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Behavioral Science > Substance Abuse > Flashcards

Flashcards in Substance Abuse Deck (95):
1

Substance abuse:

A maladaptive pattern of substance use that leads to impairment of occupational, physical, or social functioning, it is not diagnosed if the patient meets the criteria for substance dependence.

2

What is substance dependence?

Substance abuse + Withdrawal symptoms/tolerance/a pattern of compulsive use.

3

What is withdrawal?

The development of physical or psychological symptoms after the reduction or cessation of intake of a substance.

4

What is tolerance?

The need for increased amounts of the substance to achieve the same psychological effect.

5

What is cross-tolerance?

The development of tolerance to one substance as the result of using another substance.

6

What are the MC used substances in the USA?

1. Alcohol.
2. Marijuana.
3. Nonmedical use of prescription agents (eg opioids, sedatives).
4. Cocaine.
5. Hallucinogens.
6. Inhalants.
7. Heroin.

7

The use of illegal substances is more common among ...?

Adults (18-25 years of age) and is twice as common in males.

8

Most abused substances can be classified categorically as:

1. Stimulants.
2. Sedatives.
3. Opioids.
4. Hallucinogens.

9

Stimulants - CNS activators that include:

1. Caffeine.
2. Nicotine.
3. Amphetamines.
4. Cocaine.

10

Caffeine is found in ...?

1. Coffee (125mg/cup).
2. Tea (60mg/cup).
3. Cola (40mg/cup).
4. Nonprescription stimulants.
5. OTC diet agents.

11

Nicotine:

A toxi substance present in tobacco.

12

Smoking is increased most in ...?

Teenaged girls.

13

Amphetamines are used clinically for:

1. Management of ADHD.
2. Narcolepsy.
3. Depression in elderly and terminally ill.
4. Depression + obesity in patients who do not respond to other treatments.

14

The MC clinically used amphetamines are:

1. Dextroamphetamine (Dexedrine).
2. Methamphetamine (Desoxyn).
3. Methylphenidate (Ritalin).
4. "Speed", "Ice" (methamphetamine).
5. Ecstasy (MDMA).

15

Cocaine - Forms:

1. "Crack" and "freebase" are cheap, smokable forms of cocaine.
2. In expensive, pure form, cocaine is snorted.

16

Cocaine - What is seen in newborns of mothers who used cocaine during pregnancy?

1. Hyperactivity.
2. Growth retardation.

17

Cocaine - What hallucinations?

Tactile hallucinations of bugs crawling on the skin (ie formication) are seen with the use of cocaine ("cocaine bugs").

18

Caffeine, nicotine - Psychological effects of use:

1. Incr. alertness and attention span.
2. Mild improvement in mood.
3. Agitation and insomnia.

19

Caffeine, nicotine - Physical effects of use:

1. Decr. appetite.
2. Incr. BP and HR.
3. Incr. GI activity.

20

Caffeine, nicotine - Psychological effects of withdrawal:

1. Lethargy.
2. Mild depression of mood.

21

Caffeine, nicotine - Physical effects of with withdrawal:

1. Incr. appetite with slight weight gain.
2. Fatigue.
3. Headache.

22

Amphetamines, cocaine - Psychological effects of use:

1. Significant elevation of mood (lasting only 1h with cocaine).
2. Incr. alertness and attention span.
3. Aggressiveness, impaired judgement.
4. Psychotic symptoms (eg paranoid delusions with amphetamines and formication with cocaine).
5. Agitation and insomnia.

23

Amphetamines, cocaine - Physical effects of use:

1. Loss of appetite and weight.
2. Pupil dilation.
3. Incr. energy.
4. Tachycardia and other CVS effects, which can be life-threatening.
5. Seizures (particularly with cocaine).
6. Reddening (erythema) of the nose due to "snorting" cocaine.
7. Hypersexuality.

24

Amphetamines, cocaine - Psychological effects of withdrawal:

1. Significant depression of mood.
2. Strong psychological craving (peaking a few days after the last dose).
3. Irritability.

25

Amphetamines, cocaine - Physical effects of withdrawal:

1. Hunger (particularly with amphetamines).
2. Pupil constriction.
3. Fatigue.

26

Stimulant drugs work primarily by increasing the availability of ...?

DOPAMINE.

27

Amphetamine use causes ...?

RELEASE OF DOPAMINE.

28

Cocaine primarily does what?

BLOCKS REUPTAKE OF DOPAMINE.

29

Alchohol, benzos, barbs - Psychological effects of use:

1. Mild elevation of mood.
2. Decr. anxiety.
3. Somnolence.
4. Behavioral disinhibition.

30

Alcohol, benzos, barbs - Psychological effects of withdrawal:

1. Mild depression of mood.
2. Incr. anxiety.
3. Insomnia.
4. Psychotic symptoms (eg delusions and formication).
5. Disorientation.

31

Alcohol, benzos, barbs - Physical effects of use:

1. Sedation.
2. Poor coordination.
3. Respiratory depression.

32

Alcohol, benzos, barbs - Physical effects of withdrawal:

1. Tremor.
2. Seizures.
3. CVS symptoms such as tachycardia and HTN.

33

Alcohol - Acute associated problems:

1. Traffic accidents.
2. Homicide.
3. Suicide.
4. Rape.

34

Alcohol - Abuse:

1. Child physical + sexual abuse.
2. Spouse abuse.
3. Elder abuse.

35

Alcohol - Chronic associated problems:

1. B1 deficiency --> Wernicke/Korsakoff.
2. Liver dysfunction, GI problems (ulcers).
3. Reduced life expectancy.
4. Fetal alcohol syndrome.
5. Childhood history of problems such as ADHD + Conduct disorder correlates with alcoholism in the adult.

36

Identification of alcoholism:

Because alcohol abusers commonly use DENIAL as a defense mechanism, positive responses to indirect queries such as those in the CAGE questions can help a physician identify a person who has a problem with alcohol.

37

The CAGE questions are: "Do you ever ...?

1. Try to Cut down on your drinking?
2. Get Angry when someone comments on your drinking?
3. Feel Guilty about your drinking?
4. Take a drink as an Eye-opener in the morning?

38

Intoxication - Legal intoxication is defined as ...?

0.08%-0.15% blood alcohol concentration, depending on the individual state laws.

39

Intoxication - Coma occurs at a blood alcohol concentration of ...?

0.40%-0.50% in NON ALCOHOLICS.

40

Intoxication - Is it possible to have hallucinations in alc intoxication and alc withdrawal?

YES.

41

Delirium tremens:

Alc withdrawal delirium may occur during the first week of withdrawal from alc (MC on the 3rd day of hospitalization).
--> It usually occurs in patients who have beeen drinking heavily for years.

42

Mortality of DT:

20%.

43

Barbs - Frequently used and abused:

1. Amobarbital.
2. Pentobarbital.
3. Secobarbital.

44

Death from opioid abuse is common or rare?

RARE - Unless a serious physical illness is present.

45

Heroin, methadone, and other opioids - Psychological effects of use:

1. Elevation of mood.
2. Relaxation.
3. Somnolence.

46

Heroin, methadone, other opioids - Psychological effects of withdrawal:

1. Depression of mood.
2. Anxiety.
3. Insomnia.

47

Heroin, methadone, other opioids - Physical effects of use:

1. Sedation.
2. Analgesia.
3. Respiratory depression (overdose may be fatal).
4. Constipation.
5. Miosis.

48

Heroin, methadone, other opioids - Effects of withdrawal:

1. Sweating, muscle aches, fever.
2. Rhinorrhea.
3. Piloerrection (goose bumps).
4. Yawning.
5. Stomach cramps and diarrhea.
6. Mydriasis.

49

Caffeine, nicotine - Immediate management/Detoxification:

1. Eliminate or taper from the diet.
2. Analgesics to control headache due to withdrawal.

50

Caffeine, nicotine - Extended management/maintenance:

1. Peer support group (eg "smokenders").
2. Antidepressants (particularly buproion) to prevent smoking.
3. Support from family members or non smoking physician.
4. Hypnosis to prevent smoking.
5. Nicotine-containing gum, patch, or nasal spray.

51

Amphetamines, cocaine - Immediate management/detoxication:

1. Benzos to decrease agitation.
2. Antipsychotics to treat psychotic symptoms.
3. Medical and psychological support.

52

Amphetamines, cocaine - Extended management/maintenance:

Education for initiation + maintenance of abstinence.

53

Alcohol, benzos, barbs - Immediate management/detoxification:

1. Hospitalization.
2. Flumazenil to reverse the effects of benzodiazepines.
3. Substitution of long-acting barbiturate (eg phenobarbital) or benzodiazepine (eg chlordiazepoxide in decr. doses).
4. IV diazepam, lorazepam, phenobarbital if seizures occur.
5. SPECIFICALLY FOR ALCOHOL: B1 + restore nutritional state.

54

Alcohol, benzos, barbs - Extended management/maintenance:

1. Education for initiation and maintenance of abstinence.
2. SPECIFICALLY FOR ALCOHOL: AA or other peer support group (12-step program), disulfiram, psychotherapy, behavior therapy, naloxone, naltrexone, acamprosate, topiramate.

55

Heroin, methadone, opioids used medically - Immediate management/detoxification:

1. Hospitalizattion and naloxone for OD.
2. Clonidine to stabilize the autonomic nervous system during withdrawal.
3. Substitution of long-acting opioid (eg methadone) in decreasing doses to decrease withdrawal symptoms.

56

Heroin, methadone, opioids used medically - Extended management/maintenance:

1. Methadone or buprenorphine maintenance program.
2. Naltrexone or buprenorphine plus naloxone used prophylactically to block the effects of abused opioids.
3. Narcotics Anonymous (NA) or other peer support program.

57

Hallucinogens and related agents - Immediate management/detoxification:

1. Calming or "talking down" the patient.
2. Benzodiazepines to decrease agitattion.
3. Antipsychotics to treat psychotic symptoms.

58

Hallucinogens and related agents - Extended management/maintenance:

Education for initiation and maintenance of abstinence.

59

Hallucinogens and related agents include:

1. LSD.
2. PCP (angel dust).
3. Cannabis (marijuana, hashish).
4. Psilocybin (from mushrooms).
5. Mescaline (from cactus).
6. Ketamine ("Special K").

60

Hallucinogens promote altered states of consciousness which are usually pleasurable but ...?

Can also be frightening ("bad trips").

61

Incr. availability of which neurotransmitter is associated with the effects of some hallucinogens, such as LSD.

SEROTONIN.

62

Cannabis (marijuana, hashish), LSD, PCP etc - Psychological effects of use:

1. Altered perceptual states (auditory and visual hallucinations, alterations of body image, distortions of time and space).
2. Elevation of mood.
3. Impairment of memory (may be long term).
4. Reduced attention span.
5. "Bad trips" (frightening perceptual states).
6. "Flashbacks" (a re-experience of the sensations associated with use in the absence of the drug even months after the last dose).

63

Cannabis (marijuana, hashish), LSD, PCP etc - Psychological effects of withdrawal:

FEW.

64

Cannabis (marijuana, hashish), LSD, PCP etc - Physical effects of use:

1. Impairment of complex motor activity.
2. CVS symptoms.
3. Sweating.
4. Tremor.
5. Nystagmus (PCP).

65

Cannabiis (marijuana, hashish), LSD, PCP etc - Physical effects of withdrawal:

FEW.

66

What is the primary active compound of marijuana:

THC.

67

What is the effect of marijuana in low doses?

1. Incr. appetite and relaxation.
2. Causes conjunctival reddening.

68

Chronic marijuana users experience what?

1. Lung problems associated with smoking.
2. A decr. in motivation ("the amotivational syndrome") characterized by lack of desire to work, and incr. apathy.

69

Although it is not legal in the US, marijuana for medical use is permitted ...?

IN SOME STATES, primarily for treating glaucoma and cancer-treatment-related nausea and vomiting.

70

LSD and PCP - Route?

LSD = Ingestion.
PCP = Smoked in a marijuana or other cigarette.

71

Consumption of more than ... of PCP may cause seizures, coma, and death.

20mg.

72

Length of time after use that substance can be detected - Cotinine (nicotine metabolite):

1-2 days.

73

Length of time after use that substance can be detected - Amphetamine:

1-2 days.

74

Length of time after use that substance can be detected - Benzoylecgonine (cocaine metabolite):

1-3 days in occasional users.
7-12 days in heavy users.

75

Length of time after use that substance can be detected - Alcohol:

7-12h.

76

Length of time after use that substance can be detected - GGT:

7-12h.

77

Length of time after use that substance can be detected - Specific barb or benzo or its metabolite:

1-3 days.

78

Length of time after use that substance can be detected - Heroin:

1-3 days.

79

Length of time after use that substance can be detected - Methadone:

2-3 days.

80

Length of time after use that substance can be detected - Cannabinoid metabolites:

3-28 days.

81

Length of time after use that substance can be detected - PCP:

7-14 days in heavy users.

82

Length of time after use that substance can be detected - SGOT or CPK (with PCP use):

More than 7 days.

83

Emergency department findings:

Changes in the pupil of the eye and presence or absence of psychotic symptoms can quickly narrow the search for the substance responsible for the patients' symptoms in the emergency department.

84

Management of substance abuse:

Ranges from abstinence and peer support groups to drugs that block physical and psychological withdrawal symptoms.

85

Management of withdrawal symptoms includes:

Immediate treatment or detoxification ("detox") and extended management aimed at preventing relapse ("maintenance").

86

Dual diagnosis or mentally ill-chemically addicted (MICA) patients require:

Treatment for both substance abuse and the comorbid psychiatric illness (eg major depression), often in a special unit in the hospital.

87

Pupil dilation - Seen with use of:

1. Stimulants.
2. Hallucinogens (LSD).

88

Pupil dilation - Seen with withdrawal from:

1. Opioids.
2. Alcohol and sedatives.

89

Pupil constriction - Seen with use of:

Opioids.

90

Pupil constriction - Seen with withdrawal from:

Stimulants.

91

Psychotic symptoms (eg hallucinations, delusions) - Seen with use of:

1. Stimulants.
2. Alcohol.
3. Hallucinogens.

92

Psychotic symptoms (eg hallucinations, delusions) - Seen with withdrawal from:

Alcohol and other sedatives.

93

CVS symptoms - Seen with use of:

Stimulants.

94

CVS symptoms - Seen with withdrawal of:

Alcohol and other sedatives.

95

Substance use disorders include:

1. Substance abuse.
2. Substance dependence.