Addiction

Question 1

Lifetime alcohol abuse incidence

Answer 1

17.8%

Question 2

Lifetime alcohol dependence incidence

Answer 2

12.5%

Question 3

Lifetime drug abuse incidence

Answer 3

7.7%

Question 4

Lifetime drug dependence incidence

Answer 4

2.6%

Question 5

Addiction in practice

Answer 5

1/5 patients will have non-tobacco substance use

Inpatient medical services: 23% current smokers, 14% alcohol misuse, 12% drug misuse

Question 6

Preventable causes of death in 2000

Answer 6

1: tobacco (435K)
3: alcohol (85K)
9: illicit drugs (17k)

Question 7

Response-reversal learning

Answer 7

behavior initially rewarded, then change to stimulus-punishment
Primarily OFC involvement
Deficient in SUD patients

Question 8

AUDIT assessment for SUD

Answer 8

score >= 8 –> further eval

Question 9

At risk drinking

Answer 9

men => 5 standard drinks in a day, or > 14 per week

women >= 4 drinks in a day or > 7 per week

Question 10

Diagnostic criteria for SUD

Answer 10

role failures, hazardous use, interpersonal problems, craving, tolerance, withdrawal, more than intended, cut down, time spent, activities limited, use despite consequences

Question 11

Mild SUD

Answer 11

2-3 criteria

Question 12

Moderate SUD

Answer 12

4-5 criteria

Question 13

Severe SUC

Answer 13

6+ criteria

Question 14

SBIRT

Answer 14

Screening, Brief Intervention (for at risk drinking), Referral to Treatment (for SUD)

Question 15

Antabuse side effects

Answer 15

metallic taste, headaches, drowsiness or fatigue, optic neuritis, peripheral neuropathy, hepatitis, rash

Question 16

Antabuse contraindications

Answer 16

risk for MI, CVA
cognitive dysfunction (can't understand or remember what will happen when you drink)

Question 17

Naltrexone mechanism

Answer 17

pure mu opioid antagonist –> decreased DA release in nucleus accumbens, decreased drinking, blocked euphoria from alcohol

Question 18

Naltrexone administration

Answer 18

qmonth depot shot, QD 50mg PO

Question 19

Naltrexone side effects/complications

Answer 19

nausea, headaches, anxiety, sedation, hepatic failure (rare)

Question 20

Naltrexone DDIs

Answer 20

decreased benefit from opioid analgesics, decreased benefit from some antidiarrheal, decreased benefit from opioid-containing cough meds

Question 21

Acamprosate (Campral) mechanism

Answer 21

structurally resembles GABA –> enhanced GABA transmission, blocked glu tansmission –> reduced CNS hyperexcitability

Question 22

Acamprosate contraindications

Answer 22

hypersensitivity to acamprosate, severe renal impairment (CrCl less than 30 ml/min)

Question 23

Acamprosate side effects

Answer 23

diarrhea, anxiety, depression, insomnia, suicidality

Question 24

Treatment of ETOH addiction

Answer 24

Antabuse, Naltrexone, Acamprosate

Question 25

Treatment of Opioid addiction

Answer 25

methadone, buprenorphine, naltrexone

Question 26

mechanism of methadone

Answer 26

long-acting mu agonist --> reduced use, reduced harm, increased quality of life

Question 27

mechanism of buprenorphine

Answer 27

partial mu agonist

Question 28

buprenorphine side effects

Answer 28

can precipitate withdrawal

Question 29

Treatment for nicotine dependence

Answer 29

bupropion, nicotine replacement, varenicline

Question 30

Bupropion effects

Answer 30

doubles quit rates, better outcomes in combo with psychosocial tx

Question 31

Bupropion contraindications

Answer 31

hx seizure d/o, MAOi use, eating disorder

Question 32

Bupropion side effects

Answer 32

insomnia and agitation

Question 33

Nicotine gum side effects

Answer 33

TMJ, hiccups, dyspepsia

Question 34

Nicotine gum contraindications

Answer 34

1 month post MI, serious arrythmias, gastric ulcers

Question 35

Nicotine patch side effects

Answer 35

skin irritation, sleep problems if worn at night

Question 36

Nicotine nasal spray side effects

Answer 36

nose/eye irritation and cough

Question 37

Varenicline mechanism

Answer 37

partial a4B2 nicotinic acetylcholine receptor agonist