Substance use disorders Flashcards
_ is a liver enzyme that is elevated in alcoholism; very sensitive but non-specific
GGT is a liver enzyme that is elevated in alcoholism; very sensitive but non-specific
Alcoholics will often have 2:1 ratio of liver enzymes, _ > _
Alcoholics will often have 2:1 ratio of liver enzymes, AST > ALT
Alcoholics may have reduced _ and _ production
Alcoholics may have reduced albumin and platelet production
* Hypoalbuminemia and thrombocytopenia
Neurologic effects of alcohol include _ and _
Neurologic effects of alcohol include degeneration of cerebellar vermis and peripheral neuropathy
* Drunken sailor ataxia
Cardiac effects of alcohol include _ and _
Cardiac effects of alcohol include dilated cardiomyopathy and atrial fibrillation
Oral/esophageal complications of alcohol include:
Oral/esophageal complications of alcohol include:
* Dental caries
* Aspiration pneumonia
* Mallory-Weiss tears
* Esophageal varices
* Squamous cell carcinoma
GI complications of alcohol use include _ , _ , and _
GI complications of alcohol use include pancreatitis , gastritis , and liver cirrhosis
* Liver cirrhosis can lead to poor synthetic function of the liver and portal congestion
Nutritional complications of alcohol use can include [deficiency], [anemia], [anemia/deficiency], gout
Nutritional complications of alcohol use can include thiamine (B1) deficiency, sideroblastic anemia, B12/folate deficiency (macrocytic anemia), gout
Reproductive complications of alcohol use include _ and _
Reproductive complications of alcohol use include erectile dysfunction and testicular atrophy
Acute management of alcohol misuse includes administration of [nutritional support] , airway protection, antiemetics, hydration
Acute management of alcohol misuse includes administration of thiamine before glucose, airway protection, antiemetics, hydration
_ or _ are drug options for reducing the cravings for alcohol
Naltrexone or Acamprosate are drug options for reducing the cravings for alcohol
Acamprosate is a drug with [MOA] that can help to reduce alcohol cravings
Acamprosate is a central glutamate receptor antagonist that can help to reduce alcohol cravings
_ is a drug that blocks the conversion of acetaldehyde to acetic acid, inducing unpleasant hangover symptoms with alcohol use
Disulfiram is a drug that blocks the conversion of acetaldehyde to acetic acid, inducing unpleasant hangover symptoms with alcohol use
* Increases alcetaldehyde
* Causes headache, nausea, flushing
General somatic symptoms of alcohol withdrawal include:
General somatic symptoms of alcohol withdrawal include:
* Tremors
* Diaphoresis
* Agitation
* Insomnia
* Nausea
* Emesis
Seizures and hallucinations can occur in [time frame] after alcohol withdrawal
Seizures and hallucinations can occur in 12-48 hours after alcohol withdrawal
* Seizures are typically tonic clonic and hallucinations are typically visual
_ is a life threatening complication of alcohol withdrawal that involves AMS, seizures, hallucinations, autonomic instability after 48+
Delirium tremens is a life threatening complication of alcohol withdrawal that involves AMS, seizures, hallucinations, autonomic instability after 48+
First line management for alcohol withdrawal is _
First line management for alcohol withdrawal is benzodiazepines
* Anxiolysis and antiepileptic activity
_ opiod receptor has the strongest analgesic effect
Mu opiod receptor has the strongest analgesic effect
_ opiod receptor is the only receptor type responsible for sedation
Kappa opiod receptor is the only receptor type responsible for sedation
_ is the opiod receptor type responsible for tolerance
Delta is the opiod receptor type responsible for tolerance
Opiods cause [change] in adenylyl cyclase and [change] in cAMP
Opiods cause decrease in adenylyl cyclase and decrease in cAMP
* Leads to change in K+ and Ca2+ conductance and decreased presynaptic NT release
Opiods _ K+ conductance and _ Ca2+ conductance
Opiods increase K+ conductance and decrease Ca2+ conductance
_ is the only opioid that cause mydriasis
Meperidine is the only opioid that cause mydriasis
Side effects of opioid use include:
Side effects of opioid use include:
* Respiratory depression
* Somnolence/coma
* Miosis
* Pruritus (histamine release)
* Sphincter of oddi spasm
* Constipation
Respiratory depression in opioid use is due to a blunted CNS response to _
Respiratory depression in opioid use is due to a blunted CNS response to hypercarbia
Acute opioid overdose is treated with _
Acute opioid overdose is treated with Naloxone
Yawning and flu-like symptoms are classic for _ withdrawal
Yawning and flu-like symptoms are classic for opioid withdrawal
* Lacrimation, rhinorrhea, sweating, diarrhea, salivation, muscle pain and spasms, CNS pain
Repeated opioid exposure will result in _ of mu opioid receptors and tolerance
Repeated opioid exposure will result in downregulation of mu opioid receptors and tolerance (delta)
Neonatal abstinence syndrome is managed with _ or _
Neonatal abstinence syndrome is managed with methadone or morphine
Tramadol is indicated for _
Tramadol is indicated for chronic pain
* Has SNRI activity
_ is a full opioid agonist indicated for maintenance
Methadone is a full opioid agonist indicated for maintenance
* Has a slow onset, long half-life
_ is an opioid antagonist that is used to prevent opioid relapse
Naltrexone is an opioid antagonist that is used to prevent opioid relapse
* Also reduces alcohol and nicotine cravings
_ and _ are opioids with antitussive properties
Codeine and Dextromethorphan are opioids with antitussive properties
_ and _ are opioids indicated for treatment of diarrhea
Loperamide and Diphenoxylate are opioids indicated for treatment of diarrhea
Benzos:
GABAa agonism –> increased Cl- channel _ –> decreased neuronal firing
Benzos:
GABAa agonism –> increased Cl- channel opening frequency –> decreased neuronal firing
Short acting benzos include:
Short acting benzos include: ATOM
* Alprazolam
* Triazolam
* Oxazepam
* Midazolam
Long acting benzos include:
Long acting benzos include:
* Flurazepam
* Lorazepam
* Diazepam
* Chlordiazepoxide
Benzos that are metabolized outside the liver include:
Benzos that are metabolized outside the liver include: LOT (safe for people who drink a lot)
* Lorazepam
* Triazolam
* Oxazepam
Name some clinical uses of benzos:
Name some clinical uses of benzos:
* Anxiety and panic disorders
* Insomnia and sleep walking
* Alcohol withdrawal
* Status epilepticus
* Muscle relaxation
_ acting benzos have an increased risk of dependence
Short acting benzos have an increased risk of dependence
_ is a competitive GABA receptor antagonist and is the antidote to benzo overdose
Flumazenil is a competitive GABA receptor antagonist and is the antidote to benzo overdose
* Avoid it in patients with benzos dependence because it can cause acute withdrawal and induce seizure
_ increase Cl- channel opening duration
Barbiturates increase Cl- channel opening duration
* Phenobarbital, thiopental, pentobarbital, secobarbital, primidone
Barbiturates are cytochrome P450 _
Barbiturates are cytochrome P450 inducers
* Decreases concentration of other drugs
* Contraindicated for patients with porphyria
Compared to benzos, barbiturates have a _ therapeutic index
Compared to benzos, barbiturates have a more narrow therapeutic index
* Risk of respiratory and cardiovascular depression, there is no antidote
Primidone is a barbiturate often used for _
Primidone is a barbiturate often used for essential tremors
Inhalants like glue, nitrous oxide, paint thinner, poppers, solvent cleaners, etc are most commonly used by [population]
Inhalants like glue, nitrous oxide, paint thinner, poppers, solvent cleaners, etc are most commonly used by adolescents
* Causes transient euphoria, confusion, blurry vision, impaired judgement
Peri-oral and peri-nasal dermatitis should raise concern for [substance misuse]
Peri-oral and peri-nasal dermatitis should raise concern for inhalant misuse
Amphetamines have dual action.
1. _
2. _
Amphetamines have dual action.
1. Release stored catecholamines
2. Inhibit reuptake of catecholamines
Amphetamines are used for medical treatment of _ and _
Amphetamines are used for medical treatment of ADHD and Narcolepsy
Presentation of amphetamine intoxication:
Presentation of amphetamine intoxication:
* Mydriasis
* Tachycardia
* Fever
* Hypertension
* Coronary vasospasm
* Skin excoriation
* Euphoria
* Inflated sense of self
* Agitation
* Paranoia
[Treatment] may be considered for amphetamine intoxication to control agitation/ seizures
Benzodiazepines may be considered for amphetamine intoxication to control agitation/ seizures
* Otherwise just monitor for withdrawal sx and control hyperthermia/dehydration/arrhythmias
Caffeine is structurally similar to _ and will _ cAMP levels
Caffeine is structurally similar to adenosine and will increase cAMP levels
* Adenosine receptor antagonist –> increases cAMP –> increases sympathetic response
Cocaine is an inhibitor of [NT transporter]
Cocaine is an inhibitor of NET thus increasing NE concentrations
* alpha»_space;> beta agonism
In addition to inhibiting NET, cocaine also has local anesthetic properties via _
In addition to inhibiting NET, cocaine also has local anesthetic properties via inhibition of Na+ channels –> decreasing action potential transmission
Use of [drug] during pregnancy poses a risk of low birth weight, preterm birth, and placental abruption
Use of cocaine during pregnancy poses a risk of low birth weight, preterm birth, and placental abruption
* Due to vasoconstriction
If a patient presents with perforated nasal septum, you may be concerned for [drug abuse]
If a patient presents with perforated nasal septum, you may be concerned for cocaine use
* Vasoconstriction –> ischemic necrosis of the nasal septum
Cocaine may cause [effects on the heart]
Cocaine may cause coronary vasospasm, dilated cardiomyopathy, tachyarrhythmia
How does cocaine intoxication present?
Cocaine intoxication…
* Impaired judgement
* Elevated energy
* Anxiety, paranoia
* Mydriasis
* Diaphoresis
* HTN, tachycardia
* Hallucinations
Management of cocaine intoxication may include [sedative] or [autonomic drugs]
Management of cocaine intoxication may include benzos or labetalol or alpha blocker
* Note that labetalol can only be used bc it is a non-selective beta blocker
[Drugs] should be avoided in cocaine intoxication
Strict beta blockers should be avoided in cocaine intoxication
* Can lead to unopposed alpha agonism –> increased BP
_ is a drug that reduces NET and DAT activity, helping with smoking cessation
Bupropion is a drug that reduces NET and DAT activity, helping with smoking cessation
[Drug] is a 5HT2a serotonin-receptor agonist
LSD is a 5HT2a serotonin-receptor agonist
[Drug] intoxication presents with depersonalization, distorted perception of time and space, and flashbacks
LSD intoxication presents with depersonalization, distorted perception of time and space, and flashbacks
* Also hallucinations (visual and auditory), anxiety, mydriasis
Cannabis exerts its actions by binding to _ and _ receptors
Cannabis exerts its actions by binding to CB1 and CB2 cannabinoid receptors
How does cannabis intoxication commonly present?
Cannabis intoxication…
* Impaired judgement
* Euphoria
* Distorted perception of time
* Hallucinations
* Paranoia
* Increased appetite
* Dry mouth
* Conjunctival injection
* Sleep disturbances
A patient who is vomiting uncontrollably after smoking weed may have _
A patient who is vomiting uncontrollably after smoking weed may have cannabinoid hyperemesis syndrome
Cannabis withdrawal may present with _
Cannabis withdrawal may present with anxiety, restlessness, depression, decreased appetite, insomnia
[Drug] is a 5HT2a serotonin receptor and D2 receptor agonist
MDMA (ecstasy) is a 5HT2a serotonin receptor and D2 receptor agonist
* Increases serotonin and dopamine in synaptic cleft
Euphoria, hallucinations, distorted perception of time, bruxism, and hyperthermia is suggestive of [drug intoxication]
Euphoria, hallucinations, distorted perception of time, bruxism, and hyperthermia is suggestive of MDMA (ecstasy) intoxication
* Bruxism = ecstasy
* Can also cause hyponatremia and serotonin syndrome
Phencyclidine (PCP) exerts its effect as an _
Phencyclidine (PCP) exerts its effect as an NMDA antagonist
* Also inhibits the reuptake of dopamine, NE, serotonin
[Drug intoxication] can present with violence and rotary nystagmus
PCP intoxication can present with violence and rotary nystagmus
* Also erratic behavior, impulsivity, delirium, psychosis, agitation, miosis, tachycardia, HTN
Name (5) drugs that are classified as depressants
- Alcohol
- Barbiturates
- Benzodiazepines
- Opioids
- Inhalants
Name (4) substances that are considered stimulants
- Amphetamines
- Caffeine
- Cocaine
- Nicotine
Name (4) hallucinogenic drugs
- Lysergic acid diethylamide
- Cannabis
- MDMA
- Phencyclidine
[Category of drugs] cause mood elevation, reduced anxiety, sedation, behavioral disinhibition, respiratory depression
Depressants causes mood elevation, reduced anxiety, sedation, behavioral disinhibition, respiratory depression
(3) drugs that are positive allosteric modulators of the GABA-a receptor
(3) drugs that are positive allosteric modulators of the GABA-a receptor
1. Alcohol
2. Barbiturates
3. Benzos
Individuals who use alcohol will have elevated _»_space; _
Individuals who use alcohol will have elevated AST»_space; ALT
General symptoms of alcohol withdrawal present in [time duration] and include tremors, insomnia, diaphoresis, agitation, GI upset
General symptoms of alcohol withdrawal present in 4-36 hours and include tremors, insomnia, diaphoresis, agitation, GI upset
Withdrawal from alcohol may cause _ or _ in the first 12-48 hours
Withdrawal from alcohol may cause hallucinosis or seizures in the first 12-48 hours
After 48+ hours of alcohol withdrawal, there is a risk of _
After 48+ hours of alcohol withdrawal, there is a risk of delirium tremens
Flumazenil is medical management for _
Flumazenil is medical management for benzos intoxication
Inhalants act via [MoA]
Inhalants act via enhanced GABA signaling
* Effects often have rapid onset and resolution
Piloerection is a symptom of withdrawal from [drug]
Piloerection is a symptom of withdrawal from opioids
Nonspecific symptoms of [drug category] use include mood elevation, reduced appetite, psychomotor agitation, insomnia, cardiac arrhythmias, tachycardia, anxiety
Nonspecific symptoms of stimulant use include mood elevation, reduced appetite, psychomotor agitation, insomnia, cardiac arrhythmias, tachycardia, anxiety
Anxiety, tremor, seizures, insomnia are nonspecific signs of [drug category] withdrawal
Anxiety, tremor, seizures, insomnia are nonspecific signs of depressant withdrawal
[Stimulants] induce reversal of monoamine transporters
Amphetamines induce reversal of monoamine transporters
* This increases NT release
* Transporters include VMAT, DAT, SERT, NET
Euphoria, grandiosity, mydriasis, prolonged wakefulness, hyperalertness, hypertension for several hours is indicative of _
Euphoria, grandiosity, mydriasis, prolonged wakefulness, hyperalertness, hypertension for several hours is indicative of amphetamine use
* As opposed to cocaine which is shorter acting
General stimulant withdrawal symptoms include _
General stimulant withdrawal symptoms include post-use “crash”, depression, lethargy, increased appetite, sleep disturbance, vivid nightmares
Cocaine blocks the reuptake of _ , _ , and _
Cocaine blocks the reuptake of dopamine , serotonin , and norepinephrine
_ -acting benzodiazepines have active metabolites
Long-acting benzodiazepines have active metabolites
* Most benzos fall into this category except for the “ATOM” drugs
Name the benzos that are short-acting
Name the benzos that are short-acting:
Alprazolam
Triazolam
Oxazepam
Midazolam
These have a higher addictive potential
[Drug] is a competitive antagonist at the GABA benzo receptor
Flumazenil is a competitive antagonist at the GABA benzo receptor
* But can precipitate seizures
Zolpidem, Zaleplon, Eszopiclone work by [mechanism]
Zolpidem, Zaleplon, Eszopiclone work by BZ1 subtype of GABA receptor
* Used to treat insomnia
ZZZ drugs (nonbenzo hypnotics) have relatively _ duration and _ dependence risk
ZZZ drugs (nonbenzo hypnotics) have relatively short duration and low dependence risk
* Short duration because of rapid metabolism by liver enzymes
Opioids inhibit the release of 5-HT, substance P, _ , _ , _
Opioids inhibit the release of 5-HT, substance P, glutamate , NE , Ach
Tolerance to opiods does not exclude an individual from experiencing _ or _
Tolerance to opiods does not exclude an individual from experiencing constipation or miosis
Prevent opioid relapse with _
Prevent opioid relapse with naltrexone
* Once detoxified
Butorphanol is a k-opioid receptor _ and mu-opioid receptor _
Butorphanol is a k-opioid receptor agonist and mu-opioid receptor partial agonist
Pentazocine is a k-opioid receptor _ and mu-opioid receptor _
Pentazocine is a k-opioid receptor agonist and mu-opioid receptor weak antagonist or partial agonist
[Drug] is a very weak opioid agonist; it also inhibits the reuptake of NE and serotonin
Tramadol is a very weak opioid agonist; it also inhibits the reuptake of NE and serotonin
* Used for chronic pain
Risks of tramadol include decreased _ and _ syndrome
Risks of tramadol include decreased seizure threshold and serotonin syndrome
Define precontemplation, comtemplation, and preparation
- Precontemplation- denying problem
- Contemplation- acknowledging problem but unwilling to change
- Preparation- preparing for changes
