Flashcards in addiction Deck (46):
chronic, progressive behavioral disorder whose central feature is compulsive drug use despite adverse consequences. this involves the brains reward system and the alterations that reward enhancing drugs have on the system.
ventral tegmental area
location of the dopaminergic cells of the brain. they project to the nucleus accumbens. and the prefrontal cortex.
simplistically what is the NA? What is the PFC?
the reward center and the executive control center.
the reward center. integrates VTA dopamine and PFC glutamate inputs to determine motivational output.
exerts the executive control over the midbrain structures. judgement, cost-benefit analysis.
what are the different sections of the PFC
dorsolateral PFC, ventromedial PFC, anterior cingulates PFC, orbitoPFC.
statistical analysis and prioritization. top-down control. this is the cold-calculating center.
assigns emotional valiance or higher order emotional processing. drinking feels good, lowers inhibitions, less stress more social.
impulse prevention. I can beat up that football player over there.
anterior cingulate cortex.
vigilance and focus. scanning the environment on a goal.
how is decision making processed in the brain?
it is a glutamate driven process all via structures within the PFC.
how is the limbic system driven
by dopamine. D3 govern static levels that allow neuronal activity, such as wakefulness, homeostasis, alertness. D2 are pulsatile depending on motivation and drive.
where do all drugs act?
on the limbic system and reward pathways. they either enhance DA release, enhance DA action on the NA, or are DA agonists.
what happens in chronic drug use?
leads to reward circuitry changes that promote future drug use. is actually enhances reward seeking behaviors due to increased limbic function and decreased PFC function.
role of the amygdala?
the amygdala also assigns emotional valiance to events and sensations.
how should the PFC respond?
OFC should suppress doing dangerous or addictive things. VMPFC should attach positive feelings to not doing dangerous things. DLPFC calculate true risk benefit
can the brain tell the difference between benzodiazepines and alcohol?
anxiolysis, disinhibition, slurred speech, ataxia, sedation, stupor, respiratory depression, coma, death (500mg/dl).
agitation, insomnia, tremor, GI upset, inc pulse/HR/BP, seizures, hallucinations, delirium, death.
how do we stop EtOH withdrawal symptoms.
intoxication with sedatives (benzos)
anxiolysis, slurred speech, ataxia, sedation, stupor, respiratory depression, coma, death.
how do we reverse benzo OD?
flumazenil -will not work for barbiturates or alcohol.
withdrawal of benzos
agitation, insomnia, tremor, GI cramps, hyperreflexia, inc HR, seizures, hallucinations, delirium, death.
how do stimulants work?
block DA uptake and may even reverse it. the net effect is an increase in DA within the limbic system that allows for more CNS activity and excitability.
intox with stimulants
elevated mood and esteem, irritability, insomnia, appetite loss, dilated pupils, racing heart, inc BP, elevated body temp, hyperreflexia, psychosis, cardiac arrest, seizure. can cause vasospasm.
withdrawal from stimulants
fatigue, anhedonia, depression, increased sleep, increased appetite. clonidine seems to work for relieving the symptoms.
morphine, herion, codeine, hydrocodone, hydromorphone, methadone.
what are downers?
EtOH, marijuana, opiates, benzos,
what do opiates do?
activate the endogenous opioid system. mainly the mu receptors present within the brain and spinal cord. this reduces pain, increases positive emotional mild analgesia. they increase K influx and hyper polarize the cell. they activate the descending pain modulatory system and inhibit the ascending
elevated mood, pupil constriction (pinpoint), respiratory suppression, gag reflex loss, low HR/BP, constipation! there is usually a cold-dope fiend presentation.
withdrawal from opiates
restlessness, watery eyes, yawning, dilated pupils, goose flesh, runny nose and sneezing, inc HR/BP, GI distress, muscle cramps.
PCP, peyote, LSD, mescaline, psilocybin
what distinguishing characteristic does PCP cause?
intox with hallucinogens
perceptual distortion, hallucinations, depersonalization, nystagmus, tremors, hyperreflexia, racing heart, flashbacks, paranoia.
elevated mood, expansive thought, sedation, pupil constriction, red conjunctiva, increased appetite, panic, paranoia. amotivational syndrome and forgetting system are activated.
what is the percentage of smokers that die from tobacco related illness?
why do people change?
because they are ready, willing and able.
what are the stages of change?
precontemplation, contemplation, preparedness, active, maintenance.
precontemplation to contemplation? how do we help?
consciousness raising through education. emotional arousal dramatic release. social liberation and environmental reevaluation.
contemplation to preparedness
self-reevaluation. do i have the tools and support?
preparation to action
self-liberation and commitment. beliefs, family, progression, courage. you have to give them the right perspectives, the ones that appeal to them and allow them to make the steps.
action to maintenance
countering/counterconditioning, environmental control, rewards, helping relationships.
you must stop all drugs. must not use at all, ever. 12 step model is the example.
this tends to work through socratic teaching with the patient. examples
how do people who use tobacco die? do you know that your inhaling 20-sticks of dirt into your lungs everyday?-tell me about that.
how does bupropion work?
blocks neuronal reuptake/recycling of NE and DA. cigarette effects are not missed. activation is not missed