review for final Flashcards
(98 cards)
1
Q
molecular target for Cocaine
A
DAT- dopamine plasma membrane transporter
2
Q
reuptake blockade of dopamine by cocaine correlates with
A
the ability of the drug to mediate behavioral reward
3
Q
lesions of DAT expressing dopamine neurons in the midbrain leads to
A
reduction of cocaine reward
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
5
Q
target for amphetamine
A
targets vesicular monoamine storage
6
Q
neuronal vesicular monoamine transporter is a
A
ATP- dependent and linked to a vesicular proton pump
7
Q
amphetamine competes with who for binding free protons in the vesicle?
A
amphetamine
8
Q
displaced catecholamines in cytosol leak out via
A
reverse DAT transport
9
Q
partially blocks DAT reuptake?
A
amphetamine
10
Q
target for opioid
A
mu opioid receptor
11
Q
mu receptor is a
A
seven-transmembrane spanning G protein linked receptor
12
Q
what happens to mu-receptor knockouts
A
lose the rewarding actions of morphine
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
14
Q
acute morphine reward, morphine tolerance and morphine dependence are mediated through the same receptors?
A
Yes
15
Q
methadone and heroine act on what type of receptors?
A
Mu opioid receptor
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
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
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
19
Q
12-step program
A
- misused substancce is a symptom
- I am the problem
- there is a spiritual solution
- power through surrender
20
Q
4th step inventory
A
resentment- kills more alcoholics than anything else
- part of the 12 step program
21
Q
DSM 5
A
criteria for substance use disorders
22
Q
Role of the primary provider preventions
A
- discussion about risk factors
- assessment of pt. begun with use
- prevention/reduction of substance use
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
24
Q
preliminary tx. plan
A
presentation to pt/family
- determination to change
25
Treatment/ referral
Level 1, 2, 3 and 4
Level 1. outpatient tx.
Level 2. intensive outpatient program
Level 3. medically monitored program
Level 4. medically managed program
26
lifetime prevalence of abuse in males vs females?
males: 15%
females: 5%
27
incidence of abuse in males vs females s
males: 6-8%
females: 2-3%
28
what is up with the elderly and substance abuse?
prevalence of use decreases but a greater proportion not recognized
29
what is up with the women and substance abuse?
greater social stigma, poverty, parenting issues may prevent DX/RX
30
special problems in female alcoholics
- BAC 50% higher compared to men
- greater incidence of hepatic dx.
- greater cerebral atrophy
31
substance abuse diagnosed in what % in primary care clinic
- hospital estimates
2-4; at least 94% are misdiagnosed
- hospital estimates 30-70%
32
ABC' of poisoned pt.
1. Airway- most common cause of death
2. Breathing
3. Circulation/Cessation/C-spine
4. Decontamination
5. Diagnostics
6. Enhanced elimination
7. Specific antidotes
33
decontamination and types
reduce absorption from body surface
1. dermal
2. gastric
3. cathartics
4. whole bowl irrigation
34
is lab evaluation more important than history and toxidrome?
NOOOOOO
35
chem 7, CBC, APAP, ASA
suicide panel
36
opioids, benzo, cocaine, amphetamine, THC, PCP, +/- TCA
urine tox screen-- not very helpful
37
APAP, theophylline, CO, ASA, DIG, PHenobarb, ETOH, Phenytoin, Iron, Lithium
quantitative levels limited
38
symptoms of opiate/narcotic toxidrome
coma, respiratory depression
39
signs of an opioid overdose and what to do
signs: miosis, respiratory depression and coma
supportive tx.: ventilations, fluids and Naloxone
40
symptoms of sympathomimetic toxidrome
```
hypertension
tachycardia
increased temp
dilated pupils
anxiety
```
41
blood alcohol concentration
- 20-50
- 50-100
- 100-150
- 150- 250
- 300
- 400
- 600
- 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
alcoholism type I
late onset
- male/female
- after 25
- abstain is infrequent
- personality is anxious, depressed and passive-depend
- 2/3: functional/intermediate
43
alcoholism type II
early onset
- males
- before 25
- abstain frequent
- personality: antisocial, conduct dis., impulsive
- 4/5: anti-social, severe/chronic
44
neurobiological susceptibility to alcoholism:
- temperamental deviations
- pre-existing ____ deficits in type II alcoholics
- _____ receptor gene mutation
- ________ plasma Beta-endorphines
- temperamental deviations: prefrontal-midbrain neuroaxis
- pre-existing serotonin deficits in type II alcoholics
- D2-dopamine receptor gene mutation
- lower baseline plasma Beta-endorph
45
CDT is a diagnostic test that is
most sensitive indicator of relapse
46
stages of change
1. pre-contemplation
2. contemplation
3. preparation
4. action
5. maintenance
47
pre-contemplation
feedback
48
contemplation
ambivalence
49
preparation
menu
50
action
choose
51
maintenance
relapse prevention
52
drug of choice for treating withdrawal
Benzo
53
Benzo
GABA receptor
54
long actin benzo
clordiazepoxide
| diazepam
55
short acting benzo
lorazepam
56
meds in long tx. of managment of alcoholism
- disulfram
| - naltrexone
57
benzo have a role in the primary tx. of alcoholism
nope
58
pyrazole inhibits
alcohol DH
59
disulfram inhibits
aldehyde DH
60
cigarette smoking among adults
people with less education, lower income, psych illness or other substance abuse are more likely to smoke
61
are there withdrawal symptoms for nicotine?
yep
craving, impatience, insomnia, anxiety, increased appetite
62
tx. with evidence of efficacy for smoking
1. behavioral counseling
2. pharmacotherapy
3. combination
63
pharm tx. for smoking
- nicotine replacement
- bupropion
- varenicline
* each at least doubles quit rate vs placebo
64
addictive nature of a drug is in part a function of how fast it works and how fast it wears off
yep
65
physician intervention for smoking
routine advice very effective
brief counseling is more effect
1. ask
2. advise
3. assess
4. assist
5. arrange
66
positive effects of cocaine
- euphoria
- decreased sleep
- decreased appetite
- sexual stimulation
- garrulousness
67
negative effects of cocaine
- irritability
- anxiety
- restlessness
- paranoia
68
cocain-induced paranoia
- occurs in about 2/3 of heavy users
| - not necessarily dose-related, but there may be kindling effect
69
time course of cocaine effects
smoking has the fastest onset while intranasal takes the most
70
local complications of cocaine
- irritation/ulcers of nasal mucosa
- rhinorrhea
- nasal septal perforation
71
cardiovascular complications of cocaine
- MI
- ventricular dysrhythmias
- cardiomyopathy
- endocarditis
72
neurological complications of cocaine
- hemorrhagic stroke
- ischemic stroke
- grand mal seizures s
73
gender difference in intranasal cocaine response
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
cocaine metabolism:
metabolized by?
metabolite?
present in urine for _____ hr and half-life of cocaine is ________ minutes
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
tx. for cocaine dependce
1. behavioral tx.
2. cognitive-behavioral relapse prevention
3. disease model 12 step counseling
76
anti-drug abuse act of 1986
- 5 yrs w/out parole for 5gm of crack/500 gms powder cocaine
| - racial disparity
77
fair sentencing act of 2010
- 28gm crack
78
Gateway theory
age of initiation:
1. early: tobacco
2. middle: marijuana
3. late: narcotics
4. non-sepcific: cocaine
79
marijuana 4 basic clinical effects
1. stimulation: increases BP, P, RR, appetite
2. sedation
3. anesthesia
4. Hallucinogen
80
amphetamine is a
hallucinogen
81
methamphetamine leads to ____ discharge which leads to hyperthermia, sweating, tachycardia and hypertension. it also releases _____ leading to euphoria
sympathetic
- releases serotonin
82
methamphetamine effect leads to
- meth mouth
- crank bugs
- burns
83
opium is derived from _____. natural alkaloids include
derived from poppy flower
- natural alk.- morphine and codeine
84
semi-synthetics are derivatives of
morphine
85
synthetics include
methadone
86
pharm. management of withdrawal:
- full agonist
- partial agonist/antagonist
- suppress nE release
- antagonist precip. of withdrawal
= additional agents of Symptom relief
- full agonist: methadone
- partial agonist/antagonist: naloxene
- suppress nE release: clonidine
- antagonist precip. of withdrawal: naltrexone
- additional agents of Symptom relief : Benzo
87
iatrogenic misinterpretation of relief-seeking behaviors caused by undertreatment of pain that is identified by the clinician as inappropriate drug-seeking behavior
pseudoaddiction
88
less predictive drug-related behavior
Rx from multiple MDs
89
stimulants like amphetamine block
transporters
90
physical exam:
- vital signs have added one new criteria
determining pain
91
stages of change:
feedback
pre-contemplation
92
stages of change:
psychotherapy to deal with ambivalence
contemplation
93
stages of change:
menu of treatment options
preparation
94
stages of change:
let patient choose
action
95
stages of change:
relapse prevention
maintenance
96
number one drug involved in U.S. overdose death
fentanyl
97
controlled use of opioids should lie between sedation and pain
analgesia
98
informed consent is needed in ongoing persistent pain treatment
yep
