Final Substance Use Disorder Flashcards
(128 cards)
1
Q
What are the 3 main categories that drugs of abuse fall under?
A
Stimulants
Depressants
Psychedelics
2
Q
What does Schedule I mean?
A
These drugs have No Medical Use
-high abuse potential, safety not guaranteed
3
Q
What are some examples of Schedule I drugs?
A
Marijuana, THC, LSD
4
Q
What dose Schedule II mean?
A
Have a medical use but high abuse potential
-large risk of dependence
5
Q
What are some examples of Schedule II drugs?
A
Cocaine, PCP
6
Q
What does Schedule III mean?
A
Have a medical use, MODERATE abuse and dependence
7
Q
What are some examples of Schedule III drugs?
A
Marinol (THC in oil capsule) -delta 9 THC
8
Q
What does Schedule IV mean?
A
Medical potential, LOW abuse potential
9
Q
What does Schedule V mean?
A
Lowest risk of abuse
10
Q
What is the difference between Delta 9 THC and Delta 8 THC?
A
Cannabis has a thousand different bioactive molecules in it (all related to delta 9)
Delta 9 THC is the major active ingredient in marijuana
Delta 8 is slightly less potent at receptors
The Department of Agriculture Farm Bill states that some Delta 8 THC is derived from hemp which makes this molecule legal
(hemp derived molecules are legal but cannabis derived molecules are illegal)
*Note, the function between these two molecules is very very similar and therefore this does not really make sense
11
Q
Which abuse substances act directly on G Protein-Coupled Receptors?
A
Opioids
LSD/ Mushrooms
Marijuana/ K2/ Spice
Gamma Hydroxy Butyric Acid
Caffeine
12
Q
What receptors are targeted by marijuana, K2, and spice?
A
Cannabinoid receptors (CB1)
13
Q
What substances of abuse act INDIRECTLY on G protein-coupled receptors?
A
Cocaine, Amphetamine
MDM/Ecstasy
Alcohol
14
Q
How does Cocaine and Amphetamine create its abuse potential?
A
Block the dopamine transporter which blocks dopamine reuptake and allows dopamine to accumulate
-Indirectly causes overactivation of dopamine receptors
works on dopamine transporters
15
Q
Which substances of abuse work on ion channels?
A
Nicotine
PCP, Ketamine
Benzodiazepines, Barbiturates
16
Q
What receptors are targeted by nicotine and what is its function?
A
Acetylcholine receptors
-agonist
17
Q
What receptors are targeted by PCP, ketamine and what is their function?
A
NMDA receptors
-antagonist
18
Q
What receptor is targeted by benzodiazepines and barbiturates and what is their function?
A
GABA A receptors
Positive allosteric modulators
19
Q
What part of the brain is in charge of decision making and impulsivity?
A
Frontal Cortex
20
Q
What part of the brain is responsible for pleasure?
A
Nucleus accumbens
21
Q
What part of the brain is responsible for reward/value?
A
Striatum
22
Q
What part of the brain is the source of dopamine?
A
VTA
23
Q
What is the dopamine hypothesis of addiction?
A
Pleasurable events release dopamine
*Dopamine is important for assigning value to reward prediction error
*Value provides the drug with an incentive salience (learning occurs in the brain around reward) ex: expecting a red apple to taste better than a green apple
24
Q
True or False: Dopamine is required for reward learning
A
False
-dissociation between liking (direct effect) and wanting (motivation)
-“you don’t always like what you want”
25
How is dopamine involved in "liking"?
Dopamine does not encode liking, but is involved in making reward predictions and learning from outcome/error
26
what is the Glutamate Hypothesis of Addiction?
Glutamate can increase dopamine activity in the nucleus accumbens (NAcc)
Glutamate projects to the VTA (ventral tegmental area)
Destruction of this pathway reduces cocaine/morphine reward
27
What is Long Term Potentiation (LTP)?
Persistent increase in synaptic strength following intense stimulation
-Drug use induces long term changes in neuronal plasticity
-Increased glutamate AMPA receptors on surface which are making a signal more robust (easier to activate neurons)
-Rewarding substances like cocaine trigger LTP causing patients to have a memory associated with the exposure
*Rewarding substances cause relative increase in glutamatergic AMPA receptors*
28
What is drug abuse?
Use of a drug for a nontherapeutic effect
29
What is drug misuse?
Inappropriate, illegal, or excessive use of a prescription or nonprescription drug
30
What are the 11 Substance Abuse Criteria?
1. Taking drug in larger amounts or for longer than prescribed
2. Unable to stop taking
3. Preoccupied with substance (spending lots of time around it)
4. Cravings
5. Distracted because of use and not keeping up daily tasks
6. Continuing to use even when problems in relationships occur
7. Giving up other activities because of use
8. Using even when it creates danger
9. Using against your own better judgement
10. Tolerance (needing more)
11. Withdrawal symptoms
31
How many substance use criteria must a person fit to be considered "Mild"?
2-3
32
How many substance use criteria must a person fit to be considered "Moderate"?
4-5
33
How many substance use criteria must a person fit to be considered "Severe"?
>6
34
What are the 3 types of withdrawal symptoms?
Emotional Withdrawal Symptoms
Physical Withdrawal Symptoms
Dangerous Withdrawal Symptoms
35
What are some physical withdrawal symptoms?
Goose bumps (cold turkey)
Muscle spasms (kicking the habit)
36
Which substances are associate with dangerous withdrawal symptoms?
Alcohol
Tranquilizers
37
What are possible dangerous withdrawal symptoms?
Grand mal seizures
Delirium tremens (DTs)
38
What type of dependence is responsible for addiction (physical or psychological)?
Psychological dependence
*can occur even in absence of withdrawal
39
What is negative reinforcement?
Reward from escaping a negative/painful stimulus (such as withdrawal)
**NOT the same as punishment
40
What is positive reinforcement?
User feels pleasure/satisfaction
41
What is the function of psychostimulants?
Activate the CNS resulting in alertness, excitation, and elevated mood
42
What are commonly abused stimulants?
Methamphetamine
Ecstasy
Crack
Cocaine
Nicotine
43
Where does nicotine work on the dopamine receptor?
Ventral Tegmental Area
44
Where do stimulants work on the dopamine receptor?
Increase dopamine in synapses between the ventral tegmental area and nucleus accumbens
45
Which neurotransmitter is nicotine structurally similar to?
Acetylcholine
46
What differentiates the function of nicotine from acetylcholine?
Nicotine is not degraded by acetylcholinesterase!
-Therefore nicotine has a longer half-life than acetylcholine and a longer duration of action (more potent)
47
What is the most addictive stimulant?
Tobacco
48
What is the MOA of varenicline (Chantix)?
Partial agonist
-stimulates enough dopamine release to prevent withdrawal but not enough to cause addiction
49
Fenethylline is a combination of which to drugs?
Amphetamine
Theophylline
50
Arrange the neurotransmitter transporters in order of MOST to LEAST potent
M:
DAT
SERT
NERT
L:
51
What is the MOA of cocaine?
Cocaine blocks the dopamine transporter and prevents reuptake
-Dopamine is in the synaptic cleft longer and causes more stimulation of the receptor
52
What is the MOA of Meth, Ecstasy (XTC), and Bath Salts?
1. Act mostly by simple competition, structurally similar enough that they compete for the reuptake inhibitor. This is how they reduce reuptake (do not inhibit, just compete)
2. Can stimulate more release of dopamine out of the vesicles into the synaptic cleft
(*push out dopamine from vesicles*)
53
What receptor is affected by Meth, Ecstasy, and Bath Salts and what affect do they have on it?
Activate the Trace Amine-Associated Receptor (TAAR1)
**induce reverse transport**
(becomes efflux transporter and forces dopamine out)
54
What are the side effects of meth?
Neurologic: Delirium, Tremor
Psych: Anxiety, Paranoia, Hallucinations, Delusions
ENT: Dental Decay
CV: Tachycardia, Hypertension, Vasospasm
Skin: Diaphoresis (sweat)
55
True or False: The use of stimulants for cognitive enhancement has not been well supported by research
True
56
What are the symptoms of sympathomimetic toxidrome (signs of people who are abusing substances)?
MATHS
M: Mydriasis (dilated pupil)
A: Agitation, Arrhythmia, Angina
T: Tachycardia
H: Hypertension, Hyperthermia
S: Seizure, Sweating
57
How do we treat agitation, HTN, and seizures associated with substance abuse?
Benzodiazepines
58
Which drugs should be avoided in patients suspected to be abusing stimulants?
Beta Blockers
(due to unopposed alpha agonism)
59
Which symptom in a patient presenting with sympathomimetic toxicity denotes a poor prognosis?
Hyperthermia
60
What are psychedelics?
Agents that produce non-ordinary and variable forms of conscious experiences
(changes in mood, thought, and distorted perceptual sensations)
61
Why has the term "hallucinogen" fallen out of favor?
These drugs rarely produce frank hallucinations at commonly used doses
62
What is a delusion?
A fixed, false belief that is unresponsive to logic
*Paranoia is a common manifestation
(ex: a man comes to a homeless shelter convinced he arrived in a black ops helicopter)
63
What is a hallucination?
A false perception arising from internal stimuli
-Creates a false reality
(ex: there are bears floating around the ceiling)
64
What is an illusion?
A misperception of external stimuli
-Distorts reality
(ex: mistaking a man for a bear)
65
What are the 2 drug categories of psychedelics?
Classical Psychedelics
Dissociative Psychedelics
66
What are the classical psychedelics?
Derivatives of phenethylamine
Derivatives of tyramine
67
What are the dissociative psychedelics?
Phencyclidine
Ketamine
Muscimol
68
What is the naturally occurring psychedelic found in magic mushrooms?
Psilocybin (pro-drug of psilocin)
69
Mescaline combines the action of which two drugs?
LSD
MDMA
70
What is special about Phenethylamine?
It has both stimulant and psychedelic properties
*more hallucinogenic than stimulatory
71
Most classical psychedelics are agonists of which receptor?
5HT-2A
72
Which psychedelic stimulates 5-HT release and is the exception to the normal 5-HT agonist property of psychedelics?
MDMA
73
How do psychedelics impact the CNS?
Increase global integration
(areas of the brain talk to each other more than normal)
74
What is anxious ego-dissolution?
A thought disorder leading to a bad psychedelic trip (unpleasant state)
75
True or False: Psychedelics have no addictive potential
True
76
What are the potential therapeutic uses of psychedelics?
Cancer-related psychological distress
PTSD
Depression
Substance use disorder (alcohol)
77
What are the shortcomings of psychedelic clinical trials?
Small sample size (90% excluded)
Inadequate controls
Hard to determine proper control group
Selection bias (for people with experience using psychedelics)
78
Dissociative psychedelics act at which receptor?
Antagonists of NMDA receptors (glutamate)
79
What other effects can NMDA receptor antagonists have besides psychedelic?
Anesthesia
Analgesia
80
Which enantiomer of ketamine is more active?
S (+)
81
What % of high schoolers abuse dextromethorphan (DXM)?
4%
82
How does dosing of dextromethorphan vary based on if it is used for cough suppression or to induce a high?
Cough suppression: <60mg
High: 100-600mg
83
Is phencyclidine (PCP) more or less potent than ketamine?
More potent
84
Besides being an NMDA receptor antagonist, what other mechanism of action does phencyclidine (PCP) have?
D2 receptor agonist
85
What is a concerning affect associated with phencyclidine (PCP)?
Self-mutilation without recognition (dissociation with analgesia)
86
What is the MOA of muscimol?
Agonist of GABA A
*this drug comes from mushrooms but is not magic mushrooms
87
What are alkyl nitrites?
Sold as "poppers" (inhalants that release nitrous oxide causing smooth muscle relaxation)
88
Which drugs have the highest abuse potential among gay men?
Alkyl Nitrite inhalants
(because of enhanced erections, relax anal sphincter)
89
What is the greatest risk associated with alkyl nitrite inhalants?
Methemoglobinemia
90
How does the physical form of volatile solvents change?
Volatile solvents are liquid at room temperature and evaporate when exposed to air
91
What are common volatile solvents?
Toluene (glue, thinners, cement, spray paint)
Acetone (nail polish, model glue, rubber cement)
Benzene (cleaning fluid, rubber cement, tire repair)
Butane (cigarette lighter, hair spray, spray paint)
92
Which drugs have the highest frequency of use among adolescents, especially in isolated communities?
Volatile solvents
93
What are the clinical effects of high dose volatile solvents?
CNS depression
Slurred speech
Disorientation
Weakness
Sedation
94
What are the risks of inhalant abuse?
(inhaling a solvent causes less room for oxygen, symptoms result from this)
Asphyxiation
Suffocation (plastic bag)
Convulsions or Seizures
Coma
Choking
Fatal Injury
95
What is the number of inhalant fatalities in the US each year?
100-200 minimum
96
What is sudden sniffing death syndrome?
Development of fatal arrhythmias within minutes of inhalation
97
Alcohol elimination follows what kind of kinetics?
Zero order
*at or above 10-20 mg/dl
*no way to speed up metabolism
98
In alcohol metabolism, only high alcohol concentrations involves which enzyme?
CYP2E1
99
What is glucuronidation in relation to alcohol?
Test used to monitor alcohol consumption
*too sensitive for most needed purposes
*tests for ethyl glucuronide which has a long half-life
*can test alcohol use for days
100
Alcohol is metabolized by which enzyme?
Alcohol dehydrogenase
101
True or False: Men express HIGHER levels of Alcohol Dehydrogenase (ADH)
True
102
What drug is used for alcohol poisonings?
Fomepizole (Antizol)
103
What is the MOA Fomepizole (Antizol)?
Alcohol Dehydrogenase (ADH) inhibitor
-slows formation of formaldehyde and toxic metabolites
-lives has more time to metabolize metabolites further
104
Alcohol metabolism produces what compound?
Acetaldehyde
*when metabolism stops here this causes a hangover
105
Acetaldehyde produced from alcohol metabolism is metabolized by what enzyme?
Aldehyde dehydrogenase
(ALDH1B1 and ALDH2)
106
Which gene is the reason why some people flush more or cannot drink alcohol?
ALDH2*2
107
What does being heterozygous for ALDH2*2 mean?
-Have reduced metabolic activity
-Flushing and increased skin temperature upon drinking
-Can still consume alcohol just build up more acetaldehyde and more side effects
108
What does being homozygous for ALDH2*2 mean?
CANNOT DRINK ALCOHOL IT IS TOXIC
-unable to metabolize acetaldehyde
109
What is Disulfiram used for?
(Antabuse)
-Used for alcohol abuse
-If person drinks alcohol while taking this medication they will get sick
*Effects last up to 14 days
110
What 2 ligand-gated ion channels are targeted by alcohol?
GABA A
NMDA
111
What is the most common side effect of acute drinking?
Vasodilation
112
Moderate alcohol drinking can have what positive effect?
Reduced risk of coronary disease
113
Heavy/chronic alcohol use affects which organ?
Heart
114
High doses of alcohol can have what effect on thermoregulation?
Hypothermia
115
Alcohol has what effects in the GI tract?
Secretagogue
-increases acid secretion
-can cause either appetite stimulation (low dose) or depression (high dose)
116
What affect does alcohol have on the liver?
Increases fat metabolism
Fatty liver leads to cirrhosis
-Can cause: ascites, edema, and effusions
117
Where can alcohol cause cancer in the body?
Along the route of ingestion
(mouth, larynx, esophagus, stomach)
Liver
118
What is the drug interaction between alcohol and acetaminophen?
Increases toxic metabolites of acetaminophen (Ex: NAPQI)
119
What are the 3 approved treatments for alcoholism?
-Disulfiram (Antabuse)
-Acamprosate (Campral)
-Naltrexone (Revia)
120
Patients with which gene mutation respond better to Naltrexone?
118G
(SNP in mu opioid receptor)
121
When is a person with a substance use disorder considered "recovered"?
NEVER
-always recovering, never recovered
122
What is the legal blood alcohol concentration in most states?
80 mg/dL
(0.08mg%)
123
What are 2 severe side effect of alcohol withdrawal and after how much timet do they occur?
Grand mal seizures (1-2 days)
Delirium tremens (3-5 days)
124
AT what CIWA score do we medicate for alcohol withdrawal?
8 or higher
125
Which vitamin should be substituted in alcohol withdrawal patients?
Thiamine
126
Which antiseizure medication is not useful in alcohol withdrawal?
Phenytoin
127
Thiamine deficiency can cause what disease?
Wernicke's encephalopathy
128
When should thiamine be given in patients with alcohol withdrawal?
Before dextrose-containing fluids
