Flashcards in Chapter 12 Deck (50)
What is the primary source of information on the use of illicit drugs, alcohol, and tobacco in the U.S. for 12+
The NAtional survey on drugs Use andhealth (NSDUH), sponsered by Substance abuse and MEntal health service administration (SAMHSA), a division of the Department of HEalth and Human Services (DHHS).
Substance-related disorders are subdivided into two groups according to the new DSM-V (diagnostic and statistical manual of mental disorders, 5th edition)
1. substance use disorders
2. substance-induced disorders.
Define substance use disorder:
patterns of sxs resulting from use of a substance that the individual continues to take, despite experiencing problems as a result.
What are examples of substance-induced disorders?
intoxication, withdrawal, and substance abuse- mental disorders (depression, psychosis, bipolar, axiety, sleep, neurocogniitive, sexual dysfunction, delirium)
The presence and severity of substance use disorders is determined using 11 criterias. What are they.
1. substance is ofeten taken in larger amounts or over a longer period than was intended
2. a persistent desire or unsuccessful effort to cut down or control use
3. a great deal of time is spent in activities necessary to obtain, use, or recover from the effects of substance.
4. craving of a strong desire to urge to use the substance is present
5. recurrent use, resulting in failure to fulfill major role obligations at work, school, or home
6. continued use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance if present.
7. important social, occupational, or recreational acitvities are given up or reduced because of use.
8. recurrent use in situations in which it is physically hazadous occurs
9. use is continued despite knowledge of having a persistent or persisten or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
10. the repsence of tolerance,
11. occurance of withdrawl,
1) need for markedly increased amount of the substance to acheive intozication or desired effect
2) a markedly dimished effect with contined use of the asame amount of the subtance.
a) the characterisitics withdrawl syndrome from the subtance,
b) the substance or closely related substance is taken to relieve or avoid wihtdrawl symtpoms
How does one classify the severity of substance use disorder
1. mild: presence of 2-3 criteria as above
2. moderate: presence of 405 criteria
3. severe: presence of 6 or more criteria
True or False
Alcohol is the 3rd leading cause of preventable deaths in the U.S. ?
YEs, only exceeded by tobacco use and obesity.
Describe the metabolism of alcohol
ethanol > CNS > depressant. [ ] depends on the ^ ETOH.
- 1/4 absorbed into the stomach and rest in small intestine.
- metabolized at 0.5 ounc/hour
- is a depressant, but has byphasic effect. Low levels stimulate nerve cells, high levels depress.
What affects the degree in which the alcohol affects the body?
1. amount consumed
2. concentration of the drink
3. the speed of consumption
4. the presence of absence of food in the stomach
5. level of hydration
7. body type
How does alcohol affect the two type of neuronal receptors: GABA and NMDA?
increases GABA receptor inhibitory acitvity (sedative effects), chronic use creates dependence.
decrease the excitatory activity of the NMDA receptor, (memory formation, complex thiking, and neuronal excitability. chronic use followed by withdrawal can lead to seizures.
Does alcohol increase the release of dopamine?
yes, which causes the increase of pleasure feeling,s. it can also decrease, and people will seek to keep drinking to get the same feeling back.
there are studies being done to assess the dependence of alcohol on the population. What are some epudemiology traits of substance dependence
1. alterations in the metabolism of alcohol via the ALDH enzymes.
2. serotonin dysfunction- implicated as a predoisposing factor
3. rate of alcoholosm are substantially higher in relatives with alcoholics.
What systems in the body are affected by chronic alochol use?
2. Gastrointestinal tract (GI)
3. the cardiovascular
5. immune systems
How does chronic alcohol use affect the GI system?
1. suppressed appetitie
2. inflammation of digestive tract
3. decreased peristalsis and esophageal sphincter tone - GERD.
4. impaired enzyme activity/vitamin absorption
5. gi bleeds
6. chronic pancreatitis.
How does chronic alcohol use affect the liver?
1. hepatic steatosis
2. alcoholic hepatitis
---- mechanisms that damage the liver
1. production of acetaldehydes, free radicals, and cytokines as alcohol metabolizes. Alcohol indcued inflammation and cell dealth > Scarrring.
How does chronic alcoholism affect the cardiovascular system ?
4. A fib, atrial flutter, SVT, and Ventricular arrhthmias and sudden death.
5. ishemich/hemorrhagic stroke d/t HTN, coagulation and A fib.
caused by ethanol or its metabolites acetaldehyde. Increases systemic BP caused by ETOH contribute to myocardial dysfunction.
How does chronic alcohol intake affect the nervouse system
CNS and PNS affected by ETOH-induced alterations in neurotransmitter levels and neuronal cell membrane function.
- Frontal lobe the most affected.
- toxic poluneuropahty is the most frequent CNS concequence, caused by deficiency of thiamine and B vitamins.
how is the immune system affected by excessive alcohol intake?
1. increasing the risk of frequent and severe infections
2. immune system damaged from nutrition deficiency.
3. alcohol impaires B-cell lymphocyte production and function.
4. alcohol increases Hep C replication,
How does excessive chronic alcohol intake affect cancer risk?
1. WHO classified ETOH as a Group 1 carcinogen. Organs most effected: oral cavities, pharynx, esophagus, laryns, stomach, liver, breast/ovary cancer.
- works as a co-carcinogenic by enhancing the carcinogenic effects of other chemicals and by stimulating tumour growth.
- acetaldehyde interferes with DNA replicatin and repair of DNA.
inacitivate the tumourr suppressor gene BRCA1 and increase estrogen responsiveness.
What affects the Effectiveness of alcohol dependence treatement?
1. individual motivation
2. age of onset of abuse
3. duration and extent of abuse
4. compliance with tx
5. successful tx of co-morbud factors.
What is the most common form of alcohol therapy?
Psychoscocial approach- AA
based on the spiritual belief in a higher power, built on a 12 step approach used psychosocial teachniques such as rewards, social support nextworks and role models.
How are moderation programs such as moderation management different from AA?
they do not madate complete abstinence byt allow low-risk drinking.
some success, but abstinence represents the most stable form of remission for most recovering alcoholics.
What are some medications that can be used in the tx of alcohol-dependence?
1. disulfiram- prevents elimination of acetaldehydes. leading to A.E when ETOH is consumed
2. Naltrexone- competitive antagonist for opioid receptors, reduces the craving for alcohol.
3. acamprosate- restores the normal balance between neuronla excitation and inhibition that is altered by chornic alcohol use.
What would an underwriter look for when u/w alcohol use hx?
1. hx of depression/mood disorders
2. sig personal or professional stressors
3. hx of violence
4. hx of another substance use disorder
5. adverse MVR
6. unstable employment record
7. family hx of acohol abuse
8. easy access to alcohol
9. frequent falls or accident
10. participation in high risk behaviours or avocations
11. tobacco use
12. physcical signs and sxs
Which liver enzyme is primarily found in the liver?
ALT is found primarily in the liver, making it a more specific marker for liver injury, but AST is more sensitive marker for alcohol use; and AST/ALT ration greater than two is suspecious for liver disease.
GGT has been found to be elevated in association with steady ETOH use over time, but other factors can cause GGT elevations.
What is the MCV and how is it useful in detecting ETOH use?
its the mean corpuscular volume (MCV) a measure of the size of RBA.
^ [ ] represents macrocytosis, or presence of RBCs. Seen with B12 and folate deficiencies.
there is a relationship between ETOH abuse and macrocytosis. Low levels are likely to be associate to alcohol-related abnormalities.
How are Lipids affected by ETOH?
low/moderate alcohol use raises HDL. however excessive levels increase HDL to outside normal rance.
Trigs, are elevated d/t the fatty liver changes.
uric acid also can be increased.