1. Have you ever felt you should Cut down on your drinking? 2. Have people Annoyed you by criticizing your drinking 3. Have you ever felt bad or Guilty about your drinking? 4. Eye opener: have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

Trans 059: Substance Related Disorders Flashcards by Amiel Lorenzo

what is a standard drink?

12 g of absolute alcohol

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Brings alcohol concentration to 0.08% or above (5 or more drinks in male, 4 or more in female in about 2 hours)

what pattern of drinking?

Binge Drinking

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At least 60 grams or more of pure alcohol on at least one occasion in the past 7 days. what pattern of drinking?

Heavy Episodic Drinking

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Drinks <0.01 fl oz alcohol per day
(i.e. <12 drinks in the past year)

what pattern of drinking?

abstainer

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Drinks 0.22-1.00 fl oz alcohol per day
(i.e. 4-14 drinks per week)

what pattern of drinking?

Moderate drinker

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Drinks 0.01-0.21 fl oz alcohol per day
(i.e. 1-13 drinks per month)

what pattern of drinking?

Light drinker

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Drinks >1.00 fl oz alcohol per day
(i.e. >2 drinks per day) Males: >14 standard drinks per week/4 drinks per day Females: >7 standard drinks per week/3 drinks per day

waht pattern of drinking?

Heavy drinker

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drinking occasionally with few serious consequences

Pre-alcoholic stage

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drinking heavily but with few outward signs of a problem

Prodromal stage

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loss of control with occasional binges

Crucial stage

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primary daily activities involve getting and drinking alcohol

Chronic stage

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Cage Questionnaire?

Have you ever felt you should Cut down on your drinking?
Have people Annoyed you by criticizing your drinking
Have you ever felt bad or Guilty about your drinking?
Eye opener: have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

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Scoring for the cage questionnaire?

Scoring: Item responses on the CAGE are scored 0 for “no” and 1 for “yes answers. A higher score is an indication of alcohol problems. A total score of 2 or greater is considered clinically significant

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ideal level of blood alcohol level concentration?

Ideally aim for level 0.01-0.06.

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Dysphoria (anxiety, restlessness) predominate, nausea may appear. The drinker has the appearance of a “sloppy drunk”

BAC level?

0.16-0.20

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Loss of consciousness

BAC level?

0.30

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Onset of coma, possible death due to respiratory depression/arrest.

BAC level?

0.40 and up

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T or f? Effects are dependent on individual use, chronicity, and tolerance, and other factors

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Effect of alcohol in GABA?
intoxication:
Chronic intake:

GABA
- Inhibitory neurotransmitters
- GABA A and GABA B receptors is affected by alcohol (sedative, anxiolytic, anticonvulsant, hypnotic actions)
Intoxication: Increase in GABA functioning
Chronic Intake: Reduction in the number of GABA A receptors

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Basically alcohol is a CNS depressant, theoretically relaxes the brain by working on the GABA. Some people get pleasure. Some with numbing and feeling of euphoria.
 But why some people go wild?

Alcohol also binds to GABA receptors in the prefrontal cortex (involved in judging planning, control). Its control part also becomes inhibited, so a person can become disinhibited (go wild).

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effect of alcohol in dopamine?

D1, D2, D3, D4 receptors

Intake of Alcohol: Release of dopamine in the pleasure center of the brain (mesolimbic dopaminergic pathway)

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effect of alcohol in serotonin?

Works via several receptors, especially 5HT3

Intoxication: Increased serotonin in the hippocampus and striatum

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effect of alcohol in opioids?

μ-, δ-, κ-opioid receptors
Alcohol consumption: Increased endogenous opioids and μ-opioid receptors in the VTA; Greater increase in β-endorphins after ethanol challenge in those with family history of alcohol

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Effect of alcohol in norepinephrine?

Intoxication: Ethanol reduces the activity of the noradrenergic system in the locus ceruleus

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diagnostic criteria of alcohol intoxication?

A. Recent ingestion of alcohol B. clinically significant problematic behavioral or psychological changes C. one or more of the ff signs and symptoms: slurred speech, incoor, unsteady gait, nystagmus, impairment in attention or memory, stupor or coma D. signs and symptoms not attributable to a medical condition

alcohol withdrawal diagnostic criteria?

A. cessation B. 2 or more of the ff, developing within several hrs to a few days after cessation C. s/sx in B cause clinically significant distress in social etc

Earliest sign of withdrawal that occurs within 6 hours after last alcohol intake:

Tremor

alcohol related neurological disorder? Malabsorption, Poor Nutritional Habits =

Thiamine deficiency

o Ataxia, Vestibular dysfunction, Confusion, Nystagmus, Palsy what syndrome?

Wernicke Syndrome = ACUTE, Reversible

o Impaired recent memory, anterograde amnesia, confabulation what syndrome?

Korsakoff syndrome = CHRONIC, 20% Recovery

* Microcephaly, craniofacial malformations, and limb and heart defects * Short adult stature, adult maladaptive behaviors * 35% risk of having a child with defect * Precise mechanism unknown what syndrome?

Fetal alcohol syndrome

Sedative – Hypnotic – Anxiolytic –

calming sleeping-inducing anxiety-reducing

Many of the most commonly prescribed benzos are those which are most readily abused, including:

``` o ALPRAZOLAM (Xanax) o CLONAZEPAM (Klonopin) o CHLORDIAZEPOXIDE (Librium) o DIAZEPAM (Valium) o LORAZEPAM (Ativan) o TEMAZEPAM (Restoril) o TRIAZOLAM (Halcion) ```

Includes benzodiazepines (alprazolam, midazolam, lorazepam, clonazepam, diazepam), benzodiazepine-like drugs (zolpidem - “more for insomnia”), barbiturates (e.g phenobarbital – “for seizure disorder”)

Concept

• Treatment for Overdose:

o Gastric lavage, Activated Charcoal o Antidote to benzodiazepine intoxication = FLUMAZENIL  ^ Board-exam question.

o Antidote to benzodiazepine intoxication =

FLUMAZENIL

Amphetamine-like substances e.g.

MDMA (ectasy), cocaine, methamphetamine, ephedrine, phenylpropanolamine

Methamphetamine vs Cocaine?

``` Meth:  Longer, cheaper  Can be detected in urine drug screen - Stimulant - Man-made - Smoking produces a long lasting high - 50% of the drug is removed from the body in 12 hrs. - Increases dopamine release and blocks dopamine re-uptake - Limited medical use ``` ``` Cocaine:  Short acting, more expensive  Not so much detected d/t brief action - Stimulant & local anesthetic - Plant-derived - Smoking produces a brief high - 50% of the drug is removed from the body in 1 hour - Blocks dopamine re-uptake - Limited use as local anesthetic in some surgical procedures ```

Methods of use of stimulants?

* Intranasal – sinusitis, irritation, bleeding of nasal mucosa, perforated nasal septum * Through smoking – coughing, bronchitis, pneumonia * Injection – puncture marks, HIV, hepatitis

positive effects of methamphetamine

* Stimulant * Increased performance * Euphoric feeling

PSYCHOLOGICAL ADVERSE EFFECTS OF METHAMPHETAMINE

* Restlessness, dysphoria, insomnia, irritability, hostility, confusion * Anxiety symptoms * Ideas or reference, paranoid delusions, hallucinations * Lowering of disinhibition that may lead to high-risk sexual behaviors aggression and violence * Mood disturbances

NEGATIVE EFFECTS OF METHAMPHETAMINE the crash

o Anxiety, tremulousness, dysphoric mood, lethargy, fatigue, vivid nightmares (with rebound REM sleep), headache, profuse sweating, muscle cramps, stomach cramps, insatiable hunger, psychomotor retardation or agitation o Depression, with suicidal ideations o Peak of withdrawal symptoms: 2-4 days o Resolved in 1 week

“Gentle stimulant” • Elevates mood and decrease fatigue • Least harmful of all addictive drugs but can still lead to problems similar to other drugs

Cafeeine

the hallmark feature of caffeine withdrawal and may be diffuse, gradual in development, throbbing, severe, and sensitive to movement

headache

what are the classes of opiods?

Naturally occurring opioids Semi-synthetic opioids Synthetic opioids

what class of opiods? Fully synthesized from combination of chemical building blocks examples?

Synthetic Buprenorphine, methadone, fentanyl, pentazocine, alfentanil, sulfentanil, levorphanol, meperidine, propoxyphene

Compounds isolated from natural sources as starting metarials what class of opioids? examples?

semi synthetics opiods Heroin, oxycodone, hydromorphone, buprenorphine, oxymorphone and hydrocodone

what opiods class? Extracted from the plant Papaver somniferum or Endogenous neural peptides examples? xamples??

Opium, morphine, papaverine, codeine, thebaine Endorphins, enkephalins, dynorphins naturally occuring opiods

triad of opioid overdose?

Coma Pinpoint pupils respiratory depression

Medical uses of Opioid

``` o Physical trauma o Myocardial infarction o Post-surgical pain o Chronic pain o End stage cancer, and other terminal diseases o Cesarean section ```

what are the receptors affected by opioids?

Mu, Delta, Kappa

can detect most opioids – heroin, morphine, codeine, oxycodone, propoxyphene for 12-36 hours after administration

urine screening test

generic term for the psychoactive substance derived from the plant

cannabis

Concentrated extraction of the cannabis plant

hashish

what is the active compound in cannabis?

delta-9-Tetrahydrocannabinol (THC)

o Does not produce any of the psychoactive responses o a high potential for therapeutic use, including anti-epileptic, anxiolytic, antipsychotic, anti-inflammatory, and neuroprotective effects

Cannabidiol

Methods of use of marijuana?

* Pipes * Water pipes (bongs or hookahs) * Cigarettes (joints or refers) * Paper from hollowed out cigars (blunts) * Mixed into food (e.g. brownies) * Vaporization

how to test marijuana?

How to test → Urine drug screen (THC)

Development and course of marijuana withdrawal?

Most symptoms have onset within 1st 24-72 hours of cessation, peaks within the 1st week, and lasts approx. 1-2 weeks

reduction in prosocial goal-directed activities o Poor performance o Employment problems o Related to pervasive intoxication or recovery from effects of intoxication

Amotivational syndrome

There are two different synthetic forms on the market that are FDA approved:

Dronabinol (Marinol) and Nabilone (Cesamet) are approved for the indications as an appetite enhancer in AIDS patients and for nausea in patients undergoing chemotherapy

why is marijuana called the gateway drug?

“Gateway drug” - leads to use of more dangerous drugs |  Because when people take Marijuana and they like it, they may be open to try other drugs and substances.

Potent hallucinogen • Causes distorted space, time, visual perception of shapes, colors, altered sounds “Hearing colors and seeing sounds” • Found in ergot, a fungus that grows on rye and other grains

LSD LSD (d-Lysergic acid diethylamide) - “Acid”

Syndrome unique to Hallucinogens,

Hallucinogen Persisting Perception Disorder Where in following the cessation of Hallucinogen, the experienced perception disturbance still persists and bumabalik-balik parin.

The hallmark of hallucinogen persisting perception disorder is the

reexperiencing, when the individual is sober, of the perceptual disturbances that were experienced while the individual was intoxicated with the hallucinogen (

The symptoms may include any perceptual perturbations, but____________ tend to be predominant

visual disturbances

Neuroimaging results in hallucinogen persisting perception disorder cases are typically

negative

Reality testing remains [intact/affected] in patiients in hallucinogen

intact

volatile hydrocarbons that are toxic gases from glues, spray paint, hair spray, paint thinner, gasoline, nitrous oxide, laughing gas, lighter fluid, felt- tipped markers, contact cement

inhalants

in inhalants, Usually {positive/negative] in standard drug screens

negative

CLues that the patient is abusing inhalants

Clues: possession of material and paraphernalia, lingering odors, peri-oral or peri-nasal glue sniffer’s rash, association with other individuals known to use inhalants

medical complication in inhalation intoxication?

* Brain white matter pathology * Rhabdomyolysis * “Sudden sniffing death” from cardiac arrhythmia * Impairment of neurobehavioral function

derivatives of testosterone o Oral or injectable o Does not produce high but used to enhance performance and body size

Anabolic-androgenic steroids -

* AST - reflect | * ALT -

liver damage acute hepatocellular damage

AST / ALT ratio of 2:1 or greater suggests

alcoholic etiology of liver disease

biomarker for alcohol abuse CBC

GGT (gammaglutamyltransferase)

low sensitivity as standalone alcohol abuse indicator

MCV (erythrocyte macrocytic volume)

management for overdose?

``` gastric lavage activated charcoal competitive agonist supportive measures refer to toxicology/ poison control ```