L10: Addiction & Substance Abuse Disorder Flashcards
(134 cards)
1
Q
General Definition of Addiction
A
2
Q
Specific Definition of Addiction
A
3
Q
Epidemeology of substance use disorder
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- One-year prevalence of any substance use disorder in the USA is approximately 8%.
- Men > women.
4
Q
what are the most commonly used substances in addiction?
A
- Alcohol and nicotine (are the most commonly used substances)
- Most common substance In Egypt: Nicotin, cannabis all; opiate.
5
Q
Def of Acute intoxication
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- Transient disturbances of consciousness, cognition, perceptions, affect or behaviors following the large amount use of a psychoactive substance.
6
Q
Def of Harmful use
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- Use in a manner that damage to the individual’s health and with adverse effects on family and society.
7
Q
Def of Co-dependence
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- Term used to refer to family members affected by or influencing the behavior of the substance abuser. Related to the term enabler, which is a person who facilitates the abuser’s addictive behavior (e.g., providing drugs directly or money to buy drugs).
7
Q
Def of Dependence
A
8
Q
Def of Withdrawal state
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- physical and psychological symptoms occurring on absolute or relative (decrease dose) withdrawal of a substance after repeated, usually prolonged and/or high-dose use.
9
Q
def of Tolerance
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The need for increased amount of the substance to achieve the same effect.
10
Q
Def of Cross-Tolerance
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When tolerance develops to one drug as the result of use of another drug.
11
Q
Def of Addiction
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Is a slang languages used in non scientific fields.
12
Q
DSM5 Classification of Substance Related Disorders
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13
Q
DSM 5 Criteria of Substance Use Disorder
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14
Q
what are other addictive disorders in DSM5?
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15
Q
Signs of Drug Intoxication
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16
Q
Why Do Some People become addicted while others Don’t?
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17
Q
Continuum of Drug Use
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18
Q
Drugs Wheel
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19
Q
Stimulants Vs Depressants
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20
Q
…
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21
Q
Epidemeology of Alcohol Dependence
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22
Q
Standard Drinking of alcohol
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23
Q
How much alcohol can you drink at a safe level ?
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24
Clinical Presentation of alcohol intoxication
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Types of alcoholism
- Alpha
- Beta
- Gamma
- Delta
- Epsilon
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Alpha alcoholism
Earliest stage, to relieve pain, can control drinking
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Beta alcoholism
Heavy drinkers, drink daily, physical symptoms, no addiction, can quit, no withdrawal symptoms
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# ****
Gamma alcoholism
Loss of control in drinking, physical dependence, can quit, withdrawal seen
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Delta alcoholism
Physical dependence, withdrawal seen, cant quit
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# ********
Epsilon alcoholism
Final stage of drinking, continual and insatiable urge to drink (craving), compulsive drinking.
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what are drinking patterns?
- Moderate Alcohol Consumption
- Low-Risk Drinking and Alcohol Use Disorder (AUD)
- Binge Drinking
- Extreme Binge Drinking
- Heavy Drinking
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Moderate Alcohol Consumption
Defined as up to 1 drink/day for women and up to 2 drinks/day for men
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Low-Risk Drinking and Alcohol Use Disorder (AUD)
- For women, no more than 3 drinks/day and < 7 drinks/week.
- For men, <4 drinks /day and <14 drinks /week.
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Binge Drinking
- A pattern of drinking that brings blood alcohol concentration to 0.08 grams per deciliter (0.08%) or higher.
- Woman consumes 4 drinks or a man consumes 5 drinks in a 2-hour time frame
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Extreme Binge Drinking
- Drinking at levels far beyond the binge threshold, resulting in high peak blood alcohol concentrations. (i.e., 10 or more standard drinks for men, and 8 or more for women)
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Heavy Drinking
- Heavy drinking as binge drinking on each of 5 or more days in the past 30 days
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Types of drinkers
- Social Drinker
- Alcohol Abuser
- Alcoholic
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Alcohol Abuser
* An alcohol abuser's drinking habit may become physically harmful to themselves and others around them.
* They may begin to drive under the influence and could be arrested for DUI at least once.
* Along with legal problems, an alcohol abuser may begin to put work and family obligations to the side.
* Alcohol may begin to occupy their thoughts; the abuser may begin to feel like they need to have a drink more often.
* Till now they not developed tolerance and withdrawal.
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Social Drinker
- A social drinker is a person who drinks on an occasional basis.
- Whenever they do drink, a social drinker will not have any problems or negative consequences.
- Friends or family do not complain about a social drinker's consumption.
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Alcoholic drinker
- An alcoholic means that a person has an addiction to alcohol. When a person becomes an alcoholic, they are unable to control or set limits for their consumption.
- An alcoholic will have developed a tolerance and full-fill all criteria of dependance.
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Dx of **Alcohol Dependence**
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MOA of **Alcohol**
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**Alcohol** Metabolism
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Enzyems Related To Metabolism of **Alcohol** in Heavy Drinkers & Asians
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Timeline of **Alcohol** Withdrawal Symptoms
usually begin in 6-24 hours and last 2-7 days.
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Symptoms of **Alcohol** withdrawl
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Characters of **Delirium tremens (DTs)**
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Complications of **Alcoholism**
- Wernicke's encephalopathy
- Korsakoff syndrome
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What causes **Wernicke's encephalopathy**?
Caused by thiamine (vitamin B1) deficiency resulting from poor nutrition.
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Prognosis of **Wernicke's encephalopathy**
- Acute and can be reversed with thiamine therapy.
- If left untreated, Wernicke's encephalopathy may progress to Korsakoff syndrome.
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Symptoms of **Wernicke's encephalopathy**
Ataxia (broad-based), confusion, ocular abnormalities (nystagmus, gaze palsies).
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Def of **Korsakoff syndrome**
Chronic amnestic syndrome.
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prognosis of **Korsakoff syndrome**
Reversible in only about 20% of patients.
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Symptoms of **Korsakoff syndrome**
Impaired recent memory, anterograde amnesia, compensatory confabulation (unconsciously making up answers when memory has failed).
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TTT of **Alcohol Withdrawal**
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Medications used in **Alcohol Use Disorder**
**First-line treatments:**
- Naltrexone (Revia, IM-Vivitrol)
- Acamprosate (Campral)
**Second-line treatments:**
- Disulfiram (Antabuse)
- Topiramate (Topamax)
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MOA of **Naltrexone (Revia, IM Vivitrol)**
- Opioid receptor blocker works by decreasing desire/craving associated with alcohol.
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Uses of **Naltrexone (Revia, IM-Vivitrol)**
Maybe greater benefit is seen in men with a family history of alcoholism.
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SE of **Naltrexone (Revia, IM-Vivitrol)**
In patients with concurrent opioid dependence, it will precipitate withdrawal.
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MOA of **Acamprosate (Campral)**
Thought to modulate glutamate transmission.
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Use of **Acamprosate (Campral)**
- Should be started post-detoxification for relapse prevention in patients who have stopped drinking.
- Major advantage is that it can be used in patients with liver disease.
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SE of **Acamprosate (Campral)**
- Contraindicated in severe renal disease.
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MOA of **Disulfiram (Antabuse)**
Blocks the enzyme aldehyde dehydrogenase in the liver and causes aversive reaction to alcohol (flushing, headache, nausea/vomiting, palpitations, shortness of breath).
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SE of **Disulfiram (Antabuse)**
- Contraindicated in severe cardiac disease, pregnancy, psychosis.
- Liver function should be monitored.
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when is **Disulfiram (Antabuse)** best used?
- Best used in highly motivated patients, as medication adherence is issue.
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MOA of **Topiramate (Topamax)**
- Anticonvulsant that potentiates GABA and inhibits glutamate receptors.
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Use of **Topiramate (Topamax)**
Reduces cravings for alcohol and decreases alcohol use.
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Characters of **Benzodiazepines**
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Symptoms of acute intoxication of **Benzodiazepines**
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Symptoms of **Sedative & Hypnotics Withdrawal**
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TTT of **Sedative Abuse**
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THC content of different preparations of cannabis
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Hashish Vs Marijuana
- Introduction
- legality
- Derived From
- Ingestion
- Active Ingredient
- Form
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Cannabis intoxication diagnostic criteria
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Cannabis Withdrawal diagnostic criteria
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Marijuana legalization
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Neurochemistry of **Opiods**
- Opioid works via interactions with the mu and delta receptors which result in:
A. Increased activity in the mesolimbic system
B. Increased dopamine released (by inhibits the release of GABA which have inhibitory effect on the dopaminergic neurons)
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Route of adminstration of **Opiods**
* Opium would be commonly smoked.
* Heroin is usually injected
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Signs of intoxicaion & tolerance of **Opiods**
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DSM 5 Criteria of **Opiods use disorder**
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Physical complications associated with opioid misuse
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Epidemiology of opiates dependence
* 10% of opiate misusers become dependent (10% of them ever seek help)
* 2-3% die annually.
* 25% are abstinent at five years and 40% at 10 years.
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Early withdrawal symptoms of opiods
- Tolerance and withdrawal develop quickly.
- Early withdrawal symptoms (24-48 hours) include craving, flu-like symptoms, sweating and yawning. Mydriasis (dilation of the pupil), abdominal cramps, diarrhoea, agitation, restlessness, piloerection ('gooseflesh') and tachycardia occur later (7-10 days).
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reatment of opiates dependence
- Methadone
- Buprenorphine
- Naltrexone
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Pros of **Methadone**
- Administered once dally.
- Significantly reduces morbidity and mortality in opiold-dependent persons.
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Cons of **Methadone**
- Restricted to federally licensed substance abuse treatment programs.
- Can cause QTc Interval prolongation: screening electrocardiogram is indicated, particularly in patients with high risk of cardiac disease.
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MOA of **Methadone**
Long-acting opiold receptor agonist
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MOA of **Buprenorphine**
- Partial opioid receptor agonist—can precipitate withdrawal if used too soon after full opioid agonists
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Pros of **Buprenorphine**
- Sublingual preparation that is safer than methadone, as its effects reach a plateau and make overdose unlikely.
**Comes as Suboxone, which contains buprenorphine and naloxone; this preparation prevents intoxication from intravenous injection.**
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Cons of **Buprenorphine**
- Only available by prescription from specially licensed office-based physicians.
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MOA of **Naltrexone**
- Competitive opioid antagonist, precipitates withdrawal if used within 7 days of heroin use
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Pros of **Naltrexone**
- Either daily oral medication or monthly depot injection.
- It is a good choice for highly motivated patients such as health care professionals.
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Cons of **Naltrexone**
- Compliance is an issue for oral formulation.
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what are examples of stimulants?
**Examples:**
- Cocaine
- Caffiene
- Cannabis
- Amphetamine
- Tobacco
**Effects:**
* Racing speech and thoughts
* Physically strong
* Loss of apetite
* Alert, confident and energetic
* Paranoia and a low or crash
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Method of adminstration of **Cocaine**
sniffed, chewed or injected intravenously.
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Method of adminstration of Crack
Crack (a purified, very addictive form of cocaine) is smoked.
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Characters of Crack
The crack (high) is extremely short and, on withdrawal, persecutory delusions are common.
97
Effects of **Cocaine**
- Restlessness, increased energy, abolition of fatigue and hunger resemble hypomania and last about 20 minutes.
- Visual/tactile hallucinations of insects (formication) and paranoid psychoses occur.
- Post-cocaine dysphoria, with sleeplessness and intense depression, precedes withdrawal (depression, insomnia and craving).
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Effects of Crack
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effects of Amphetamine
- Uneven heartbeat, rise in blood pressure, physical collapse, stroke, heart attack, and death
- cause euphoria, increased concentration and energy, mydriasis, tachycardia and hyper-reflexia, followed by depression, fatigue and headache. Acute use may cause psychosis.
100
effects of methamphetamine
- Memory loss, damage to heart and nervous system, seizures, and death
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Effects of Cocaine
- Damage to nose lining and liver, heart attack, seizures, stroke, and death
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Effects of Crack
Damage to lungs if smoked, seizures, heart attack, and death
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MOA of amphetamines **Speed**
Taken orally or intravenously
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Charactesr of Methamphetamines
Chemically related but more potent, long lasting and harmful; it can be ingested, snorted or smoked (as crystal meth).
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Characters of Naphyrone and mephedrone
Closely related to amphetamines. They were originally manufactured as legal highs' but are now class B drugs.
106
Characters of Khat
- Used particularly by men from Somalia and Yemen;
- Contains cathinone, an amphetamine-like stimulant causing excitement and euphoria
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Stimulant withdrawal diagnostic criteria
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Lobacco Withdrawal diagnostic criteria
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Done
✅
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Stimulant intoxication diagnostic criteria
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What are substances with variable effect?
- HALLUCINOGENS/ PSYCHEDELICS & DISSOCIATIVE DRUGS
- EMPATHOGENS
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Examples of **HALLUCINOGENS/ PSYCHEDELICS & DISSOCIATIVE DRUGS**
Phencyclidine (PCP - Angel Dust)
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MOAd of **Phencyclidine**
Phencyclidine (PCP - Angel Dust) is usually smoked.
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Effects of **Phencyclidine**
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Empathogens
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Inhailants & Volatile Drugs & Solvents
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MOAd of **Solvents**
sniffed,
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Age of using **Solvents**
principally by boys (aged 8-19 years)
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Sign of abuse of **Solvents**
red rash around the mouth
and nose may be a sign of abuse).
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Effects of **Solvents**
Initial euphoria is followed by drowsiness.
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Dependence in **Solvents**
Psychological dependence is common but physical dependence is rare.
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Examples of **Solvents**
Amyl nitrite and butyl nitrite and isobutyl nitrite (called 'poppers')
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Characters of **Solvents**
- Sniffed from small bottles.
- They deliver a short, sharp high.
- Side effects include severe headache and feeling faint.
- They are toxic and can be fatal if swallowed
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Chronic abuse of **Solvents**
weight loss, nausea, vomiting, polyneuropathy and cognitive impairment.
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Toxic effects of **Solvents**
bronchospasm, arrythmias, aplastic anemia, hepatorenal and cerebral damage
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How do people misuse **Anabolic Steroids**?
to increase muscle growth and body bulk.
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MOAd of **Anabolic Steroids**
swallowed or injected.
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AE of **Anabolic Steroids**
* gynecomastia in men and clitoral enlargement in women
* bone hypertension
* cardiac disorders
* liver (e.g. drug induced hepatitis)
* renal impairment
* shrinking of testicles and priapism
Infertility
* aggression and irritability.
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Course of addiction and substance use disorder
1. Addiction (with or without treatment)
2. Remission
3. relapse
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Outcome of addiction and substance use disorders
* Chronicity
* Natural recovery
* Morbidity
* Death
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Steps of TTT of addiction
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Infection (HIV and hepatitis C) is the greatest risk associated with injecting drug use; harm reduction strategies aim to minimize infection (e.g. needle exchange and improve safety.
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