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Substance Use Disorders 1 Flashcards

1
Q

Among adults 18 or older, of those who first tried alcohol at age _____, 13.8% classified with dependence or abuse

A

14 or younger

(1.8% if age at first use age 21 or older)

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2
Q

Prevalence of alcohol use disorders

A
  • 20 million alcohol-abusing or dependent
  • Similar to the rates of chronic diseases (asthma, DM, depression)

(economic loss of $134 billion in productivity)

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3
Q

Alcohol use MC in _______.

A

men

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4
Q

Alcohol use in hospitilized patients

A

25-50%

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5
Q

________ (3) disorders more likely to be dependent on alcohol.

A
  1. Antisocial personality
  2. Anxiety
  3. Mood
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6
Q

Relation of blood alcohol levels (BAL) to symptoms dependent on _______.

A

tolerance

(legally intoxicated when but alcohol is greater than 0.08 g/dL)

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7
Q
  • BAL: 0-100 → symtpoms
  • BAL 100-150 →
  • BAL 150-250 →
  • BAL > 250 →
  • BAL > 350 →
A
  • Initially feel tranquil, sedated
  • uncoordinated, irritable
  • slurred speech, ataxicc
  • pass out, unconscious
  • comatose, death
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8
Q

CAGE questionnaire

A
  1. Ever felt you should Cut down on your drinking?
  2. Annoyed by criticism of your drinking?
  3. Feel bad or Guilty about your drinking?
  4. Eye-openers? (steady nerves to get rid of hangover)

(one positive answer = 90% chance of alcohol disorder)

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9
Q

Be suspicious of patients who

A
  1. Ability to drink more than others
  2. Have accidents or false
  3. Blacking out
  4. Lying to family or co-workers
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10
Q

Abnormal laboratory findings for alcohol-use disorder

A
  • High blood alcohol concentration
  • Increased MCV, high cholesterol, elevated liver enzymes (GGT acutely)
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11
Q

Physical findings alcohol use disorder (3)

A
  1. Enlarged red nose and reddened palms
  2. Enlarged liver and spider veins
  3. Gynecomastia and testicular atrophy
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12
Q

Medical complications of alcohol abuse include fatty liver, GI problems, pancreatitis, Wernicke’s encephalopathy, _____ (5).

A
  1. Cancers of many organs
  2. Cardiomyopathy → heart failure
  3. Cerebellar damage → ataxia
  4. Neuropathy
  5. Infections: TB, frequent pneumonias

(If pregnant → Fetal alcohol syndrome)

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13
Q

Psychiatric complications of alcohol abuse (6)

A
  1. Anxiety
  2. Dementia (from alcoholism)
  3. Depression
  4. Suicide
  5. Withdrawal problems
  6. Increased use of other drugs
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14
Q

Social complications of alcohol abuse (4)

A
  1. Accidents, fights & falls
  2. Legal problems
  3. Loss of jobs
  4. Marital and family problems
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15
Q

Alcohol use disorder: problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following occurring within a 12-month period:

A
  1. Drink more & longer than intended
  2. Desire or unable to quit
  3. Much time spent using or recovering from alcohol
  4. Craving
  5. Failure of obligations at work, school or home duties
  6. Use despite social or interpersonal problems
  7. Reduced social, occupational or recreational activities
  8. Use in situations where it is physically hazardous
  9. Use in spite of persistent physical or psychological problem caused or exacerbated
  10. Tolerance: the need for more for the desired effect or diminished effect of same amount
  11. Withdrawal: a characteristic syndrome of symptoms or the same or a closely related substance is taken to avoid/relieve withdrawal symptoms
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16
Q

Genetics of alcohol abuse

A
  • Molecular genetics find differences in genes encoding for alcohol metabolizing genes

(High rates among other family members, Twin and adoption studies)

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17
Q

Mechanism of action of alcohol: neurotransmitters

A
  • Positive reinforcement by dopamine action (mesolimbic DA pathway)
  • Withdrawal symptoms due to disturbances in GABA and glutamine
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18
Q

Alcohol causes DA activation of neurons in the _______

A

mesolimbic structures is the main source of feelings of pleasure and therefore extremely rewarding (direct and indirect action)

(all drugs lead to dopamine)

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19
Q

Role of GABA and alcohol withdrawal

A
  • Alcohol potentiates GABA → diminishes receptor sensitivity
  • Chronic use of alcohol → reduced potentiation of GABA-mediated chloride flux through the GABAA receptor channel complex ⇒ tolerance
20
Q

GABA-mediated neurotransmission is decreased in alcohol withdrawal, leading to the _____ symptoms

Thus ______, which also potentiate GABA, are effective against some of the withdrawal symptoms.

A
  • hyperactivity
  • benzodiazepines
21
Q

Role of glutamate in alcohol withdrawal

A

Alcohol inhibits glutamate at the NMDA receptor→ patient feels calm → chronic use up regulates receptors → alcohol abstinence increases activated tone.

(partial seizures, anxiety & sleep problems)

22
Q

Alcohol withdrawal symptoms (8)

A
  1. Autonomic hyperactivity (sweating or HR > 100)
  2. Anxiety
  3. Insomnia
  4. Hallucinations or Illusions (Transient)
  5. Psychomotor agitation
  6. Tremor (hands)
  7. Seizures
  8. N/V

(2 or more of the these → alcohol withdrawal)

23
Q

Alcohol withdrawal is called

A

Delirium tremens

(because withdrawal can lead to delirium)

24
Q

Alcohol withdrawal delirium symptoms usually develop shortly after or during withdrawal symptoms and include:

A
  1. Disturbance of consciousness with reduced ability to focus, sustain or shift attention
  2. Change in cognition (such as memory deficits, disorientation, or language) or perceptual disturbance
  3. Fluctuates during the course of the day
25
Alcohol withdrawal begins within ______ after sensation or significant decrease in use.
* 12 to 18 hours (Dr. Slagle says 18-24 hours is more realistic)
26
Treatment of alcohol withdrawal (4)
1. **Benzodiazepines (BZD’s)** (works similarly to alcohol in binding to GABA receptor) or **chlordiazepoxide** 2. Day 1: aim to markedly **depress the withdrawal symptoms**, then decrease that amount by 20% over the next four days 3. **Replace fluids** 4. **Thiamine and folic acid** (Usually accomplished in 5 days)
27
When are long-acting BZD used to treat alcohol withdrawal?
Those who do not have severe liver disease or brain damage (diazepam or chlordiazepoxide)
28
Long-acting benzodiazepines used for alcohol withdrawal
1. Diazepam 2. Chlordiazepoxide
29
Short-acting drugs used for alcohol withdrawal
1. Oxazepam 2. Lorazepam (more frequent dosing for those with liver or brain damage)
30
Treating alcohol withdrawal with anticonvulsants such as _______ (3) will prevent seizures, preserve cognition and may aid in relapse prevention.
1. valproic acid 2. carbamazepine 3. gabapentin
31
Getting patients into treatment: 40% of medical and patient admissions are related to complications of alcohol dependence. Substance use disorders are often undetectable and undiagnosed. How do you help these patients?
* Thorough and accurate **substance use history** should be part of any medical or psychiatric interview * **SBIRT**: Screen, Brief Intervention and Referral to Treatment (pronounced "S-Birt")
32
Goals of assessing substance abuse (4)
1. **Identify substance abuse** 2. **Accurate diagnosis** (including relation to medical or psychiatric problems) 3. **Be positive**: help them believe substance abuse can actively be treated 4. Assess patients **willingness to change** and stage of change
33
5 stages of change
1. Precontemplation: not interested 2. Contemplation: aware but not ready to commit 3. Preparation: have decided to change 4. Action: started modifying Behavior 5. Maintenance: preventing relapse
34
Motivational interviewing is useful in the ______ Stage of Change. Therapist is supportive and non-judgemental. Explore \_\_\_\_\_\_\_\_. Desired outcome is \_\_\_\_\_\_\_. (Avoid confrontational questions circumvent defensiveness and create open environment)
* contemplative * ambivalence about changing addictive behaviors * resolution of ambivalence and facilitation of increased readiness to consider change
35
Rehabilitation of alcohol abuse (3)
1. **CBT**: Group & Individual 2. **12 step programs** ( AA – many choices based on gender, sexual orientation, age, religious focus) 3. **Tx underlying psychiatric illnesses** (Other therapies such as Network, Family, Couples, Inpatient Programs, Therapeutic Communities)
36
Pharmacological approach to alcohol dependence to prevent relapse
1. Disulfiram 2. Naltrexone 3. Acamprosate 4. Psychiatric medications for tx of co-occurring disorders
37
Disulfiram (Antabuse) MOA (Discovered in the 1930s when workers exposed to it became ill after drinking alcohol)
Inhibits aldehyde dehydrogenase → Increasing the concentration of acetaldehyde → flushing, HA, N/V
38
Disulfiram (antabuse) produces sensations of ______ (4).
1. feeling hot 2. facial flushing 3. pounding headaches 4. N/V
39
Disulfiram (Antabuse) side effects (4)
1. Metallic taste 2. Sulfur-like odor 3. Psychosis 4. Neuropathy (Rarely hepatotoxic)
40
Disulfiram (antabuse) FDA approved for managing \_\_\_\_\_.
chronic alcoholics who wish to remain abstinent so that psychotherapeutic treatment might be most effective (Compliance is an important problem—medication works best if supervised by a spouse or partner)
41
Dose of disulfiram is usually _____ daily. If the patient decides they want to stop Disulfiram and continue to drink they must wait \_\_\_\_\_\_days
* 250 mg * 5
42
Opioid antagonist: Alcohol consumption affects the production, release and activity of \_\_\_\_.
opioid peptides
43
Opioid peptides mediate some of alcohol’s rewarding effects by enhancing \_\_\_\_\_\_\_\_.
midbrain dopamine (DA) release (Genetic high risk/FH+ individuals have an exaggerated alcohol-induced rise in Beta-endorphin levels. Naltrexone tx decreases pleasurable effects of EtOH)
44
\_\_\_\_\_\_\_\_ drug may work best in those whose alcoholic disease is characterized by craving.
Naltrexone 50 mg/day (Efficacy is best among motivated patients; Depot (IM shot) Naltrexone (Vivitrol), 380 mg once a month, may enhance compliance and has recently become available)
45
Naltraxone AE (4)
1. Anxiety 2. Headache 3. Nausea 4. Sedation (Cannot be prescribed in patients with severe liver disease or in patients taking opioids)
46
Excitatory neurotransmitter N-methyl-D-aspartate (NMDA) contributes to alcohol’s _______ (3) effects. Therefore, NMDA antagonists reduce the intensity of \_\_\_\_\_\_.
1. intoxicating 2. cognitive 3. dependence-forming * Post-cessation alcohol craving on exposure to high-risk drinking situations
47
Acamprosate MOA
NMDA antagonist or inhibitory modulator (poor bioavailability: 11%, no risk of liver damage)

Behavioral Medicine (35 decks)

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