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ICM - Exam 1 > Substance Use Disorders > Flashcards

Substance Use Disorders Flashcards

1
Q

Sedative hypnotics - 4 examples

A

Benzos

Barbiturates

Meprobamate

GHB

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2
Q

Lifetime prevalence of alcohol dependence

A

Lifetime = 12-15%

Annual = 4-6%

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3
Q

Lifetime prevalence of drug abuse or dependence is appx. ___%

A

6%

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4
Q

Who’s at greater risk for alcohol dep. ?

A

Men (4-5x)

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5
Q

__% of patients on opioid analgesics for noncancer pain will experience addiction

A

20%

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6
Q

What’s the reward center in the brain that drives addiction? How?

A

Nucleus accumbens

Allows for release of DA

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7
Q

Addictive drugs tend to increase DA activity in the _______ (area)

A

mesolimbic area of the forebrain

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8
Q

THC acts in the…

A

HC and amygdala

(according to the picture in the lecture)

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9
Q

________ is ver similar to stimulant self administration

A

Self administration of electrical stimulation in reward areas

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10
Q

Possible factors in alcohol genetics (4)

A
  1. Initial sensitivity to EtOH
  2. increased tolerance
  3. metabolic differences (ADH)
  4. event related potentials in EEGs after stimulus
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11
Q

Alcohol is the most ___ drug because it ______

A

the most complex

does not act via a specific NT or receptor

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12
Q

Alcohol mechanism

A

indirectly stimlates the release of DA in the NA

Directly stimulates GABA-alpha receptor

Inhibits the NMDAr

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13
Q

what is PAWS?

A

Post alcohol withdrawal syndrome

Residual upregulated glutamate, which can persist for months but is particularly important in the days/weeks following cessation of drinking.

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14
Q

Cocaine MOA

A

`Blocks DA reuptake in the mesolimbic system

Stimulates NE release in peripheral system

blocks SODIUM channels

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15
Q

Amphetamine mechanism

A

Directly stimulates DA release in mesolimbic system

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16
Q

opiates bind to…

A

the mu, sigma, and kappa receptors

both centrally and peripherally

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17
Q

Mu, Sigma, and Kappa opiate receptors act via what MOA

A

They cause DA release in VTA

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18
Q

This drug results in the strongest withdrawal

A

Opiates

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19
Q

Substance abuse disorder definition

A

A maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by 2 or more of the following occurring within a 12 month period

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20
Q

Rating the criteria in substance use disorder

A

2-3 = Mild

4-5 = Moderate

6 or more = Severe

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21
Q

Criteria for Alcohol use disorder

A
  1. Taken in larger amounts OR over a longer period of time than intended
  2. Unsuccessful effort to cut back
  3. Lots of time spent obtaining/using/recovering
  4. Craving or urge to use
  5. Affects work or home functioning
  6. Continued use despite social or interpersonal problems
  7. Given up social, occupational, or recreational activities
  8. Continued use despite hazardous situations
  9. Continued use despite physical or psych problem
  10. Tolerance
  11. Withdrawal
22
Q

Remission for alcohol use disorder (definitions)

A

Early remission = 3-12 months without use

Sustained remission = more than 12 months without use

23
Q

What is CAGE?

A

Have you Cut down drinking?

Have you been Annoyed by criticism?

Have you felt Guilty about things you’ve done while drinking?

Do you ever have an Eye opener?

24
Q

Opioid mususe behaviors

A
  • Loss of control (lost prescriptions, early refills, doctor shopping)
  • Use despite negative consequences
  • Prior addiction
  • Physical dependence
25
Q

Other physical findings

A

Parotid enlargement, Liver enlargement, Pupil size

26
Q

Lab testing in drug/EtOH abuse (4)

A
  • BAL
  • Liver TA’s
  • MCV elevation
  • Uring and serum drug testing
27
Q

one beer raises BAL how much?

A

.025

28
Q

Other names for AST and ALT

What are the usual relationships?

A

SGOT and SGPT

Usually AST is greater than ALT

29
Q

Elevations in Liver TA’s usually take about how much alcohol?

A

6 beers per day

30
Q

What other enzyme is induced by alcohol

A

GGT

31
Q

Screening test

A

ELISA

32
Q

Confirmatory test

A

chromatography

33
Q

Drugs with high sensitivity

A

Alcohol

Marijuana

Cocaine

Amphetamines

34
Q

Drugs with high specificity

A

Cocaine, Opioids

35
Q

Drigs that give false positives

A

Amphetamines and Benzos

36
Q

Drugs that give false negatives

A

Opioids and Benzos

37
Q

Drug with short half life and long half life

A

Marijuana has a long excretion time (not same as half life)

Cocaine has a short half life

38
Q

What is wrong with alcohol testing?

A

too sensitive

39
Q

Assess where the patient is (5 steps)

A
  • Precontemplation
  • Contemplation
  • Action
  • Maintenence
  • Relapse
40
Q

When presenting the Dx, what are the “Do’s” (6)

A

State the Dx

Express concern

Explain that it is an actual disease (use medical data if needed)

Explain that it’s treatable

Explain there is individual responsibility

Develop a plan (based on stage) for change

41
Q

4 components of treatment

A
  • Managing withdrawal
  • Behavioral approaches
  • Treatment of coexisting mental health issues
  • Pharmacotherapy
42
Q

Drugs that require detox

A
  1. Alcohol (tremors, diaphoresis, elevated BP)
  2. Sedative Hypnotics (anxiety, myoclonus, seizures)
  3. Opiates (diarrhea, cramps, anxiety)
43
Q

Pharmacotherapies (5)

A
  • Detox agents
  • Disulfram (aversion)
  • Anticraving (Naltrexone, Wellbutrin, acamprosate)
  • Replacement (methadone, nicotine)
  • Underlying disease (anti-anxiety agents, anti-depressants)
44
Q

Disulfiram mechanism, and risks

A

Inhibits aldehyde dehydrogenase –> accumulation of aldehyde

Results in disulfiram-ethanol reaction (flushing, nausea, HoTN)

Hepatoxicity

45
Q

What do studies of disulfiram indicate?

A

abstinence is directly related to compliance but no overall difference in abstinence

46
Q

Naltrexone MOA

Uses?

Risks?

A

Blocks the mu receptor (opioid antagonist)

Decrease the reinforcing properties of alcohol, and decrease the risk and length of relapse.

Hepatoxicity, blocks opioid pharmacotherapeutics

47
Q

Methadone and Buprenorphine use, administration

A
  • Replaces heroin and other opiates (most successful treatment available for heroin addiction)
  • Administered in controlled setting in combo with counseling and other interventions
48
Q

Almost all alcohol dependent patients…

A

will have Sx of depression

(however also an increased risk of…

underlying depression–> substance abuse)

49
Q

What are dissociative anesthetics

A

PCP, Ketamine

50
Q

Inhalant drugs of abuse

A

solvents, nitrous, alkyl nitrites

ICM - Exam 1 (8 decks)

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