Chapter 7: Substance Use Disorders

Question 1

How is dopamine thought to cause addictive behavior?

Answer 1

increases desire for stimulus.

Question 2

CAGE questions?

Answer 2

Have you ever tried to Cut down on alcohol intake and not succeeded?

Have you ever been Annoyed about criticism concerning your drinking?

Have you ever felt Guilty about your drinking behavior?

Have you ever had to take a drink as an Eye-opener in the morning to relieve the anxiety and shakiness?

Question 3

What are some lab indices of alcohol use?

Answer 3

• Increased transaminases (AST/ALT) ( typically 2:1 ratio)
• Increased bilirubin
• increased gamma GT (recent alcohol intake)
• Breathalyzer
• blood alcohol level

Question 4

Be able to draw out the stages of behavioral of change.

Answer 4

Refer to diagram

Question 5

Intoxication

Answer 5

impairment due to acute drug use

Question 6

Withdrawal

Answer 6

effects of cessation or reduced drug use once patient develops tolerance for the drug

Question 7

Substance use disorders

Answer 7

continued use of substance despite adverse consequences, negative impact on home, work, and social setting

Question 8

What is tolerance?

Answer 8

diminished efficacy of a drug after repetitive use; requires increased dosage for the same effect

Question 9

Compare and contrast naltrexone and acamprosate?

Answer 9

both effective at reducing cravings, but naltrexone may be used while the patient is still using alcohol

Question 10

What are signs and symptoms of alcohol intoxication?

Answer 10

talkative, gregarious, moody, disinhibited

Question 11

What is the treatment for alcohol intoxication? (if severe)

Answer 11

If severe, consider mechanical ventilation

Question 12

What are the signs and symptoms of withdrawal from alcohol?

Answer 12

tremors, hallucinations, seizures, DTs

Question 13

How would you treat alchol withdrawal?

Answer 13

thiamine, MVI, folic acid, bennzodiazepines

Question 14

Effect of alcohol action on glutamate and GABA?

Answer 14

decreases glutamate and increases GABA

Question 15

What are the signs and symptoms of amphetamine/cocaine (NE releaser) intoxication?

Answer 15

euphoria, hypervigilance, autonomic hyperactivity, weight loss, pupillary dilation, perceptual disturbances

Question 16

How would you treat one with amphetamine intoxication?

Answer 16

antipsychotics and benzos, antihypertensives

Question 17

What are signs of amphetamine withdrawal?

Answer 17

anxiety, tremors, headaches, increased appetite, depression, risk of suicide

Question 18

What are the treatments for withdrawal from amphetamine?

Answer 18

if suicidal, consider antidepressants

Question 19

Where is the location of cocaine/amphetamine activity?

Answer 19

mesolimbic pathway, nucleus accumbens

Question 20

Other names for bath salts?

Answer 20

synthetic cocaine, flakka

Question 21

What are some signs and symptoms of intoxication of bath salts?

Answer 21

• irritabiilty, perceptual disturbances, agitation
• symptoms can last up to 1 week

Question 22

How do you treat bath salt intoxication?

Answer 22

antipsychotics and /or benzos

Question 23

What are signs and symptoms of bath salt withdrawal?

Answer 23

anxiety and depression

Question 24

How do you treat bath salt withdrawal?

Answer 24

if suicidal: consider SSRIs

Question 25

Signs and symptoms of cannabis intoxication?

Answer 25

impaired motor coordination, slowed sense of time, social withdrawal, increased appetite, conjunctival injection, psychosis

Question 26

How do you treat cannabis intoxication?

Answer 26

antipsychotics if needed

Question 27

What are the signs and symptoms of withdrawal from cannabis?

Answer 27

irritability, anxiety

Question 28

Where is the action of cannabis at in the body?

Answer 28

inhibitory G protein, GABA, increased serotonin

Question 29

What are the signs and symptoms of K2/ spice *synthetic marijuana?

Answer 29

perceptual disturbances, agitation, seizures

Question 30

How wold you treat intoxication with K2 spice?

Answer 30

antipsychotics and/or benzodiazepines

Question 31

What are some signs and symptoms of hallucinogens?

Answer 31

ideas of reference, perceptual disturbances, impaired judgement, dissociative symptoms

Question 32

How do you treat hallucinogens intoxication?

Answer 32

* place in a quiet room * antipsychotics, benzos

Question 33

Where is the location of action of hallucinogens?

Answer 33

stimulate glutamate and serotonin

Question 34

What are some signs and symptoms of inhalant intoxication?

Answer 34

* belligerence, apathy, aggression, impaired judgement, stupor or coma * nasal crusting, rash, drunken appearance, dilated pupils * use can be fatal * Parkinsonism has been associated with huffing

Question 35

What is the treatment for intoxication with inhalants?

Answer 35

antipsychotics

Question 36

What are the signs and symptoms of withdrawal from inhalants?

Answer 36

nausea, excessive sweating, muscle cramps, headaches, chills, agitation, shaking and hallucinations

Question 37

What is the treatment of withdrawal from inhalants?

Answer 37

benzodiazepines, antipsychotics

Question 38

What is the location of inhalant in the body/ site of action?

Answer 38

GABA, cerebellum

Question 39

What are the signs and symptoms of using opiates?

Answer 39

apathy, dysphoria, pinpoint pupils, drowsiness, slurred speech, coma, death

Question 40

What is the treatment for opiate intoxication?

Answer 40

naloxone

Question 41

What are the signs and symptoms of opiate withdrawal?

Answer 41

fever, chills, runny nose, diarrhea, muscle spasms, cramps

Question 42

How would you treat those withdrawing from opiates?

Answer 42

clonidine, methadone, buprenorphine

Question 43

Where is the location of action of opiates in the body?

Answer 43

* mu, kappa, and delta receptors * nucleus accumbens

Question 44

What are the signs and symptoms of using Krokodil?

Answer 44

skin, blood vessel bone, and muscle damage leading to gangrene, phlebitis, and sepsis

Question 45

Other names for Krokodil?

Answer 45

desomorphine *synthetic opiates

Question 46

Treatment for intoxication of Krokodil?

Answer 46

symptomatic

Question 47

Signs and symptoms of PCP?

Answer 47

belligerence, psychomotor, agitation, violence, nystagmus, hypertension, seizures

Question 48

PCP stands for what?

Answer 48

phencyclidine

Question 49

How would you treat someone with PCP intoxication?

Answer 49

* place in a quiet room * antipsychotics/ benzodiazepines

Question 50

What are the signs and symptoms of PCP withdrawal?

Answer 50

* elevated body T, seizures, muscle breakdown * muscle twitching, agitation, hallucinations

Question 51

How do you treat withdrawal of PCP?

Answer 51

benzodiazepines, antipsychotics

Question 52

What is the location of action of PCP?

Answer 52

antagoinist of N-methyl D-aspartate glutamate receptors

Question 53

What are the signs and symptoms of intoxication with anabolic steroids?

Answer 53

irritability, aggression, mood instability, psychosis

Question 54

How do you treat intoxication with anabolic steroids?

Answer 54

administer antipyschotics

Question 55

What are the signs and symptoms of anabolic steroid withdrawal?

Answer 55

depression, headaches, anxiety

Question 56

How do you treat withdrawal from anabolic steroids?

Answer 56

if depressed consider SSRIs

Question 57

Where is the action of drugs when one is treated with anabolic steroids?

Answer 57

may activate dopamine and serotonin release

Question 58

Other names for ecstasy?

Answer 58

MDMA, Molly, E, X

Question 59

What are the signs and symptoms of ecstasy intoxication?

Answer 59

euphoria, mile hallucinations, visual disortions, enhanced sensations, hyperthermia, bruxism, autonomic hyperactivity, seizures, dry moth

Question 60

How do you treat intoxication with ecstasy?

Answer 60

dantrolene, benzodiazepines, hydration

Question 61

What are the signs and symptoms of withdrawal from ecstasy?

Answer 61

depression, anxiety, and panic attacks

Question 62

How do you treat withdrawals from ecstasy?

Answer 62

SSRIs

Question 63

What is the location of the effects of X?

Answer 63

* increases serotonin and dopamine * affects hypothalamus (drinking behavior/body temp); motor neurons of spinal cord (muscle spasms and jaw clenching)

Question 64

What is the addiction pathway named?

Answer 64

mesolimbic dopamine pathway or Nucleus Accumbens pathway (NAc) pathway

Question 65

Draw out a schematic for the NAc pathway.

Answer 65

refer to page 84

Question 66

Some features of child with fetal alcohol syndrome?

Answer 66

* small head * low nasal bridge * epicanthal folds * short nose * flat midface * thin upper lip * smooth philthrum * Underdeveloped jaw

Question 67

Signs and Symptoms of benzodiazepine intoxication.

Answer 67

* slurred speech, confusion, memory deficits, falls * respiratory depression (rare)

Question 68

Treatment for benzodiazepine intoxication?

Answer 68

supportive flumazenil or mechanical ventilation if needed

Question 69

Withdrawal signs and symptoms of benzodiazepine use.

Answer 69

* increased anxiety, tremors * insomnia * seizures

Question 70

Where is the location/ effect of drug action of benzodiazepine use?

Answer 70

GABA

Question 71

What are the signs and symptoms of barbiturate intoxication?

Answer 71

* Restlessness, agitation, insomnia, N/V, anxiety * Tremors, seizures, hallucination, increased heart rate * Respiratory depression

Question 72

How do you treat intoxication with barbiturates?

Answer 72

supportive mechanical ventilation

Question 73

What are the signs and symptoms of withdrawal from barbiturates?

Answer 73

* anxiety, depression * cognitive impairment * memory deficits, lack of attention * seizures and delirium

Question 74

Treatment for barbiturate withdrawal?

Answer 74

phenobarbital

Question 75

Location/ effect of drug action of barbiturates?

Answer 75

GABA