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Neuro Part 2 > Week 7.4 > Flashcards

Week 7.4 Flashcards

1
Q

Why is tolerance clinically important?

A
  • acute tolerance predicts development of alcoholism
  • chronic tolerance maintains abuse
  • increases risk of complications
  • increases cross-tolerance of depressant drugs
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2
Q

The most abused drug in America is ___.

A

marijuana

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3
Q

How did the 2010-2012 crackdown on painkillers affect opioid-related deaths?

A

it increased them as more people turned to heroin instad

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4
Q

Earlier in life, one’s risk of addiction is more dependent on ___ than in adults.

A

familial environment

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5
Q

Later in life, one’s risk of addiction becomes more reliant on what factor?

A

genetics

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6
Q

What three classes of genes correlate with addiction?

A
  • tolerance
  • self-recognition of alcohol-related problem
  • withdrawal and continued use despite problems
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7
Q

What personality trait correlates with addiction?

A

externalizing/impulsive phenotypes

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8
Q

What three social factors greatly influence or trigger a person’s genetic liability for addiction?

A
  • peer interactions
  • permissive parenting
  • availability of substances
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9
Q

What kind of parenting style leaves genetically predisposed adolescents at greater risk for addiction?

A

a permissive parenting style

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10
Q

What is the relationship between addiction and impulsivity?

A
  • early drug use affects development, causing more impulsivity
  • impulsivity increases risk of continued use and addiction
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11
Q

Which DA receptors increase AC activity?

A

D1 and D5

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12
Q

What is the difference between drugs with a direct and indirect effect?

A

those with a direct effect act at synapses in the nucleus accumbens while indirect ones act outside the nucleus accumbens to influence activity within it

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13
Q

How does cocaine increase DA in the NA?

A

binding and blocking DAT

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14
Q

How do amphetamines increase DA in the NA?

A

competes with DA to be taken up by DAT, leaving more DA in the cleft

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15
Q

Why does amphetamine withdrawal cause a mood disorder?

A

because it replaces DA in synaptic vesicles, limiting future supply

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16
Q

What makes certain drugs a greater risk for abuse?

A

rapid onset/increase in DA (free base or IV)

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17
Q

Effects of acute stimulant use.

A
  • behavioral activation
  • cue conditioning and cue-induced craving
  • psychosis
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18
Q

Effects of chronic stimulant use.

A
  • aggression
  • paranoia
  • hallucinations
  • delusions
  • cognitive dysfunction
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19
Q

Complications of stimulant use.

A
  • seizures
  • vasoconstriction (ischemia and hypertension)
  • pulmonary toxicity
  • hepatotoxicity
  • HIV
  • sudden cardiac death
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20
Q

Withdrawal symptoms of stimulants.

A
  • lethargy
  • exhaustion
  • irritability
  • hunger
  • poor concentration
  • dysphoria and suicidal ideation
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21
Q

How is stimulant withdrawal treated?

A

tricyclics

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22
Q

How do opioids increase DA in the NA?

A

bind mu-receptors are presynaptic terminals in the VTA, reducing GABA release and disinhibiting the VTA

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23
Q

How does alcohol increase DA in the NA?

A

the same way as opioid receptors

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24
Q

What are the effects of chronic opioid use?

A
  • analgesia
  • euphoria, tranquility, anxiolytic
  • respiratory depression
  • diminished GI motility
  • cough suppression
  • nausea, vomiting, pruritis
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25
Q

Physical tolerance to opioids takes how long to develop?

A

4-6 weeks

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26
Q

Withdrawal from chronic opioid use is likely to last how long?

A

acute withdrawal for 7-10 weeks followed by subacute symptoms for up to a year

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27
Q

Early symptoms of opioid withdrawal.

A
  • anxiety
  • nausea
  • pilorection
  • yawning
  • lacrimation
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28
Q

Late symptoms of opioid withdrawal.

A
  • diarrhea
  • abdominal cramps
  • myalgia
  • insomnia
  • dysphoria
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29
Q

How do we manage opioid withdrawal?

A
  • methadone detox

- reduce discomfort

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30
Q

What is buprenorphine?

A

a partial opioid receptor agonist with high affinity

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31
Q

Endogenous cannabinoids have what role?

A
  • learning
  • memory
  • motivation
  • reward
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32
Q

Where are cannabinoid receptors found?

A
  • CB1 in the CNS

- CB2 in the PNS

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33
Q

Describe cannabinoids.

A
  • lipids
  • freely diffusable
  • not stored
  • retrograde messengers
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34
Q

How do cannabinoids induce reward?

A

inhibition of GABAergic input to the VTA

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35
Q

Effects of cannabinoid use.

A
  • sensory amplification
  • time distortion
  • increased appetite
  • perceptual distortions
  • euphoria/relaxation
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36
Q

Why do cannabinoids have few withdrawal effects?

A

because they are lipid in nature and thus there is no shape decline in effects

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37
Q

Withdrawal symptoms of cannabinoid use.

A
  • anxiety
  • dysphoria
  • insomnia
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38
Q

How does MDMA increase DA in the NA?

A
  • inhibits vMAT, leaving NT in the presynaptic cytosol

- taken up by MAT and reverse MAT direction

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39
Q

What is serotonin syndrome?

A

side effects of MDMA

  • confusion
  • hyperthermia
  • hyperreflexia
  • myoclonus
  • rhabdomyolysis
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40
Q

How does PCP work?

A
  • NMDA receptor antagonist

- partial D2 receptor agonist

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41
Q

Acute effects of inhalants.

A
  • dizzy
  • drowsy
  • disinhibited
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42
Q

What are the risk of inhalant use?

A
  • drastically low BP
  • sudden cardiac death
  • neuronal deterioration
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43
Q

What are the six stages of change?

A
  • precontemplation
  • contemplation
  • preparation
  • action
  • maintenance
  • relapse
44
Q

Alcohol is primarily absorbed where in the GI tract?

A

the duodenum

45
Q

Peak BAC can be variable based on what factors?

A
  • amount
  • rate
  • food composition
  • gastric emptying
  • gastric metabolism
  • use of other medications
46
Q

How does food consumption affect alcohol absorption/

A

it slows gastric emptying

47
Q

Why do women achieve higher BACs then men?

A
  • women have less total body water
  • women have less gastric ADH activity
  • men have a high liver volume and amount of ADH
48
Q

How is ethanol metabolized?

A
  • ethanol to acetaldehyde by alcohol dehydrogenase

- acetaldehyde to acetate by aldehyde dehydrogenase

49
Q

Alcohol is primarily metabolized by what organ?

A

the liver

50
Q

Alcohol dehydrogenase follows what order kinetics?

A

zero order, meaning that it is a linear rate

51
Q

What is disulfiram?

A

an aldehyde dehydrogenase inhibitor prescribed to alcoholics to make them sick when they drink

52
Q

What is the primary source of inter-individual variability in alcohol metabolism?

A

genetic polymorphisms in the alcohol metabolic enzymes

53
Q

Which alcohol dehydrogenase allele is associated with higher metabolic rate?

A

ADH2*3

54
Q

What aldehyde dehydrogenase allele is associated with asian glow?

A

ALDH2*2

55
Q

How can alcohol increase a second drug’s effect when the two are taken together?

A
  • synergistic depressive effects
  • increase absorption
  • comete for metabolic enzymes
56
Q

Give an example of how alcohol can increase the toxicity of another drug.

A

induces higher expression and activity of MEOS (microsomal ethanol oxidizing system), which will convert acetaminophen to a toxic metabolite

57
Q

How does alcohol interact with phenytoin?

A
  • increase the effect by competing for metabolic enzymes

- decrease the effect by up regulating the metabolic pathway

58
Q

What is tolerance?

A

decreased physiologic and psychologic effects of a drug with prolonged exposure to that drug

59
Q

What is acute tolerance?

A

that which occurs during the time-course of a single exposure to that drug

60
Q

What is chronic tolerance?

A

that which occurs with repeated and regular use of that drug

61
Q

What are four reinforcing effects of alcohol?

A
  • euphoria
  • altered consciousness
  • relief of anxiety
  • relief off withdrawal
62
Q

Name four effects alcohol has on NT systems.

A
  • facilitates GABA transmission
  • blocks NMDA
  • activates the opioid system
  • indirectly increases DA in the nucleus accumbens
63
Q

The sedative effects of alcohol are mediated by which NT changes?

A

increased GABA and diminished NMDA signaling

64
Q

Craving for alcohol is mediated by what NT change?

A

the diminishing opioid levels as the effects wear off

65
Q

The eleven criteria for substance use disorder fall into what four categories?

A
  • impaired control
  • social impairment
  • risky use
  • physical dependence
66
Q

__ grams of alcohol equal one drink.

A

14 grams

67
Q

What qualifies as a “heavy drinker”?

A

5 drinks in a day at least weekly

68
Q

When do women experience their peak weekly drinking?

A

between the ages of 50 and 59

69
Q

Binge drinking rates are highest for which age group?

A

18-29

70
Q

Which race experiences the most heavy drinkers?

A

northern europeans

71
Q

What morbidities are highly associated with alcohol?

A
  • industrial accidents
  • suicide
  • hospitalizations
  • marital violence
  • violent crime
72
Q

The life expectancy of an alcoholic is __ years less than a normal individual.

A

15

73
Q

__% of alcoholics will experience spontaneous remission

A

20

74
Q

Alcohol decreases absorption of what substances?

A

folate, thiamine, B12

75
Q

Alcohol increases absorption of what in the small intestine?

A

iron

76
Q

What are the major complications of alcoholic cirrhosis?

A
  • esophageal varicies and bleeding
  • bleeding hemorrhoids
  • encephalopathy
77
Q

Why do many alcoholics suffer from anemia?

A
  • blood loss (more instances, fewer platelets)
  • hypersplenism
  • decreased folate absorption
  • direct toxic effect on erythropoiesis
78
Q

What are the criteria for fetal alcohol syndrome?

A
  • growth retardation
  • altered mrophogenesis
  • CNS involvement
79
Q

What are the signs of CNS involvement in those with fetal alcohol syndrome?

A
  • microcephaly
  • irritability in infancy
  • altered muscle tone
  • poor coordination
  • hyperactivity
  • intellectual disability
80
Q

What are the facial dysmorphologies commonly associated with FAS?

A
  • flat midface
  • short nose
  • indistinct philtrum
  • thin upper lip
81
Q

How does acute alcohol use cause death?

A

respiratory depression

82
Q

Alcoholics have a higher prevalence of which psychiatric illnesses?

A
  • antisocial personality disorder

- depression

83
Q

Describe alcoholic polyneuropathy.

A
  • lower extremities more than upper
  • distal more than proximal
  • “burning feet” sensation
84
Q

Alcoholic polyneuropathy is due to what?

A

vitamin B complex deficiency

85
Q

What are the features of Wernicke’s encephalopathy?

A

triad of CN VI paralysis, truncal ataxia, and confusion

86
Q

What brain structure is affected in those with Wernicke’s encephalopathy?

A

the cerebellum

87
Q

What causes Wernicke’s encephalopathy?

A

thiamine deficiency (typically secondary to alcoholism)

88
Q

What is Korsakoff’s syndrome?

A

the inability to retain new informaiton

89
Q

How do we prevent the progression from minor alcohol withdrawal to major withdrawal?

A

with benzodiazepines

90
Q

What are the symptoms of persistent alcohol withdrawal?

A

insomnia, anxiety, depression

91
Q

What is a dry drunk?

A

someone in remission from alcoholism continuing to experience persistent alcohol withdrawal

92
Q

What is central pontine myelinosis?

A

a possible CNS affect of alcoholism that results in quadriplegia due to rapid sodium correction

93
Q

What is Bignami syndrome?

A

a syndrome of seizures, coma, and quadriparxsis due to demyelination of the corpus callosum often associated with red wine

94
Q

How can alcoholic dementia be distinguished from Alzheimer’s?

A

alcoholic dementia will stop progressing with abstinence

95
Q

What is considered “at risk drinking”?

A

level of consumption directly harmful or correlated with greater health problems

  • more than 14 in a week or 5 in a day for men
  • more than 7 in a week or 4 in a day for women
96
Q

What are the CAGE questions?

A
  • felt you should cut down?
  • felt annoyed by criticism of your drinking?
  • felt guilty about your drinking?
  • eye opener?
97
Q

Symptoms of early alcoholism?

A
  • anorexia
  • diarrhea
  • palpitations
  • insomnia
  • impotence
  • poor memory
98
Q

What happens to MCV in alcoholics?

A

it increases due to folate deficiency

99
Q

What liver enzyme values suggest alcoholic liver disease?

A

AST/ALT > 1, ALT<300

100
Q

Who should receive brief alcohol use intervention?

A

at risk drinkers who don’t qualify for a diagnosis of alcoholism

101
Q

What is the goal of alcohol use intervention?

A

moderate drinking

102
Q

What are the elements of brief alcohol use intervention?

A
  • feedback
  • advice
  • commitment
  • tracking
103
Q

How do we treat major alcohol withdrawal?

A
  • supportive care
  • benzodiazepines
  • antipsychotics
104
Q

What is naltrexone?

A

an opioid receptor antagonist that helps attenuate alcohol relapse

105
Q

What is acamprosate?

A

a GABA agonist and NMDA antagonist that helps maintain abstinence

Neuro Part 2 (18 decks)

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