Exam 1: Substance Abuse Disorder

Question 1

Sensitization

Answer 1

increased response to a drug with repeated use

Dose vs response: shift left

ex: cocaine

Question 2

Tolerance

Answer 2

adaptation, effect diminishes over time

dose vs response: shift right

Question 3

2 types of tolerance

Answer 3

1. metabolic-faster
   (induction by liver enzymes)
2. cellular - over time (receptor downregulation)

Question 4

Acute vs protracted tolerance

Answer 4

acute = after a single administration

Question 5

Cross tolerance

Answer 5

tolerance to one drug leads to tolerance of others in the same class
ex: hydrocodone and oxycodone

Question 6

Withdrawal

Answer 6

behaviors exhibited when drug use ends, typically opposite of drug effect

Question 7

Induction of withdrawal

Answer 7

abrupt d/c
rapid dose reduce
decrease blood level of drug
giving antagonist

Question 8

Addiction

Answer 8

primary chronic, neurobiological disease + genetic/psychosocial/environmental factors

Question 9

5C’s of addiction

Answer 9

Chronicity
Control (impaired)
Compulsive use
Continued use despite harm
Craving

Question 10

Drug abuse

Answer 10

maladaptive patterns of substance use w/ repeated adverse consequences related to repeated use

Question 11

Dependence

Answer 11

body adapts to presence of drug - needs it to maintain homeostasis

Question 12

Testing for drugs

Answer 12

Gold standard: urine (1-30days)
Hair: 7days - 3 months
Blood: 0-3 days (unless long half life)
Saliva: same as blood

Question 13

Testing: drug interactions

Answer 13

Synthetic opioids = false negative for opiates
- methadone
- fentanyl
Some benzos (clonazepam) = false negative
OTC meds (sudafed) = false positive for amphetamine

Question 14

short half life urine toxicology

Answer 14

meth
lorazepam
cocaine
heroin
(few days)

Question 15

long half life urine toxicology

Answer 15

buprenorphine
cannabinoids
diazepam
methadone
(several days-few weeks)

Question 16

Creatinine Normalizing equation

Answer 16

Creatinin - normal drug level = urine drug/urine creatinine *100

Question 17

Repeated self administration

Answer 17

1. pleasure
2. classical conditioning
3. incentive salience (craving, DA release from cues)

Question 18

Risk factors for SuD

Answer 18

-dysfunctional childhood/abuse
-ADHD, school problems, conduct disorder
- early onset SU (before 14)
- personal hx of a SUD
- genetic predisposition (positive family hx)

Question 19

Young patients & opioid use

Answer 19

• marijuana can be used as marker for those at risk for rx misuse
• use of opioids before high school graduation is associated with 33% increase in risk of later opioid misuse

Question 20

Hair testing pro/con

Answer 20

pro: long observation period
Observable
con: need 150 strands, not many labs do this
- nape = recent
- crown = older
- scalp = most reliable

Question 21

Urine testing pro/con

Answer 21

pro: reasonable detection limits, need creatinine normalize to follow levels
Limits: can falsify or alter sample, observeable

Question 22

Blood testing pro/con

Answer 22

pro: can use if cant get urine/saliva
con: short detection time, more invasive, few labs do this

Question 23

saliva testing pro/con

Answer 23

pro: can use if cant get urine/saliva
con: short detection time,

Question 24

Benzodiazepines

Answer 24

Depressant
sedative hypnotics
potentiate GABA

Question 25

Benzo intoxication

Answer 25

decreased BP respiratory depression memory impairment (ROOFIE, date rape drug flunitrazepam) poor coordination sleepiness, slurred speech GI issues Urinary retention

Question 26

Benzo withdrawal

Answer 26

aniety insomnia restlessness muscle tension irritability blurred vision diaphoresis nightmares depression paranoia hallucinations seizures psychosis

Question 27

Benzo overdose treatment

Answer 27

Flumazenil contraindicated for TCA overdose or benzo dependent patients (withdrawal seizure)

Question 28

Barbituates overdose tx

Answer 28

supportive care, o2/fluids taper, change to long acting, substitute anticonvulsant

Question 29

Barbituate effect

Answer 29

similar to alcohol Disinhibition Mood lability Unsteady gait Slurred speech Nystagmus Amnesia Poor judgment

Question 30

Barbituates withdrawal

Answer 30

Anxiety N/V Postural hypotension Seizures Delirium, insomnia Hyperpyrexia Taper, change to longer acting phenobarbital, substitute anticonvulsant

Question 31

GHB effect

Answer 31

amnesia hypotonia Coma Seizures Respiratory depression Vomiting

Question 32

GHB treatment

Answer 32

supportive, o2 vent, fluids

Question 33

GHB withdrawal

Answer 33

agitation mental status change Elevated HR and BP

Question 34

Opiate effect

Answer 34

Euphoria Dysphoria Apathy Motor retardation Sedation Slurred speech Attention impairment Miosis (pinpoint pupil) Constipation

Question 35

Opioid withdrawal

Answer 35

lacrimation, rhinorrhea, mydriasis, goosebumps, diaphoresis Insomnia, yawning Muscle ache/pain

Question 36

Opioid overdose treatment

Answer 36

naloxone detox: Methadone Buprenorphine Clonidine Lofexidine Maintenance: methadoone buprenorphine abstience: naltrexone PO or IM

Question 37

DXM intoxication

Answer 37

Heightened sense of perceptual awareness Altered time perception Visual hallucinations Hyperexcitability Lethargy Ataxia Slurred speech, sweating Hypertension Nystagmus

Question 38

DXM PKPD

Answer 38

Major 2D6 substrate Minor 2C9,2C19,2E1 substrate Inhibits 2D6 weakly

Question 39

DXM overdose

Answer 39

Seizures Loss of conciousness Brain damage Irregular heartbeat Death

Question 40

Xylazine

Answer 40

tranquilizer central a2 agonist severe skin necrosis

Question 41

Xylazine withdrawal

Answer 41

agitation, severe anxiety

Question 42

Cocaine intoxication sx

Answer 42

Euphoria, elation, gradiosity Loquacity Alertness Mydriasis Change BP Tachycardia Sweat.chhills N/V Decreased fatigue Paranoia, aggression Motor agitation

Question 43

Cocaine withdrawal

Answer 43

Depression Fatigue Nightmares Sleep disturbances Increased appetite Bradyarryhtmias Tremor

Question 44

Cocaine overdose

Answer 44

Cardiac arrest Myocardial infarction Stroke Arrhythmia Seizures Hyperthermia Nasal septum ulceration Kindling = potentiate psychosis/hallucinations

Question 45

Cocaine treatment

Answer 45

Lorazepam, haldol, antiarrythmics, supportive off label: Bromocriptine 2.5 mg tid