Addiction and Substance Misuse

Question 1

List the ICD-10 criteria for dependence

Answer 1

Strong desire to take the substance
Difficulty in controlling substance use
Withdrawal state
Neglect other pleasures
Persistence despite evidence of harm

Question 2

Which dopaminergic pathway, associated with reward, is involved in addiction?

Answer 2

Mesolimbic pathway

Question 3

What is the effect of dopamine release upon behaviour?

Answer 3

Motivates us to repeat behaviour

Involved in pleasurable experience

Question 4

What effect do drugs like amphetamine and cocaine have on dopamine?

Answer 4

Increase release of dopamine

Question 5

If dopamine receptors are repeatedly stimulated, what can eventually develop?

Answer 5

Tolerance

due to downregulation/decreased sensitivity of receptors

Question 6

What is the consequence of developing tolerance in addiction?

Answer 6

Threshold for feeling reward is increased; normal pleasurable experience don’t evoke enough of a reward response

Question 7

Frontal lobe areas associated with executive functioning develop before those areas associated with emotion. True/False?

Answer 7

False

Other way around!

Question 8

Which parts of the brain are associated with memory learning?

Answer 8

Amygdala

Hippocampus

Question 9

Which parts of the brain are associated with inhibitory motor control?

Answer 9

Prefrontal cortex

Anterior cingulate gyrus

Question 10

Which parts of the brain are associated with motivation/drive?

Answer 10

Orbito-frontal cortex

Subcallosal cortex

Question 11

Which parts of the brain are associated with reward?

Answer 11

Nucleus accumbens
Ventral pallidum
[mesolimbic pathway]

Question 12

How many ml of alcohol = 1 unit?

Answer 12

10ml

Question 13

What is the equation for calculating no. of units of alcohol?

Answer 13

[% x volume]/10

Question 14

What are the current guidelines for low risk alcohol drinking?

Answer 14

No more than 14 units per week, ideally spread over 3 or more days

Question 15

What are the parameters of increased risk alcohol drinking?

Answer 15

Regular consumption of 15-35 units a week

Question 16

What are the parameters of high risk alcohol drinking?

Answer 16

Regular consumption of over 35 units a week

Question 17

Which marker can be an indicator of alcoholic liver injury?

Answer 17

GGT

Question 18

Which marker identifies men who have been drinking 5+ units of alcohol a day for a year or more?

Answer 18

Carbohydrate deficient transferin

Question 19

What is the most common cause of a raised MCV?

Answer 19

Alcoholism

Question 20

What effect does alcohol have on excitatory glutamatory ion channels?

Answer 20

Inhibits action of glutamate receptors

Question 21

What effect does alcohol have on inhibitory GABA ion channels?

Answer 21

Potentiates action of GABA receptors

Question 22

Alcohol withdrawal leads to less/more glutamate activity and less/more GABA activity

Answer 22

Alcohol withdrawal leads to more glutamate activity and less GABA activity

Question 23

List clinical features of alcohol withdrawal

Answer 23

Restlessness, tremor
Sweating
Anxiety
Loss of appetite and sleep
Tachycardia
Seizure, delirium tremens

Question 24

Which drugs are used to manage alcohol withdrawal?

Answer 24

Benzodiazepine

Thiamine (parenteral)

Question 25

Which drug is the 1st line agent for alcohol detox relapse prevention?

Answer 25

Naltrexone

Question 26

Which drug should be started as soon as alcohol detox is complete?

Answer 26

Acamprosate

Question 27

Which alpha-2-receptor agonist can help with opiate detox?

Answer 27

Lofexidine

Question 28

What are the 2 main detox agents used for opiate misuse?

Answer 28

Methadone | Bruprenorphine

Question 29

What effect does mephedrone have on neurotransmitters?

Answer 29

Inhibits reuptake of serotonin, noradrenaline and dopamine

Question 30

What are the user effects of taking mephedrone?

Answer 30

Feeling of ecstasy, openness | Increased confidence and desires

Question 31

Taking mephedrone increases susceptibility to ladybird attacks. True/False?

Answer 31

True

Question 32

List the main categories of legal highs

Answer 32

``` Stimulants Empathogens Psychedelics Dissociatives Cannabinoids Depressants Opioids ```

Question 33

What is sympathetic toxidrome and which drug is it related to?

Answer 33

Amphetamines | Range of toxic autonomic effects e.g. tremor, sweating, pain, confusion, vomiting etc.

Question 34

What is serotonin syndrome?

Answer 34

Excess serotonin causes hypomania, agitation, myoclonus and hyperactive autonomic state

Question 35

Which drugs can cause serotonin syndrome?

Answer 35

``` Antidepressants Cough medication Tramadol Antibiotics Herbal products ```

Question 36

What effect on neurotransmission does methamphetamine have?

Answer 36

Inhibits reuptake of noradrenaline and dopamine

Question 37

Synthetic cannabinoids can be more potent than cannabis. True/False?

Answer 37

True | 800x more potent!

Question 38

Which legal high causes a detachment from reality, including depersonalisation and derealisation? [dissociative]

Answer 38

Ketamine