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Psych Week 2 > ICL 9.5: Drug Altered Consciousness - Intoxication and Withdrawal > Flashcards

ICL 9.5: Drug Altered Consciousness - Intoxication and Withdrawal Flashcards

1
Q

what is the dopamine hypothesis?

A

what all addictive drugs have in common is their ability to release dopamine in the pleasure areas of the brain

behaviors can also release dopamine! like food, gambling and sex can get the same dopamine surges as chemicals and it makes it hard to quit the chemical addictions

if a person has a problem with one drug, they have a liability to become addicted to other drugs

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2
Q

what is consciousness?

A

the state of being awake and aware of one’s surroundings

from coma and deep anesthesia to sleep to alert wakefulness

altered states of consciousness include hypnosis and meditative states, drug altered consciousness/awareness, and dissociative disorders

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3
Q

what is the path to addiction?

A

genetics: addiction starts with addiction; there is a genetic predisposition based on if you’re more or less sensitive to the toxic effects of alcohol

social learning: when we grow up, is drug use part of the environment? are mom and dad and friends doing it?

choice/perscription: we chose at some point to use and some people don’t which starts the process

so somewhere along the line you get your first dose and if you’re not turned off, you may due to social learning and genetics, use more and more of the product

then you get into reinforcement. people are getting positive and/or negative reinforcement for drinking or smoking pot or heroine –> this causes us to develop classically conditioned responses

now you’re starting to have actually reward and memory changes in the brain via the nucleus accumbens and the dopamine pathway

you start to have negative consequences because the drugs are taking over your life and some people are able to moderate their use or even stop using; you have to overcome the conditioning but once you get through all that and rewire reward and memory changes, it’s much more about choice

however, people that have reward and memory changes which lead to altered pleasure, it becomes less about choice and more about disease because your brain has physically changed and that’s why addiction is an illness

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4
Q

what are the 4 classifications of abused substances?

A
  1. depressants
  2. opiods (classified as a depressant)
  3. stimulants
  4. hallucinogens
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5
Q

what are depressants?

A

drugs that reduce the central nervous system activity which include:

  1. sedatives/hypnotics (calming/sleep effects) Barbiturates, Ativan,
  2. anxiolytic (anxiety reducing effects) Benzodiazepines, Valium, Xanax
  3. alcohol is the most common and abused depressant
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6
Q

what are opioids?

A

a class of drug called Opiate analgesics; they are sometimes included with depressants; these drugs include:

  1. dilaudid
  2. demerol
  3. darvon
  4. percodan
  5. oxycontin
  6. morphine
  7. codeine
  8. heroin
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7
Q

what are stimulants?

A

drugs that activate the central nervous system, producing arousal, increased alertness and elevated mood

these range from the legal
caffeine and nicotine, to the abused ADHD medications (Ritalin, Adderall) and the illegal cocaine and amphetamines and cannabis

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8
Q

what are hallucinogens?

A

drugs that stimulate perceptions like time, visual, auditory, sensory sensations that are at odds with reality

  1. LSD
  2. PCP
  3. psilocybin
  4. cannabis
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9
Q

what kind of withdrawal symptoms does a drug cause?

A

in general, the withdrawal symptoms from a class of drugs is the opposite of the typical signs and symptoms and toxic effects of that drug

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10
Q

what are the typical signs and symptoms of depressants?

A
  1. pronounced effect on the CNS from being physically/emotionally calm and relaxed
  2. slurred speech (opioids is slow speech!)
  3. staggering gait
  4. altered perception
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11
Q

what are the toxic reactions that can happen from depressants?

A
  1. anesthesia, coma
  2. ↓ CNS, cardiac & respiratory process, can result in death
  3. ↓ temperature, reflexes & gut motility
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12
Q

what are the withdrawal symptoms from depressants?

A
  1. anxiety
  2. tremors
  3. seizures
  4. anorexia
  5. nausea
  6. weakness
  7. insomnia
  8. craving
  9. delirium
  10. tachycardia

these withdrawal symptoms are the opposite of the typical signs and symptoms of depressants!

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13
Q

what is delirium tremens?

A

profound confusion, misperceptions, disorientation, hallucinations, paranoid delusions caused by withdrawal from alcohol

the longer one has used alcohol, the greater risk they have of experiencing DTs especially with a sudden absence of alcohol

there is a high risk for DT’s in presence of withdrawal seizures

mortality is 10 - 15% if untreated, 1 -2% if treated

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14
Q

how do we treat depressant withdrawal?

A
  1. clonidine (not a 1st line treatment for alcohol)
  2. benzodizepines
  3. campral
  4. ReVia (naltrexone)
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15
Q

how are benzodiazepines used to treat depressant withdrawal?

A

used to treat the psychomotor agitation experienced during withdrawal

it also prevents progression from minor withdrawal symptoms to major ones

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16
Q

how is campral used to treat depressant withdrawal?

A

acamprosate inhibit the actions of excitatory neurotransmitters

it’s approved to reduce cravings for alcohol in individuals who are in a formal program for alcohol abuse recovery

it’s cost effective after the individual has already been abstinent from alcohol from several days to two weeks

does not address withdrawal symptoms; it’s for after detox or after someone has abstained from alcohol that adding this medication can help reduce the craving

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17
Q

how is ReVia used to treat depressant withdrawal?

A

naltrexone originally used to reduce cravings for individuals with opiate use disorders (e.g., addictions to heroin, Vicodin, etc.)

it can also reduce cravings for alcohol, and some studies suggest that it is more effective at reducing alcohol cravings than it is at reducing cravings for opioids

does not address withdrawal symptoms; it’s for after detox or after someone has abstained from alcohol that adding this medication can help reduce the craving

18
Q

what are the typical signs and symptoms of opioids?

A
  1. ↑ euphoria followed by drowsiness
  2. numbing of physical sensation (pain) AND emotional reaction/experience; the emotional part is why people can get psychologically dependent
  3. constipation
19
Q

what are the toxic reactions from opioids?

A
  1. ↓ Respiration & pulmonary edema
  2. respiratory depression, convulsions, coma, death
  3. slow, not slurred speech
  4. miosis – pinpoint pupils
20
Q

what are the withdrawal symptoms of opioids?

A
  1. ↑ lacrimation (tearing), rhinorrhea (runny nose) sweating–> you’re leaking everywhere on your body
  2. fine tremor
  3. dilated pupils
  4. tachycardia
  5. irritability and muscle aches/tension
21
Q

how do you treat opiod withdrawal?

A
  1. clonidine
  2. methadone or buprenorphine
  3. ReVia (naltrexone)
22
Q

how is clonidine used to treat depressant withdrawal?

A

approved to treat high blood pressure

it works on calming the sympathetic system

often used to detox off heroin

23
Q

how is methodone/buprenorphine used to treat depressant withdrawal?

A

they are substituted for heroin and then tapered which can extend the detox

these medications help people go back to work and get integrated back into their families! but there’s a lot of resistance because people were worried you were just switching one drug to another that they could get addicted to

24
Q

how is ReVia used to treat depressant withdrawal?

A

naltrexone was originally used to reduce cravings for individuals with opiate use disorders (e.g., addictions to heroin, Vicodin, etc.)

it can also reduce cravings for alcohol, and some studies suggest that it is more effective at reducing alcohol cravings than it is at reducing cravings for opioids

does not address withdrawal symptoms

25
Q

what are the typical signs and symptoms of stimulants?

A
  1. ↑ heart and respiratory rates
  2. ↑ blood pressure
  3. ↓ appetite; weight loss
  4. increased alertness and energy; euphoria
  5. heightened sexuality
26
Q

what are the toxic reactions that can happen from stimulants?

A
  1. manic like state, psychosis, anxiety (panic),
  2. ↑ heart rate and blood pressure
  3. electrocardiogram abnormalities
  4. loss of coordination, physical collapse
  5. ↑ temperature & reflexes
27
Q

what are the withdrawal symptoms from stimulants?

A
  1. ↑ depression, irritability, lethargy, insomnia
  2. ↑ craving

later rebound and a need for sleep

28
Q

how do you treat stimulant withdrawal?

A

benzodiazepine to control CNS stimulation

29
Q

what are the signs and symptoms of hallucinogens?

A

can vary based on drug used; hallucinogens typically do not come with tolerance and withdrawal effects, however, for some there can be a psychological withdrawal from some drugs in this classification

experiences can include:
1. sense of euphoria/well-being

  1. intensification of emotions
  2. feelings of sensuality
  3. altered perception of time, sensations, objects and self (depersonalization)
30
Q

what are “bad trips”?

A

bad trips can be caused by hallucinogens and may involve:

  1. hallucinations
  2. paranoia
  3. convulsions
  4. unconsciousness
  5. memory loss
  6. anxiety
31
Q

which drugs are hallucinogens?

A

phencyclidine (PCP) = violence, impulsivity, psychosis

MDMA (ecstasy) = hallucinations, disinhibition, distorted sense of time and senses

32
Q

how do you treat hallucinogens?

A
  1. benzodiazepines

2. antipsychotics

33
Q

how are benzodiazepines used to treat hallucinogen withdrawal?

A

for use with agitated behavior

not something that is likely to be prescribed on an ongoing

34
Q

how are antipsychotics used to treat hallucinogen withdrawal?

A

may be used as adjunct if there are significant hallucinations

caution: associated with QT prolongation, decreased seizure threshold, or temperature dysregulation

35
Q

depending on dose, the use of this drug can result in dulled senses, drowsiness, sometimes accompanied by positive changes in mood. it is physically and psychologically addictive. withdrawal symptoms include tearing, running nose, sweating, GI upset diarrhea, anorexia, chills, insomnia, muscle spasm, violent yawning and increased irritability.

A. alcohol
B. stimulant
C. opioid
D. LSD

A

opioid

this leaking from every hole in the body is common in extreme withdrawal of opioids!!

36
Q

the use of this drug results in feelings of euphoria, decreased fatigue and need for sleep, decreased appetite and may increase feelings of sexuality and prolonged orgasm. withdrawal symptoms include intense craving and drug seeking behavior, agitation, depression, decreased appetite and fatigue often followed by exhaustion and need to sleep

A. stimulant
B. anxyolytic
C. depressant
D. opiod

A

stimulant

37
Q

intoxicating effects include restlessness and increased diuresis and withdrawal effects are headaches, difficulty concentrating and flu like symptoms

A. cocaine
B. alcohol
C. amphetamine
D. caffeine
E. PCP
A

caffeine

38
Q

what are substance related disorders?

A

it encompass 10 separate class of drugs and characterized by problems related to compulsive and habitual use of a substance

39
Q

what is the DSM5 criteria for substance related disorders?

A

a problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two (2) of the following, occurring within a 12-month period:

  1. substance taken in larger amounts or over a longer period than was intended
  2. persistent desire or unsuccessful efforts to cut down or control substance
  3. great deal of time spent in activities to obtain, use, recover from the substance
  4. craving or strong desire to use
  5. recurrent use resulting in a failure to fulfill major role, obligation at work, school, home
  6. continued use despite having persistent or recurrent social interpersonal problems caused or exacerbated by the use
  7. important social, occupational, or recreational activities are given up or reduced due to use
  8. recurrent use in situations in which it is physically hazardous
  9. substance use continued despite knowledge of having a persistent or recurrent physical problem or psychological problem that is likely caused/exacerbated by the substance
  10. tolerance 1) need for markedly increased amounts to achieve the desired effect; 2) markedly diminished effect with continued use of the same amount
  11. withdrawal 1) having characteristic withdrawal symptoms for the substance; 2) the substance or related substance is taken to avoid withdrawal 10 and 11 not considered to be met for those taking opioids solely under appropriate medical supervision
mild = 2-3 symptoms
moderate = 4-5 symptoms
severe = 6+ symptoms
40
Q

what is the summary of substance abuse?

A

there is not a single explanation for the etiology of substance abuse/dependence; however the dopamine reward pathway is involved when most substances of abuse are used

intoxication and withdrawal effects are generally the opposite of one another and knowing these signs and symptoms are important to help a patient presenting with possible overdose or severe withdrawal

treatment of withdrawal can involve the use of another drug in the same class as the substance being withdrawn from

Psych Week 2 (18 decks)

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