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Substance Use/Abuse Disorders > Substance abuse > Flashcards

Substance abuse Flashcards

1
Q

Most common substance abuse disorders

A

Alcohol, tobacco, cannabis,stimulant, hallucinogen, opioid

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2
Q

Psychoactive drug

A

affect emotion, mind, behavior

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3
Q

Substance Use/Abuse Concepts

A 
Addiction vs substance use disorder
Clinical and functional impairment
Neurobiology model
-binge and intoxication
-withdrawal and negative effect
-preoccupation and anticipation
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4
Q

Brainstem

A

controls basic functions ( hear rate, breathing)

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5
Q

Cerebellum

A

motor control

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6
Q

Limbic system

A

reward center and feelings of pleasure
hippocampus: storage and retrieval of memory
Amygdala: sensory information and emotions

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7
Q

Diencephalon

A

Hypothalamus: regulation of basic drives and autonomic nervous system
Thalamus: sensory perception and movement

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8
Q

Cerebral cortex

A

sensory, motor and association areas

frontal, parietal, occipital and temporal lobes

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9
Q

Synapse

A

electrical synapse

chemical synapse

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10
Q

Neurotransmitters (can reinforce effects of drugs)

A

dopamine, opioid peptides, GABA, Glutamate, Serotonin, Acetylcholine

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11
Q

Addiction

A

Overwhelming compulsion; repetitive drug-taking behavior despite serious health & social consequences

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12
Q

Substance Dependence

A

Overwhelming desire to take a drug, cannot stop taking drug, 2 categories (physical & psychological)

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13
Q

Physical Dependence

A

Altered physical condition caused when nervous system adapts to repeated substance use, uncomfortable symptoms result when the agent is discontinued—known as withdrawal

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14
Q

Psychological Dependence

A

No obvious physical discomfort when substance discontinued, overwhelming desire to continue substance use; may be associated with home or social environment, craving continues for months or years, craving responsible for relapse

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15
Q

Tolerance

A

Biologic condition; body adapts to repeated administration of a drug, Requires higher doses of drug to produce initial effect, Common in substances that affect nervous system, Does not indicate addiction or substance abuse

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16
Q

Heroin

A

The most addictive drug, heroin is a very dangerous substance. It is less widely used than some of the other substances, likely because it is typically taken by injection.

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17
Q

Ecstasy

A

This drug, also known as MDMA (3,4-methylenedioxy-methamphetamine), is most often associated with clubs and raves, especially because the dopamine it helps to release simulates a feeling of connection between users. It is especially risky because the pills are generally less than 30 percent pure and can contain other serious drugs.

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18
Q

Crystal Meth

A

Crystal meth is almost 3X stronger than cocaine. It provides a much longer high as well as extreme crashes that make the user want to use again.

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19
Q

Cocaine

A

This white powder is one of the most notorious illicit drugs. It causes bursts of energy and euphoria, which are very tasking on the heart and brain.

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20
Q

Marijuana

A

The leaves of the cannabis plant are by far the most popular illicit drug among teens and younger people. The THC in the plant causes sensations of relaxation and sometimes mild hallucinations.

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21
Q

LSD

A

LSD “acid” is one of the most famous drugs of the Woodstock era, becoming mainstream in the 1960s. Trips can last for several hours and include very powerful hallucinations. Made synthetically and processed into strips.

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22
Q

Ventral tegmental area (VTA)

A

Connects to basal ganglia within limbic system

Basal ganglia function involved in emotions and motivation

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23
Q

Drug activation for VTA

A

Dopamine
Reward pathway
Median forebrain

24
Q

Increased levels of Dopamine

A

Feelings of well-being, exhilaration, and pleasure
Psychologic dependence
Physical dependence
Tolerance

25
Q

Body held in depressive state (alcohol)

A

Decreased GABA release
More drug needed for desired effect
Withdrawal

26
Q

Modulation of dopamine

A

Serotonin
-Regulates release of dopamine at the VTA of the brain
GABA
-Inhibitory effects on dopamine release onto dopaminergic neuron

27
Q

Addiction

A

User-related factors
Genetics, personality, prior experience, disorders
Environmental factors
Societal and community norms, role models, peer influences, educational level
Agent or drug factors
Cost, availability, dose, mode of administration, speed of onset/termination, length of drug use
Impossible to predict accurately if person will become substance abuser

28
Q

Alcohol

A

Leading cause of preventable death
Risk factors
Genetic, Psychologic, Environmental
Alcohol intoxication
Physical abnormalities consistent with behavioral changes
Alcohol overdose
Impairments that increase the risk of harm
Alcohol withdrawal
Onset of manifestations 24-72 hours after cessation of drinking
Life-threatening
Goal: cessation of drinking
Treatment Types:
Behavioral treatments, Medications, Mutual support groups

29
Q

Alcohol Effects

A 
Brain effects
Enhances effects of inhibitory GABA 
Decreases effects of excitatory glutamate
Increases dopamine in reward center
Acts as a sedative and depressant
Interrupts REM sleep
Fetal alcohol spectrum disorders
Physical problems
Behavioral issues
Learning difficulties
Effects of early alcohol use
Impaired growth and development
Increased risk for dependency
Increased risk taking
Liver Failure
Hypoglycemia:  inhibits glycogenolysis
30
Q

Alcohol abuse manifestations: Intoxication

A

Increased risk taking
Cognitive changes
Ataxia
Nausea/vomiting

31
Q

Alcohol abuse manifestations: Overdose

A

Unconsciousness
Coma
Respiratory depression
Death

32
Q

Alcohol abuse manifestations: Withdrawal

A

Mild: Insomnia, irritability, headache, nausea
Moderate: Tremors, anxiety, insomnia, nausea, confusion, sweating
Severe: Uncontrollable shaking, agitation, vomiting, sweating hallucinations, seizures, death

33
Q

Alcohol: Heavy Use

A

Chronic malnutrition
Cancer
Hormonal changes
Brain tissue loss from alcohol toxicity
Organic brain syndrome
Wernicke-Korsakoff syndrome
Chronic alcoholism → thiamine deficiency → brain tissue ischemia & cell death
Wernicke’s: Acute confusion, ataxia, ophthalmoplegia (weakness of eye muscles)
Korsakoff’s: amnesia, psychosis, confabulation (misinterpreted memories)
Delirium tremens (DT) with very long-term consumption
Hallucinations, confusion, disorientation
Medical emergency
Withdrawal can be treated with antiseizure medications
Nursing: CIWA Scale

34
Q

Clinical Institute Withdrawal Assessment

A 
Assigns a point value for:
 anxiety
agitation
headache
hallucinations
N/V
auditory disturbances
tactile disturbances
visual disturbances
altered senses
diaphoresis
tremors
35
Q

Tobacco Use (Nicotine)

A 
Characterized by:
Persistent tobacco use, Compulsive tobacco use, Physiologic dependence on tobacco
Associated with poorer general health
Key statistics
42 million Americans continue to smoke
Vaping by middle & high school students increased by 50%
Comorbidities
Psychiatric conditions
Decreased immunity
Associated diseases/conditions
COPD
Cardiovascular disorders
Cancers
Nicotine:  Highly carcinogenic (>1000 chemicals)
36
Q

Tobacco (Nicotine): Effects

A 
Activation of specific areas of brain
Visual attention
Arousal
Motor activation
Stimulation and sedation
Impaired reproductive health
Fertility issues
Increased risk of miscarriage
Health problems for the mother and baby
Immediate physiological effects
Tachycardia, Hypertension, Increased respiration
Physical assessment
Hoarse voice, Stained nails and teeth
37
Q

Tobacco (Nicotine): Withdrawl

A 
Irritability/frustration/anger
Anxiety
Difficulty concentrating, headache
Increased appetite
Restlessness, increased heart rate, increased B/P
Depressed mood
Insomnia
38
Q

Tobacco (Nicotine): Cessation treatments

A

Smoking cessation aids
Nicotine replacement medication
Behavioral therapy
Bupropion (Zyban) & varenicline (Chantix) used to help quit

39
Q

Cannabis

A

Third most commonly used drug in United States
Marijuana
Derived from hemp plant
Main psychoactive chemical: tetrahydrocannabinol (THC)
Can be smoked or mixed into foods
Total tissue elimination of a single dose = 30 days
THC: Increases dopamine release
Via binding to CB1 & CB2 receptors
Results in impaired judgment
Increases risk-taking

40
Q

Cannabis intoxication

A

≥2 signs or symptoms within two hours of using cannabis

41
Q

Cannabis withdrawal

A

Cessation of frequent and prolonged cannabis usage
≥3 signs and symptoms over ~1 week
Irritability & restlessness, Insomnia & tremors, Chills & weight loss

42
Q

Cannabis use disorder

A

Significant impairment/distress in multiple areas

Development of tolerance/withdrawal over 12 months

43
Q

Cannabis: Treatment

A

cognitive-behavioral therapy

44
Q

Stimulants

A

Most commonly abused stimulants
Amphetamines, Methamphetamine & Cocaine
methylphenidate (Ritalin) ADHD: calms children, opposite for adults
Can be synthetic or plant-based
Can be inhaled or taken orally or intravenously
Cardiovascular consequences of cocaine
Sympathetic nervous system (SNS) effects
Effects on cardiomyocytes
Vasculature effects
Long-term consequences
Treatment:
Medications, Counseling, Inpatient, residential, outpatient treatment, Peer support, 12-step programs
Withdrawal:
Mental depression & anxiety, extreme fatigue & hunger

45
Q

Amphetamines and synthetic cathiones

A

Cross blood-brain barrier
Rapid onset of effects when injected or inhaled
Increases synaptic activity of dopamine and norepinephrine
Pharmacologic use: narcolepsy and attention-deficit/hyperactivity disorder

46
Q

Methamphetamine

A

Crosses blood-brain barrier
Onset of action within seconds after smoking or injecting
Increases dopamine, norepinephrine, and serotonin

47
Q

Cocaine

A

Absorbed through mucous membranes
Onset of action within seconds up to 90 minutes
Blocks reuptake of dopamine and norepinephrine causing euphoria

48
Q

Hallucinogens

A

All Schedule I Drugs (cannot be prescribed)
Alter sensory perception, mood, & thought patterns
Types
Psilocybin (mushrooms), Mescaline, Peyote, Lysergic acid diethylamide (LSD), Phencyclidine (PCP) , 3,4-methylenedioxy methamphetamine (MDMA, Ecstasy), Ketamine (date-rape drug)
Appear to involve interaction of:
Serotonin, Dopamine, Glutamate
Treatments
No approved medications
Behavioral therapy and counseling
Withdrawal:
Rarely observed, depends on specific drug
Flashbacks, tolerance, moderate-to-high psychological dependence with little to no physical dependence

49
Q

Hallucinogen Intoxication:

Cardiovascular

A

Tachycardia, palpitations, hypertension/hypotension

50
Q

Hallucinogen Intoxication: Neurologic

A

Tremors

Hyperreflexia

51
Q

Hallucinogen Intoxication: Mood, cognition, emotions

A 
Paranoia
Suicidal ideation
Anxiety
Depression
Euphoria
Intensification of feelings
Acute cognitive impairments
Megalomania
Depersonalization
52
Q

Opioids

A

Chemical structure similar to alkaloids, Analgesics, Interact at one of three receptor main opioid receptor systems

53
Q

Opioid use disorder

A

Chronic, relapsing illness of a pattern of opioid use, negative health consequences
Naturally occurring
Morphine & codeine
Semisynthetic
Hydromorphone, oxycodone, hydrocodone, and heroin
Synthetic
Meperidine, methadone, tramadol, and fentanyl
Various routes of administration
Potent analgesic & CNS depressive effects
Can produce euphoria, Highly addictive, Rapid progression to physiologic dependence followed by tolerance & subsequent withdrawal

54
Q

Opioids cont.

A

Cause substantial morbidity & mortality
Overdose is a life-threatening emergency
General clinical manifestations of opioid toxicity
Decreased or unchanged vital signs, Decreased bowel sounds, Sedation or coma, Seizures, Miosis
Other signs
Track marks, Perforated nasal septum
Treatment for opioid use disorders
Medication-assisted treatment with buprenorphine or methadone
Withdrawal Symptoms: (intense but not life-threatening)
Excessive sweating, restlessness, and pinpointed pupils, Agitation, goose bumps, tremor, and violent yawning ,Increased heart rate, orthostatic hypotension, Nausea/vomiting and abdominal cramps and pain, Muscle spasms with kicking movements and weight loss

55
Q

Opioid Antagonist

A 
Therapeutic Class:  Opioid antagonist
Examples:  naloxone(Narcan) 
Mechanism of Action:  
binds to opiate receptors (competes)
Actions & Uses:
Reversal of known or suspected opioid overdose, including respiratory and/or CNS depression
Adverse Effects:
Increased blood pressure, pain, headache, nasal effects (dryness, edema, congestion, inflammation), opioid withdrawal
Interactions:
Caution with cardiotoxic drugs
Pregnancy Category:  C
56
Q

Disulfiram

A 
Examples: disulfiram (Antabuse)
Mechanism of Action:
Interferes with the hepatic oxidation of acetaldehyde
Actions & Uses:
Management of ethanol abuse
Interactions:
Alcohol

Substance Use/Abuse Disorders (4 decks)

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