcohol withdrawal delirium (delirium tremens) usually occurs within 72 hours, although patients remain at risk for the first week.
Cocaine increases what class of neurotransmitters?
catecholamines
Which drug is most commonly associated with ER visits?
cocaine
Dronabinol is which controlled substance category?
III
What is a precursor to serotonin?
5-hydroxyindoleacetic acid (5-HIAA)
Rash on face (mouth, nose)?
Glue sniffers disorder (inhalant use disorder)
Which metabolite of caffeine is responsible for the stimluant and addictive part?
Paraxanthines
What type of brain damage can cocaine cause?
Nonhemorrhagic cerebral infarctions
Organophosphate intoxciation is treated with what?
Atropine (not physostigmine)
What metabolite is seen in a glue sniffer’s blood?
Hippuric acid
Paternal Cannabis use and baby exposure?
Paternal cannabis use can result in infant exposure and increased risk of sudden infant death syndrome
Which drug has the highest rates of use and of substance use disorders according to the Substance Abuse and Mental Health Services Administration (SAMHSA)?
marijuana
Most widely used mood altering drug in the world?
caffeine. For use disorder, must consume 250 mg
What is 90 in 90?
Attending 90 12-step groups in 90 days
The pathophysiological changes most likely responsible for symptoms of alcohol withdrawal delirium include which of the following?
Decreased GABA and NMDA receptor inhibition, resulting in delirium and sympathetic overdrive
Amount of time to be free of alcohol before starting antabuse?
12 hours
What is the mechanism for sudden death in inhaling?
The increased sensitization of myocardium to catecholamines
What drug requires occasional eye exams?
Lamotrigine associated photopigmentation/photosensitivity occurs due to an unknown mechanism
The dangerous symptoms of alcohol withdrawal occur due to overactivity of which neurotransmitter?
glutamate
What natural things mimic lsd?
Catnip and morning glory seeds
Easier to OD on methadone or buprenorphine?
Methadone
MOA of meth
Amphetamine works by reversing the function of dopamine transporter proteins which normally transport dopamine back into the neurons and causes an efflux of dopamine out of the neuron for the exchange of amphetamine
