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Pharm III > Substance Use Disorder > Flashcards

Substance Use Disorder Flashcards

1
Q

Illicit substances

A

Substances that have been obtained illegally or prescription medications used to get high (or alter the sensorium in some way)

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2
Q

Abuse

A

Taking a prescribed, non-prescribed prescription, OTC med, or illicit substance with the INTENT TO CAUSE ephoria, enhanced sensorium, “escape”, or other changes in mood/emotion

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3
Q

Misuse

A

Taking prescribed or nonprescribed medication (s) for non-prescribed purposes with intent to treat
Taking/sharing another person’s medications for intent to treat
Taking the medication outside the boundaries of the prescription: dosage, frequency, routes (intent to treat)

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4
Q

Addiction

A 
Craving
Compulsion to use
Continued use despite known consequences
Loss of control
Chronic dz
Frequently characterized by relapse
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5
Q

Pseudo-addiction

A

A healthcare induced condition in which health professionals misinterpret a pt’s request for more medication due to inadequate treatment of a condition. The pt’s request for more medication is misinterpreted as “drug seeking behavior” similar to that seen in addicts not in recovery

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6
Q

Physiological dependence

A 
The nl functioning of the body with prolonged drug or chemical exposure such that rapid removal or cessation of the drug produces withdrawal sx frequently characterized by:
Tachycardia
Anxiety
Nausea
Diaphoresis
Irritability
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7
Q

Physiological dependence s/sx in opioids

A

Myoclonus

Jerking

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8
Q

Physiological dependence s/sx with alcohol

A

Seizures
Tremors
Hallucinations

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9
Q

Tolerance

A

An increased dose is required to achieve the same desired physiologic response

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10
Q

Cross-tolerance

A

A pharmacological phenomenon that may be characterized as an inability to achieve a specific pharmacological effect d/t prolonged exposure of a similar pharmacological substance

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11
Q

Examples of cross-tolerance

A

Benzos-alcohol-anticonvulsants (gabapentin, carbamazepine, phenobarb)
All opioids to other opioids
Antihistamines-phenothiazines-TCAs-antipsychotics

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12
Q

What are these substances/medications doing for the abuser/addict?

A

Inducing euphoric/dissociative effects
Self-medicating underlying psychological disorders frequently undiagnosed
Additive or synergistic effects
Treatment of “abused” drug’s side effects
Treatment of diseases or disease processes caused by abused substances

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13
Q

Additive or synergistic effects

A

Sedation
Euphoria
Dissociation

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14
Q

Treatment of “abused” drug’s side effects

A

Itching
N/V
Anxiety
Erectile dysfunction

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15
Q

Tx of diseases or disease processes caused by abused substances

A

Depression
Anxiety
Bipolar

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16
Q

Drug diversion

A

Any time a medication moves in a direction it’s not prescribed for or not allowed by federal or state law

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17
Q

Opiates that are abused

A 
Hydrocodone
Oxycodone
Hydromorphone
Morphine
Codeine
Fentanyl
-IV
-Patches
Methadone
Buprenorphine
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18
Q

Benzos that are abused

A

Clonazepam
Alprazolam
Diazepam
Lorazepam

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19
Q

Stimulants that are abused

A

Methylphenidate
Armodafanil
Phentermine

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20
Q

Antipsychotics that are abused

A

Quetiapine
Olanzipine
Haloperidal
Risperidone

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21
Q

Muscle relaxants that are abused

A

Cyclobenzoprine
Metaxalone
Carisoprodal
Tizanidine

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22
Q

Anticonvulsants that are abused

A

Gabapentin
Carbamazepine
Pregabalin
Lamotrigine

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23
Q

Other analgesics that are abused

A

Tramadol

Butalbital/actaminophen

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24
Q

Antiemetics that are abused

A

Promethazine

Ondansetron

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25
Q

Performance enhancing drugs that are abused

A

Steroids

Epogen

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26
Q

Others that are abused

A

Tamoxifen

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27
Q

Sex enhancers that are abused

A

Sildenafil
Tadalafil
Vardenafil

28
Q

Classic behaviors regarding prescription meds

A 
Doctor shopping
Pharmacy shopping
Poly practitioner use
Early refills
Polypharmacy
Brand names only across the board
Reporting multiple thefts/losses
Persistently running out of controlled substances on weekends
29
Q

Peculiar med behaviors

A

Changing dosage forms
Changing pharmacists to request an early refill
Changing” requestor of” “early refill”

30
Q

Common features of addiction to a chronic disease

A

Lifelong
Remissions/exacerbations occur
Results in poor response to behavioral interventions alone
Effectively managed pharmacologically
Untreated, it results in morbidity/mortality

31
Q

Principal neurotransmitters

A 
Dopamine
Nor/epinephrine
Serotonin
Acetylcholine
GABA
32
Q

EtOH and the neurotransmitter correlates

A

Me-enkephalin
GABA
5HT

33
Q

BZDs and the neurotransmitter correlates

A

GABA

Glycine

34
Q

THC and the neurotransmitter correlates

A

Ach

35
Q

Heroin and the neurotransmitter correlates

A

Enkephalin
Endorphin
DA

36
Q

Cocaine/amphetamine and the neurotransmitter correlates

A

NE
5HT
DA
Ach

37
Q

Nicotine and the neurotransmitter correlates

A

NE
Endorphin
Ach

38
Q

LSD and the neurotransmitter correlates

A

Ach
DA
5HT

39
Q

Rewards

A

Humans, as well as other organisms, engage in behaviors that are rewarding
The pleasurable feelings provide positive reinforcement so that the behavior is repeated.

40
Q

The reward pathway

A

The ventral tegmental area is connected to both the nucleus accumbens and the prefrontal cortex and it sends information to these structures via its neurons. The neurons of the VTA contain the neurotransmitter dopamine which is released in the nucleus accumbens and in the prefrontal cortex

41
Q

MOA of heroin

A

Once in the brain, it’s converted to morphine by enzymes; the morphine binds to opiate receptors in certain areas of the brain.
Morphine also binds to areas involved in the pain pathway (including the thalamus, brainstem and spinal cord).

42
Q

Which types of neurons participate in opiate action?

A

One that releases dopamine
A neighboring terminal containing a different neurotransmitter (probably GABA)
The post-synaptic cell containing dopamine receptors

43
Q

Drugs and the reward pathway

A

They increase the activity of the reward pathway by increasing dopamine transmission

44
Q

S/sx of opioid withdrawal

A 
N/V
Diarrhea
"Goose flesh"
Yawning
Pupil dilation
Chills
Flu-like sx
Algias/myalgias
45
Q

How to tell if someone taking buprenorphine or methadone is not in recovery

A

Continued use
Noncompliance
Continued negative behaviors
Minimal behavior/environment

46
Q

How to tell when someone taking buprenorphrine and methadone is in recovery

A 
Sx controlled
Counseling
Behavior changes
Environmental changes
Minimized drug use
47
Q

How does medication assisted tx fit into the picture?

A 
Only 5% of the big picture
Screening/assessment/motivational interviewing
Goal setting/target setting
Counseling
Support group
48
Q

What are the goals of tx?

A 
Abstinence from substance abuse/recovery
Social stability lost by substance abuse
Establish mental well being
Decrease aberrant behaviors (prostitution, injection of substance)
Decrease HIV, hep C, STIs
Decrease domestic violence
Decrease criminal behavior
49
Q

What are the surrogate markers of SUD recovery?

A 
Med compliance
Counseling compliance
Urine drug screen compliance
Return to work
Positive relationship development
50
Q

Goals of pharmacotherapy- opioid addiction

A

Reduce cravings and compulsion to “use” while trying to “normalize” behaviors and lifestyles
Minimize withdrawal
Minimize risky abuse behaviors like IV drug abuse, aberrant sexual behavior, criminal behavior
Minimize or prevent relapse

51
Q

Drugs used to treat opioid addiction

A

Methadone
Buprenorphrine or buprenorphrine//naloxone (Suboxone)
Naltrexone

52
Q

How do meds used to treat opioid addiction work?

A

Stimulate reward receptors in the brain but don’t cause a huge dopamine surge

53
Q

Methadone

A

Regulated by SAMHSA and the medication is distributed in certified clinics. The critical part of methadone tx occurs during the induction.
Typically, pt is started on about 30 mg/day with Day 1 max of 40 mg PO

54
Q

Common side effects of methadone

A 
Dry mouth
Constipation
Nausea or loss of appetite
Feeling anxious or restless
Insomnia
Weakness or drowsiness
Decreased sex drive
55
Q

Goal of methadone dosage

A

Establish the dosage that will keep the pt free from withdrawal sx for a 24-hr period

56
Q

Average daily dose of methadone

A

70-120 mg/day

57
Q

What to avoid with methadone

A

Use of current benzos due to risk of overdose and death

58
Q

Characteristics of methadone

A 
Oral/IM
Long-acting
Pharmacokinetics DO NOT correspond to pharmacodynamics
Daily doses (acute vs chronic)
Tapering compared to buprenorphine
59
Q

Buprenorphine

A

Only approved office-based MAT for opioid dependence. Physician must have DEA waiver in order to prescribe buprenorphine products
Combo buprenorphine/naloxone should be used for induction, stabilization, and maintenance
The mono product buprenorphine should be reserved only for use in pregnant women who need maintenance tx and the rare individual who is allergic to buprenorphine/naloxone

60
Q

Average daily dose of buprenorphine

A

12-16 mg
90% of the mu receptors are occupied at 16 mg
A pt on more than 16 mg/day should generate a serious re-evaluation of the pt’s tx status

61
Q

Side effects of buprenorphine

A 
HA
Nausea
Sweating
Constipation
Stomach pain
Problems sleeping
Sublingual irritation
62
Q

What to avoid with buprenorphine

A

Use of concurrent benzodiazepines d/t risk of overdose and death

63
Q

How does buprenorphine work in treating addiction when it is 50-80x more potent than morphine?

A

It stimulates the receptors in the reward center of the brain
That diminishes cravings, compulsions, etc

64
Q

MOA of naltrexone

A

Long-acting oral opioid antagonist.
When taken correctly it completely blocks the reinforcing properties of ingested opioids
Pt must be opioid free for several days before starting naltrexone in order to avoid precipitating withdrawal

65
Q

Oral dose of naltrexone

A

50 mg daily

66
Q

Side effects of naltrexone

A 
N/V
HA
Anxiety
Fatigue
Insomnia
Elevated LFTs
Injection site reactions

Pharm III (8 decks)

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