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Flashcards in Addiction Deck (80):
1

What is the immediate effect of most abused substances?

increase the availability of NTs that signal the nervous system to feel pleasure

2

Define substance abuse

a maladaptive pattern of substance use over at least 12 months that leads to impairment of occupational, physical, or social functioning. Substance abuse is not diagnosed when the patient meets the criteria for substance dependence.

3

Define substance dependence

substance abuse + withdrawal symptoms, tolerance or a pattern of compulsive use

Medical professionals look for 3 or more criteria from a set that includes 2 physiological and 5 behavioral pattherns over a 12-month period.

physiologic
1) tolerance 2) withdrawal
behavioral
1) being unable to stop once using starts
2) exceeding self-imposed limits
3) curtailing time spent on other activities
4) spending excessive time using or getting drugs
5) taking a drug despite deteriorating health

4

Define withdrawal

development of physical or psychological symptoms after the reduction or cessation of intake of a substance

5

Define cross-tolerance

development of tolerance to one substance because of using another substance

6

The most impt feel good NT is DA. Where is it produced, where does it project and when stimulated where is it released toward?

DA is produced in neurons of the mesolimbic dopaminergic tract in the VTA. These neurons project forward thru the medial forebrain bundle and when stimulated release DA toward the nucleus accumbens (NA) and frontal cortex

7

What is glutamate's role in addictive behavior? How have drug companies used this to treat addiction?

Glutamate is associated specifically with the maintenance of addictive behavior. THerefore, agents that block glutamate's activity can reduce drug cravings.

8

Patients with diagnoses of both mental illnesses and substance abuse are called?

mentally ill-chemically addicted (MICA) patients or dual diagnosis

9

What are the four classes of abused substances?

-sedatives
-opiods
-stimulants
-hallucinogens and related agents

10

What's a useful strategy to see if a pt has a problem with alcohol?

Ask "CAGE" questions starting with "Do you ever..."
1. try to CUT down on your drinking
2. get ANGRY when someone comments on your drinking
3. feel GUILTY about your drinking
4. take a drink as an EYE-OPENER in the morning.

A positive ans to any two of the questions or just the last question --> alcohol problem

11

list the 3 frequently abused barbiturates

-amobarbital
-pentobarbital
-secobarbital

12

Benzodiazepines are safer than barbiturates except when?

taken with another sedative like alcohol.

13

In the sedatives group of abused substances, list the 3 substances

-alcohol
-benzodiazepines
-barbiturates

14

What is alcohol withdrawal delirium aka delirium tremens (DTs)? When is it observed? What else can cause DTs?

commonly observed on abt the 3rd day of withdrawal in pts who have been drinking heavily for at least 5 years. It is a life-threatening condition with a mortality rate of 20%. Withdrawal from benzodiazepines can also lead to the DTs.

15

How do you treat delirum tremens brought upon from alcohol withdrawal?

oral and IV fluids for dehydration as well as benzodiazepines (chlordiazepoxide, diazepam, and lorazepam)

16

List the 12 steps to recovery that the AA uses.

1. admitted that we were powerless over alcohol
2. came to believe that a power greater than ourselves could restore our sanity
3. made a decision to turn our will and our lives over to GOD
4. made a searching and fearless moral inventory of ourselves
5. admitted to GOD, to ourselves, and to another human being that exact nature of our wrongs
6. were entirely ready to have God remove all these defects of character
7. humbly asked Him to remove our shortcomings
8.made a list of all persons we had harmed and became willing to make amends to them all
9. made direct amends to such ppl whenever possible, except when to do so would injure them or others.
10. continued to take personal inventory and when we were wrong promptly admitted it
11. sought thru prayer and meditation to improve our conscious contact with God
12. having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs.

17

How does disulfiram prevent alcohol use?

It's a daily ingestion that will block breakdown of alcohol and results in acetaldehyde accumulation --> intense nausea, headache, flushing.

18

T/F: psychotherapy alone has been very successful in treating alcoholism

False

19

All opiods have potential to cause physical and psychological dependence. Some can even improve mood. When compared with medically used opiods (morphine), abused opiods (heroin) have more what effects?

more europhic action and are more potent, can cross BBB more quickly and have a faster onset of action

20

What's the classic clinical triad of opiod overdose? What are some other symptoms?

classic clinical triad: coma, respiratory depression, miosis (pinpoint pupils)

other symptoms: hypotension, bradycardia, hypothermia

21

What's the most common cause of death from opiod overdose? How has this affected management?

respiratory arrest is the most common cause of death from opioid overdose. emergency treatment includes establishing an airway and supplying mechanical ventilation. Also, naloxone, an opioid receptor antagonist, is used to reverse respiratory suppression.

22

What are some physical withdrawal symptoms of opioids?

-flu-like effects (sweating, fever, rhinorrhea, muscle aches, autonomic instability)

23

Which is more dangerous: barbiturate (sedative) withdrawal or opioid withdrawal?

barbiturate b/c it can be fatal whereas opioid withdrawal is rarely fatal unless a serious underlying physical illness is present.

24

What's the detoxification process of opioid addicts?

a synthetic opioid (methadone) can be given over a period of weeks in decreasing doses.

25

What's an effective way to prevent a return to the dangers of heroin since most abusers end up abusing again (recidivism)?

substitution and continued use of legal opioids, such as methadone (full agonist replacement) or buprenorphine (partial agonist replacement)

26

List the 2 minor stimulants and the 2 major stimulants.

2 minor: caffeine + nicotine
2 major: amphetamine + cocaine

27

Which stimulant blocks the reuptake of DA? Which stimulates the release?

amphetamine stimulates the release of DA while cocaine blocks the reuptake of DA.

28

What are some symptoms of intoxication of too much caffeine, a minor stimulant?

restlessness, agitation, flushing of the face, and tachycardia

29

What is ecstasy?

combination of an amphetamine and a hallucinogen

30

What is speedballing?

users of heroin (or another depressant) counteract its sedating effect by mixing it with a stimulant like cocaine.

31

The "high" with cocaine is often followed by?

mood depression, a change that can occur in less than 1 hour

32

What are some psychotic symptoms that cocaine users feel?

-sensations of bugs crawling on the skin (cocaine bugs)

33

Withdrawal symptoms from stimulants is associated with?

depression, headache, hunger, and insomnia

***in contrast to sedatives and opioid withdrawal, not a lot of physical symptoms

34

List some hallucinogens and related agents

-LSD
-PCP ("angel dust")
-cannabis
-psilcybin (from mushrooms)
-mescaline
-ketamine (Special K)

35

Chronic users of marijuana experience?

lung problems associated with smoking and a decrease in motivation (amotivational syndrome) characterized by decreased desire to work and increased apathy

36

LSD and PCP are most commonly used hallucinogens. Although both alter perception, there are differences in the methods of use, NT systems affected, and behavioral effects. List these differences.

-LSD is usually ingested
-PCP is smoked
-effects of LSD --> increased serotonin
-effects of PCP --> bind with NMDA receptors of glutamate-gated ion channels
-PCP is assoc with HTN, agitation and episodes of violent behavior while LCD use does not cause these symptoms.
-PCP also shows hyperthermia and nystagmus
-PCP is toxic --> seizures, coma and death if OD

37

Rapid ED identification of abused substances: pupil constriction

seen with use of?
seen with withdrawal from?

seen with use of opioids
seen with withdrawal from stimulants

38

Rapid ED identification of abused substances: pupil dilation

seen with use of?
seen with withdrawal from?

seen with use of stimulants, LSD
seen with withdrawal from opioids, alcohol and other sedatives

39

Rapid ED identification of abused substances: psychotic symptoms

seen with use of?
seen with withdrawal from?

seen with use of stimulants, alcohol, hallucinogens and related agents

seen with withdrawal from alcohol and other sedatives

40

Rapid ED identification of abused substances: cardiovascular symptoms

seen with use of?
seen with withdrawal from?

seen with use of stimulants
seen with withdrawal from alcohol and other sedatives

41

A patient is feeling tiredness and headache as well as extreme hunger. What is the patient having a withdrawal from?

amphetamines

42

What are signs of heroin withdrawal?

excessive salivation, lacrimation, sweating, rapid heart rate, restlessness, and agitation

43

Withdrawal from benzodiazepines is associated with?

tremor, insomnia, anxiety

44

Are respiratory depression and sedation associated with use of or withdrawal from sedative agents?

use of

45

What's the metabolite that's found in the urine of smokers ?

cotinine

46

What's a cocaine metabolite?

zoylecgonine

47

What's the metabolite found in body fluids of heavy alcohol users?

GGT

48

Elevated levels of which 2 enzymes are found in use with PCP that reflect muscle damage?

SGOT and CPK

49

What is addiction?

a chronic but treatable brain disorder in which ppl lose ability to control their need for alcohol or other drugs

50

The American Psychiatric Association says a person is dependent if their pattern of substance use leads to clinically significant impairment or distress shown by 3 or more of the following in a 12-month period. List those 7 symptoms.

1. tolerance (a need for more, markedly diminished effect with continued use)
2. withdrawal
3. substance is taken in larger amts or over a longer period than intended
4. persistent desire or unsuccessful efforts to cut down or control substance use
5. a great deal of time is spent in activities necessary to obtain the substance, use the substance or recover from its effects
6. impt social, occupational or recreational activities are given up or reduced b/c of substance use
7. substance is used despite knowing it's causing problems

51

What are the 5 widely recognized risk factors of people becoming addicted?

1. genes
2. mental illness
3. early use of drugs
4. social environment
5. childhood trauma

52

T/F: stress and addiction are very intertwined

True

53

Prefrontal cortex -major NT?

glutamate
if it's working --> "stop" system
exerts executive control over midbrain structures, judgement, cost-benefit analysis

54

Where does dopamine come from?

VTA

sends dopamine to many other circuits

55

What's the reward center of the brain

nucleus accumbens integrates VTA (dopamine) and PFC (glutamate) inputs to determine motivational output

56

State the functions of these parts of the brain:
-DLPFC
-VMPFC
-OFC
-ACC

DLPFC: statistical analysis, prioritizing, top down control center
VMPFC: assigns emotional valience
OFC: impulse prevention
ACC: vigilance

57

Decision making is driven by which NT via which structures?

glutamate via PFC

58

Limbic drive is dopamine driven. Explain what D3 and D2 receptors govern

D3 receptors govern static levels of DA neuronal activity to allow homeostatic wakefulness (tonic phase)

D2 receptors are pulsatile depending on motivation, drive, reward expectations (pulsatile phase)

59

List the three steps of the limbic drive that are excessive in addictive behaviors.

1. VTA supplies DA to NA
2. The NA receives input and projects
3. the amygdala assigns a pleasure, threat, or emotional value to the linkage btw 1 and 2

60

Which part of the brain attach positive feelings to not doing dangerous things?

ventromedial prefrontal cortex (VMPC)

61

Which part of the brain should suppress doing dangerous or addictive things?

Orbitofrontal cortex (OFC)

62

Which part of the brain should calculate true risk/benefits ratio of doing addictive things?

dorsolateral prefrontal cortex (DLPFC)

63

benzodiazepines vs alcohol, which is longer acting? shorter acting or longer acting can be used to treat withdrawal?

benzodiazepines

longer acting drugs can help withdrawal symptoms

64

How to treat benzodiazepine overdose?

flumazenil

65

Opiods affect 3 receptors. List them. The one of interest is?

-Mu, delta, kappa receptors
-Mu (OP3, MOP) receptors reduces pain, increases positive emotion

66

Which drug is the only drug that causes horizontal nystagmus?

PCP -a hallucinogen

67

T/F: cannabis can cause tachycardia

True even though it's viewed as a relaxing drug

68

Describe the "Stage of Change Model. List the five stages

1) Precontemplation
2) Contemplation
3) Preparation
4) Action
5) Maintenance

69

There are 5 stages of change and processes that help one move from one stage to the other. Explain the processes that help go from stage 1) precontemplation to stage 2) contemplation

-consicousness raising
-emotional arousal/dramatic release
-social liberation/environmental re-evaluation

70

There are 5 stages of change and processes that help one move from one stage to the other. Explain the processes that help go from stage 2) contemplation to stage 3) preparation

self-evalution

71

There are 5 stages of change and processes that help one move from one stage to the other. Explain the processes that help go from stage 3) preparation to stage 4) action

self-liberation/commitment

72

There are 5 stages of change and processes that help one move from one stage to the other. Explain the processes that help go from stage 4) action to stage 5) maintenance

countering/counterconditioning
environmental control
rewards
helping relationships

73

Describe the socratic teaching in getting someone to stop drugs using smoking as an example

-tell the pt a fact about doing the drug and ask pt how these pts die

ex. persons who inhale nicotine die on avg 10 yrs earlier. How do they die?

74

Describe the clarification/reflexive listening method of getting someone to stop drugs using smoking as an example

-tell the patient a negative fact about doing the drug then ask the pt to tell you about it

ex. you are inhaling 20 sticks of dirt, carcinogen, and nicotine every day. tell me about that... 50% of ppl die from doing what you're doing. Isn't it like committing suicide?

75

Describe the confrontation/double sided reflection

-tell the patient that he continues to have bad symptoms from the drug, ask why he's still doing it then?

ex. you're starting to suffocate from smoking, but you don't want to stop. tell me about it

76

Explain how the nicotine patch/gum work

replace harmful inhaled tobacco smoke with nicotine (full agonist is replaced with full agonist)

prevents withdrawal

77

How does antidepressant bupropion SR (NDRI) mechanism work for smoking cessation?

blocks neuronal reuptake/recycling of NE and DA, leading to more NE and DA in synapses. This may desensitize DA reward circuitry so cigarette based activation is not missed by the pt. Also provide alertness, energy, better cognition and mood so that cigarette effects are not missed

78

What are some side effects of bupropion SR?

-boxed warning for psychiatric worsening, agitation, depression, anxiety suicidality, esp < 25
-precautions for inducing mania
-dry mouth, insomnia, nausea, tremor, rash

79

What is Varenicline? How is it used in smoking cessation? Side effects?

instead of full nicotine agonism and reward pathway firing, it does this partially allowing system to be active and avoid most withdrawal and provide some of the benefits of nicotine use w/o the harm

so it is a partial nicotine receptor agonist

side effects: insomnia, vomiting, constipation, headache, abnormal dreams, agitation, depression, psychosis, suicidal behavior, do not reduce cardiovascular events

80

What's the most effective pill for smoking cessation?

Varenicline -a partial nicotine receptor agonist