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Flashcards in Addiction III Deck (21)
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1

describe substance intoxication

  • the development of a reversible substance-specific syndrome due to recent ingestion of a drug
  • the syndrome is due to drug effects on the CNS and causes significant maladaptive behavioral or psychological changes

2

describe DSM-5 criteria for alcohol intoxication

  • a significant maladaptive psychological/behavioral change (e.g. impaired judgement) PLUS ≥ 1 of the following:
    • slurred speech
    • incoordination
    • unsteady gait
    • nystagmus
    • impaired attention or memory
    • stupor or coma

3

describe substance withdrawal

  • the development of a substance-specific syndrome following cessation of a substance after heavy/prolonged substance use
  • the syndrome causes significant distress or impairment in functioning 

4

describe acute withdrawal effects

  • withdrawal symptoms tend to be opposite of intoxication
  • symptoms usually appear within 72 hours after reduction of drug use and may last several weeks
  • when the drug history of a patient is unknown, withdrawal effects can be mistaken for a medication side effect or undiagnosed medical complication

5

describe diagnostic criteria for substance use disorder

  • a maladaptive pattern of substance use as manifested by ≥ 2 of the following 11 symptoms in a 12 month period:
    • impaired control
      • taken in larger amount that intended
      • persistent unsuccessful attempts to cut back
      • time consuming (obtaining, using, recovering)
      • cravings or strong desire for the substance
    • social impairment
      • failure to fulfill major role obligations (e.g. work)
      • social/interpersonal problems related to drug
      • reduction or important activities
    • risky use
      • use in physically hazardous situations
      • use despite having physical/psychological probem related to substance
    • pharamacological criteria (physical dependence)
      • tolerance 
      • withdrawal upon cessation
      • if tolerance and withdrawal are the only 2 symptoms after appropriate use of prescribed drug, then SUD not diagnosed

6

describe controlled (scheduled) substances

  • controlled drugs are placed in one of 5 distinct categories (schedules) by the DEA based on its medical usefulness and its "harm risk"
    • potential for abuse
    • likelihood of causing addiction
  • I = most harmful, V = least harmful
  • doctor cannot prescribe drugs in Schedule I

7

describe schedule I and schedule II drugs

  • Schedule I: drugs with a high harm risk and NO safe, accepted medical use
    • examples: heroin, marijuana, LSD, ecstasy
  • Schedule II: drugs with a high harm risk but with safe and accepted medical use; these drugs are highly addictive
    • examples: most opioids (morphine) and stimulants (methylphenidate) and some barbituates 

8

describe schedule III, IV and V drugs

  • schedule III, IV, V: drugs with harm risk less than schedule II drugs with safe and accepted medical uses in the US
  • examples:
    • schedule III: several barbituates, anabolic steroids, codeine (Tylenol III), dronabinol (synthetic marijuana)
    • Schedule IV: most benzos (diazepam)
    • Schedule V: liquid codeine preparations (Robitussin)

9

give examples of sedatives (CNS depressants)

  • alcohol
  • benzodiazepines (e.g. diazepam, lorazepam)
  • barbituates (e.g. phenobarbital, secobarbital)
    • barbituates have a low safety margin and high abuse potential

10

describe symptoms of sedative intoxication

suppression of function

  • intoxication
    • sedation, sleepiness, decreased anxiety
    • disinhibition, impaired judgement
    • slurred speech, incoordination
    • stupor or coma
    • respiratory depression
  • OD is potentially lethal

11

describe other potential affects of sedatives

  • anticonvulsant and anesthetic effects
  • disrupted sleep architecture resulting in unrefreshing sleep
  • alcohol-related brain damage (ARBD) (e.g. Korsakoff's amnesia)
  • cross tolerance to other sedatives 

12

describe withdrawal from sedatives

  • withdrawal
    • agitation, insomnia, anxiety
    • ANS hyperactivity
    • nausea or vomiting
    • hand tremor
    • transient hallucinations 
    • seizures
  • the ANS hyperactivity can be fatal

13

describe hallucinations from sedative withdrawal

  • hallucinations
    • can occur in any sensory modality, including tactile:
      • formication: sensation of bugs crawling under the skin
    • can occur as the main symptoms of withdrawal without physical symptoms (alcohol hallucinosis)

14

describe delirium tremens (DTs) as seen in sedative withdrawal

  • a delirium (a confusional state) may also occurs as part of sedative withdrawal:
    • severe and uncommon
    • seen after chronic heavy use of a sedative (esp. alcohol)
    • associated with high mortality rate

15

describe disulfiram (pharmacological treatments for alcohol withdrawal)

  • disulfiram (antabuse) inhibits the enzyme that breaks down acetaldehyde
    • after alcohol use, acetaldehyde accumulation causes a toxic reaction (e.g. nausea) for 30-60 min
    • USE: due to poor compliace, disulfiram is given only short-term if person will be in a high risk situation; knowing about toxic effect is disincentive to take first drink

16

describe naltrexone (Revia) 

  • naltrexone (Revia): an opioid receptor blocker that reduces the pleasurable effects of alcohol
  • USE: this drug helps a person stop drinking after a few drinks when a "slip" occurs (i.e. this helps to avoid a full relapse)

17

describe acamprosate (Campral)

  • acamprosate (Campral): an NMDA receptor antagonist that reduces the anhedonia or protracted abstinence, and thereby decreases the craving for alcohol
  • USE: because acamprosate causes the person to feel euthymic, it helps to prevent the "slip" from happening in the first place

18

describe inhalants (CNS depressant)

  • substances with psychoactive vapors (e.g. glues, paints)
    • similar to sedative intoxication
    • teenage experimentation is common
    • signs: rashy, red and runny nose, chemical smell, face discoloration
    • associated with morbidity (organ failure/mortality); sudden sniffing death syndrome

19

list the major stimulants

  • amphetamines
    • e.g. methamphetamine, MDMA, Adderall
  • amphetamine-like drugs
    • methylphenidate (Ritalin)
  • cocaine

20

describe intoxication by major stimulants

  • psychological 
    • euphoria and grandiosity
    • psychomotor acceleration and stereotypies
    • paranoia and hallucinations
  • physical
    • elevated heart rate & bp (life-threatening)
    • appetite loss and insomnia
    • mydriasis 
    • seizures

21

contrast methamphetamine and cocaine

  • both are especially addictive due to direct action on the reward pathway, producing an intense "rush" followed by euphoria
  • effects of cocaine shorter lasting than meth: 
    • half life = 30 min (cocaine) vs 12 hrs (meth)
    • cocaine use is thus more frequent
  • physical changes with methamphetamine such as meth mouth and meth face