Addiction Flashcards
(67 cards)
1
Q
general def. of dependence
A
patient find the drug so pleasurable and reinforcing that they have difficulty controlling their use of the substrance
2
Q
what is neurobio explanation
A
- in nucleaus accumbens and medial forebrain, DA is transmitter
- tied with memory and executive function
3
Q
what does DA drive
A
survival benefits - food, sex, nurturing
4
Q
how do drugs tie into these pathways
A
- cocaine directly blocks DA reuptake
- other drugs do so via other neurotransmitters
5
Q
5 things that give a drug addictive potential
A
- rapid onset of action
- high potency at receptor
- short duration of action
- tolerance
- withdrawal
6
Q
2 ways tolerance is increased
A
- # of receptors and sensitivity
2. levels of neurotransmitters
7
Q
what does rate of tolerance developlment depend on
A
the effects - for opiods
- pain is slow
- sedation is fast
8
Q
what happens in withdrawal
A
receptors that resist the drugs are now unoppsed - get opposite effects
9
Q
how do genes inflence alc.
A
for naive drinkers
- fewer adverse effects
- greater tolerance
- more pos. effects
10
Q
2 psychiatric risk factors
A
- use releives negative mood states
2. have other mental disorders
11
Q
4 social risk factors
A
nothing to do, nothing to lose
- lack of meaningful life
- lack of social support
- cultural attitudes towards
- peer influences
12
Q
6 clinical features of dep
A
- drug becomes main focus of time and life
- neglects major responsiblities
- continued use despite consequences
- try to quit but relapse
- tolerance, withdrawal
- cravings
13
Q
4 Cs
A
Compulsive use
Cut down (unable)
Cravings
Consequences
14
Q
steps to a substance use Hx
A
IPTARRR Initiation Pattern Treatment hx Abstinence Relapse Risk assessment Readiness to change
15
Q
why is it important to address smoking
A
- killa
- smoking cessation counselling is one of the most cost-effective interventions available
16
Q
benefits to quit
A
- breathe easier in 24hr
- cough better in 2 weeks
- risk of CAD down 50% in one year
- risk of stroke normalizes in 5 years
- risk of dying normalizes in 15 years
17
Q
4 effects of nicotine
A
- psychoactive effects - chamelon
- CV effects - incre HR, output, BP
- app suppresion
- incr. metabolic rate
18
Q
pharma of nicotine
A
binds to ACH receptor in nuleaus accumbens
19
Q
why so addictive
A
- rapid onset
- 200 puffs a day
- easy to self regulate
- very reinforcing - hardest to quit
20
Q
what is withdrawal timing of nicotine
A
24hr - beings - irritable, anxiety, depressed mood
5day - severe withdrawal last
months - still have the urge
21
Q
4 general types of intervention
A
- init. smoking cessions
- counselling
- pharma
- combo - more effective than either alone
22
Q
5 As of smoking cessation
A
- ask - do you smoke
- advise - clear and strong
- assess - within 30 days
- assist - START
- arrange follow up
23
Q
what is START for assisste
A
Set a quit date Tell friends/fam Anticipate and plan for challenges Remove all cigs Talk to doc
24
Q
4 meds
A
- nicotine replacement
- buproprion
- varenicline
- combo therapy
25
what is effect of meds
double chance
26
2 types of NRTs
patch - good in first 2 weeks
| gum - good for breakthrough cravings
27
what is buproprion
atypical antidep - elevates DA levels
| - 1-2 weeks to work
28
what is veranacline
champix
| - partial nictotine agonist - give effect and blocks other nictoine
29
5 effective public health strategies
1. incr. cost
2. pass clean air leg.
3. create effective anti-smoking
4. ban tobacco advertising
5. provide cessation aids
30
what is alc. epi
80% men and 60% of women use at some time
30-50% have an adverse effect
15% chance of disorder
31
what is psych effect of alc
CNS depressent
low dose - anxiolytic, pleasure, disinbi
high dose - sedative/hyponotic
32
2 main transmitters in alc
GABA - CNS inhibition
| glutamate - CNS exitatation
33
what happens in acute, chronic and withdrawal of alc
acute - GABA dominant
chronic - equal
withdrawal - glut dominante - autonomic arousal
34
2 Sx with 6-24hrs of withdrawal
1. tremor
| 2. diaphoresis
35
Sx at 8-254hrs
hallucinations
36
sx at 24-48 hours
seizures
37
sx of 72+ hours
DTs - can be high mortality
38
what are DTs
- tahcy
- tremor
- diaphoresis
- fever
- disorientation
39
goals of detox
- manage sx of withdrawal
- prevent serious events
- bridge to treatment
40
main treatment of withdrawal
benzos
41
5 stages of alc intervention
1. ID
2. intervention
3. detoxification
4. rehabilitations
5. prevention
42
what is SBIRT
Screening, Brief Intervention, Referral to Treatment
43
3 important things to ask about
1. all patients
2. weekly amount
3. maximum in a day over last month
44
CAGE
Cut down
Annoyed
Guilt
Eye-opener
45
what is brief screen
in past year how often have you have 5 or 4 drinks in one sitting
46
what is safe drinking
men - 15/wk and max 3/day
women 10/wk and max 2/day
can have an extra on special occasions
47
what is FRAMES brief intervention
```
Feedback
Responsibilty is on patient
Advice to change
Menu of options
Empathic style
Self-efficacy
```
48
3 drugs for alc. and mech
naltrexone - opiod antagonist - don't get high
acamproate - enhances GABA to releive sub-acute withdrawal
disulfram - ALDH inhib - get toxic buildup and feel bad
49
what is effect of opiods
act on mu opiod receptors and get sense of peace/happiness
50
why don't all pts become addicted
most don't have the reinforecing effects
51
3 keys for doctors when prescribing opiods
1. select patients carefully
2. titrate doses slowly and carefully
3. watch for "aberrant behavior"
52
what is opiod withdrawal
- flu-like sx
| - psych sx predominate
53
how does methadone work
has slow onset and long half-life
| - releives sx without sedation or euphoria
54
what is buprenorphine (suboxone)
- sub-lingual partial agonsit
- binds tigtly and displaces other opiods
- ceiling effect so can't OD
55
what is contingency mgmt
- daily dispensing, supervised
- gradual introduction of take home doses as well
- urine screens
56
compications of THC
- poor social funct.
- depression
- addiction
- MVA
- drug-induced psychosis
57
who to be concerned about with THC
more than a joint/day
58
what is THC use in pain
- weak evidence
| - contains carconogens
59
what is cocaine effect
blocks re-uptake of DA
| - most reinforceing drug
60
5 therapies of substance use
```
MI
CBT
AA
contingency mgmt
family therapy
```
61
what is MI
- collaborative! and conversational
- use PT strengths
- style is as a guide
- need to also be empathic
62
3 keys to CBT
1. recognize triggers
2. avoid high risk situations
3. cope with cravings
63
what is AA programs
12 steps
- alc. is medical and spiritual disease
- abstinence based
- accept loss of control
- need a sponsor
64
what is contingency mgmt
based on operant conditioning
- reward abstience
- punish drug use
65
what does contingency mgmt look like
- find target bahev. (eg drugs in urin)
- clear consequences of success and failure
- immediate reinforcement
- incentives and punishments immediate
66
what is family therapy
rewards and focus on abstinent behavior while retoring family system
67
what is addiction among physician
lifetime 8-14%
M>F 7:1
more alc, opiods, sedatives
