MANAGEMENT OF SUBSTANCE USE DISORDERS Flashcards by Qúophy Calbert

What is substance use disorder

Persistent use of substances illegal or illicit despite substantial harm and adverse consequences
OR
Problematic pattern of use leading to significant impairment or distress

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What is drug abuse

Inappropriate and usually excessive self-administration of a drug for non-medical purposes

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Common combinations of drugs of abuse

Alcohol and Heroin
Nicotine and alcohol
Cocaine and Heroin
Cocaine and Benzodiazepines
Heroin and Barbiturates

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Why is therapeutic index reduced by tolerance to a drug

The toxicity and lethality profile does not shift to the same magnitude or doesn’t shift at all

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What is tolerance

Reduced reaction to a drug following repeated use

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Types of tolerance

Innate tolerance
Acquired tolerance

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Types of acquired tolerance

Pharmacokinetic
Pharmacodynamic

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Types of pharmacodynamic adaptations that cause tolerance

Short term
Long term adaptation or synaptic plasticity

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What is cross tolerance

Acquiring tolerance to a drug ad requiring higher than normal doses of a second drug to have its effects.

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What causes cross tolerance

Enzyme induction

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What is sensitization

Non associative Progressive amplification of response to a drug on repeated administration

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What is sensitization

Non associative Progressive amplification of response to a drug on repeated administration

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What is sensitization

Non associative Progressive amplification of response to a drug on repeated administration

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What is a non associative process

Non-associative learning is when an individual’s response to a stimulus changes in the absence of new stimuli. It is based on frequency

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Types of drug dependence

Physiological dependence or Physical dependence
Psychological dependence or addiction

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What type of dependence is responsible for withdrawal syndrome

Physical dependence

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What type of dependence is responsible for withdrawal syndrome

Physical dependence

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Explain physiological dependence

Resetting of homeostatic mechanisms in response to repeated drug use
Drug is needed to maintain near normal function of organs or systems

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Which type of dependence causes pleasurable sensations that cause the user to continually seek for the substance or activity

Psychological dependence

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Drug addiction or substance dependence is a chronically relapsing disorder characterized by ………………..,………..,……..

Compulsion to seek and take drug
Loss of control in limiting intake
Emergence of a negative emotional state when access to drug is prevented

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Addiction is a chronic relapsing disorder with roots both in …………

Impulsivity
Compulsivity
Neurobiological problems

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Examples of non-substance addiction they produces a rush or thrill

Gambling
Sex
Food
Internet
Mobile devices
Shopping

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Four main dopaminergic pathways

Nigrostriatal pathway
Mesolimbic pathway
Mesocortical pathway
Tuberohypophyseal or tuberoinfundibular pathway

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Describe the nigrostriatal pathway

Cell bodies largely in the substantia nigra whose axons terminate in the corpus striatum

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Describe the mesolimbic pathway

Cell bodies in midbrain ventral tegmental area and fibers project via the medial forebrain to parts of the Lombok system, especially the nucleus acumbens and the amygdaloid nucleus

Describe the mesocortical pathway

Cell bodies in the VTA and axons which project via the MFB bundle to the frontal cortex

Describe the tuberohypophyseal pathway

Neurons running from the ventral hypothalamus to the median eminence and pituitary gland

Functions of the mesolimbic pathway

Reward and learned behaviors

Function of the mesocortical pathway

Higher order cognitive functions like motivation, reward, emotion and impulse control

Function of the nigrostriatal pathway

Regulation of movement

Function of the tuberoinfundibular pathway

Regulates prolactin secretion

Categories of dopamine receptors

D1-like (D1, and D5) Gs coupled - activates adenylyl Cyclase and PKA D2 like ( D2, D3, D4) Gi/Go coupled- inhibits adenylyl cyclase, calcium and activates PLC and K

Which dopamine receptors are implicated in addiction

D1 and D5

A example of a sigma receptor agonist

Cocaine

Function of the sigma receptor

Plays a role in drug addiction

What type of receptor is the sigma receptor

GPCR

Which pathway is linked to the sigma receptor

MAP kinase pathway

What is another name for the brain reward pathway

Mesolimbic Dopaminergic pathway

Which dopaminergic pathway does all drugs of abuse potential target

Mesolimbic pathway

Ways in which drugs of abuse act

Increase dopamine release Prevent dopamine reuptake Prevent dopamine breakdown by enzymes Stimulate dopamine receptors Inhibit GABA pathways

Class 1 drugs of abuse

Opioids Tetrahydrocannabinol (THC) Gammahydroxybutyrate (GHB) LSD Mescaline Psilocybin Act on GPCRs

Class 2 drugs of abuse

Benzodiazepines Nicotine Ethanol Ketamine Phencyclidine Act on channels

Class 3 drugs of abuse

Cocaine Amphetamine Ecstasy Act on transporters

Major connections of the mesolimbic pathway and the functions

Locus ceruleus- Arousal and novelty Amygdala- Stress and anxiety Hippocampus - Context and memory Prefrontal cortex- executive function, cognitive control Orbitofrontal cortex - judgement and decision making

How does punishments criticism or disappointment affect dopamine levels on the VTA

Decreases dopamine and increased GABA

Functions of the ventral pallidum

Regulation of motivational salience, behavior and emotion

How is the size of the VTA affected by addiction

Decreases in size

Effect of addiction of dopamine receptors

D1 and D5 are downregulated, internalized and their transcription is reduced

Effect of addiction of secondary messengers relays to dopamine receptors

Decoupling of second messenger relays to decrease effect size

How is the size of the nuclei accumbens affected by addiction

Branches out and enlarges

Effects of addiction on proinhibitory pathways

Upregulation of inhibitory receptors Increased production of inhibitory neurotransmitters

What is allostasis

Allostasis is defined as the process of maintaining homeostasis through the adaptive change of the organism’s internal environment to meet perceived and anticipated demands.

………… forms one of the major reasons for relapse into drug use years after successful rehabilitation

Allostasis

Three different Variables of drug addictions

Drug or agent factors Host factors Environmental factors

Classification of drug addiction based on DSM V criteria

Mild 2-3 symptoms Moderate 4-5 symptoms Sever 6 or more symptoms

Examples of narcotic or opioid analgesics

Heroin Morphine Codeine Tramadol

Examples of abused CNS depressants

Alcohol Sedative/Hypnotics Anxiolytics

Examples of abused CNS stimulants

Cocaine Methyxanthines Nicotine Amphetamines

Other drugs of abuse

Psychedelics and Hallucinogens Marijuana Dissociative Anaesthetics Anticholinergics

Which drugs of abuse act on 5HT2A receptors

LSD Mescaline Psilocybin

Drugs of abuse that antagonize NMDA receptors

Phencyclidine Ketamine

The five R’s for enhancing motivation to quit drug addiction

Relevance Risks Rewards Roadblocks Repetition

Components of counseling a drug addict

Ask Advise Assess Assist Arrange

MANAGEMENT OF SUBSTANCE USE DISORDERS Flashcards

(63 cards)