18. Drug Addiction Flashcards

1
Q

What is substance abuse?

A

Pattern of harmful use of a substance for mood-altering purposes

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2
Q

What is tolerance defined as?

A

Either:
Need increased amounts to achieve desired effect
or
decreased effect from using the same amount of the substance

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3
Q

What is withdrawal defined as?

A

Either:
Characteristic set of symptoms for that substance
or
Substance is taken to relieve or avoid withdrawal symptoms

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4
Q

What are the types of tolerance?

A
Innate
Pharmacokinetic
Pharmacodynamic
Conditioned
Acute
Reverse
Cross-tolerance
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5
Q

What is the difference between innate and conditioned tolerance?

A

Innate is a genetic lack of sensitivity eg. codeine and CYP2D
Conditioned is an adaptation to environmental cues eg. smell of the drug increases tolerance

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6
Q

What is the difference between pharmacokinetic and pharmacodynamic tolerance?

A
Kinetic= change in metabolism of the drug eg. barbituates
Dynamic= change in receptor activity
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7
Q

What is physical dependence?

A

Drug specific withdrawal symptoms are produced by a sudden stop or decrease in amount of drug, or administering an antagonist

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8
Q

What is a Dependence Syndrome?

A

Need drug to maintain normal function

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9
Q

What pathway is targeted by drugs of abuse?

A

Mesolimbic dopaminergic pathway

  • from ventral tegmental area in midbrain
  • to nucleus accumbens in forebrain
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10
Q

What pathways are activated by nicotine?

A

Dopamine reward pathway
Central nicotinic receptors
Peripheral nicotinic receptors

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11
Q

What effect does nicotine have at central nicotinic receptors?

A

Anxiolytic

Suppresses appetite

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12
Q

What effect does nicotine have at peripheral nicotinic receptors?

A

Increase BP

Smooth muscle contraction

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13
Q

Why is it said that ‘the first cigarette is the best one’ and what effect does this mechanism have long term?

A

Nicotinic receptors have a ‘rapid switch off’ after initial stimulation
Over time there is a compensatory upregulation of nAChR

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14
Q

What are the withdrawal symptoms of nicotine?

A

Lightheaded, waking up at night
Poor concentration, irritability, depression, restlessness
Craving and increased appetite

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15
Q

What are the behavioural treatments for nicotine withdrawal?

A

CBT
Motivational interviewing
Mindfulness

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16
Q

What is the pharmacological treatment for nicotine withdrawal?

A

Nicotine replacement therapy
Bupoprion (increase dopamine)
Varenicline (partial agonist of nicotine receptor)

17
Q

What compound is the addictive component of cannabinoids?

A

THC

18
Q

How does cannabis lead of increased release of dopamine?

A

Cannabinoid receptors decrease GABA release

19
Q

What is the MOA of cocaine?

A

Blocks DAT and VMAT transporters

-stops reuptake of dopamine, NA and serotonin

20
Q

What is the MOA of amphetamines?

A

Block DAT

21
Q

What are the signs of an overdose of psychostimulants?

A

Increase temperature, HR and BP

Heart failure, seizure, respiratory depression

22
Q

What is the treatment for an overdose of psychostimulants?

A

Benzodiazepines

Ca++ channel blockers to decrease BP

23
Q

What are the symptoms of a psychostimulant withdrawal?

A

Difficulty concentrating
Restlessness
Depression and anxiety

24
Q

What is the treatment for psychostimulant withdrawal?

A

Propanolol for high BP

Disulphiram

25
Q

What are the effects of a high dose of meth?

A

Psychosis
Seizures
Dysphoria
Increased temp

26
Q

What drugs can be given for the symptoms of meth withdrawal?

A

SSRIs

Diphenhydramines

27
Q

What is the MOA of opiates?

A

Decrease GABA release

28
Q

What is the treatment for opiate overdose?

A

Naloxone

29
Q

How is opiate addiction treated?

A

Methadone or buprenorphine

30
Q

What are the withdrawal symptoms of benzodiazepines?

A

Anxiety
Insomnia
Seizures

31
Q

What is the treatment for benzodiazepine withdrawal?

A

Buspirone (anti-anxiety)
Propanolol (BP, palpitations)
Carbamazepine (anti-seizure)

32
Q

What is the treatment for benzodiazepine overdose?

A

Flumazenil

33
Q

What is the MOA of alcohol?

A

Decrease excitation by blocking NMDA

Bind to GABA increasing inhibition

34
Q

What is the treatment for alcohol withdrawal?

A

Benzodiazepines for seizures and anxiety
Haloperidol for hallucinations and delirium
Pancreatic enzyme supplementation