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Addiction boards > Random pearls from BEST > Flashcards

Random pearls from BEST Flashcards

1
Q

Pharmacologic changes re MTD in pregnancy (4)

A

Increased gut transit time (increased absorption), 50% increase in blood volume (lower concentration), induction in CYP3A4 activity, Increase in accumulation in adipose (supposedly can be problematic in postpartum state)

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2
Q

“Seeking Safety”

A

evidence-based treatment approach for PTSD and SUD

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3
Q

Network therapy def

A

individual psychotherapy or family therapy in which an attempt is made to involve not only immediate family members but also other relatives, friends, and neighbors as sources of emotional support and possible vocational opportunity.

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4
Q

Screening tool for unhealthy substance use in adolescents

A

CRAFFT (ridden in Car, use Alone, Family/Friends concerned, gotten in Trouble)

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5
Q

Schedule 1 meds

A

no currently accepted medical use and high potential for abuse. Heroin, LSD, cannabis, MDMA, methaqualone, peyote

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6
Q

Schedule 2 meds

A

High potential for abuse, can only be prescribed in triplicate. Cocaine, methamphetamine, opioids, meperidine, dexadrine, adderall, ritalin

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7
Q

Schedule 3 meds

A

can be prescribed by phone. Moderate-to-low potential for dependence. APAP w codeine, ketamine, anabolic steroids, testosterone

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8
Q

Schedule 4 meds

A

can be prescribed by phone. “Low” potential for abuse. Benzos, ambien, tramadol

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9
Q

Schedule 5 meds

A

can be prescribed by phone . Limited quantities of certain opioids like robitussin with codeine, lomotil, lyrica

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10
Q

Limbic system (hippocampus and amygdala) role in addiction

A

memory and emotional context (triggers)

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11
Q

Orbito-frontal cortex role in addiction

A

reward processing

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12
Q

Nucleus accumbens role in addiction

A

dopaminergic / pleasure from drugs and behaviors

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13
Q

Insula role in addiction

A

integrating and giving meaning to sensations such as hot/cold as well as cravings

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14
Q

Pseudowithdrawal def

A

intensification of symptoms when wd is imminent

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15
Q

Rebound def

A

intensification of pre-treatment symptoms after discontinuation. Distinguish from “recurrence” by whether symptoms merely returned vs intensified

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16
Q

Sensitization def

A

opposite of tolerance (increased effect with repeat doses)

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17
Q

“stacking” in anabolic steroids

A

using multiple types simultaneously

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18
Q

“pyramid” in anabolic steroids

A

increasing dose, then tapering prior to competition

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19
Q

Effects of anabolic steroids

A

increase muscle strength, but not bone mass, aerobic capacity, injury time. Can increase irritability.
In women, masculinization, weight gain, irr periods

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20
Q

Toxicity of anabolic steroids

A

PO administration associated with LFT abnormalities

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21
Q

anabolic steroid withdrawal illness script

A

Looks like depression

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22
Q

Gambling disorder risk and meds

A

DSM-5 recognized, about 50% of risk attributable to genetic influences. Meds with evidence: naltrexone, lithium, paroxetine

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23
Q

rate of SUD in Eds

A

50% of patients with eating disorder have SUDs

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24
Q

Gene with variants that modulate naltrexone efficacy for AUD

A

OPRM1

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25
Q

Kratom pharmacology

A

mitragynine. Antagonist at kappa opioid receptor, agonist vs partial agonist at mu receptor.

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26
Q

Salvia pharmacology and effects

A

salvinorin A. kappa opioid agonist→ hallucinosis and dissociation, not reliably euphoria

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27
Q

methanol poisoning illness script

A

vision loss, hyperventilation, abd pain, parksinonian features, AGMA, increased ICP. Can occur with huffing.
Tx: fomepizole.

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28
Q

Stages of changes and their associated pitfalls for patients

A

Pre-contemplative → resistance

Contemplation → demoralization

Action → dropout

Maintenance → relapse

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29
Q

mechanism of LSD and psilocybin

A

serotonin 5HT-2A agonists

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30
Q

Features of therapeutic community

A

Structured daily regimen
Assigned role models
Use of peer community as healing agent (“community-as-method”)

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31
Q

Active metabolites of heroin

A

6-MAM
morphine
3-MAM

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32
Q

risk of SUD attributable to genetic factors

A

40-60% (supposedly)
Outweighs parental substance use in adoption studies

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33
Q

Principles of twelve-step facilitation

A

Abstinence (goal)

Acceptance (of one’s loss of control over substance consumption)

Spirituality (“power greater than oneself”)

Pragmatism (collaborative approach to do whatever is needed to avoid first drink)

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34
Q

Role of recovery coach

A

Encourage healthy structures and rituals. Best utilized as part of comprehensive treatment plan

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35
Q

Unique toxicity of meperidine

A

Decreased seizure threshold d/t normeperidine accumulation

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36
Q

PNPLA3 and MBOAT7

A

genes associated with incr risk of alcohol-related liver disease

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37
Q

GABRA2

A

gene likely associated with severity of AWS and daily alcohol use

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38
Q

CYP2A6

A

Metabolizes nicotine to cotinine. Reduced activity associated with reduced smoking risk due to increased adverse effects

39
Q

GABA agonists

A

benzo - GABA-A
etoh - gaba-a
GHB - gaba-b
baclofen - gaba-b

40
Q

benzo overdose mortality

A

remarkably low – lethal dose not established for most benzos
Problem is combination w other drugs

41
Q

prevalence of tobacco use in OUD

A

75-90%

42
Q

convergent therapy

A

combination of multiple modalities (eg meds and CBT)

43
Q

cause drug testing

A

done when there is suspicion of use (distinguish from random)

44
Q

CYP 2D6

A

hydrocodone –> hydromorphone
AND
Codeine –> morphine

slow metabolizers achieve very low levels, fast metabolizers can have rapid high levels

45
Q

Harrison act and controlled substances act

A

Harrison 1914 - codified illegal vs legal and taxable

CSA - governs medical use

46
Q

D4R gene

A

dopamine R. variants associated w lower dop tone –> incr risk of smoking and relapse

47
Q

conditional confidentiality

A

generally afforded to adolescents 14-18

48
Q

relative dopamine release of diff drugs

A

meth&raquo_space; cocaine > heroin/nicotine > sex/food

49
Q

MTD and NAS

A

higher doses not associated w incr risk for NAS

50
Q

Fidelity ethical principle

A

Being truthful/faithful to duties as a medical professional. Includes CME and maintenance of competence

51
Q

1976 Court case establishing that correctional authorities must reasonably assess and treat incarcerated people?

A

Estelle v Gamble

52
Q

dopamine transporter A9 allele

A

associated with more severe AWS and DTs risk!

53
Q

primary vs secondary vs tertiary prevention

A

primary - preventing incidence
secondary - identifying and intervening as early as possible (includes screening)
Tertiary - preventing complications by active treatment
quaternary - avoiding harm through overmedicalization

54
Q

URICA

A

University of RI Change Assessment - measures motivation to change across range of behaviors

55
Q

CRI

A

Coping Response inventory - measures coping skills

56
Q

InDUC

A

Inventory of drug use consequences – measures adverse effects from drug use

56
Q

RAATE

A

Recovery Attitude and treatment evaluator – measures resistance to change

57
Q

MAST-G

A

Michigan Alcoholism Screening Test - Geri – older adult alcoholism screening instrument. 24-item scale, superior to other screening tests

58
Q

Hyperalgesia vs allodynia

A

hyperalgesia - increased pain from painful stimulus
allodynia - pain from non-painful stimulus

59
Q

DrInc vs AUDIT

A

DrInC - Drinker inventory of consequences : assesses adverse impacts in domains of physical, social, impulsive, interpersonal, and intrapersonal
AUDIT: assesses drinking patterns and failed efforts to control

60
Q

Khat and bath salts

A

Cathinone - stimulant alkaloid derived from khat. MAO reuptake inhibitor
Bath salts - synthetic analogues

61
Q

healthy drinking limits

A

men under 65 - 4 per sitting / 14 per week
women under 65 - 3 per sitting / 7 per week
over 65 - 2 per sitting / 7 per week
Above this is “heavy use” (per NIDAA)

62
Q

Webb vs US

A

interpreted Harrison Act to declare that physicians maintaining patients with addiction on usual dose of prescribed opioid is not “good faith” and therefore indictable.
DATA-2000 was then necessary to allow physicians to prescribe schedule III-V opioids with FDA indication for OUD (currently describes only bup since methadone is schedule II)

63
Q

FRAMES

A

Brief intervention outline:
Feedback
Responsibility
Advice
Menu of strategies
Empathy
Self-Efficacy

64
Q

CDT

A

Carbohydrate deficient transferrin – biomarker for HEAVY alcohol use

65
Q

Categorical levels of substance use (low risk, unhealthy, etc)

A

low risk - complete absence or use at very low risk for adverse events
Unhealthy: both hazardous and harmful
Hazardous: risky use that has not yet developed adverse effects
Harmful: +adverse effects

66
Q

disulfiram toxicity/contraindication

A

psychosis - can precipitate!
Hepatic metabolism, not appropriate with impairment

67
Q

phencyclidine false positive

A

venlafaxine

68
Q

varenicline and alcohol

A

can increase toxic effects (drunkeness, blackouts). patients should be cautioned

69
Q

Smoking cessation in pregnancy/lactation

A

NRT - less data, most trials stopped early for adverse pregnancy effects. Risk/benefit
Bupropion - generally safe, including lactation. probably first line
Varenicline - limited data, probably safe

70
Q

Fentanyl patch –> increased drug delivery

A

fever/increase in skin temp

71
Q

pharmacokinetics vs dynamics

A

PK - time course of concentration following administration (what body does to drug)
PD - drug effects relative to concentration (what drug does to body)

72
Q

cocaine MOA

A

NE reuptake inhibitor

73
Q

MA MOA

A

inhibits DA reuptake, promotes release

74
Q

cocaethylene effects

A

incr cardiotoxicity, hepatotoxicity, seizures

75
Q

e-cigarette solvent

A

propylene glycol

76
Q

MDMA mechanism

A

releaser and/or reuptake inhibitor of presynaptic monamines (5HT, DA ,NE

77
Q

dextromethorphan mechanism

A

at high doses, nonselective 5HT reuptake inhibitor, NMDAR antagonist (like ketamine) –> dissociative hallucinogen

78
Q

phencyclidine mechanism

A

NMDAR antagonist, also has anticholinergic properties

79
Q

Stark Law

A

prohibits physicians from referring Medicare patients for health services with which the physician (or family) have financial relationship

80
Q

toluene illness script

A

paint thinner, extreme intoxication and AMS

81
Q

low-acuity patient presenting for first episode of care requesting inpatient tx

A

should be referred for outpatient tx first.

82
Q

evaluation for depression in AUD

A

should be done on admission to detox/treatment, even though many sx resolve with abstinence

83
Q

standard drinks

A

1.5 oz liquor, 5 oz wine, 12 oz beer (standard mass-consumption beverages, not high ABV)

84
Q

why is lorazepam preferred in cirrhosis?

A

undergoes gluconuridation to inactive metabolites (other bzd have active metabolites)

85
Q

e-cigs regulation and outcomes

A

ENDS (electronic nicotine delivery systems) FDA regulated since 2016
helpful in harm reduction. At 52 weeks, 18% of people stop cigs (compared to 9% for NRT)– many ppl become dual-users. huge variability in nicotine levels and has harmful pregnancy outcomes. heavy metals present in both ENDS and cigarettes.
No approved meds for vaping use disorder

86
Q

adolescent ENDS use

A

3X risk of cigarette smoking

87
Q

top-line outcome for methadone and bup

A

50% relative risk reduction for death by overdose

88
Q

smoking effects on life expectancy

A

on average, smokers die 10 yrs early. smoking leads to premature death in at least 50% of long-term smokers

89
Q

factors increasing risk of overdose in LTOT

A
  • OME >90
  • long-acting opioids
  • history of overdose
  • OUD
  • MDD
90
Q

SSPs + MOUD impact on infectious risk

A

decr HIV and HCV by ~67%

91
Q

CV effects of ecigs

A

improved endothelial function and vascular stiffness, no hard outcomes

92
Q

Medial OFC

A

“stinking thinking” i.e. aberrant motivation/reward thinking

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