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Addiction in medicine > review for final > Flashcards

review for final Flashcards

1
Q

molecular target for Cocaine

A

DAT- dopamine plasma membrane transporter

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2
Q

reuptake blockade of dopamine by cocaine correlates with

A

the ability of the drug to mediate behavioral reward

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3
Q

lesions of DAT expressing dopamine neurons in the midbrain leads to

A

reduction of cocaine reward

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4
Q

cocaine reward in transgenic DAT vs DAT knockouts

A
  • in transgenic mice the reward is altered

- in knockout the reward is intact due to reuptake of dopamine at the NEPI and 5-HT plasma membrane transporters

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5
Q

target for amphetamine

A

targets vesicular monoamine storage

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6
Q

neuronal vesicular monoamine transporter is a

A

ATP- dependent and linked to a vesicular proton pump

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7
Q

amphetamine competes with who for binding free protons in the vesicle?

A

amphetamine

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8
Q

displaced catecholamines in cytosol leak out via

A

reverse DAT transport

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9
Q

partially blocks DAT reuptake?

A

amphetamine

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10
Q

target for opioid

A

mu opioid receptor

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11
Q

mu receptor is a

A

seven-transmembrane spanning G protein linked receptor

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12
Q

what happens to mu-receptor knockouts

A

lose the rewarding actions of morphine

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13
Q

mu receptor activates Gi, Go and Gq proteins, which then activate ___ and ___ channels, adenylyl cyclase in distinct cell types

A

K and Ca

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14
Q

acute morphine reward, morphine tolerance and morphine dependence are mediated through the same receptors?

A

Yes

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15
Q

methadone and heroine act on what type of receptors?

A

Mu opioid receptor

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16
Q

cannabinoids active ingredient?what is it?

receptor primarily in CNS? PNS?

endogenous ligand

A
  • delta-9-tetrahydrocannabinol
  • G protein linked
  • CB1- CNS
  • CB2- PNS
  • endogenous ligand: anandamide
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17
Q

target of ehtanol

positive modulator? negative?

withdrawal? what is increased during acute withdrawal

A

disinhibits dopamine neurons in VTA (euphoric effect)

  • positive modulator of GABA receptors
  • negative modulators of NMDA receptors

withdrawal upregulates NMDA receptors and in acute there is increased neuronal excitability

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18
Q

SMART

A
  • disruptive thinking about the misused substance is the problem
  • I can solve the problem
  • tools are learned to deal with situations
  • power through knowledge of techniques
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19
Q

12-step program

A
  • misused substancce is a symptom
  • I am the problem
  • there is a spiritual solution
  • power through surrender
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20
Q

4th step inventory

A

resentment- kills more alcoholics than anything else

  • part of the 12 step program
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21
Q

DSM 5

A

criteria for substance use disorders

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22
Q

Role of the primary provider preventions

A
  1. discussion about risk factors
  2. assessment of pt. begun with use
  3. prevention/reduction of substance use
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23
Q

screening as a primary provider

A

avoid sterotypes

  • single alcohol screening Q- how many times in the past year have you had 5/4 more drinks in a day
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24
Q

preliminary tx. plan

A

presentation to pt/family

  • determination to change
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25
Q

Treatment/ referral

Level 1, 2, 3 and 4

A

Level 1. outpatient tx.

Level 2. intensive outpatient program

Level 3. medically monitored program

Level 4. medically managed program

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26
Q

lifetime prevalence of abuse in males vs females?

A

males: 15%
females: 5%

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27
Q

incidence of abuse in males vs females s

A

males: 6-8%
females: 2-3%

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28
Q

what is up with the elderly and substance abuse?

A

prevalence of use decreases but a greater proportion not recognized

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29
Q

what is up with the women and substance abuse?

A

greater social stigma, poverty, parenting issues may prevent DX/RX

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30
Q

special problems in female alcoholics

A
  • BAC 50% higher compared to men
  • greater incidence of hepatic dx.
  • greater cerebral atrophy
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31
Q

substance abuse diagnosed in what % in primary care clinic

  • hospital estimates
A

2-4; at least 94% are misdiagnosed

  • hospital estimates 30-70%
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32
Q

ABC’ of poisoned pt.

A
  1. Airway- most common cause of death
  2. Breathing
  3. Circulation/Cessation/C-spine
  4. Decontamination
  5. Diagnostics
  6. Enhanced elimination
  7. Specific antidotes
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33
Q

decontamination and types

A

reduce absorption from body surface

  1. dermal
  2. gastric
  3. cathartics
  4. whole bowl irrigation
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34
Q

is lab evaluation more important than history and toxidrome?

A

NOOOOOO

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35
Q

chem 7, CBC, APAP, ASA

A

suicide panel

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36
Q

opioids, benzo, cocaine, amphetamine, THC, PCP, +/- TCA

A

urine tox screen– not very helpful

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37
Q

APAP, theophylline, CO, ASA, DIG, PHenobarb, ETOH, Phenytoin, Iron, Lithium

A

quantitative levels limited

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38
Q

symptoms of opiate/narcotic toxidrome

A

coma, respiratory depression

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39
Q

signs of an opioid overdose and what to do

A

signs: miosis, respiratory depression and coma

supportive tx.: ventilations, fluids and Naloxone

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40
Q

symptoms of sympathomimetic toxidrome

A 
hypertension
tachycardia
increased temp
dilated pupils 
anxiety
41
Q

blood alcohol concentration

  • 20-50
  • 50-100
  • 100-150
  • 150- 250
  • 300
  • 400
  • 600
A
  • 20-50: exhilaration, loss of inhibition
  • 50-100: impaired judment/coordination
  • 100-150: difficulty with gait/balance
  • 150- 250: lethargy and difficulty sitting upright
  • 300: coma
  • 400: respiratory depression
  • 600: death
42
Q

alcoholism type I

A

late onset

  • male/female
  • after 25
  • abstain is infrequent
  • personality is anxious, depressed and passive-depend
  • 2/3: functional/intermediate
43
Q

alcoholism type II

A

early onset

  • males
  • before 25
  • abstain frequent
  • personality: antisocial, conduct dis., impulsive
  • 4/5: anti-social, severe/chronic
44
Q

neurobiological susceptibility to alcoholism:

  • temperamental deviations
  • pre-existing ____ deficits in type II alcoholics
  • _____ receptor gene mutation
  • ________ plasma Beta-endorphines
A
  • temperamental deviations: prefrontal-midbrain neuroaxis
  • pre-existing serotonin deficits in type II alcoholics
  • D2-dopamine receptor gene mutation
  • lower baseline plasma Beta-endorph
45
Q

CDT is a diagnostic test that is

A

most sensitive indicator of relapse

46
Q

stages of change

A
  1. pre-contemplation
  2. contemplation
  3. preparation
  4. action
  5. maintenance
47
Q

pre-contemplation

A

feedback

48
Q

contemplation

A

ambivalence

49
Q

preparation

A

menu

50
Q

action

A

choose

51
Q

maintenance

A

relapse prevention

52
Q

drug of choice for treating withdrawal

A

Benzo

53
Q

Benzo

A

GABA receptor

54
Q

long actin benzo

A

clordiazepoxide

diazepam

55
Q

short acting benzo

A

lorazepam

56
Q

meds in long tx. of managment of alcoholism

A
  • disulfram

- naltrexone

57
Q

benzo have a role in the primary tx. of alcoholism

A

nope

58
Q

pyrazole inhibits

A

alcohol DH

59
Q

disulfram inhibits

A

aldehyde DH

60
Q

cigarette smoking among adults

A

people with less education, lower income, psych illness or other substance abuse are more likely to smoke

61
Q

are there withdrawal symptoms for nicotine?

A

yep

craving, impatience, insomnia, anxiety, increased appetite

62
Q

tx. with evidence of efficacy for smoking

A
  1. behavioral counseling
  2. pharmacotherapy
  3. combination
63
Q

pharm tx. for smoking

A
  • nicotine replacement
  • bupropion
  • varenicline
  • each at least doubles quit rate vs placebo
64
Q

addictive nature of a drug is in part a function of how fast it works and how fast it wears off

A

yep

65
Q

physician intervention for smoking

A

routine advice very effective

brief counseling is more effect

  1. ask
  2. advise
  3. assess
  4. assist
  5. arrange
66
Q

positive effects of cocaine

A
  • euphoria
  • decreased sleep
  • decreased appetite
  • sexual stimulation
  • garrulousness
67
Q

negative effects of cocaine

A
  • irritability
  • anxiety
  • restlessness
  • paranoia
68
Q

cocain-induced paranoia

A
  • occurs in about 2/3 of heavy users

- not necessarily dose-related, but there may be kindling effect

69
Q

time course of cocaine effects

A

smoking has the fastest onset while intranasal takes the most

70
Q

local complications of cocaine

A
  • irritation/ulcers of nasal mucosa
  • rhinorrhea
  • nasal septal perforation
71
Q

cardiovascular complications of cocaine

A
  • MI
  • ventricular dysrhythmias
  • cardiomyopathy
  • endocarditis
72
Q

neurological complications of cocaine

A
  • hemorrhagic stroke
  • ischemic stroke
  • grand mal seizures s
73
Q

gender difference in intranasal cocaine response

A

males:

  • higher peak plasma cocaine levels
  • detected cocaine effects faster
  • experienced more episodes of euphoria
  • hear rate paralleled plasma levels

females:

  • earlier onset
  • more rapid development of dependence
  • slower recovery
74
Q

cocaine metabolism:

metabolized by?

metabolite?

present in urine for _____ hr and half-life of cocaine is ________ minutes

A

metabolized by plasma cholinesterases

metabolite is benzoylecgonine which is inactive

present in urine for 48 hr and half-life of cocaine is 40-60 minutes

75
Q

tx. for cocaine dependce

A
  1. behavioral tx.
  2. cognitive-behavioral relapse prevention
  3. disease model 12 step counseling
76
Q

anti-drug abuse act of 1986

A
  • 5 yrs w/out parole for 5gm of crack/500 gms powder cocaine

- racial disparity

77
Q

fair sentencing act of 2010

A
  • 28gm crack
78
Q

Gateway theory

A

age of initiation:

  1. early: tobacco
  2. middle: marijuana
  3. late: narcotics
  4. non-sepcific: cocaine
79
Q

marijuana 4 basic clinical effects

A
  1. stimulation: increases BP, P, RR, appetite
  2. sedation
  3. anesthesia
  4. Hallucinogen
80
Q

amphetamine is a

A

hallucinogen

81
Q

methamphetamine leads to ____ discharge which leads to hyperthermia, sweating, tachycardia and hypertension. it also releases _____ leading to euphoria

A

sympathetic

  • releases serotonin
82
Q

methamphetamine effect leads to

A
  • meth mouth
  • crank bugs
  • burns
83
Q

opium is derived from _____. natural alkaloids include

A

derived from poppy flower

  • natural alk.- morphine and codeine
84
Q

semi-synthetics are derivatives of

A

morphine

85
Q

synthetics include

A

methadone

86
Q

pharm. management of withdrawal:
- full agonist
- partial agonist/antagonist
- suppress nE release
- antagonist precip. of withdrawal

= additional agents of Symptom relief

A
  • full agonist: methadone
  • partial agonist/antagonist: naloxene
  • suppress nE release: clonidine
  • antagonist precip. of withdrawal: naltrexone
  • additional agents of Symptom relief : Benzo
87
Q

iatrogenic misinterpretation of relief-seeking behaviors caused by undertreatment of pain that is identified by the clinician as inappropriate drug-seeking behavior

A

pseudoaddiction

88
Q

less predictive drug-related behavior

A

Rx from multiple MDs

89
Q

stimulants like amphetamine block

A

transporters

90
Q

physical exam:

  • vital signs have added one new criteria
A

determining pain

91
Q

stages of change:

feedback

A

pre-contemplation

92
Q

stages of change:

psychotherapy to deal with ambivalence

A

contemplation

93
Q

stages of change:

menu of treatment options

A

preparation

94
Q

stages of change:

let patient choose

A

action

95
Q

stages of change:

relapse prevention

A

maintenance

96
Q

number one drug involved in U.S. overdose death

A

fentanyl

97
Q

controlled use of opioids should lie between sedation and pain

A

analgesia

98
Q

informed consent is needed in ongoing persistent pain treatment

A

yep

Addiction in medicine (10 decks)

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