Alcohol & Substance Abuse

Question 1

3 C’s that indicate alcohol use disorder

Answer 1

control, craving, consequences

Question 2

alcohol is a CNS ___

Answer 2

depressant

Question 3

how does alcohol have stimulatory effects

Answer 3

depression of inhibitory control mechanisms in the brain

Question 4

alcohol targets which 4 systems to exhibit acute and chronic effects

Answer 4

GABA, DA, glutamate, and opioid peptide

Question 5

ordered hierarchy of affected brain areas leading to CNS effects with alcohol

Answer 5

frontal cortex, cortex, cerebellum, diencephalon, brain stem/midbrain

Question 6

sequence of response to alcohol (actual seen effects)

Answer 6

euphoria, impaired thought processes, decreased mechanical efficiency

Question 7

acute effects of alcohol on GABA

Answer 7

enhances

Question 8

acute effects of alcohol on glutamate

Answer 8

inhibits and reduces release

Question 9

acute effects of alcohol on doapmine

Answer 9

increases firing rate

Question 10

chronic effects of alcohol on GABA

Answer 10

reduces effectiveness (down regulates)

Question 11

chronic effects of alcohol on glutamate

Answer 11

increases receptors (upregulates)

Question 12

chronic effects of alcohol on dopamine

Answer 12

withdrawal decreases firing rate/release

Question 13

which 2 organ systems are most affected by chronic alcohol use

Answer 13

CNS & liver

Question 14

potential chronic CNS effects from alcohol

Answer 14

addiction, Wernicke’s, cortical atrophy, dementia

Question 15

potential chronic liver effects from alcohol

Answer 15

steatosis/fatty liver, alcohol hepatitis, cirrhosis, pancreatitis.

Question 16

how is alcohol absorption affected by food? changes in women?

Answer 16

food delays absorption
women have less breakdown before absorption so higher bioavailability

Question 17

distribution of alcohol is equal to

Answer 17

total body water

Question 18

alcohol follows __ metabolism via __ and is primarily __

Answer 18

zero order/capacity limited
alcohol dehydrogenase
oxidized

Question 19

minor signs of alcohol withdrawal occur within

Answer 19

5-10 hours

Question 20

symptoms of minor alcohol withdrawal

Answer 20

autonomic hyperactivity: tremulousness, hyperhidrosis, tachycardia, HTN, GI upset
anxiety, insomnia, vivid dreams, anorexia, diaphoresis, palpitations, HA

Question 21

major alcohol withdrawal effects occur within

Answer 21

12-72 hours

Question 22

symptoms of major alcohol withdrawal

Answer 22

hallucinations, seizures

Question 23

when does delirium tremens occur with alcohol withdrawal

Answer 23

48-96 hours

Question 24

symptoms of delirium tremens in alcohol withdrawal

Answer 24

disordered consciousness, hallucinations, disorientation, tachycardia, HTN, fever, agitation, elevated cardiac indices, hyperventilation, etc.

Question 25

which agents are used for management/prophylaxis of alcohol withdrawal

Answer 25

thiamine, D5 & 1/2NS, multivitamins, diazepam, lorazepam, or other benzos

Question 26

agents used to maintain sobriety from alcohol

Answer 26

naltrexone acamprosate disulfiram baclofen gabapentin topiramate

Question 27

used for alcohol sobriety and blocks opioid receptors, given IM or PO

Answer 27

naltrexone

Question 28

AEs of naltrexone

Answer 28

nausea, HA, dizziness, insomnia, anxiety

Question 29

which alcohol sobriety agent requires being opioid free? for how long

Answer 29

naltrexone, 7-10 days

Question 30

alcohol sobriety agent that levels activity of GABA and glutamate

Answer 30

acamprosate

Question 31

AE of acamprosate

Answer 31

diarrhea

Question 32

alcohol sobriety agent that blocks acetylaldehyde dehydrogenase and the enzymes involved in DA metabolism

Answer 32

disulfiram

Question 33

which alcohol sobriety agent required 12 or more hours abstinent from alcohol to use

Answer 33

disulfiram

Question 34

do not use disulfiram if...

Answer 34

severe cardiac disease/occlusion, hepatic impairment, etc.

Question 35

gold standard for drug tox testing

Answer 35

urine

Question 36

creatinine normalized drug level =

Answer 36

(urine drug level) / (urine creatinine) x 100

Question 37

increased response to a drug with repeated use

Answer 37

sensitization

Question 38

behaviors displayed by a user when drug use ends

Answer 38

withdrawal

Question 39

state of adaptation in which exposure to a drug induces changes that result in diminution of one or more of the drugs effects over time

Answer 39

tolerance

Question 40

primary, chronic, neurobiologic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations

Answer 40

addiction

Question 41

5 C's of drug addiction

Answer 41

chronicity impaired control compulsive use continued use despite harm craving

Question 42

maladaptive pattern of substance use characterized by repeated adverse consequences related to repeated use of it

Answer 42

drug abuse

Question 43

the body adapts to the presence of a drug and needs it for homeostasis

Answer 43

dependence

Question 44

drug classes that are depressants

Answer 44

sedative hypnotics (benzos, barbs) GHB DXM Opiates

Question 45

agent that can be used for a benzo overdose

Answer 45

flumazenil

Question 46

how to manage benzo withdrawal

Answer 46

taper the dose

Question 47

drug that activates opiate receptors on neurons

Answer 47

opiate agonist

Question 48

drug that binds opiate receptors and blocks them

Answer 48

opiate antagonist

Question 49

binds opiate receptors but not to the same degree as full agonists

Answer 49

partial opiate agonist

Question 50

agent used for treatment of opiate overdose

Answer 50

naloxone

Question 51

agents used for opiate withdrawal

Answer 51

methadone, buprenorphine, clonidine, lofexidine

Question 52

agents used for opiate maintenance

Answer 52

methadone buprenorphine

Question 53

agent used for opiate abstinence maintenance

Answer 53

naltrexone

Question 54

dosing scheme of methadone for withdrawal

Answer 54

follows a taper

Question 55

brand names of buprenorphine containing naloxone

Answer 55

suboxone zubsolv (tabs or film) bunavail

Question 56

buprenorphine is a major substrate of

Answer 56

cyp3a4

Question 57

partial opioid agonist binding with high affinity to u and mu receptors causing analgesic effect

Answer 57

buprenorphine

Question 58

which sub abuse drug is preferred for pregnancy? what is the alternative

Answer 58

methadone preferred subutex alternative

Question 59

objective of methadone for sub abuse maintenance

Answer 59

suppress s/s of withdrawal, extinguish craving, block reinforcing effect of illicit opiates

Question 60

method of dosing for methadone maintenance

Answer 60

start low and go slow

Question 61

can patients take methadone doses home?

Answer 61

only after a certain amount of time in the program with other factors considered

Question 62

maintenance buprenorphine forms that are MONTHLY injections

Answer 62

sublocade, brixidi, naltrexone

Question 63

maintenance buprenorphine form that is also a WEEKLY injection (& monthly)

Answer 63

brixidi

Question 64

in order to receive sublocade patients must have received a transmucosal product for at least

Answer 64

7 days

Question 65

BBW for sublocade

Answer 65

serious harm or death given IV due to formation of a solid mass upon contact with bodily fluids

Question 66

brixidi is indicated for patients

Answer 66

receiving buprenorphine currently

Question 67

naltrexone BBW

Answer 67

acute hepatitis, hepatocellular injury

Question 68

how long must you be opiate free to take naltrexone

Answer 68

7-10 days

Question 69

types of stimulant drugs

Answer 69

cocaine amphetamines methamphetamine PCP ketamine

Question 70

types of hallucinogens

Answer 70

LSD Psilocybin mescaline

Question 71

animal tranquilizer responsible for many OD deaths that targets a2 adrenergic receptors with no reversal agent

Answer 71

xylazine