Substance Use Disorder

Question 1

neurobiology of addiction/tolerance

Answer 1

1. exposure ➔ pleasurable feeling ➔ hippocampus
2. Ventral tegmental area ➔ dopamine ➔ nucleus accumbens ➔ pleasurable feeling
3. dopamine ➔ prefrontal cortex ➔ learnt behaviour and addiction that this was a pleasurable experience
4. overtime ➔ build tolerance ➔ body downregulates dopamine receptors to maintain homeostasis
5. need more of the substance to induce same feelings of pleasure

Question 2

s/s of alcohol intoxication (depressants)

Answer 2

• euphoria
• behavioural disinhibition
• resp depression
• poor coordination

Question 3

s/s of alcohol withdrawal (depressants)

Answer 3

• anxiety
• poor appetite
• N/V
• tremor
• seizures
• insomnia
• psychosis
• delirium tremens
• death (CAN BE FATAL)

Question 4

time line for alcohol withdrawal symtpoms

Answer 4

6-8 h from last drink
peaks on 2nd day of abstinence
improves by day 4-5d

Question 5

timeline for seizure risk for alcohol withdrawal

Answer 5

6-48h post reduction/discontinuation

Question 6

s/s of delirium tremens

Answer 6

severe, get them hospitalized
- arrythmias
- high fever
- severe confusion/disorientation
- seizures
- extreme agitation
- heavy sweating
- hallucinations and delusions

Question 7

timeline for delirium tremens

Answer 7

can present anytime within teh withdrawal period (5d) even after they clear the 48h seizure risk timeline

Question 8

specific s/s of opioid withdrawal

Answer 8

profound diarrhea
piloerection (goosebumps)
yawning
not deadly though

Question 9

examples of depressants

Answer 9

alcohol
benzodiazepines
opioids
barbiturates

Question 10

examples of stimulants

Answer 10

amphetamine
cocaine
methylanediate
caffeine
MDMA (ecstasy/molly)

Question 11

examples of hallucinogens

Answer 11

LSD (acid)
shrooms - psilocybin
PCP
ketamine
cannabis

Question 12

s/s of stimulant intoxication

Answer 12

• euphoria
• mania
• psychomotor agitation
• psychosis (esp paranoia)
• insomnia
• cardiovascular complications ➔ stroke, MI, arrhythmias)
• seizures

Question 13

s/s of stimulant withdrawal

Answer 13

• “crash”
• cravings
• dysphoria
• suicidality

Question 14

s/s of hallucinogen intoxication

Answer 14

• distortion of sensory stimuli
• enhancement of feelings
• psychosis ➔ esp visual hallucinations
• poor coordinations
• delirium
• anxiety

Question 15

s/s of hallucinogen withdrawal

Answer 15

not usually any

Question 16

RF for substance use

Answer 16

1. genetics: fhx, predisposition, personality (impulsive personality)
2. early exposure to substances
3. childhood adverse events
4. access to substances
5. psychiatric comorbidities
6. social factors: unemployment, housing instability, poor social support
7. chronic medical conditions

Question 17

Top 3 addicting drugs

Answer 17

1. heroin
2. methadone
3. nicotine

Question 18

stages of motivational interviewing

Answer 18

1. precontemplation
2. contemplation
3. preparation
4. action
5. maintenance
6. is relapse but hopefully theres no relapse

Question 19

tell me about addiction potential?

Answer 19

inhaled or IV ROA have increased addiction potnetial bc of the immediate feelings of euphoria

how long the drug lasts in the body also impacts the level of addiction ➔ fast clearance ➔ immediate withdrawal ➔ looking for next dose ➔ addiction

Question 20

what does CAGE questionnaire stand for and function?

Answer 20

alcohol use disorder screening questionnaire

C - felt the need to CUT down on drinking
A - felt ANNOYED by critics of the drinking?
G - felt GUILTY about drinking
E - ever had an EYE opening experience about the drinking

Question 21

what does the AUDIT (-C) tell us?

Answer 21

alcohol screening

Question 22

what is PAWSS and COWS

Answer 22

prediction scores for alcohol and opioid withdrawal severity

Question 23

how to investigate substance use disorders?

Answer 23

1. tox screen ➔ blood alcohol levels + urine
2. vitamins ➔ thiamine, B12, folate
3. CBC ➔ macrocytic anemia
4. LFTs, Cr, Urea
5. blood borne infection and STI ➔ HIV, syphillus, hepatitis, gon/chalmydia

Question 24

pharmacological tx for alcohol dependance

Answer 24

1. naltrexone - opioid antagonist, to reduce cravings
2. acamprosate - GABA agonist
3. disulfiram - inhibits alcohol metabolism

Question 25

other support for those that want to quit alcohol

Answer 25

support groups - AA
consider residential centres
nutritional support - thiamine and B12 replacement and folic acid

can consider CBT or family therapy

Question 26

pharmacological tx for those wanting to quit opiods

Answer 26

• suboxone - opiod agonist
• methadone - opioid agonist
• kadian - opiod agonist

Question 27

tx for alcohol withdrawal

Answer 27

CIWA protocol
- thiamine and fluids
- benzodiazepines ➔ basically giving them depressant again to remove the stimulant like withdrawal s/s
- give anticonvulsants for seizure risk (valprioc acid)

Question 28

tx for opioid withdrawal

Answer 28

• opioid agonists – suboxone, methadone, kadian

Question 29

tx for alcohol overdose

Answer 29

pump the stomach

Question 30

tx for opioid overdose

Answer 30

naloxone

Question 31

pt education for substance use disorders

Answer 31

safe supply and safe supplies
harm reduction
don’t use alone ➔ hotline