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DT2 Exam 2 > Addiction > Flashcards

Addiction Flashcards

1
Q

addiction in women

A

more likely to become addicted in less time

develop larger habits

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2
Q

MOA opioids

A

stimulate the mu receptors in CNS

cause euphoria, apathy, psychomotor retardation, analgesia, respiratory depression, constipation, miosis

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3
Q

clinical effects of opiates

A

drowsy
slurred speech
impaired attention
impaired memory

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4
Q

tolerance and dependence of opiates

A

after 3 weeks of daily use

decreased interval and increase dose to achieve euphoria

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5
Q

symptoms that tolerance does not develop to

A

miotic effects
constipation
respiratory depression

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6
Q

signs of overdose to opiates

A 
coma
circulatory collapse
pinpoint pupils
bradycardia
hypothermia
severe respiratory depression
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7
Q

withdrawal from opiates

A 
can occur 6-48 hours depending on agent used 
yawning
piloerection
lacrimation
rhinorrhea
perspiration
tremor
restlessness
myalgia
muscle spasms
anorexia
N/V
abdominal cramps, diarrhea
fever/chills/flush
can last as long as 10 days 
PE-hypertension, hyperventilation, tachycardia
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8
Q

timeline of withdrawal

A

3-4 hours after last dose-drug craving, anxiety, fear of withdrawal
8-14 hours after last dose-anxiety, restlessness, insomnia, yawning, rhinorrhea, lacrimation, diaphoresis, stomach cramps, mydriasis
1-3 days after last dose-tremor, muscle spasm, vomiting, diarrhea, hypertension, tachycardia, fever, chills, piloerection

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9
Q

treatment of withdrawal

A

any opioid

do not give any with antagonist properties-will precipitate immediate withdrawal

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10
Q

perinatal complications of opiates

A 
intrauterine growth restriction
respiratory distress
preterm labor and delivery
abruption
fetal death
decreased head circumference
depressed Apgar scores
meconium staining of amniotic fluid
chorioamnionitis
neonatal absistence syndrome
opioids are not teratogenic
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11
Q

concurrent complications of opioid use in pregnancy

A 
hep C
HIV/hep B
legal
abuse
psychiatric comorbidities
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12
Q

management of opioids in pregnancy

A

avoid withdrawal

can be life threatening to fetus-hypoxia, bradycardia, intrauterine demise

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13
Q

treatment of choice for opiate addicted pregnant women

A

methadone

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14
Q

outcomes of methadone maintenance

A

improve perinatal outcome
avoidance of IV drug-decrease HIV, hep, bacterial endocarditis
minimize drug seeking behaviors-prostitution, STDs

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15
Q

buprenorphine vs methadone

A

fewer withdrawal symptoms
lower potential for respiratory depression
methadone more effective for polypharmacy

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16
Q

advantages of buprenorphine treatment

A

gestation was longer
birthweight was higher
lower incidence of NAS
shorter hospital stay

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17
Q

contraindication in MARC

A

long standing benzodiazapine addiction

monitored withdrawal prior to initializing buprenorphine

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18
Q

treatment of neonatal abstinence syndrome

A

supportive therapy

diazepam, chlorpromazine, phenobarbital, methadone

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19
Q

CNS symptoms of NAS

A 
disturbed sleep patterns
hyperactivity
hyperreflexia
tremors
increased muscle tone
myoclonic jerk
shrill cry
convulsions
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20
Q

metabolic symptoms of NAS

A 
fever
hypoglycemia
mottling
sweating
yawning
vasomotor instability
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21
Q

respiratory symptoms of NAS

A 
nasal flaring
nasal stuffiness
sneezing
tachypnea
yawning
hiccups
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22
Q

GI symptoms of NAS

A

excessive sucking
poor feeding
vomiting
diarrhea

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23
Q

drugs that cause withdrawal

A 
opiates
nicotine 
irritability from marijuana
alcohol
delayed withdrawal from benzos or psychotropic medications
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24
Q

drugs in WV

A 
buprenorphine prominent
methadone decreasing in frequency 
marijuana
prescription opiates decreasing
heroin increasing
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25
Q

hallmark of neonatal withdrawal

A

jitteriness

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26
Q

endogenous opiates

A

endorphins, enkephalins, dynorphins

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27
Q

locus coeruleus

A

norepinephrine is synthesized

physiological response to stress and pain

28
Q

opates effect on locus coeruleus

A

decrease cAMP
increase K efflux
decrease Ca
decrease NE release

29
Q

opiate withdrawal pathogenesis

A

inhibiting effect is gone

supranormal increase in NE

30
Q

disuse hypersensitivity

A

increase in receptors

due to depressed neural system now hypersensitive to stimulus

31
Q

alternate pathways

A

drugs may depress primary neural pathway
alternate pathway now becomes prominent
when drug removed both operate in additive fashion

32
Q

preferred testing for withdrawal

A

umbilical cord-looking at tissue
reflects in utero exposure comparable to meconium screening
fewer false negatives than urine analysis

33
Q

opioid agents used to treat NAS

A

morphine sulfate
neonatal opium solution
methadone
buprenorphine

34
Q

adjunct agents used to treat NAS

A

phenobarbital

clonidine

35
Q

morphine

A

full mu opiate receptor agonist

metabolized in liver then renally excreted

36
Q

methadone

A

full mu opiate agonist

metabolized extensively by hepatic N-demethylation

37
Q

buprenorphine

A

partial mu agonist-exhibits ceiling effect

metabolized by N-dealkylation to norbuprenorphine and glucuronidation

38
Q

reasons to initiate treatment

A

vomiting, diarrhea, dehydration, poor weight gain

39
Q

phenobarbital

A

GABA agonist

preferred adjunct when polysubsance abuse with benzodiazepines

40
Q

clonidine

A

alpha 2 adrenergic receptor agonist

lower height or arousal and excitability

41
Q

CHH NAS

A

observe for 5-7 days
utilize Finnegan scoring system
methadone weaning protocol
clonidine as adjunct

42
Q

adolescent substance abuse

A

much quicker interval from Rx to IV drug use

43
Q

youth drug overdose

A

males 2.5x more likely to die

44
Q

social warning signs of drug abuse in adolescents

A

school performance/delinquency
sexual practices
neurodevelopment/cognition

45
Q

medical warning signs of drug abuse in adolescents

A

abscesses/skin infections
hep C/HIV
mental health concerns

46
Q

THC/CBD

A

hemp producing lower THC ratio

47
Q

role of endocannabinoids

A

regulation of movement, memory, appetite, body temperature, pain, immunity

48
Q

CB1

A

CNS
neuronal proliferation
migration
synaptogenesis

49
Q

CB2

A

immune cells
retina
spleen

50
Q

pharmacology of marijuana

A 
psychoactive substance
lipophilic
small molecular size
easily crosses cellular barriers
rapidly absorbed in the bloodstream
51
Q

MOA marijuana

A

THC decreases inhibitory GABA release
less refractory period between neuronal depolarization
allows neurons to fire quickly
induces apoptosis

52
Q

Random-patient gains weight and complains about not being able to get as high as s/he used to. Why? Also what would be a concern in telling them to lose weight?

A

leptin reduces level of endocannabinoids
letpin from fat to decrease hunger (activates POMC/CART like cocaine)
THC stored in fat so as they lose the weight, it will go into the blood stream-like being high again and likely to cause + drug screens

53
Q

definition of addiction

A

primary, chronic disease of brain reward, motivation, memory and related circuitry
characteristic biological, psychological, social, and spiritual manifestation
pathologically pursuing reward, relief by substance use
inability to abstain

54
Q

characterizations of addiction

A 
inability to consistently abstain
impairment of behavioral control
craving
diminished recognition of significant problems
dysfunctional emotional response
55
Q

addiction as chronic disease

A

similar relapsing rates (40-60%)

56
Q

drug overdoses M vs. F

A

males more common

57
Q

drug overdose by age

A

highest 30-39

58
Q

predictors of effective treatment

A

readily available and affordable
plan must be modified to meet changes
remain in treatment for adequate time
counseling and treatment of co-occurring mental illness

59
Q

medication assisted treatment principles

A

must work through same receptors
short term prevention of withdrawal
long term control of cravings
allow addict to regain control of their lives

60
Q

benefits of medication assisted treatment

A 
increased retention in treatment
reduced drug use
increased rate of abstinence from illicit drugs 
decreased criminal activity
decreased infectious disease transmission
decreased OD rates
NAS easier to treat
restore familial relationships
return as productive members of society
61
Q

naltrexone

A

opioid antagonist
not addictive, no dependency, no sedation
used for alcoholism
must be drug free prior to starting

62
Q

phase one of treatment

A

induction

finding the right dose

63
Q

phase two of treatment

A

maintenance

providing stability

64
Q

phase three of treatment

A

detoxification

weaning patient to lower dose

65
Q

components of comprehensive program

A 
physician
group therapy
individual therapy
primary care
specialty care
socio/spiritual recovery
66
Q

short comings of MAT

A 
low to medium intensity
treats opioid dependence
difficulty controlling chronic pain
street market for buprenorphine
difficult treating co-morbid anxiety 
limited naltrexone therapy

DT2 Exam 2 (6 decks)

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