Substance use Disorders Flashcards
what are the 3 broad categories of Symptoms of Substance use disorder (SUD)
(1) physical dependence (tolerance and withdrawal),
(2) craving
(3) diminished capacity to control one’s use (substance use becomes the priority over other important things in one’s life)
All substances of abuse increase dopamine release in the ________
nucleus accumbens
why are adolescents more vulnerable to addiction than adults?
reward-related circuitry processing matures earlier while neural processing of inhibition are not yet fully developed.
“At-risk drinking” for Men is _______
≥ 5 standard drinks in a day
or > 14 per week
“At risk drinking” for women is ____
Women ≥ 4 in a day
or > 7 per week
describe what is seen in an Anabuse reaction
Flushing Headache Nausea Dizziness Tachycardia
what are the Contraindications for anabuse use
Risk for MI
Risk for CVA
Cognitive dysfunction (can’t understand or remember what will happen if drinks)
what are some side effects/complications of naltrexone
Nausea (10%) Headaches (7%) Anxiety (2%) Sedation (2%) Hepatic failure (rare)
what are contraindications for Naltrexone use
Pregnancy category C Lactation safety unknown Hepatic failure/acute hepatitis At risk for opioid withdrawal Hypersensitivity to naltrexone
what is the MOA of Acamprosate
Enhances GABA transmission
Interferes with Glutamate transmission
what is the contraindications of Acamprosate
Hypersensitivity to Acamprosate
Severe renal impairment (creatinine clearance ≤ 30mL/min)
What are the side effects of Acamprosate
Some side effects/complications: Diarrhea (10-17%) Anxiety (5-8%) Depression (4-8%) Insomnia (6-9%) Suicidality (1.4% vs. 0.5%)
name the 3 drugs used in opioid addiction
Methadone
Buprenorphine
Naltrexone
______ is used in nicotine dependence Tx
Bupropion
what are the contraindications for Bupropion
hx seizure disorder,
MAO inhibitor,
eating disorder
what are the side effects of Bupropion
Insomnia/agitation
Avoid nicotine gum if ________
1 month post MI,
serious arrhythmias,
gastric ulcers
What are the downsides of the nicotine patch
Skin irritation (avoid if systemic eczema),
slow delivery,
wearing at night may cause sleep problems
Same cardiovascular warnings as gum
Varenicline is a ________- and is used for Smoking cessation
Partial agonist α4β2 nicotinic acetylcholine receptor
what is Motivational interviewing
Aims to facilitate and enhance a person’s intrinsic motivation to change addictive behavior
OARS is technique used in MI to increase intrinsic motivation for change. what does it stand for
Open ended questions,
Affirmations,
Reflections,
Summary
what are examples of affirmations made in MI
Recognize effort
Appreciation of strengths
Use of positive reframes
Describe contingency management
Detection
Reinforcers provided with behavior
Reinforcers are withheld when behavior not occur
In MI the physician asks strategic questions, which may elicit ___________ statements
“self motivating”
what are 4 good strategies in MI besides OARS
Express empathy
Roll with resistance
Develop discrepancies
Support self-efficacy
