6/17- Substance-Related and Addictive Disorders II Flashcards Preview

Term 5: Behavioral Science > 6/17- Substance-Related and Addictive Disorders II > Flashcards

Flashcards in 6/17- Substance-Related and Addictive Disorders II Deck (59):
1

Sedatives, hypnotics, and anxiolytics include what?

- Barbiturates

- Benzodiazepines

- Prescription sleep meds

2

How is intoxication with sedative, hypnotic, or anxiolytic defined?

- Recent use of sedative, hypnotic, or anxiolytic

- Maladaptive behavioral or pscyhological changes 1 or more:

- slurred speech

- incoordination

- unsteady gait

- nystagmus

- impaired attn/memory

- stupor/coma

3

How is withrdrawal from sedative, hypnotic, or anxiolytic defined?

- Cessation (or reduction in) prolonged use of a sedative, hypnotic, or anxiolytic 2 or more (developing in hours-few days):

- autonomic hyperactivity (diaphoresis, HR > 100)

- hand tremor

- nausea/vomiting

- anxiety

- insomnia

- hallucinations (A/V, tactile)

- pscyhomotor agitation

- grand mal seizures

4

List of some Barbiturates?

- Phenobarbital (Luminal)

- Butalbital (Fiorinal)

- Secobarbital (Seconal)

- Amobarbital (Amytal)

- Phentobarbital (Nembutal)

5

Characteristics of Barbiturates?

- Uses

- Result from long-term use

Uses:

- Sedatives/anxiolytics

- Anticonvulsants

May have:

- Tolerance

- Dependence/withdrawal

- Lethal in overdose

6

What has largely replaced the use of barbiturates?

Benzodiazepines (think: similar to transition of TCA -> SSRIs)

7

List of Benzodiazepines

- Alprazolam (Xanax)

- Lorazepam (Ativan)

- Oxazepam (Serax)

- Chlordiazepoxide (Librium)

- Clonazepam (Klonopin)

- Diazepam (Valium)

- Temazepam

- Triazolam

8

Indications for Benzodiazepines?

- Highly effective anxiolytics and sedatives

- Muscle relaxants, anticonvulsants, amnestics

- GAD, Panic Disorder

- Insomnia

- Increase affinity of GABAA receptor for endogenous GABA, bind to BZD binding site

May see,cross-tolerance with alcohol and barbiturates (alcohol-like effects; treat withdrawal symptoms)

9

Risks of Benzodiazepines?

- Tolerance -> dose escalation

- Abrupt discontinuation -> withdrawal

- Requires gradual tapering of dose

- Abuse potential

- Low lethality in overdose, unless combined with other sedatives, then lethal !!!

- Intoxication, confusion, falls: esp. in elderly

- Paradoxical agitation - Disinhibition

10

What are some hypnotics? Used for?

Prescription sleeping medications

- Zolpidem (Ambien)

- Zaleplon (Sonata)

- Eszopiclone (Lunesta)

- Remelteon (Rozerem)

- Chloral hydrate (Noctec)

- Meprobamate (Miltown

11

What are opiates? What are opioids?

Opiates- opium and naturally-occurring derived drugs (morphine and codeine)

Opioid- class of substances that acts on opioid receptors, includes synthetic drugs that bear little resemblance to opium

12

What are some natural opiates?

- Opium

- Morphine

- Codeine

13

What are some semi-synthetic derivatives of opioids?

- Heroin

- Hydrocodone 

- Hydromorphone

- Meperidine - Oxycodone

14

What are some synthetic opioids?

- Fentanyl

- Meperidine

- Methadone

- Propoxyphene

15

3 phenomena seen in the neurobiology of opiods?

1. Euphorigenicity of the drugs

2. Capacity to positively reinforce drug seeking

3. Avoidance of aversive feelings (including withrawal)

16

What are the different opioid receptors?

Responsible for?

Mu

- Opioid drugs (morphine is prototypic agonist)

- Analgesia, respiratory depression, mood elevation, constipation, immuno-suppression, physical dependence

Delta

- similar to mu

Kappa

- Dysphoria (endogenous dynorphins)

OFQ/N

- Analgesic or pro-nociceptive ffects

17

Which receptor do opioid drugs bind?

Mu opioid R

18

What is opioid intoxication?

Recent use of an opioid

Problematic behavior or psychological changes:

- Initial euphoria followed by apathy, dysphoria

- Psychomotor agitation or retardation

- Impaired judgment & social/occupational fxn

Pupillary constriction and 1 or more:

- Drowsiness/coma

- Slurred speech

- Impaired attention/meory

19

What is opioid withdrawal?

- Cessation of or reduction in prolonged opioid use (or administration of an antagonist)

3 or more:

- Dysphoric mood

- Nausea/vomiting

- Muscle aches

- Lacrimation/rhinorrhea

- Diarrhea

- Pupillary dilation/piloerection/diaphoresis

- Yawning

- Fever

- Insomnia (everything runs)

20

Opioid Intoxication vs. Withdrawal?

A image thumb
21

Treatment of opioid intoxication?

Naloxone (Narcan): IV, IM, SC, ET

- Treatment of acute opioid overdose (0.4-2.0 mg Q 2-3 min prn)

- Diagnosis of physical dependence via relief upon reception

- Poor PO absorption (wouldn't be able to take it by mouth at this point anyway)

- Rapid parenteral metabolism

22

Treatment of opioid withdrawal: detoxification?

Often done inpatient b/c so distressing

- Clonidine (Catapres)

- Methadone

23

Characteristics of opioid withdrawal treatment with Clonidine

Clonidine (Catapres)

- Alpha 2 adrenergic agonist and anti-HTN

- Suppresses autonomic Sx of opiate wd

- Allows for more rapid etox

- Monitor for hypotension

- SE: hypotension, sedation, limits outpt use

- Lethargy, restlessness, anxiety, insomnia, cravings, not well relieved

Benzodiazepines for anxiety

Low-dose propranolol for restlessness

24

Characteristics of opioid withdrawal treatment with Methadone

Methadone

- Mu receptor agonist

- Commonly used drug to treat withdrawal Sx

- Detox over several days inpatient

- 6 mo outpatient

- Morphine: methadone equivalency varies widely (2.5:1 to 14:1)

- Careful not to overdose

- More rapid with clonidine

- Outpatient taper very gradual

25

Characteristics of opioid withdrawal treatment with Buprenorphine?

Buprenorphine

- Partial agonist at mu receptors

- Becoming more widely used for detox

26

Characteristics of opioid withdrawal treatment with Ultrarapid detoxification?

- General anesthesia, antagonist therapy

- Efficacy and safety being studied

27

Treatment of opioid use disorder?

Agonist replacement:

- Methadone maintenance

- Buprenorphine maintenance

Opioid antagonists:

- Naltrexone- only antagonist currently used

28

Characteristics of opioid use disorder with Buprenorphine?

- Mu-receptor agonist

- Decreased acute euphoric effects

- Readily absorbed orally

- 4 hrs to peak concentration

- Large extravascular reserve (not much withdrawal if weaned off)

- T1/2 of 1-2 days

- Cytochrome P450 CYP3A4

29

Characteristics of opioid use disorder with methadone maintenance therapy?

- High doses alleviate craving, induce cross tolerance, blocks heroin-induced euphoria

- Theory: no need for heroin or associated maladaptive behaviors with obtaining the drug

- Proven efficacy in reducing: heroin use, other drug use, health problems, crime

- Controversy: primary purpose crime reduction? trading one addiction for another?

30

Characteristics of opioid use disorder with Buprenorphine?

Partial agonist at mu opioid recpetors (kappa antagonist)

- High affinity for mu receptors (can precipitate w/d)

- Dissociates very slowly from receptors (long duration of action: 24-48 hrs, reduced capacity to produce withdrawal Sx)

- Ceiling effect, low risk of overdose, no respiratory depression Less effective for those with larger opioid habits

31

Formulations of Buprenorphine?

Subutex: SL buprenorphine tabs

- Office based treatment of opiate dependence

Suboxone: SL buprenorphine/naloxone tabs (naloxone there to prevent abuse; for safety)

- Okay for take home dosing

- Naloxone has no activity PO; full antagonist if injected

- Minimizes risk of diversion Buprenex: IM buprenorphine

- FDA approved for pain

- Inpatient detox protocols exist

32

Characteristics of opioid use disorder with Naltrexone (ReVia)?

- Opioid antagonist

- Treatment of opioid addiction

- Orally effective and long acting

- Initiate after drug free (7 days heroin, 10 days methadone)

- Better in populations with established careers, family support, high motivation

- SE: decreased energy, hepatotoxicity

33

What are some common stimulants?

- Amphetamine-type substances

- Cocaine

- Other stimulants

34

How is stimulant intoxication defined?

- Recent use of a stimulant

- Maladaptive behavioral or psychological changes: euphoria or affective blunting, changes in sociability, hypervigilance, interpersonal sensitivity, anxiety, tension, anger, sterotyped behaviors, impaired judgment

2 or more:

- Pupillary dilation

- Tachy/bradycardia

- BP changes

- Diaphoresis/chills

- Confusion, seizures, dyskinesias, dystonias, coma

- N/V

- Psychomotor agitation, retardation

- Weight loss

- Muscle weakness, respiratory depression

- Chest pain, cardiac arrhythmia

+/- Psychosis

35

How is stimulant withdrawal defined?

- Cessation of or reduction in prolonged stimulant use

- Dysphoric mood

- Withdrawal dysphoria- often severe (psychiatric emergency!)

2 or more:

- Fatigue

- Vivid, unpleasant dreams

- insomnia or hypersomnia

- Increased appetite

- Psychomotor retardation or agitation

36

What are some amphetamine substances/medications?

- Methamphetamine

- Amphetamine

- Dextroamphetamine

- Methylphenidate

- Adderall

- Dexedrine

- Ritalin

- Concerta

37

Mechanisms of amphetamine activity?

- Inhibits DA reuptake

- Promotes DA release via DA transporter

- Slow metabolism, effects last several hours longer than cocaine

38

What is the natural source of cocaine?

Erythroxylon coca plant

39

Characteristics (broad) of cocaine?

- Indigenous to S. America

- First used 2000 years ago

- Chemically isolated in 1880s

- Sigmund Freud impressed with "mood and work"

- Involved in original Coca-Cola formula

40

Forms and delivery of cocaine? Times of action

Snorting powdered cocaine (intranasal)

- 2-3 min

Injecting dissolved cocaine (intravenous)

- 15-30 sec

Smoking "crack" cocaine (inhalational)

- 6-8 sec

41

What are some of the reinforcing effects of cocaine?

- Extreme euphoria in pure form

- Hyperalertness

- Grandiosity

- Hypersexuality

- Hypertalkativeness

- Rapid onset of action

- Rapid extinction of euphoria

- Rapid tolerance

42

Mechanisms of cocaine activity?

Immediate mechanism of action:

- Increased NT levels (DA, NE, 5-HT)

- Inhibition of reuptake

Mesolimbic dopamine system

43

What is the natural origin of cannabis/marijuana?

Cannabis sativa plant

44

Characteristics (broad) of cannabis?

- Indigenous to Central Asia and China

- Used by humans for > 4000 years-

- "Gateway" or entry drug for many addicts

- Most commonly abused illicit drug

- "marijuana", "hashish", "kush"

45

Cannabis has been legalized for medical use in treating what conditions?

- Cancer

- HIV

- Glaucoma

46

How is cannabis intoxication defined?

- Recent use of cannabis

- Problematic behavioral or psychological changes: impaired coordination, euphoria, ANXIETY, sensation of slowed time, impaired judgment, social withdrawal

2 or more:

- Conjunctival injection - Increased appetite

- Dry mouth

- Tachycardia

47

How is cannabis withdrawal defined?

- Cessation or reduction in heavy and prolonged cannabis use (daily or almost daily/at least a few months)

3 or more (generally mild, flu-like Sx):

- Irritability, anger, or aggression

- Nervousness/anxiety

- Sleep difficulty

- Abdominal pain, tremors, sweats, fever, chills, headache

- Restlessness

- Depressed mood

- Decreased appetite/wt loss

- NAUSEA, vomiting

48

Chronic adverse effects of cannabis?

- Cognitive difficulties (concentration, memory)

- Impaired motor function

- Depression

- Paranoia

- Psychosis

- Amotivational Syndrome

49

What are some common hallucinogens?

- Phenycyclidine (PCP)

- Ergot

- LSD

- Mescaline

- Psilocybin

- MDMA (ecstasy)

50

Characteristics (broad) of Phencyclidine (PCP)?

- "Dissociative anesthetic"

- 1960s: street use

- "Angel dust"

- PCP lace marijuana cigarettes

- Surreptitiously mixed with other illicit drugs- economics

- Inhalational, intranasal, IV

- PCP binding site on NMDA receptors

51

Characteristics of Ketamine?

- Veterinary anesthetic

- Club drug

- "Special K"

- PCP-like pharmacology

- Inhalational, intranasal, IV, tablets

52

How is Phencyclidine intoxication characterized?

- Recent use of phenycyclidine (or pharmacologically-similar substance)

- Problematic behavioral changes: belligerence, assaultiveness, impulsiveness, unpredictability, psychomotor agitation, impaired judgment

2 or more:

- Nystagmus (vert or hor)

- HTN or tachycardia

- Numbness/decreased pain

- Ataxia

- Dysarthria

- Muscle rigidity

- Seizures or coma

- Hyperacusis

53

How is intoxication with other (non-PCP) hallucinogens characterized?

- Recent use of a hallucinogen (other than PCP)

- Problematic behavioral or psychological changes: anxiety/depression, IOR, fear of losing one's mind, paranoia, impaired judgment

- Perceptual changes in full wakefulness and alertness: intensification of perceptions, depersonalization, derealization, illusions, hallucinations, synesthesias (hearing colors, seeing sounds)

2 or more:

- Pupillary dialtion

- Tachycardia

- Sweating

- Palpitations

- blurred vision

- Tremore

- Incoordination

54

What is Hallucinogen Persisting Perception Disorder?

(Flashbacks)

Following cessation of use: re-experiencing of perceptual symptoms experienced while intoxicated with the hallucinogen

- Geometric hallucinations

- False perceptions of mvt in peripheral vision

- Flashes of color

- Intensified colors

- Trails of images of moving objects

- Positive afterimages

- Halos around objects

- Macropsia, micropsia (things appearing larger/smaller than they really are)

55

What are some common inhalants?

Aliphatic and aromatic hydrocarbons

- Gasoline, glue, paint thinner, spray paint

Halogenated hydrocarbons

- Cleaners, typewriter correction fluid, spray can propellants

Toluene, benzene, acetone, methanol, others

"Huffing" and "Bagging"

56

How is inhalant intoxication characterized?

- Recent short-term, high-dose exposure to inhalants

- Problematic behavioral or psychological changes: belligerance, assaultiveness, apathy, impaired judgment or function

2 or more:

- Dizziness

- Nystagmus

- Incoordination

- Slurred speech

- Unsteady gait

- Lethargy

- Depressed reflexes

- Psychomotor retardation

- Tremor

- Muscle weakness

- Blurred vision/diplopia

- Stupor or coma

- Euphoria

57

What are bath salts?

- Synthetic cathinones (Catha edulis- "Khat")

- Mephedrone

- Originally sold as "bath salts"

- Labeled "not for human consumption"

- No relation to Epsom salts

- Amphetamine-like: DA, NE, 5-HT release

- Psychosis and agitation

58

What are characteristics of synthetic Cannabinoids?

- Research compounds: designer drugs

- Mixed with leaves from traditional herbs

- Spice, K2, incense

- Very little structural similarity to cannabis

- Psychosis and agitation

59

General Take Home Points:

- Abuse:

- Dependence:

- New in DSM 5: Substance ______

- Intoxication states are the opposite of withdrawal states

- Common neurobiological addiction process across substances

General Take Home Points:

- Abuse: maladaptive pattern of substance use

- Dependence: behavioral (drug seeking and drug taking) and physiological (tolerance and withdrawal)

- New in DSM 5: Substance Use Disorder (spectrum)

- Intoxication states are the opposite of withdrawal states

- Common neurobiological addiction process across substances