Substance use disorder Flashcards
What are the “5 C’s” of addiction?
Chronicity
Impaired control over drug use
Compulsive use
Continued use despite harm
Craving
Ability of a second drug of the same class (similar MOA) to maintain the dependence of an original drug
Cross-dependence
Pharmacological treatment is always necessary for withdrawal from these two types of substances, since it can be life threatening
Alcohol and depressants
Subjective need or compulsion to use the drug in order to maintain a feeling of well being
May be present even in the absence of physical dependence
Psychological dependence
This intoxication sign is common to most drugs with the sole exception of nicotine
Euphoria
Euphoria is common to most drugs with the sole exception of this
Nicotine
All used substances appear to activate the same reward pathway with this as the final common neurotransmitter
Dopamine
Increased response to repeated and intermittent administration of the drug
Sensitization
These three enzymes metabolize alcohol
Alcohol and aldehyde dehydrogenase
Catalase
Alcohol oxidase (CYP)
This enzyme converts alcohol to aldehyde
Alcohol dehydrogenase
Is alcohol dehydrogenase zero or first oder?
Zero order
This enzyme is the primary route for alcohol metabolism
Alcohol dehydrogenase
Is alcohol dehydrogenase inducible?
No
Are alcohol oxidase and catalase zero or first oder?
First
Are alcohol oxidase and catalase induced?
Yes (by ethanol and other drugs)
This enzyme converts acetaldehyde to acetic acid
Aldehyde dehydrogenase
This enzyme is the point of “disulfiram-like” inhibition
Aldehyde dehydrogenase
Is ethanol withdrawal serious?
Yes - potentially lethal
1-2 days after start of withdrawal from ethanol, these appear and increase in intensity, may be life threatening
Convulsions
Early signs (within one day) of withdrawal from this substance include vivid dreams, insomnia, tachycardia, and hypertension
Ethanol
Visual hallucinations may occur anytime after the start of withdrawal from this substance
Alcohol
This symptom of ethanol withdrawal may occur anytime after the start of withdrawal
Visual hallucinations
1-2 days after start of withdrawal from this substance, convulsions appear and increase in intensity, may be life threatening
Ethanol
About 3 days after start of withdrawal from this substance, delirium tremens appear
Ethanol
About 3 days after start of withdrawal from ethanol, this symptom appears
Can include tremors, delirium, confusion, and sympathetic overdrive leading to cardiovascular instability and death
Delirium tremens
Delirium tremens is associated with withdrawal from this substance
Ethanol
Uncomplicated withdrawal from alcohol is treated with this
Benzodiazepines
Alcohol related seizures (complicated withdrawal) is a medical emergency and is treated also with this drug, but in an intensive care setting
Benzodiazepines
Seizures generally present after this much time of alcohol withdrawal
At the end of the first day
Delirium tremens usually occurs this much time after cessation of alcohol
48-72 hours
This symptom of alcohol withdrawal is a medial emergency, and involves autonomic hyperactivity, disorientation, visual or tactile hallucinations
Fluctuate from lethargic to agitated
Delirium tremens
This drug for alcohol craving reduction is administered oral or by extended-release injection
Naltrexone
This drug for alcohol craving reduction is a competitive mu-opiate receptor antagonist that reduces drug cravings
Naltrexone
Naltrexone is a competitive antagonist of this receptor
Mu-opiate receptor
Is naltrexone an agonist or antagonist of the mu-opiate receptor?
Antagonist
This drug for alcohol craving reduction appears weak at preventing a lapse, but better at preventing a lapse from becoming a relapse
Naltrexone
This drug for alcohol craving reduction is a GABAergic agonist that modulates alcohol cravings
Acamprosate
This drug for alcohol craving reduction appears good at preventing a lapse
Acamprosate
Is Naltrexone or Acamprosate better at preventing a lapse of alcohol use?
Acamprosate
(naltrexone is better at preventing a lapse from becoming a relapse)
Acamprosate is an agonist of this
GABA
Is acamprosate an agonist or antagonist of GABA?
Agonist
This drug is used as aversive therapy for ethanol
Disulfiram
Disulfiram inhibits this enzyme
Aldehyde dehydrogenase
This drug is reserved for the motivated ethanol abstinent patient that fears relapse
Disulfiram
Use of disulfiram results in the buildup of this compound, which makes the user sick after alcohol
Acetaldehyde
Do cross tolerance and cross dependence occur with depressants?
Yes
Does tolerance to depressants develop slowly or rapidly?
Slowly
Tolerance of depressants to this symptom is slow to develop and has a ceiling
Respiratory depression
Tolerance to respiratory depression is slow to develop and has a ceiling with these substances
Depressants
Does alcohol or benzoes have a shorter half life?
Alcohol
(so symptom of abstinence syndrome develop earlier)
Is withdrawal from depressants serious?
Yes - potentially life threatening
(regardless of half life)
Withdrawal from this type of depressant has the highest mortality rate
Barbiturate
How is depressant withdrawal treated?
- establish a stabilizing dose of the drug
- begin a slow taper process
Pinpoint pupils, respiratory depression, and constipation are signs of intoxication with this type of substance
Opioid
Is withdrawal from opioids serious?
Rarely life threatening
Hypertension, racing heart, and loss of electrolytes (vomiting and diarrhea) may be complications
Withdrawal from this type of substance is rarely life-threatening but hypertension, racing heart and loss of electrolytes (vomiting and diarrhea) may be complicating factors
Opioids
If decision is made to relieve symptoms of opioid withdrawal with opiate replacement, either of these 2 drugs are recommended
Methadone
Buprenorphine
Methadone and Buprenorphine are recommended to relieve symptoms of withdrawal from this type of substance
Opioids
This drug can be used to treat the hypersympathetic activity of opioid withdrawal
Clonidine
Clonidine can be used to treat the hypersympathetic activity of withdrawal from this type of substance
Opioids
Clonidine can be used to treat this activity that occurs with opioid withdrawal
Hypersympathetic
Buprenorphine-Naloxone combinations are used for this
Opioid dependence maintenance
Combinations of these two drugs are used for opioid dependence maintenance
Buprenorphine-Naloxone
This drug is used for aversive therapy from opiates
Naltrexone
This drug blocks opiate activity, preventing any desirable effects of opiates
Requires an abstaining opiate user motivated to stay opiate-free but fears relapse
Naltrexone
Naltrexone is used as aversive therapy from this type of substance
Opiates
D-isomer of opiate normally used as antitussive
Dextromethorphan
Dextromethorphan is used to treat this
Cough
Is antitussive
This drug is the antidote to Dextromethorphan
(especially higher dose effects)
Naloxone
Intoxication with this antitussive is achieved by large oral doses
High dose: Hyperexcitability, lethargy, ataxia, slurred speech, diaphoresis, hypertension, nystagmus, mydriasis
Higher dose: Dissociative anesthetic-like sensations
Dextromethorphan
This is a partial nicotine agonist
Has been noted to increase the risk of seizures, and risk is increased when combined with bupropion
Varenicline
Varenicline is a partial agonist to this
Nicotine
Varenicline has an increased risk of this, and the risk is increased when combined with bupropion
Seizures
Varenicline increases the risk of seizures, and this risk is increased when combined with this drug
Bupropion
Bupropion decreases drug craving, drug reward, and withdrawal symptoms of this type of substance
Nicotine
This is the most widely consumed behaviorally active substance
Caffeine
Peripheral actions of caffeine includes inhibition of this type of enzyme
PDEs
(results in sustained levels of cAMP and cGMP)
Central actions of caffeine involve antagonism of these two compounds
Adenosine and GABA-inhibitory action
Does caffeine dilate or constrict coronary vessels?
Dilates
Does caffeine dilate or constrict cerebral vessels?
Constricts
Does caffeine relax or stimulate smooth muscle?
Relax
Does caffeine relax or stimulate skeletal muscle?
Stimulate
In coronary insufficiency, what effect does caffeine have on cardiac function?
Cardiac depressant
(is usually a cardiac stimulant)
In coronary insufficiency, what effect does caffeine have on coronary vessels?
Constricts
(usually dilates)
Caffeine actions in a patient with this condition may be reversed of what is normal
(cardiac depressant, coronary vessel constrictor)
Coronary insufficiency
What is the half-life of cocaine?
1 hour
What is the half-life of amphetamine?
12 hours
cocaine is this type of substance
Stimulant
Amphetamine is this type of substance
Stimulant
This pattern of misuse of stimulants is an intense pleasure as drug is administered
Rush
This pattern of misuse of stimulants is periods of intense drug use, also called binge
Run
This pattern of misuse of stimulants is the end of a run, characterized by prolonged sleep, depression, hunger and weakness
Crash
Rush, run, and crash are patterns of misuse of this type of substance
Stimulants
Withdrawal from this type of substance begins shortly after last dose with increased drug cravings, intense dysphoria, depression, anxiety and agitation
Stimulants
Within a day or so of withdrawal from this type of substance, hypersomnia, increased appetite, and cravings vary in intensity
Stimulants
Within a day or so of withdrawal from stimulants, does insomnia or hypersomnia occur?
Hypersomnia
Within a day or so of withdrawal from stimulants, is appetite increased or decreased?
Increased
In withdrawal from this type of substance, patients without depression or suicidal tendencies can be treated outpatient
Stimulants
Cocaine is metabolized to this compound in the presence of alcohol
Cocaethylene
(a longer acting psychoactive compound; has a higher risk of death)
Cocaine is metabolized to cocaethylene in the presence of this
Alcohol
This is metabolized to cocaethylene in the presence of ethanol
Cocaine
This stimulant produces profoundly positive feelings (empathy, relief of anxiety, extreme relaxation) at recreational doses
Ecstasy
This type of cannabinoid receptor is found in CNS; mediates the rewarding properties of cannabinoids
CB1
This type of cannabinoid receptor is prominent in the immune system
CB2
These are homologs of marijuana produced in the brain
Endocannabinoids
Marijuana is derived from this
Cannabis sativa
This active ingredient of Cannabis stimulates appetite and reduces nausea
9-Tetrahydrocannabinol (THC)
This active ingredient of Cannabis is used for reducing pain and inflammation, and controlling epileptic seizures
Non-psychoactive
Cannabidiol
Is 9-Tetrahydrocannabinol (THC) or Cannabidiol a psychoactive component of Cannabis?
THC
What effect does cannabis have on heart rate and BP?
Mild increase
In heavy users of this substance, amotivational syndrome of apathy, dullness, impaired judgement, decreased concentration and memory, loss of interest in personal hygiene, and a general reduction of goal-directed behavior may occur
Cannabis
A hyperesmesis syndrome may occur in current, heavy users of this substance
Abdominal pain, epigastric or periumbilical
Recurrent episodes of severe nausea and intractable vomiting
Resolution of symptoms with cessation
Cannabis
Do hallucinogens change mood and thought patterns?
Generally yes
Do hallucinogens cause constricted or dilated pupils?
Dilated
Cross-over sensory patterns (hear sights, smell sounds, etc) may occur with higher doses of this type of substance
Hallucinogen
Powerful hallucinatory drugs (such as LSD) can trigger this
Most typically observed in recurrent users or have underlying personality disorders
Flashbacks
Are hallucinogens considered addictive?
No
Phencyclidine (PCP) is this type of substance
Hallucinogen
Phencyclidine (PCP) is a dissociative anesthetic chemically related in action to this compound
Ketamine
This is a dissociative anesthetic chemically related in action to ketamine
Phencyclidine (PCP)
This drug provides feelings of detachment from environment and self
Often used as a spike for another drug
Phencyclidine (PCP)
Chronic effects of this drug include flashbacks, persistent speech problems, social withdrawal and isolation, toxic psychosis
Phencyclidine (PCP)
Rash/irritation around mouth and nose, Red, glassy, watery eyes, Excitability and unpredictable behavior and Odor on clothes, skin and breath are signs of use of this type of substance
Inhalants
Chronic use outcomes of this type of substance include cardiac arrhythmias, liver and kidney damage, cancer, and gateway use to other drugs of misuse
Inhalants
In general approach to substance use disorder, is pharmacological treatments or psychosocial therapy primary?
Psychosocial therapy
(Pharmacological treatments are secondary to psychosocial therapy)
What are the five stages of change in substance use disorder?
Precontemplation
Contemplation
Preparation
Action
Maintenance
A person with no intent to change and sees positive aspects of behavior rather than negative, may be in this stage of change
Precontemplation
A person who is willing to consider changing, and is mostly ambivalent and becomes quickly resistant or defensive, may be in this stage of change
Contemplation
This drug is the first-line for alcohol withdrawal prevention
Benzos
This drug reduces alcohol cravings but should not be used in patients taking opioids
Naltrexone
Naltrexone reduces alcohol cravings, but should not be used in patients taking these drugs
Opioids
This drug for alcohol use disorder is safe in liver disease but avoided in renal failure
Acamprosate
Acamprosate is avoided in patients with this organ failure
renal
This drug is short acting and given for opioid overdose
Naloxone
This drug is given in controlled settings for opioid use disorder, and is a long-acting full opioid agonist
Methadone
This drug is a partial opioid agonist with a ceiling effect (less respiratory depression)
Buprenorphine
Is methadone a partial or full opioid agonist?
Full
(prevents withdrawal; long half life)
Is Buprenorphine a partial or full opioid agonist?
Partial
(reduces cravings)
Is Buprenorphine a partial or full opioid agonist?
Partial
Suboxone is a combination of these two drugs, and is discourages misuse of opioids
Blocks euphoric effects if injected
Buprenorphine + Naloxone
This drug used for opioid withdrawal has adverse effects of respiratory depression and QT prolongation
Methadone
What is the first line treatment for stimulant use disorder?
Supportive therapy
*No FDA approved medications
Agitation in stimulant use disorder should be managed with this drug
Benzos
This type of drug should be avoided in acute cocaine intoxication due to unopposed alpha-adrenergic vasoconstriction
Beta blockers
What is the first line treatment for cannabis use disorder?
Supportive therapy
*No FDA approved medications
In treatment of withdrawal from this type of substance, gradual taper is key
Benzodiazepine
Benzodiazepine withdrawal is similar to withdrawal from this substance
Alcohol
Opioid overdose should be treated with this drug
Naloxone
Opioid maintenance therapy should involve either of these 2 drugs
Methadone
Buprenorphine
Is withdrawal from stimulants life threatening?
No
(treat with CBT)
Are there FDA-approved treatments for stimulant, cannabis, or benzodiazepine use disorders?
No
