Substance Use Disorder 3 Flashcards
Sedative-hypnotics and anxiolytics: indications: General anesthesia, muscle relaxant, ______ (3)
(GABA receptor agonist)
- Anxiety
- Sleep
- Seizures
(produce physical and psychological dependence. Do not prescribe if they have been addicted to other drugs)
_____ is one of the oldest known naturally occurring anxiolytic drugs
Valerian
Classes of sedative hypnotics: meprobamate, Quaaludes, ______(4)
- Barbiturates
- Benzodiazepine
- Sleep drugs: Zolpidem (Ambien) and eszopiclone (Lunesta)
- Valerian
Benzodiazepine can be deadly when combined with _____. Widely prescribed and are usually the culprit of _____.
- Other depressant drugs
- escilation to physical dependence
Benzodiazepine signs of abuse: Cognitive dysfunction, self-neglect, ______ (4).
- Disinhibition
- Lethargy
- Blackouts
- Accidents
(High intoxication→ poor coordination, slurred speech)
Long-acting benzodiazepines
- chlordiazepoxide (Librium)
- diazepam (Valium)
- flurazepam (Dalmane)
Medium action benzodiazepines
- alprazolam (Xanax)
- clonazepam (Klonopin)
- temazepam (Restoril)
Short-acting benzodiazepines
- lorazepam (Ativan)
- oxaxepam (Serax)
- triazolam (Halcion)
(midazolam)
Very short action benzodiazepine
midazolam (Versed
(picmonic: “Maid-Z-Lamb”)
Treatment of sedative hypnotic dependence: ______ should be used to monitor for over/mis-use.
- Rx monitoring program
Treatment of sedative hypnotic dependence: Consider _____ program. ______ may prevent seizures – use for a brief time.
- an inpatient detox (outpatient less sucessful)
- Anticonvulsants
Stimulants elevate mood, increase ______ & _____ and decrease ______.
- energy
- alertness
- appetite
Stimulants cause autonomic hyperarousal including elevated _____ (3).
- blood pressure
- heart rate
- pupil dilation
(Can make individuals irritable, paranoid, euphoric, and experience hallucinations)
Stimulants medical indications (4)
- ADHD
- Depression: dextroamphetamine, methylphenidate
- Weight loss
- Sleep disorders
- methylphenidate
- dextroamphetamine
are used to treat which 2 disorders?
- ADHD
- Depression
Pseudoephedrine type drugs, useful for cold congestion, are precursors to _____ and are now restricted
methamphetamine
(you can buy it but you must talk to the pharmacist)
Common problem with stimulants: teenagers may _______. College/graduate students ______
- steal their younger siblings Ritalin and use it or sell it
- use it to study
What is the difference between Cocaine and Methamphetamine mechanisms of action?
Both increase dopamine in the synapse
- Cocaine blocking reuptake → rapid sense of intense pleasure
- Meth increased dopamine release at the synapse
Methamphetamines (aka “speed” or “meth”) are easily synthesized & instructions readily available. Method of administration:
- smoked
- injected
Nevada has the _____(lowest/highest) use of meth.
lowest
Medical complications of stimulant drugs (5)
- MI
- Psychosis
- Strokes
- Seizures → anoxic brain damage
- Infections : HIV, Hep C & B
Treatment of stimulant intoxication:
- Psychosis: antipsychotics
- Irritability: _____
- Depression: _____
- Benzodiazepines
- No trmt, unless it lasts >2 weeks, then antidepressants
(CBT recommended; acute withdrawal may cause depression assoc. w/the “crash”)
Substitution drug for stimulants
No “substitute” medication is available, but …
bupropion (Welbutrin XL) with naltrexone (Vivitrol) may diminish use
List the hallucinogens (4)
- LSD
- Mescaline
- MDMA (Ecstasy)
- Peyote
Hallucinogens cause psychotic-like experiences along with _____ symtpoms (5).
- Increased HR &BP
- Sweating
- Miosis
- Blurry vision
- Tremors
(stimulants cause mydriasis, increased BP & HR)
“Bad Trips” from hallucinogens can lead to _____. Some may develop ______ (2)
- to severe anxiety and paranoia
- flashbacks
- chronic psychosis
(Ecstasy can cause intense feelings of attachment and energy during high but cognitive and memory deficits in chronic use)
_____ may calm a patient high on hallucinogens.
BZD
PCP MOA
(Originally an anesthetic for animals)
- Antagonist of NMDA receptors
- Activates dopamine neurons
(Easily synthesized and is often added to other drugs)
PCP induces
- Euphoria
- Derealization
- Tingling
- Warmth
(PCP, cannabis, meth, opioids & inhalants cause euphoria)
PCP Moderate doses →
PCP Higher doses →
- bizarre behavior, myoclonic jerks, confusion
- coma, seizure, respiratory depression
(Can produce delirium, psychosis, mood disorders, flashbacks, agitation and violence)
Which 2 drugs can cause psychosis & flashbacks?
- hallucinogens
- PCP
(Cannabis can produce psychosis also, but not flashbacks)
THC is the active ingredient in marijuana contains many ______.
Carcinogens
Marijuana is used medicinally for :
- Nausea
- Anorexia
(“gateway drug”)
Cannabis can precipitate _____in vulnerable population.
psychosis
(PCP and hallucinogens also)
Intoxication of marijuana last for approximately_____ and gives a sense of ____.
- 2-4 hours
- euphoria and serenity, slowed time, heightened senses
(PCP, cannabis, meth, opioids & inhalants cause euphoria)
Heavy use of marijuana can lead to anxiety, paranoia _____ (5)
- Decreased motivation
- Memory problems
- Perceptual disturbances
- Poor attention
- Poor coordination
Caffeine stimulant effects include increased_____. Higher doses can cause ________. Massive dose can cause ______.
- alertness and improved verbal and motor performance
- restlessness, irritability and insomnia
- Seizures and coma
Caffeine Withdrawal from heavy use causes
- Depression
- Headaches
- Irritability
- Lethargy
Caffeine can aggravate _____ (4 conditions)
- Insomnia
- Gastric & esophageal ulcers
- Anxiety
Abstinence Based and Psychosocial Treatments (4)
- Inpatient detox & rahab: inpatient or intensive outpatient (IOP)
- 12 Step Programs
- Counseling (Cognitive Behavior based, family)
- Sober Living Residences
Why patients don’t seek substance abuse treatment?
- Not ready to stop using
- No money/insurnace
- Negative effect on job
- Worried what others think
- Didn’t know where to go
- Want to do it on their own
Co-occurring psychiatric disorders and substance use are most common with ______
Common w/alcohol abuse
(78% of alcohol dependent men and 86% of women met lifetime criteria for another psychiatric disorder including drug dependence)
Treatment of co-occurring disorders
(Integration of services is very important)
- CBT: anxiety disorders and substance abuse
- Meds (avoid in addictive personality)
- SSRI’s very helpful in depression and may require higher doses as alcohol may have induced hepatic microsomal activity
(Do not wait for extended abstinence to treat )
Gambling disorder criteria: persistent and recurring problematic Behavior leading to impairment or distress: 4 or more of the following in 12 months
- Spending more to achieve desired excitement
- Try to get $ from others to gamble
- “chasing” one’s losses (return to “win it back”)
- Unsuccessful attempts to quit
- Restless or irritable when they stop
- Preoccupied with gambling
- Gambles when feeling distressed
- Lies about gambling
- Jeopardized or lost a significant relationship, job, or educational or career
(bold, underline, itilics to group the symptoms: money, quitting, distress, lies & losses)
Gambling disorder frequently Co-occurs with _____ disorders (6)
- lifetime alcohol use disorder
- drug use
- nicotine dependence
- mood disorder
- anxiety
- personality disorder
Treatment of gambling disorder
- Gamblers Anonymous – high dropout rate
- Treat co-occurring disorders
- CBT – psychoeducation, challenge beliefs, acquire skills, facilitate lifestyle changes, restructure environment
- Marital and Family Treatments
(Medication – studies ongoing but none approved)
Inhalants produce feelings of ______ (3).
- Excitation
- Euphoria
- Disinhibition
Inhalants AE
- Dizziness
- Slurred Speech
- Ataxia
What are used as inhalants (5)
- airplane glue
- gasoline
- laboratory solvent
- nail polish remover
- paint thinner
Nicotine withdrawal sx
- Decreased HR
- Anxiety
- Craving
- Irritability
- Restlessness
Nicotine cessation tx
(important to encourage and assess quitting)
- Bupropion
- Varenicline/Chantix (partial nicotine agonist)
- Nicotine replacement (patches, gum, lozenges, inhalers)
Cathinones (aka “bath salts”) are naturally occurring ______derived from the leaves of Catha edulis
amphetamines
Synthetic cannabinoids (street names: spice and K2) are _______agents that bind to the cannabinoid receptor
cannabimimetic
Describe the general intoxication profile of cathinones & synthetic cannabinoids
Difference between synthetic cannabinoid and cathinone complications
- cannabinoids: rhabdo, nephrotoxicity, cardiac arrest
- cathinones: suicidality, respiratory depression, paranoia
(both have psychosis)
Why is it difficult to treat novel psychoactive substances?
Inability to know the potency, chemical composition and added adulterants in each batch of street drugs
Novel psychoactive substances are difficult to treat to do to not knowing the composition. How would you treat it?
- Supportive care
- IV fluids
- Electrolyte repletion
- End-organ evaluation of: kidneys, lungs, heart, and brain
- BZD, antipsychotics, nalaxone (if opioid toxidrome)
