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Life Stages > Substance use disorders > Flashcards

Substance use disorders Flashcards

1
Q

_ is a liver enzyme that is elevated in alcoholism; very sensitive but non-specific

A

GGT is a liver enzyme that is elevated in alcoholism; very sensitive but non-specific

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2
Q

Alcoholics will often have 2:1 ratio of liver enzymes, _ > _

A

Alcoholics will often have 2:1 ratio of liver enzymes, AST > ALT

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3
Q

Alcoholics may have reduced _ and _ production

A

Alcoholics may have reduced albumin and platelet production
* Hypoalbuminemia and thrombocytopenia

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4
Q

Neurologic effects of alcohol include _ and _

A

Neurologic effects of alcohol include degeneration of cerebellar vermis and peripheral neuropathy
* Drunken sailor ataxia

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5
Q

Cardiac effects of alcohol include _ and _

A

Cardiac effects of alcohol include dilated cardiomyopathy and atrial fibrillation

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6
Q

Oral/esophageal complications of alcohol include:

A

Oral/esophageal complications of alcohol include:
* Dental caries
* Aspiration pneumonia
* Mallory-Weiss tears
* Esophageal varices
* Squamous cell carcinoma

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7
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A
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8
Q

GI complications of alcohol use include _ , _ , and _

A

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

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9
Q

Nutritional complications of alcohol use can include [deficiency], [anemia], [anemia/deficiency], gout

A

Nutritional complications of alcohol use can include thiamine (B1) deficiency, sideroblastic anemia, B12/folate deficiency (macrocytic anemia), gout

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10
Q

Reproductive complications of alcohol use include _ and _

A

Reproductive complications of alcohol use include erectile dysfunction and testicular atrophy

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11
Q

Acute management of alcohol misuse includes administration of [nutritional support] , airway protection, antiemetics, hydration

A

Acute management of alcohol misuse includes administration of thiamine before glucose, airway protection, antiemetics, hydration

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12
Q

_ or _ are drug options for reducing the cravings for alcohol

A

Naltrexone or Acamprosate are drug options for reducing the cravings for alcohol

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13
Q

Acamprosate is a drug with [MOA] that can help to reduce alcohol cravings

A

Acamprosate is a central glutamate receptor antagonist that can help to reduce alcohol cravings

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14
Q

_ is a drug that blocks the conversion of acetaldehyde to acetic acid, inducing unpleasant hangover symptoms with alcohol use

A

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

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15
Q

General somatic symptoms of alcohol withdrawal include:

A

General somatic symptoms of alcohol withdrawal include:
* Tremors
* Diaphoresis
* Agitation
* Insomnia
* Nausea
* Emesis

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16
Q

Seizures and hallucinations can occur in [time frame] after alcohol withdrawal

A

Seizures and hallucinations can occur in 12-48 hours after alcohol withdrawal
* Seizures are typically tonic clonic and hallucinations are typically visual

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17
Q

_ is a life threatening complication of alcohol withdrawal that involves AMS, seizures, hallucinations, autonomic instability after 48+

A

Delirium tremens is a life threatening complication of alcohol withdrawal that involves AMS, seizures, hallucinations, autonomic instability after 48+

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18
Q

First line management for alcohol withdrawal is _

A

First line management for alcohol withdrawal is benzodiazepines
* Anxiolysis and antiepileptic activity

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19
Q

_ opiod receptor has the strongest analgesic effect

A

Mu opiod receptor has the strongest analgesic effect

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20
Q

_ opiod receptor is the only receptor type responsible for sedation

A

Kappa opiod receptor is the only receptor type responsible for sedation

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21
Q

_ is the opiod receptor type responsible for tolerance

A

Delta is the opiod receptor type responsible for tolerance

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22
Q

Opiods cause [change] in adenylyl cyclase and [change] in cAMP

A

Opiods cause decrease in adenylyl cyclase and decrease in cAMP
* Leads to change in K+ and Ca2+ conductance and decreased presynaptic NT release

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23
Q

Opiods _ K+ conductance and _ Ca2+ conductance

A

Opiods increase K+ conductance and decrease Ca2+ conductance

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24
Q

_ is the only opioid that cause mydriasis

A

Meperidine is the only opioid that cause mydriasis

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25
Q

Side effects of opioid use include:

A

Side effects of opioid use include:
* Respiratory depression
* Somnolence/coma
* Miosis
* Pruritus (histamine release)
* Sphincter of oddi spasm
* Constipation

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26
Q

Respiratory depression in opioid use is due to a blunted CNS response to _

A

Respiratory depression in opioid use is due to a blunted CNS response to hypercarbia

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27
Q

Acute opioid overdose is treated with _

A

Acute opioid overdose is treated with Naloxone

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28
Q

Yawning and flu-like symptoms are classic for _ withdrawal

A

Yawning and flu-like symptoms are classic for opioid withdrawal
* Lacrimation, rhinorrhea, sweating, diarrhea, salivation, muscle pain and spasms, CNS pain

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29
Q

Repeated opioid exposure will result in _ of mu opioid receptors and tolerance

A

Repeated opioid exposure will result in downregulation of mu opioid receptors and tolerance (delta)

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30
Q

Neonatal abstinence syndrome is managed with _ or _

A

Neonatal abstinence syndrome is managed with methadone or morphine

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31
Q

Tramadol is indicated for _

A

Tramadol is indicated for chronic pain
* Has SNRI activity

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32
Q

_ is a full opioid agonist indicated for maintenance

A

Methadone is a full opioid agonist indicated for maintenance
* Has a slow onset, long half-life

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33
Q

_ is an opioid antagonist that is used to prevent opioid relapse

A

Naltrexone is an opioid antagonist that is used to prevent opioid relapse
* Also reduces alcohol and nicotine cravings

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34
Q

_ and _ are opioids with antitussive properties

A

Codeine and Dextromethorphan are opioids with antitussive properties

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35
Q

_ and _ are opioids indicated for treatment of diarrhea

A

Loperamide and Diphenoxylate are opioids indicated for treatment of diarrhea

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36
Q

Benzos:
GABAa agonism –> increased Cl- channel _ –> decreased neuronal firing

A

Benzos:
GABAa agonism –> increased Cl- channel opening frequency –> decreased neuronal firing

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37
Q

Short acting benzos include:

A

Short acting benzos include: ATOM
* Alprazolam
* Triazolam
* Oxazepam
* Midazolam

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38
Q

Long acting benzos include:

A

Long acting benzos include:
* Flurazepam
* Lorazepam
* Diazepam
* Chlordiazepoxide

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39
Q

Benzos that are metabolized outside the liver include:

A

Benzos that are metabolized outside the liver include: LOT (safe for people who drink a lot)
* Lorazepam
* Triazolam
* Oxazepam

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40
Q

Name some clinical uses of benzos:

A

Name some clinical uses of benzos:
* Anxiety and panic disorders
* Insomnia and sleep walking
* Alcohol withdrawal
* Status epilepticus
* Muscle relaxation

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41
Q

_ acting benzos have an increased risk of dependence

A

Short acting benzos have an increased risk of dependence

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42
Q

_ is a competitive GABA receptor antagonist and is the antidote to benzo overdose

A

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

43
Q

_ increase Cl- channel opening duration

A

Barbiturates increase Cl- channel opening duration
* Phenobarbital, thiopental, pentobarbital, secobarbital, primidone

44
Q

Barbiturates are cytochrome P450 _

A

Barbiturates are cytochrome P450 inducers
* Decreases concentration of other drugs
* Contraindicated for patients with porphyria

45
Q

Compared to benzos, barbiturates have a _ therapeutic index

A

Compared to benzos, barbiturates have a more narrow therapeutic index
* Risk of respiratory and cardiovascular depression, there is no antidote

46
Q

Primidone is a barbiturate often used for _

A

Primidone is a barbiturate often used for essential tremors

47
Q

Inhalants like glue, nitrous oxide, paint thinner, poppers, solvent cleaners, etc are most commonly used by [population]

A

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

48
Q

Peri-oral and peri-nasal dermatitis should raise concern for [substance misuse]

A

Peri-oral and peri-nasal dermatitis should raise concern for inhalant misuse

49
Q

Amphetamines have dual action.
1. _
2. _

A

Amphetamines have dual action.
1. Release stored catecholamines
2. Inhibit reuptake of catecholamines

50
Q

Amphetamines are used for medical treatment of _ and _

A

Amphetamines are used for medical treatment of ADHD and Narcolepsy

51
Q

Presentation of amphetamine intoxication:

A

Presentation of amphetamine intoxication:
* Mydriasis
* Tachycardia
* Fever
* Hypertension
* Coronary vasospasm
* Skin excoriation
* Euphoria
* Inflated sense of self
* Agitation
* Paranoia

52
Q

[Treatment] may be considered for amphetamine intoxication to control agitation/ seizures

A

Benzodiazepines may be considered for amphetamine intoxication to control agitation/ seizures
* Otherwise just monitor for withdrawal sx and control hyperthermia/dehydration/arrhythmias

53
Q

Caffeine is structurally similar to _ and will _ cAMP levels

A

Caffeine is structurally similar to adenosine and will increase cAMP levels
* Adenosine receptor antagonist –> increases cAMP –> increases sympathetic response

54
Q

Cocaine is an inhibitor of [NT transporter]

A

Cocaine is an inhibitor of NET thus increasing NE concentrations
* alpha&raquo_space;> beta agonism

55
Q

In addition to inhibiting NET, cocaine also has local anesthetic properties via _

A

In addition to inhibiting NET, cocaine also has local anesthetic properties via inhibition of Na+ channels –> decreasing action potential transmission

56
Q

Use of [drug] during pregnancy poses a risk of low birth weight, preterm birth, and placental abruption

A

Use of cocaine during pregnancy poses a risk of low birth weight, preterm birth, and placental abruption
* Due to vasoconstriction

57
Q

If a patient presents with perforated nasal septum, you may be concerned for [drug abuse]

A

If a patient presents with perforated nasal septum, you may be concerned for cocaine use
* Vasoconstriction –> ischemic necrosis of the nasal septum

58
Q

Cocaine may cause [effects on the heart]

A

Cocaine may cause coronary vasospasm, dilated cardiomyopathy, tachyarrhythmia

59
Q

How does cocaine intoxication present?

A

Cocaine intoxication…
* Impaired judgement
* Elevated energy
* Anxiety, paranoia
* Mydriasis
* Diaphoresis
* HTN, tachycardia
* Hallucinations

60
Q

Management of cocaine intoxication may include [sedative] or [autonomic drugs]

A

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

61
Q

[Drugs] should be avoided in cocaine intoxication

A

Strict beta blockers should be avoided in cocaine intoxication
* Can lead to unopposed alpha agonism –> increased BP

62
Q

_ is a drug that reduces NET and DAT activity, helping with smoking cessation

A

Bupropion is a drug that reduces NET and DAT activity, helping with smoking cessation

63
Q

[Drug] is a 5HT2a serotonin-receptor agonist

A

LSD is a 5HT2a serotonin-receptor agonist

64
Q

[Drug] intoxication presents with depersonalization, distorted perception of time and space, and flashbacks

A

LSD intoxication presents with depersonalization, distorted perception of time and space, and flashbacks
* Also hallucinations (visual and auditory), anxiety, mydriasis

65
Q

Cannabis exerts its actions by binding to _ and _ receptors

A

Cannabis exerts its actions by binding to CB1 and CB2 cannabinoid receptors

66
Q

How does cannabis intoxication commonly present?

A

Cannabis intoxication…
* Impaired judgement
* Euphoria
* Distorted perception of time
* Hallucinations
* Paranoia
* Increased appetite
* Dry mouth
* Conjunctival injection
* Sleep disturbances

67
Q

A patient who is vomiting uncontrollably after smoking weed may have _

A

A patient who is vomiting uncontrollably after smoking weed may have cannabinoid hyperemesis syndrome

68
Q

Cannabis withdrawal may present with _

A

Cannabis withdrawal may present with anxiety, restlessness, depression, decreased appetite, insomnia

69
Q

[Drug] is a 5HT2a serotonin receptor and D2 receptor agonist

A

MDMA (ecstasy) is a 5HT2a serotonin receptor and D2 receptor agonist
* Increases serotonin and dopamine in synaptic cleft

70
Q

Euphoria, hallucinations, distorted perception of time, bruxism, and hyperthermia is suggestive of [drug intoxication]

A

Euphoria, hallucinations, distorted perception of time, bruxism, and hyperthermia is suggestive of MDMA (ecstasy) intoxication
* Bruxism = ecstasy
* Can also cause hyponatremia and serotonin syndrome

71
Q

Phencyclidine (PCP) exerts its effect as an _

A

Phencyclidine (PCP) exerts its effect as an NMDA antagonist
* Also inhibits the reuptake of dopamine, NE, serotonin

72
Q

[Drug intoxication] can present with violence and rotary nystagmus

A

PCP intoxication can present with violence and rotary nystagmus
* Also erratic behavior, impulsivity, delirium, psychosis, agitation, miosis, tachycardia, HTN

73
Q

Name (5) drugs that are classified as depressants

A
  1. Alcohol
  2. Barbiturates
  3. Benzodiazepines
  4. Opioids
  5. Inhalants
74
Q

Name (4) substances that are considered stimulants

A
  1. Amphetamines
  2. Caffeine
  3. Cocaine
  4. Nicotine
75
Q

Name (4) hallucinogenic drugs

A
  1. Lysergic acid diethylamide
  2. Cannabis
  3. MDMA
  4. Phencyclidine
76
Q

[Category of drugs] cause mood elevation, reduced anxiety, sedation, behavioral disinhibition, respiratory depression

A

Depressants causes mood elevation, reduced anxiety, sedation, behavioral disinhibition, respiratory depression

77
Q

(3) drugs that are positive allosteric modulators of the GABA-a receptor

A

(3) drugs that are positive allosteric modulators of the GABA-a receptor
1. Alcohol
2. Barbiturates
3. Benzos

78
Q

Individuals who use alcohol will have elevated _&raquo_space; _

A

Individuals who use alcohol will have elevated AST&raquo_space; ALT

79
Q

General symptoms of alcohol withdrawal present in [time duration] and include tremors, insomnia, diaphoresis, agitation, GI upset

A

General symptoms of alcohol withdrawal present in 4-36 hours and include tremors, insomnia, diaphoresis, agitation, GI upset

80
Q

Withdrawal from alcohol may cause _ or _ in the first 12-48 hours

A

Withdrawal from alcohol may cause hallucinosis or seizures in the first 12-48 hours

81
Q

After 48+ hours of alcohol withdrawal, there is a risk of _

A

After 48+ hours of alcohol withdrawal, there is a risk of delirium tremens

82
Q

Flumazenil is medical management for _

A

Flumazenil is medical management for benzos intoxication

83
Q

Inhalants act via [MoA]

A

Inhalants act via enhanced GABA signaling
* Effects often have rapid onset and resolution

84
Q

Piloerection is a symptom of withdrawal from [drug]

A

Piloerection is a symptom of withdrawal from opioids

85
Q

Nonspecific symptoms of [drug category] use include mood elevation, reduced appetite, psychomotor agitation, insomnia, cardiac arrhythmias, tachycardia, anxiety

A

Nonspecific symptoms of stimulant use include mood elevation, reduced appetite, psychomotor agitation, insomnia, cardiac arrhythmias, tachycardia, anxiety

86
Q

Anxiety, tremor, seizures, insomnia are nonspecific signs of [drug category] withdrawal

A

Anxiety, tremor, seizures, insomnia are nonspecific signs of depressant withdrawal

87
Q

[Stimulants] induce reversal of monoamine transporters

A

Amphetamines induce reversal of monoamine transporters
* This increases NT release
* Transporters include VMAT, DAT, SERT, NET

88
Q

Euphoria, grandiosity, mydriasis, prolonged wakefulness, hyperalertness, hypertension for several hours is indicative of _

A

Euphoria, grandiosity, mydriasis, prolonged wakefulness, hyperalertness, hypertension for several hours is indicative of amphetamine use
* As opposed to cocaine which is shorter acting

89
Q

General stimulant withdrawal symptoms include _

A

General stimulant withdrawal symptoms include post-use “crash”, depression, lethargy, increased appetite, sleep disturbance, vivid nightmares

90
Q

Cocaine blocks the reuptake of _ , _ , and _

A

Cocaine blocks the reuptake of dopamine , serotonin , and norepinephrine

91
Q

_ -acting benzodiazepines have active metabolites

A

Long-acting benzodiazepines have active metabolites
* Most benzos fall into this category except for the “ATOM” drugs

92
Q

Name the benzos that are short-acting

A

Name the benzos that are short-acting:
Alprazolam
Triazolam
Oxazepam
Midazolam

These have a higher addictive potential

93
Q

[Drug] is a competitive antagonist at the GABA benzo receptor

A

Flumazenil is a competitive antagonist at the GABA benzo receptor
* But can precipitate seizures

94
Q

Zolpidem, Zaleplon, Eszopiclone work by [mechanism]

A

Zolpidem, Zaleplon, Eszopiclone work by BZ1 subtype of GABA receptor
* Used to treat insomnia

95
Q

ZZZ drugs (nonbenzo hypnotics) have relatively _ duration and _ dependence risk

A

ZZZ drugs (nonbenzo hypnotics) have relatively short duration and low dependence risk
* Short duration because of rapid metabolism by liver enzymes

96
Q

Opioids inhibit the release of 5-HT, substance P, _ , _ , _

A

Opioids inhibit the release of 5-HT, substance P, glutamate , NE , Ach

97
Q

Tolerance to opiods does not exclude an individual from experiencing _ or _

A

Tolerance to opiods does not exclude an individual from experiencing constipation or miosis

98
Q

Prevent opioid relapse with _

A

Prevent opioid relapse with naltrexone
* Once detoxified

99
Q

Butorphanol is a k-opioid receptor _ and mu-opioid receptor _

A

Butorphanol is a k-opioid receptor agonist and mu-opioid receptor partial agonist

100
Q

Pentazocine is a k-opioid receptor _ and mu-opioid receptor _

A

Pentazocine is a k-opioid receptor agonist and mu-opioid receptor weak antagonist or partial agonist

101
Q

[Drug] is a very weak opioid agonist; it also inhibits the reuptake of NE and serotonin

A

Tramadol is a very weak opioid agonist; it also inhibits the reuptake of NE and serotonin
* Used for chronic pain

102
Q

Risks of tramadol include decreased _ and _ syndrome

A

Risks of tramadol include decreased seizure threshold and serotonin syndrome

103
Q

Define precontemplation, comtemplation, and preparation

A
  1. Precontemplation- denying problem
  2. Contemplation- acknowledging problem but unwilling to change
  3. Preparation- preparing for changes

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