SECTI0N 2 PRINCIPLES OF ADDICTION MEDICINE Flashcards

Question

history of marijuana

Answer 1

–in use for 12,000 years –Probably started in Central Asia –Brought to America's in 1600s I English and Spanish –Euphoric properties discovered in India about 2000 BC –Recreational use began to surge in 1930s during prohibition –American use ended in 1937 with marijuana tax act

Answer 2

``` –prevention of weight loss in AIDS patients –Pain management –Anti-nausea –glaucoma control –Control of movement disorders ```

Answer 3

–CB 1 receptors played a role in regulating pain behavior –CB 1 agonist produce analgesia at several sites of pain transmission –CB 2 receptor is critical component of inflammatory pain –THC may prevent opioid tolerance and dependence –THC produces analgesia only at doses high enough to produce dysphoria –THC is no more potent than commonly used opioid analgesia –Low dose of THC will prevent tolerance and addiction to morphine

Answer 4

–must be smoked frequently to depress intraocular pressure –Cannabis alone will not lower pressure enough to prevent optic nerve damage –Is no more effective than other glaucoma treatments

Answer 5

–most common Route is hand rolled joint = 0.5–1 g of cannabis gives 5–150 milligrams of THC –2–3 milligrams THC needed to produce high and occasional user –If taken with food, onset of psychoactive effects in about 1 hour –THC can be deposited in fatty tissues for long periods after use –Behavioral effects of THC are proportional to plasma concentration

Answer 6

marijuana modifies –Object distance and outlines leading to distortion –decreases ability to discriminate shapes –Decreases ability to make rapid critical judgments –Slows reaction time and information processing –Impairs perceptual motor coordination –Short-term memory –Impairs attention –effects are dose-related

Answer 7

cognitive effects of cannabis –Decreased cognition and memory –All cognition and memory affected –Effects not as great as chronic alcoholism –Chronic heavy users have significantly lower educational achievement, income, social life, and health

Answer 8

–at low doses, a mixture of depression and stimulation | –At high doses predominantly CNS depression with hyperreflexia

Answer 9

–about 9% chance of chronic users becoming dependent –Develops with repeated exposure –Characterized by lack of control of cannabis use and use despite adverse personal consequences

Answer 10

``` withdrawal effects are generally opposite of those produced by marijuana –Insomnia –Anorexia –Anxiety –Irritability –Depression –Tremor ``` –Similar to tobacco in severity –concurrent withdrawal from cannabis and nicotine produces worse withdrawal than individual drugs –27% of cannabis users report use of cannabis to reduce or prevent withdrawal –Clonidine will reduce withdrawal signs

Answer 11

–cannabis increase his risk of schizophrenia –Increases schizophrenic symptoms –Above effects increase if cannabis use early in adolescence –Produces threefold increased risk of psychosis

Answer 12

–respiratory system is main damage –Contains same carcinogens as tobacco –Can produce chronic cough, airway inflammation, and abnormal cell growth

Answer 13

THC –increases HIV infection –Increase his heart rate –Synergistic with alcohol in developing steatosis –Altered pituitary hormones –Not much effect on kidney –Can induce galactorrhea –Can disrupt female reproductive system –Can contribute to low birth weight children –accumulates and passes in breast milk –Reduce in testosterone and sperm production

Answer 14

–produces alterations and thought, mood, perception –Minimal autonomic side effects and cravings –Failed to produce excessive stupor or central simulation classical hallucinogens = serotonergic hallucinogens ––Indole alkylamines ––Phenyl alkyl amine Designer drugs

Answer 15

–mescaline in use for more than 5000 years –LSD discovered in 1940 –LST = 1000 times more potent than mescaline –LST similar structure to serotonin –Hallucinogen = psycho mimetic

Answer 16

–LSD –Mescaline (peyote cactus) –DOM –psilocybin

Answer 17

``` MDMA produces –Extroversion –Heightened mood –confidence and well-being –Dry mouth and increased thirst –Difficulty concentrating –Impaired balance –Dizziness –Jaw clenching –Lack of appetite –Restlessness –Moderate perceptual changes, primarily intensification of tactile visual and acoustic perception –No frank hallucinations ```

Answer 18

classical hallucinogens do not contain amphetamine-like or cocaine like reinforcing properties Exceptions are MDMA and MDA which have some addicting potential

Answer 19

MDMA –Best that it hallucinogen –Females are sensitive to psychotropic and physical effects –males more sensitive to acute physiologic effects –High-dose MDMA has risk of persistent cognitive impairments and disturbance of affect and personality –In general, classical hallucinogens are free of toxicity Noted MDMA is not a classic hallucinogen

Answer 20

dissociatives –Several heterogeneous chemicals which are antagonists to the N methyl aspartate receptor of the excitatory neurotransmitter glutamic acid in the brain –Share common features with hallucinogens –––But hallucinogens primarily affect 5 Ht 2 a instead of NMDA Examples –Phencyclidine, ketamine –Dextromethorphan –Nitrous oxide Sub-anesthetic doses of phencyclidine and ketamine induced psychotomimetic state resembling schizophrenia

Answer 21

ketamine is used in general anesthesia –Schedule 3 –Sometime used for prehospital analgesia and conscious sedation –Especially useful in children PCP –No longer available commercially –More potent than ketamine and longer-lasting –More likely than ketamine to produce seizures –Usually smoked Dextromethorphan= DXM –Most commonly abused over-the-counter drug –Using large quantities for mental effects –has low toxicity

Answer 22

PCP = phencyclidine = angel dust = Hogg = Crystal = Chuck Norris –Developed as intravenous anesthetic –Produces symptoms of schizophrenia with delusions and hallucinations –Blunted affect Produces ambivalence and asociability –Produces autistic-like effects Similar to ketamine

Answer 23

DXM= skittles –synthesized in 1954 as opioid analgesic –D isomer is antitussives and has less narcotic properties –Does not produce respiratory depression or CNS depression In very high doses produce his PCP like mental effects Crash sometimes used in over 200 times recommended dose –Often used by adolescence because of unavailability ––Highest frequency in 15–16-year-old ––most common was Coricidin HBP colds and cough tablets

Answer 24

PCP half-life 7–46 hours –Metabolizes and liver –Excreted in urine Ketamine –Rapid onset, short duration DXM readily absorbed from gut –Peaks in 2 hours

Answer 25

3 types of effects of dissociatives A. Confusion, delirium, psychosis B. Semicoma,, C., coma With seizures

Answer 26

–dysphoria –Reduced memory and retention –Apathy –Irritability

Answer 27

dextromethorphan has serotonergic effects –Increase since of this and release of serotonin –Inhibits reuptake of serotonin –Few side effects in therapeutic doses Tacitly produced body rash, itching, nausea, vomiting –Higher doses may produce dizziness, drowsiness, altered vision cardiovascular and CNS effects resembling PCP –Euphoria or hallucinations began within 30 minutes of intoxicating dose

Answer 28

volatile alkyl nitrates ––able nitrite ––butyl nitrite Nitrous oxide ``` Solvents, fuels, anesthetics ––Toluene ––Xylene ––trichloroethene ––Tetrachloroethylene ––dichloroethylene ––Butane, isoprene ––ether ––Ketones ```

Answer 29

–problems of inhalants most common among 12–17 murals –Inhalant use is secondary only to alcohol, tobacco and marijuana –Most common among non-Hispanic weight use –Half abusers continue for 2 years –growing problem in developing countries –Often associated with other substance abuse disorders –Often gateway drug

Answer 30

–often droplets –Very rapid onset, user often falls down immediately –Users sometimes become unconscious –Rapid elimination usually via lungs –metabolized inhalants contributed to liver toxicity –Readily into brain

Answer 31

the following have reinforcing parties –Toluene –Chloroform –Nitrous oxide

Answer 32

–cause respiratory depression | –Are neurotoxic

Answer 33

–Respiratory and eye irritation –Coughing respiratory compromise –Livers most important target for exposure to solvents –Especially halogenated cut hydrocarbons –Some kidney damage reported –Benzene and vinyl chloride are known carcinogens

Answer 34

–usually diverted licit medications –female hormones rarely diverted –Usually uses supraphysiologic doses –Organ toxicity often reversible

Answer 35

testosterone 17 alpha L collated derivatives of testosterone 17 beta esterified derivatives of testosterone Modified ring structure analogs

Answer 36

1930 = and I asked her own isolated from urine 1940s = testosterone synthesized –1954 weightlifting champion Soviet coach in phone US coaches that members were taking testosterone –1984 huge number of collegiate and amateur athlete's using

Answer 37

``` substances are being developed there neither illegal nor band, but difficult to detect –Human growth hormone –DeHydro epi androsterone –Erythropoietin –Thyroxine ```

Answer 38

athletes use 10–20 times therapeutic dose –Therapeutically used in women to treat metastatic breast cancer and bone –methyltestosterone plus estrogen use to alleviate menopause symptoms

Answer 39

–can stunt growth –Very few users actually have serious harm –Most effects are reversible –high rate of abnormal personality traits in bodybuilder's Score higher and paranoia, schizoid, antisocial, borderline, histrionic, narcissistic, Passive-aggressive personality profiles

Answer 40

–usually reversible in 3 months after stopping –Benefits usually remain –Can cause "roid rage" –About 3% develop hepatocellular adenomas–benign or malignant –frenzied and violent behavior during cycle of high-dose anabolic steroid resemble hypomania or mania ––Talks faster, more energy, sleeps less ––Becomes impulsive ––Usually followed by depression

Answer 41

–20% of all direct admissions from primary care involve alcohol –Illicit and prescription drug abuse up to 10% in primary care –1 in 5 hospital admissions directionally relates to substance abuse

Answer 42

Screening and Brief Interventions –Time-limited, client center, designed to reduce substance abuse –Average duration 5–20 minutes –Emphasizes reduction rather than abstinence –Not related to readiness to change –Can work in pre-contemplators

Answer 43

"do you sometimes drink beer, wine or other alcohol beverages?" "How many times in the past year have you had 5 drinks in a day?" men < 65 years old = 5 drinks women and men >65 years = 4 drinks

Answer 44

–5 drinks per day <65 years old –14 drinks per week under 65 years old –4/7 drinks per day/week over 65 years or female

Answer 45

at risk drinking = exceeding safe limits, but abuse/dependence criteria not met

Answer 46

–doesn't work well for opioid abuse –Otherwise, one of the highest ranking preventative services ever evaluated –Results in significant reduction in heavy drinkers and alcohol consumed –Effect lasts at least 4 years –Equal for men and women –Multiple encounters more effective than single –Be I seems to reduce mortality by one third in population of heavy drinkers

Answer 47

alcohol abuse occurs in 5% of general emergency room admissions And 50% trauma admissions most young people mature out of hazardous drinking without intervention

Answer 48

40% of college students report binge drinking and prior 2 weeks One third meet criteria for alcohol abuse SPI effective in college students

Answer 49

2% of pregnant women engaged in binge drinking | –13% of nonpregnant women engaged in binge drinking

Answer 50

–7–14 standard drinks per week associated with developmental problems –Moderate intellectual behavior deficits Alcohol during first trimester associated with –Low birthweight –Decreased birth length Alcohol drinks second and third trimesters can produce developmental delay Alcohol is concentrated in breastmilk and can inhibit milk production

Answer 51

alcohol is major risk factor for all categories of fatal and nonfatal injury –Up to 70% life-threatening injuries about alcohol

Answer 52

–10% of older people admitted to the hospital have alcohol –Alcoholism is third most common psychiatric disorder among elderly –One third of older alcoholics are late onset alcoholics

Answer 53

GGT= will sensitive marker of alcohol abuse –Increase in 75% of patients with alcohol dependence –Elevated in 50% of patients hospitalized for alcohol related problems –Elevated 30% of people who drink heavy amounts and have alcohol-related problems But, is elevated with –Fatty liver –Obstructive liver disease –Certain medications including anticonvulsants –5 drinks per day ×2 weeks we'll elevated GGT in most individuals –GGT drops by 50% in 2 weeks GGT drops to normal in 6-8 weeks

Answer 54

–may take 4 months to return to normal ``` Nonalcohol related conditions can increase MCV –Chronic liver disease –Hypothyroidism –Folate deficiency –Megaloblastic disorder ```

Answer 55

–is more sensitive than GGT

Answer 56

if AST >ALT, likely to be alcoholic problem if ALT >AST probably liver disease

Answer 57

serum alcohol levels will be higher than blood alcohol levels Therefore 1.14/1.00 correction factor

Answer 58

–amphetamines have D and L isomers –D isomers have stronger CNS effects and more abuse potential –CG/MS cannot distinguish D from L isomer –Amphetamines have the most false positive screening tests ––Phenyl propyl alanine ––Pseudoephedrine ––Vicks nasal inhaler ––Appetite suppressants containing ephedrine and phentermine

Answer 59

tolmetin | sertraline

SECTI0N 2 PRINCIPLES OF ADDICTION MEDICINE Flashcards

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