substance use / addictive disorders (2) Flashcards
thw use of alcohol/drugs for the purpose of intoxication, or, in the case of prescription drugs, for purposes beyond their intended use
abuse
an irresistable psychological/physiological need to continue the substance use or behavior despite the harm it causes; may or may not include physical dependence
addiction
physiological requirement for the substance by the brain, as evidenced by development of tolerance and withdraw when use decreases or stops
physical dependence
an urgent desire for a substance or behavior to which one is addicted, often in response to triggers, that is very difficult to resist
craving
Physiological adaptation to a substance such that increasing amounts are needed to achieve the same effect
tolerance
Substances that are pharmacologically interchangeable in terms of how the body responds. Example if one develops a tolerance to alcohol, he also has tolerance for benzodiazepines and would require a higher dose of the benzo to achieve the usual effect. We take advantage of this property to treat dependence
cross tolerance
State characterized by adverse physical and psychological symptoms occurring when one ceases using a substance to which the brain has acclimated
withdrawal
Anything which cues or prompts a response
trigger
Safely withdrawing a person from an addictive substance, usually under medical supervision, by providing a substance for which there is cross tolerance in gradually decreasing amounts
detoxification
The reoccurrence of alcohol or drug dependent behavior in an individual who has previously abstained for significant time beyond the period of detoxification
relapse
Why should we not assume that a negative tox screening means that the person is not abusing substances or the other way around
Some common meds can cause false positives, and some may not show up
Which theory of addiction is when the nature of the substance itself reinforces its use. Once the brain has been exposed it has to have it
Chemical Hook theory
Which experiment related to theories of addiction was where addicted rats were divided into two groups, one placed in a rat park with toys and tunnels and food and company, while the other was in a traditional rat cage lacking amenities. This time when offered the drugged water and plain water the rats and the Rat Park chose the plain water, while rats in the standard cage continued to abuse the drug. It concluded that if we have what we need we will not self medicate
Alexander experiment
Which addiction theory states that with accumulating exposure to rewarding activities or substances, the brain narrows its focus to just those behaviors or substances, resulting in an every increasing focus on thoughts and actions that cue evokes. At the same time the brain becomes less and less able to control one’s response to those cues, an example is seeking out cocaine after seeing any white powder
Impaired response inhibition and salience attribution (iRISA)
Are there genetic predispositions to addiction
yes
Is alcohol abuse associated with a higher risk for cancer
yea
What kind of questions are asked in an alcohol use disorder assessment
- Have you had times when you ended up drinking more or longer than you intended?
- Have you more than once wanted to cut down or stop drinking or try to but couldn’t?
- Have you spent a lot of time drinking? Being sick or getting over the after effects?
- Have you experienced craving or found that drinking often interfered with taking care of your home or family
Which neurotransmitter increases in response to alcohol?
GABA
What condition is when alcohol causes gastric irritation, reduces absorption of B vitamins, interferes with conversion of thiamine into thiamine pyrophosphate?
Wernicke’s Encephalopathy
What are symptoms of Wernicke’s Encephalopathy?
Acute onset; oculomotor dysfunction, Ataxia, ptosis and confusion
What kind of treatment does Wernicke’s encephalopathy require? (And what med)
Emergency treatment to prevent permanent damage
IV THIAMINE
Which syndrome has a gradual onset and is characterized by retrograde and anterograde amnesia with sparing of intellectual function and some aspects of memory
Korsakoff’s syndrome
characteristic features of Korsakoff’s syndrome
apathy or increased talkativeness, confabulation and cackling laugh
can wernicke’s and Korsakoff’s happen together
yes
How soon can alcohol withdrawal occur
As soon as two hours after the last drink
What are early symptoms of alcohol withdrawal!!!!
Tremors, diaphoresis, rapid pulse over a hundred, elevated blood pressure >150/90, headache
Describe the three main problems in alcohol withdrawal syndrome
- Hallucinosis (Partially visual, usually recognizes it as not real, starts 24+ hours after last drink)
- Grand Mal seizures (Generally self limiting, starts 24-48 hours after the last drink)
- Changes in cognition (At any point), May last 30 to 50 days
What is severe alcohol withdrawal also called
Delirium tremens
A severe alcohol withdrawal, or delirium tremens, a medical emergency?
yes
What is the onset of delirium tremens
3-5 days after last drink or cross-tolerence meds
How long does delirium tremens last?
2-3 days
Treatment of severe alcohol withdrawal or delirium tremens
-replace thiamine, niacin, folate, magnesium IV
- Replace electrolytes
-glycogen
-benzos
-baclofen
-antipsychotic
Which medication for alcohol dependence is used adjunctively for aversion therapy, it causes unpleasant side effects when consumed with alcohol
disulfiram
Which medication that reduces alcohol cravings binds with opioid receptors to block euphoric effects of alcohol and reduce cravings
naltrexone
Which medication that helps reduce alcohol cravings is an anti-convulsant that reduces dysphoria and insomnia when stopping alcohol use, helps reducing relapse and amount of alcohols consumed
gabapentin
Which CNS stimulate produces a euphoric rush of mental alertness and energy, less 10 to 20 minutes and is followed by intense let down
cocaine
Which three neurotransmitters does cocaine increase?
Dopamine, norepinephrine, serotonin
What is characterized by CNS stimulation followed by depression
intoxication
What kind of symptoms is toxicity classified with
Mydrysis, encephalopathy, seizures, decreased responsiveness, hypertension, rapid and possibly irregular pulse, hyperpyrexia, coma, respiratory and cardiovascular failure
Which substance blocks reuptake of norepineprene dopamine, affects peripheral nervous system
amphetamines
What are the main meds used to treat alcohol withdrawal
benzos and anticonvulsants
When is nicotine toxic
In high doses to young children
Which medication for treatment of tobacco addiction reduces cravings and weight gain associated with smoking cessation
bupropion
Which medication blocks nicotine receptors
varenicline
Which dose of caffeine can cause tremors, poor motor performance, and insomnia
300 mg
Which dose of caffeine can cause tachycardia, Stimulate respiratory, vasomotor, and vagal centers in cardiac muscles; dilate pulmonary and coronary blood vessels, and constrict blood flow in the brain
> 500mg
How is benzodiazepine withdrawal treated?
tapering
What negative symptoms can Molly or other club drugs cause?
Severe dehydration or hyperthermia
What is a crystalline form of MDMA but often cut with other drugs
molly
Which club drug has users reporting euphoria, sense of emotional openness, increased empathy or sympathy, increased energy, heightened sexual arousal and pleasure, increased sensory sensitivity
ecstasy
Which addictive club drug is also the treatment for narcolepsy
GHB
What does opiate withdrawal syndrome include
Rebound hyper excitability
What are some autonomic symptoms of opiate withdrawal
Diarrhea, rhinoria, diaphoresis, lacrimation, shivering, nausea, vomiting, fever, low or high blood pressure, low or high heart rate, piloerection
What are central nervous system symptoms of opiate withdrawal
Sleeplessness, restlessness, agitation, fasciculations and tremor, yawning, impaired concentration, dysphoria, irritability
Which medication is taken every other day for opiate addiction
LAAM
Which medication is taken daily for opiate withdrawal
methadone
describe what kind of drugs LAAM and methadone are and how they sre given
They’re both opioid agonists and schedule two narcotic drugs, they are only given in special programs, they replace other opiates and although they are addicting they do not significantly impair functioning or produce significant euphoria. They replaced other more addictive opioids with medications that reduce craving
Which medication for opiate addiction is a narcotic antagonist used in emergency treatment of opioid intoxication or overdose to reverse the effects of the narcotic, causes immediate withdrawal by displacing opiates from their receptors
naloxone (narcan)
Which medication for opiate addiction is taken every three days and mimics the effects of narcotics in some ways but not others. Has ceiling action where it blocks further effects of opioids when present and higher amounts. Given sublingual
buprenorphine
Which addiction medications are related to opioid antagonists that reduce opioid receptor response to abused opioids, essentially blocking the effects of them
nalmefene / naltrexone
Which intervention for addiction is given during ER visits, teaches how to reduce drug use, provides harm reduction information, gives information about consequences of drug convictions, provides information on and discuss harm reduction strategies, and offers and arranges follow up visits
Brief intervention therapy
how is someone with a dual diagnosis treated?
integrated treatment model, treat both at once in the same setting
what are the main steps of integrated treatment for a person with a dual diagnosis
-engage
-persuade
-actively treat
-provide relapse prevention interventions
-intensive case management
what is ambivalence and is it normal?
resistance, yes
differences in professional treatment vs. support group
-trained professional vs. volunteer
-groups don’t involve detox or pharm treatments
-support groups are free
-access to professional treatment may be difficult
what is AA based on?
belief of a higher power
