Substance use & Addiction Flashcards Preview

BRS Year 2 v1 > Substance use & Addiction > Flashcards

Flashcards in Substance use & Addiction Deck (40)
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1
Q

what is the typical course of alcohol/drug use, harmful use and addiction?

A

recreational use, no difficulties
want/need becomes increasingly regular use (harmful use)
need - spiralling dependence (addiction)

2
Q

what is harmful use of drugs/alcohol?

A

actual damage caused to mental/physical health in the absence of diagnosis of dependence syndrome

3
Q

what is dependence?

A

strong desire or compulsion to take drug
difficulties in controlling taking drug - onset, termination, levels of use
physiological withdrawal state when stopped/reduced
evidence of tolerance
progressive neglect of alternative interests
persisting with substance use despite evidence of consequences

4
Q

what drug causes the most harm in the UK?

A

alcohol in both harm to users and harm to others

5
Q

what is addiction vs dependence?

A

addiction is compulsive drug use despite harmful consequences
dependence is a physical and biological adaption to a substance

6
Q

what factors affect addiction?

A

social, environmental factors
specific drug factors
personal factors (genetic, personality etc)

7
Q

how does alcohol acutely affect brain chemistry?

A

blocks NMDA receptor (blocks excitatory)
therefore impaired memory
boosts GABA-A receptor (boosts inhibitory)
therefore anxiolysis, sedation

8
Q

how does alcohol chronically affect brain chemistry?

A

upregulation of excitatory system to adapt to NMDA receptor being blocked chronically
reduced function in inhibitory system as GABA-A switches subunits to be less sensitive to alcohol

9
Q

how do you treat alcohol withdrawal?

A

benzodiazepines to boost GABA function

10
Q

how does alcohol withdrawal affect brain chemistry?

A

NMDA receptor upregulated, increase of Ca2+ leading to hyperexcitability (seizures) cell death

11
Q

how is addiction reinforced?

A

reward deficiency - positive reinforcement
overcoming adverse state e.g anxiety/withdrawal - negative reinforcement
impulsivity and compulsivity

12
Q

what is the reward pathway in the brain?

A

ventral striatum dopamine system

13
Q

how do cocaine and amphetamines impact dopamine rewards?

A

block reuptake - prolonged effect of dopamine

amp also enhances dopamine release

14
Q

levels of what can predict extent of reinforcing/rewarding brain responses?

A

levels of D2 receptors in the brain

higher D2 leads to less pleasurable responses

15
Q

what change in brain chemistry makes some addicts more likely to relapse?

A

blunted response to anticipation of reward in ventral striatum

16
Q

what regions of the brain are involved in bingeing/intoxication?

A

thalamus, dorsal striatum

17
Q

what regions of the brain are inolved in withdrawal?

A

brainstem, hypothalamus

18
Q

what regions of the brain are involved in craving? PHIB

A

prefrontal cortex,
hippocampus,
insula,
basolateral amygdala

19
Q

how does reinforcement change over the course of addiction?

A

change from positive to negative reinforcement - avoiding bad effects so aggression, fear when unable to access it

20
Q

what regions are targets for addiction withdrawal drugs?

A

reward system: dopamine and mu opioid
stress system: kappa opioid, noradrenaline and CRF
amygdala

21
Q

what are the brain chemistry changes to compulsions from voluntary to habitual drug use?

A

transition from striatal control over drug taking
ventral to dorsal striatum
both to form habits
memory in hippocampus drives cravings

22
Q

what drugs are used to support alcohol withdrawal?

A

benzodiazapines

23
Q

what drugs are used to support abstinence and neuroprotection in alcoholism?

A

acamprosate

24
Q

what drugs are used to modulate reward system in alcoholism and block heroin use in opioid addicts?

A

naltrexone

25
Q

what are questions to test the signs of harmful use/dependency in alcoholism?

A

CAGE - cut down, angry, guilty, eye opener

26
Q

how do you perform a mental state examination?

A
appearance + behaviour
speech
mood
thoughts
perceptions
cognition
insight
27
Q

what is the clinical opiate withdrawal scale? COWS

A
heart rate
sweating
restlessness
pupil size
bone/joint aches
runny nose/tears
GI upset
tremor (outstretched hands)
yawning
anxiety/irritability
goosebumps
28
Q

what are the ICD-10 requirements for dependency syndrome?

A

3+ in past year:
strong desire/sense of compulsion
difficulties in controlling behaviour around substance
physical withdrawal
tolerance
neglect of interests/pleasures/social life
persisting with use despite harmful effects

29
Q

what are the ICD-10 requirements for harmful use classification?

A

a pattern of substance use causing damage to health
adverse social consequences
bingeing
no other diagnosis e.g dependency syndrome

30
Q

what assessments are done for alcohol abuse?

A

note history of seizures, delirium tremens, psychosis, haematemesis, melaena
examine for jaundice, anaemia, clubbing, cyanosis, oedema, ascites, lymphadenopathy, DVT
investigations: fibroscan/ultrasound, bloods (LFTs, GGT, lipids, U&E, amylase), breathalyser, urine drug screen

31
Q

what assessments are done for opioid ab/use?

A

examination for collapsed veins/track marks, endocarditis, skin abscesses, hep/HIV, pneumonia
investigations: bloods (LFTs, U&E, GGT, glucose), breathalyser, urine drug screen, sexual health screening/BBV

32
Q

what are the immediate effects of alcohol?

A

CNS - impaired reaction time, motor coord/sedation, coma, death
stomach - nausea, inflammation, bleeding
skin - flushing, sweating, heat loss and hypothermia, formation of broken capillaries
sexual - reduced erection response in men, reduced vaginal secretion in women

33
Q

what are the chronic effects of alcohol?

A

CNS - damaged/destroyed brain cells, reduced brain size, impaired memory, limb sensation loss
cardiovascular - weakened muscle, high BP, irregular heartbeat, risk of stroke
immune system - less resistance to disease
digestive - cirrhosis, stomach/pancreas inflammation, risk of lip/mouth/larynx/eosophagus/liver/rectal/stomach/pancreatic cancers, kidney failure, obesity, nutrient deficiencies
reproductive - menstrual irregularities, impotence and testicular atrophy
bone - risk of osteoporosis, risk of fractures and falls

34
Q

what are the minor effects of alcohol withdrawal?

A
tremulousness
diaphoresis (sweats)
fever
anxiety
agitation
nausea/vomiting/retching
35
Q

when do alcohol withdrawal symptoms often start?

A

onset after 6hrs from last drink

36
Q

what is DT in alcohol withdrawal?

A

delirium tremens

37
Q

what is delirium tremens?

A

auditory/visual hallucinations, confusion, hypertension, agitation, tachycardia, fever, tremor in hands and body
medical emergency - mortality 15-20%

38
Q

what are the effects of opioids?

A

analgesic effect

sense of euphoria

39
Q

what are the symptoms of an opioid overdose?

A
not moving/cant be woken
slow/not breathing
choking/gargling/snoring
tiny pupils
clammy or cold skin
blue lips+nails
40
Q

how is an opioid overdose managed?

A

naloxone injection/nasal spray
repeat if no response after 3 mins
recovery position

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