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Neuro Psych & Abuse Exam 1 > Substance Abuse > Flashcards

Substance Abuse Flashcards

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1
Q

addiction definition

A

primary, chronic, neurobiological disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations

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2
Q

5 C’s

A

chronicity, impaired control over drug use, compulsive use, continued use despite harm, craving

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3
Q

drug abuse definition

A

maladaptive pattern of substance use characterized by repeated adverse consequences related to the repeated use of a substance

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4
Q

sensitization
ex?

A

inc response to a drug w repeated use ; shifting of dose-response curve to the left
cocaine-induced euphoria, movement, cataplexy and seizures

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5
Q

tolerance
types

A

state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug’s effect over time
shifting dose response curve to the right

metabolic and cellular types

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6
Q

risk factors for substance use disorders (SUDs)

A

dysfunctional childhood, abuse
ADHD, school problems, conduct disorder
early onset of substance absue (esp before 14yo)
personal hx SUD
genetic predisposition (+ FHx)

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7
Q

tests and how long drug stays detectable for

A

hair: 7d-3mo
urine: 1-30d
blood, saliva: 0-3d

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8
Q

synthetic opioids do/do not produce a + test for opiates?
ex)

A

do not
methadone, fentanyl

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9
Q

opiates that may not produce a positive test

A

oxycodone, benzos

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10
Q

benzo that may not produce a positive benzo test

A

clonazepam

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11
Q

OTC med that can make you test positive for amphetamines

A

pseudoephedrine

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12
Q

equation to determine drug concentration normalized to creatinine

A

[drug level in urine / creatinine] x 100

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13
Q

lab tests for SUD

A

vitamin D, B12, iron, folate, LFTs, thyroid, hematology, BMP, HIV, Hep C

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14
Q

Depressants

A

sedative hypnotics (benzos, barbs)
GHB
opiates
DM

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15
Q

benzos MOA
info

A

potentiate inhibitory actions of GABA at several CNS sites including the limbic system
rapid tolerance w chronic dosing

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16
Q

benzos effects

A

dec BP
memory impairment
confusion
drowsiness
anterograde amnesia
GI
urinary retention
bloodshot eyes
slurred speech
poor coordination
resp dep

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17
Q

three drugs w life-threatening withdrawal

A

alcohol
benzos
barbituates

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18
Q

benzo overdose tx

A

flumazenil 0.2mg/min up to 3mg max
good to taper so pt doesnt dip into withdrawal

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19
Q

flunitrazepam aka_______

A

roofies

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20
Q

barbituates effects

A

like EtOH intoxication
disinhibition
amnesia
poor judgement
mood liability
unsteady gait
nystagmus

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21
Q

barbituate wdrawal and tx

A

life threatening
taper off barb and add long acting (phenobarb), can subst anticonvulsant

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22
Q

GHB
what is it

A

gama-hydroxybutyrate
type of depressant
tx for narcolepsy
Xyrem is CIII

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23
Q

GHB effects vs toxicity

A

amnesia
hypotonia

toxicity is coma, seizures, resp dep, vomiting

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24
Q

GHB wdrawal

A

agitation, AMS, inc BP HR, tachy c

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25
GHB overdose tx
supportive, vent, O2, intubate, fluids, thiamine
26
opiates MOA
binds opiate receptors in CNS, causing inhibition of pain pathways, altering the perception of and response to pain; generalized CNS depressants
27
opiates drugs
heroin, morphine, codeine, hydrocodone, hydromorphone, fentanyl, oxycodone, tramadol, tapentadol, meperidine
28
opioid overdose tx
naloxone 0.4-2mg IV/IM/SQ, 2 or 4mg nasal spray
29
methadone MOA use CYPs!
binds opiate receptors in CNS, causing inhibition of pain pathways, altering the perception of and response to pain; generalized CNS depressants detox or maintenance substrate of CYP 3A4, 2C9, 2C19, 2D6 inhibits 2D6, 3A4
30
methadone and pregnancy
decreased halflife, may need increased dose
31
opioid wdrawal tx
methadone 20-80mg, taper by 5-10mg daily
32
methadone maintenance dose
<30-40mg a day
33
buprenorphine MOA
u opiate receptors, partial mu agonis and weak kappa antagonist
34
bup is a substrate of _______
3A4!
35
bip inhibits ____
1A2, 2A6, 2C19, 2D6 all weakly
36
buprenorphone has _______ so it can displace a ______
high affinity; full agonist
37
bup can push someone into _____ w opiate on board
w drawal
38
non-candidates for bup management
comorbid dependence on other CNS depressants significant untx psych active/chronic SI/HI multiple tx relapses poor response to suboxone complex medical
39
candidates for bup management
physically dependent as well as addicted no CIs interested compliance is promising willing to follow safety precautions willing after review of tx
40
probuphine candidates
on = 8mg suboxone or equiv / day clinically stable
41
probuphine dosing
74.2mg/implant x four implants at one time for 6 months
42
probuphine vs SL bup
probuphine is non-inferior
43
probuphine BBW
implant migration protrusion expulsion and nerve damage w insertion and removal of rod implants
44
sublocade
SQ injection 100mg or 300mg
45
which opioid addiciton tx have REMS
probuphine sublocade
46
clonidine MOA AE
alpha 2 stimulator in brain stem, activates inhibitory neuron resulting in dec sympathetic outflow in CNS AE: drowsy, dizzy, xerostomia, HA, orthostatic hypot,fatigue, abdominal pain, bradyc
47
Lofexidine (Lucemyra) MOA AE
alpha 2 stimulator in brain stem, activates inhibitory neuron resulting in dec sympathetic outflow in CNS AE: orthostatic hypot, bradyc, insomnia, dizziness, drowsy, xerostomia
48
Wdrawal sx management: pain
NSAIDs, APAP, muscle relaxants, neuropathic agents
49
wdrawal sx management: N/V
metoclopramide, zofran, anti-diarrheal
50
wdrawal sx management: anxiety, sleep, restlessness
insomnia meds, muscle relaxants, hydroxyzine
51
naltrexone po dosing AE BBW
25mg po qd x1wk then 50mg qd AE: GI upset BBW: acute hepatitis, hepatocellular injury
52
what is vivitrol and who can receive it
naltrexone XR approved for opioid dependence in pt who meet DSM criteria for opioid dependence, recently received opioid detox and opioid free for at least 7d
53
vivitrol (Naltrexone XR) exclusions
acute hepatitis or LF in withdrawal on opioid analgesics current opioid dependence +urine screen for opiate known allergy failed naltrexone challenge test
54
naltrexone vs bup
no significant differences in relapse rates
55
Ki what can bump what
dec Ki --> can bump off higher Ki drug from R
56
DXM is MOA
dextromethorphan potent NMDA receptor blocker at high doses pharmacology is similar to PCP and ketamine
57
DXM effects
hyperexcitability, hallucinations, lethargy, ataxia, slurred speech, sweating, HTN, nystagmus, altered time perception abuse can cause death, brain damage, seizure, loss of consciousness, and irregular HR
58
stimulants includes ______
cocaine, amphetamine, methamphetamine, PCP, ketamine
59
cocaine effects
euphoria, elation, grandiosity alertness mydriasis tachyc sweat/chills NV insomnia paranoia aggression motor agitation
60
cocaine toxicity
cardiac arrest, MI, stroke, arrhythmia, seizures, hyperthermia, nasal septum ulceration, potentiate psychosis, hallucination
61
cocaine wdrawal
depression, fatigue, nightmares, sleep disturbance, inc appetite, bradyarrhythmia, tremor
62
cocaine overdose tx
supportive, lorazepam, haldol, antiarrhythmic agents prn cardio issues
63
amphetamine MOA
blocks reuptake of DA, NE, inc release of DA and NE, MAOi
64
amphetamine effects
dec fatigue slert dec appetite in activity inc resp hypertherm irritability insomnia confusion tremor convulsions anxiety paranoia aggression stroke, MI, arrhythmia meth mouth
65
amphetamine overdose tx
supportive, haldol, lorazepam
66
MDMA aka____ effects
ecstacy, amphetamine derivative empathy relaxation euphoria dec inhibition anxiety pranoia irrational psychosis touch muscle tension faint chills. sweat inc HR BP hypertherm
67
PCP moa
DA, 5HT, NE reuptake inibitor
68
PCP effects at low vs high doses
low: sedation, ataxia, nystagmus, slurred speech, paresthesia high: inc HR BP, temp, diaphoresis, muscle rigidity, seizure, coma
69
ketamine MOA
releases endogenous catecholamines, produces cataleptic-like state via direct action on cortex and limbic system, reduces polysynaptic spinal reflexes
70
ketamine effects
inc HR BP, hallucinations, vivid dreams, resp dep, hypertonia, dystonia, seizures, neuropathy, cardiac arrest, psychedelic effects
71
hallucinogens includes
LSD, psilocybin, mescaline
72
weed effects
euphoria, disinhibition, impaired cognition, short term memory loss, divided attention skills
73
cocaine + EtOH =
cocathylene
74
Q-ball =
quetiapine (Seroquel) + cocaine
75
speedball =
heroine + cocaine
76
krokodil componenets
desmorphoine, gasoline, lighter fluid, iodine, HCL, red phosphorous that causes skin erosions/ulcers and infections
77
krokodil overdose s sx
slow shallow breathing, small pupils, slurred speech, pale face, blue lips/nails, choking/gurgline
78
kratom vs morphone
13x more potent than morphine

Neuro Psych & Abuse Exam 1 (5 decks)

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