Trans 059: Substance Related Disorders Flashcards
what is a standard drink?
12 g of absolute alcohol
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
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
Drinks <0.01 fl oz alcohol per day
(i.e. <12 drinks in the past year)
what pattern of drinking?
abstainer
Drinks 0.22-1.00 fl oz alcohol per day
(i.e. 4-14 drinks per week)
what pattern of drinking?
Moderate drinker
Drinks 0.01-0.21 fl oz alcohol per day
(i.e. 1-13 drinks per month)
what pattern of drinking?
Light drinker
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
drinking occasionally with few serious consequences
Pre-alcoholic stage
drinking heavily but with few outward signs of a problem
Prodromal stage
loss of control with occasional binges
Crucial stage
primary daily activities involve getting and drinking alcohol
Chronic stage
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?
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
ideal level of blood alcohol level concentration?
Ideally aim for level 0.01-0.06.
Dysphoria (anxiety, restlessness) predominate, nausea may appear. The drinker has the appearance of a “sloppy drunk”
BAC level?
0.16-0.20
Loss of consciousness
BAC level?
0.30
Onset of coma, possible death due to respiratory depression/arrest.
BAC level?
0.40 and up
T or f? Effects are dependent on individual use, chronicity, and tolerance, and other factors
T
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
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).
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)
effect of alcohol in serotonin?
- Works via several receptors, especially 5HT3
Intoxication: Increased serotonin in the hippocampus and striatum
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
Effect of alcohol in norepinephrine?
Intoxication: Ethanol reduces the activity of the noradrenergic system in the locus ceruleus
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
