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Charis & Ellie VS Psych > Addiction, alcohol and Substance Misuse > Flashcards

Addiction, alcohol and Substance Misuse Flashcards

(54 cards)

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1
Q

What is the reward pathway?

A

Mesolimbic pathway

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2
Q

What is amotivating signal?

A

Dopaminergic activity in mesolimbic pathway

-It incentivizes behaviour and is involved in normal pleasurable experiences

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3
Q

What activates mesolimbic pathway?

A

All drugs of abuse, therefore person can develop a want to seek these drugs continually

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4
Q

Concept of tolerance?

A

Repeated exposure to drug leads to down regulation of dopamine receptors meaning more is needed to get same response

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5
Q

What ‘puts brakes on’ mesolimbic pathway?

A

Prefrontal cortex, however it is not fully mature until 20s so is vulnerable whilst person is developing

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6
Q

What is dysfunctional in addicted people?

A

Prefrontal cortex

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7
Q

What other structures are implicated in development of addiction?

A

Hippocampus

Amygdala

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8
Q

Explain how stress plays a role in addiction?

A

Chronic stress leads to dampening of dopaminergic activity through the down regulation of D receptors, which reduces sensitivity to normal rewards encouraging exposure to highly rewarding behaviours

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9
Q

Criteria for dependance?

A
  • 3 or for at least 1 month:
  • Sense of compulsion
  • Craving
  • Physiological withdrawal
  • Preoccupation with substance use
  • Persistent use despite harmful consequences
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10
Q

What can criteria for dependence be used for?

A

Any addiction

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11
Q

What is hazardous drinking?

A

-Pattern of alcohol consumption that increases the harmful consequences for user

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12
Q

What is hazardous drinking defined as in women?

A

> 14 units but <35 units a week

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13
Q

What is hazardous drinking defined as in men?

A

> 14 units but <50 units a week

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14
Q

What is harmful drinking?

A

Pattern of alcohol consumption that is causing mental or physical damage

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15
Q

What is harmful drinking defined as in women?

A

> 35 units a week

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16
Q

Harmful drinking in men defined as?

A

> 50 units a week

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17
Q

Criteria for alcohol withdrawal?

A

Any 3 of:

  • Tremor of outstretched hands, tongue or eyelids
  • Sweating
  • Nausea, retching or vomiting
  • Tachycardia/HT
  • Anxiety
  • Psychomotor agitation
  • Headache
  • Insomnia
  • Malaise or weakness
  • Transient visual, tactile or auditory hallucinations or illusions
  • Generalized tonic clonic seizures
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18
Q

What is delirium tremens?

A

-Most serious withdrawal state- medical emergency

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19
Q

When does delirium tremens occur?

A

1-3 days after alcohol cessation

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20
Q

Presentation of delirium tremens/

A
  • Disorientation
  • Agitated
  • Marked tremor
  • Tactile visual hallucinations (insects etc)
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21
Q

Signs of delirium tremens?

A
  • Sweating
  • Tachycardia
  • Tachypnoea
  • Pyrexia
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22
Q

How can delirium tremens be treated?

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A
  • Correct dehydration
  • Electrolyte abnormalities and thiamine replacement
  • Give chlordiazepoxide
23
Q

What does chlordiazepoxide help with?

24
Q

What is included in Wernicke Korsakoff Syndrome?

Study These Flashcards
A

Wernicke’s encephalopathy

Korsakoff syndrome

25
What are WE and KS bothe due to?
Thiamine deficiency
26
What causes Wernicke's encephalopathy?
Acute thiamine deficiency
27
What does acute thiamine deficiency result in?
Cytotoxic oedema in mamillary bodies
28
Signs/symptoms of Wernicke's encephalopathy?
Ocular dysfunction Ataxic gait Acute confusion
29
Prevent progression of Wernicke's syndrome to what and by doing what?
To Korsakoff's By thiamine replacement and early recognition
30
What is Korsakoff's due to
Chronic thiamine deficiency
31
What is there in Korsakoff's?
Cerebral atrophy
32
How does Korsakoff's present?
Profound anterograde and retrograde amnesia - Confabulation to fill in memory gaps - Generally lacks insight
33
Key treatment for Korsakoff's?
Abstinence and nutrition but generally chances of recovery are low
34
Diagnostic markers of alcohol misuse in recent weeks?
- Elevated GGT | - Elevated mean corpuscular volume
35
Managemnet of alcohol withdrawal?
- Reassure - Long acting Benzos alleviate symptoms - Vitamin supplementation - Thiamine prophylactically
36
Why are long acting benzos used in alcohol withdrawal?
To help alleviate symptoms | -They are cross tolerant with alcohol due to action on GABA receptors, usually chlorodiazepoxide is used
37
What happens to dose of chlordiazepide over 7 days?
Reduced
38
Relapse prevention for alcohol dependence syndrome?
- CBT - Motivational enhancement therapy - 12 step facilitation therapy - Behavioural self control therapy - Family and couple therapy
39
Benzos and alcohol dependence syndrome?
-No place for benzos post detox
40
1st line pharmacological treatment for alcohol dependence syndrome?
Naltrexone: | -Opioid antagonist that reduces reward for alcohol
41
Other pharmacological treatments for alcohol dependence?
- Acomprosate reduces cravings | - Disulfiram inhibits alcohol dehydrogenase leading to accumulation of acetaldehyde
42
Side effects of disulfiram?
If alcohol is ingested it causes flushed skin, tachycardia, N&V, arrhythmias and hypotension
43
Pharmacological management of opioid use?
Naloxene -Methadone or buprenorphine: heroin substitute for withdrawal
44
Why are methadone and buprenorphine good?
Methadone: orally Buprenorphine: sublingual Therefore less risk of non-sterile needles and also because taken once daily there are less peaks in opioid levels
45
Tools used for alcohol screening?
FAST AUDIT (Alcohol use ID test) CAGE (Screens for dependence)
46
Physiology of alcohol?
Alcohol inhibits action of excitatory NMDA glutamate controlled ion channels -Alcohol potentiates actions of inhibitory GABA type A controlled ion channels
47
Usual onset of delirium tremens?
Insidious with night time confusion
48
Dopamine release effects?
- Ability to update information within prefrontal cortex - Ability to select new goals - Ability to avoid compulsive repetition behaviour
49
Who gets addiction?
About 50% is heritable
50
Most common opioid?
Heroin (brown powder)
51
What are natural opioids?
Morphine Cocaine Natural from opium poppy
52
Semi synthetic opioids?
Hydrocodone | Hydromorphone
53
Fully synthetic opioids?
Methadone | Tramadol
54
Indications for when buprenorphine should be taken?
In front of community pharmacist

Charis & Ellie VS Psych (23 decks)

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