SUBSTANCE USE DISORDERS Flashcards
Reward pathway
Ventral tegmental area (VTA)
Nucleus accumbens
Prefrontal Cortex
Neurotransmitter increased in all drugs that lead to addiction
Dopamine
morphine-like neurotransmitters
neuropeptides
when the body becomes less responsive to the drug with repeated exposure
tolerance
painful physical and psychological symptoms that follow discontinuation of a drug
withdrawal
DSM-5 criteria for substance dependence
three or more symptoms in the same 12-month period
binge drinking
5 or more drinks on the same occasion during 1 or more day in the past month
heavy drinking
5 or more drinks on the same occasion 5 or more days in the past month
low-risk drinking
Men: No more than 4 drinks on one occasion or
14 drinks per week
Women: No more than 3 drinks per day or
7 drinks per week for women
CAGE
Cutting down
Annoyed
Guilty
Eye-opener
Autonomic hyperactivity disorientation hallucinations fluctuating levels of consciousness delusions
Delirium Tremons (DTs)
Used for maintenance of alcohol abstinence
Disulfiram (Antabuse)
How long does it take for disulfiram to take effect?
It is imediate
How long to wait to take disulfiram after last drink?
12 hours
blocks second stage metabolism of alcohol
irreversibly inhibits aldehyde dehydrogenase
disulfiram (Antabuse)
labs needed before starting disulfiram
LFTs
leads to negative effects of alcohol toxicity
disulfiram
blocks mu receptors
opioid receptor antagonist
naltrexone
Can take days or weeks to take effect
naltrexone
Labs to take before starting naltrexone for alcohol dependence
LFts, CBC, BMP, TSH
May be less effective for patients who are not abstinent at time of treatment initiation
naltrexone
Can augment with naltrexone
acamprosate
Good choice for those who have recently abstained from alcohol (begin fifth day of abstinence)
“artificial alcohol”
Prevents people from drinking but does not prevent withdrawal symptoms
acamprosate
Reduces glutamate
enhances GABA
acamprosate
No labs needed before starting
acamprosate
Three times a day dosing
acamprosate
50 mg daily dosing
or 100 mg M, W, and 150 mg Friday
naltrexone
Dosing for disulfiram
once daily
least expensive alcohol misuse drug
naltrexone
Most common for alcohol use disorder
naltrexone
disulfiram
acamprosate
