Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Behavioral Medicine > Substance Use Disorder 2 > Flashcards

Substance Use Disorder 2 Flashcards

1
Q

List of the substance use disorders from greatest to least popular

A
  1. Alcohol
  2. Illicit drugs
  3. Alcohol + illicit drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the most commonly used illicit drug

A

Marijuana

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

In an effort to end opioid misuse, Physicians have decreased the number prescriptions, but patience no use ______.

A
  1. heroin
  2. fentanyl

(10 million misuse prescription pain relievers)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Source of prescription drugs (5)

A
  1. 1/2 obtained “free from friend/relative.”
  2. 8.9% bought from friend/relative, 5.2% stole from friend/relative
  3. 18.1% from doctor
  4. 4% drug dealer or other stranger
  5. 0.3% the Internet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which drug is the most commonly misuse opiates subtype?

A

Buprenorphine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Why is heroin use decreasing?

A
  1. More patients are in treatment
  2. Some have switch to Fentanyl
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Drug overdose related deaths came to the attention of the government in _____.

A

2009

(they are still climbing, tho Rx opioids are currently the lowest cause)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Majority of drug overdose-related deaths are by prescription opioids, heroin and now fentanyl. What is the timeline of this crisis?

A
  • 1999 to 2013: Opioid Rx & quadrupled
  • 2018: 47,600 opioid related with 32,000 fentanyl type drugs

(often oxy, hydrocodone, methadone or combination of EtOH + drug (BZD))

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

The opioid epidemic: prescription opioids lead rapidly to tolerance → _______→ _______.

A
  • Eventually the source dries up or is insufficient → Stealing, lying and doctor shopping, buying on the street

(Frequently the user learns heroin is cheaper and easily obtained)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Endogenous opioids include the _______ (3)

A
  1. β-endorphins
  2. Enkephalins
  3. Dynorphins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

______ (2 drugs) are technically opioids and not opiates.

A
  1. fentanyl
  2. methadone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Opiates are compounds derived or synthesized from the natural products and binds to receptor and its derivatives isolated from _______.

A

the poppy plant

(Synthetic compounds such as methadone and fentanyl are technically opioids and not opiates)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Opiate mechanisms: All opioid receptors are Gi protein-coupled have direct impact on _____and indirect effect on _____

A
  • adenyl cyclase system
  • ion channels which modulate potassium and calcium flux
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Exogenous opioids lead to rapid receptor desensitization and tolerance. Opioids inhibit _____ release ultimately increasing ______ in the ______system

A
  • GABA
  • dopamine
  • mesolimbic

(Endogenous opioids have effects on multiple systems, all of which may be affected in abuse of opiates)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Fentanyl is a _____

A

potent synthetic opioid

(Produced in Mexico and China – often mixed with heroin or amphetamines. As they become illegal, the drug chemists/dealers tweak it to make it legal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Fentanyl is medically indicated in: (2)

A
  1. Severe cancer pain when other opioids no longer effective
  2. Fentanyl, Schedule II: anesthesia & post-op pain

(available as a long-acting transdermal (skin) patch and in lozenges or lollipops. Fentanyl test strips are now available)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

fentanyl toxidrome:

A

CPR-3H + eurphoria, N/V, constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Kratom is from _____, administered via _____. MOA?

A
  • herb from southeast Asia
  • admin: smoke, oral, tea
  • Mu opioid receptor

(widely available bc it is legal; 55% become dependent)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Small doses of Kratom are ______ while larger doses have ______ effect.

A
  • stimulatory
  • sedative-narcotic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

People use Kratom in self-managed _____

A

opioid withdrawal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Kratom binds to ______ (4).

A
  1. Opioid mu receptors
  2. serotonin
  3. noradrenaline
  4. dopamine

(similar to opioid withdrawal: cravings and relapse)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Kratom (from the Mitragyna speciosa tree) has been used by Thai and Malaysian people since the 1800’s for : (4)

A
  1. euphoria
  2. stimulation
  3. analgesia
  4. opioid w/d
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Mnemonic MATHS (sympathetomimetic toxidrome sx)

A
  • Mydriasis
  • Arrhythmia, agitation, angina
  • Tachycardia, Tachypnea
  • Hypertension, hyperthermia
  • Seizures, sweating
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Mnemonic: CPR-3H (Narcotic Opioid Toxidrome)

A

(depressant effects. i.e. fentanyl toxidrome: CPR-3H + eurphoria, N/V, constipation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

The μ Receptor in Normal Physiology: functions (7)

A
  1. Endogenous response to pain
  2. Neuroendocrine function including the HPA axis and Reproductive
  3. Immunological function
  4. Gastrointestinal function
  5. Cardiovascular function
  6. Pulmonary function and respiratory drive
  7. Mood, affect, cognition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What can you do for people who are addicted to opioid as far as education?

A

tell them that opioids work on the experience of pain, but not tx pain → ibuprofen can treat the source, refer to pain management doc (accupuncture, TENS, nerve block)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Pain in the United States: how many Americans have pain. Rx for opioid worldwide.

A
  • Approximately 30% of Americans have pain, Older adults: 40%
  • About 80% of world opioid use is in USA

Opioids are most prescribed class of medications in the U.S.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Opioids are important analgesics for______.

A

acute pain

(less evidence for effectiveness in chronic pain…

2014: 245 million Rx for opioids - 65% short-term (< 3 wks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Increases in misuse and diversion have tracked with increased prescribing of opioids. Mu receptors are widespread in the brain and are involved in _____ (3).

A
  1. pain perception & emotional response
  2. pleasure
  3. respiratory depression

(Safety issues and adverse events including overdose, death, and addiction)

30
Q

Major medical complications of opioid dependence

A

Infection from injecting

(Aspiration pneumonia also common)

31
Q

Hep (B, C, D), HIV & STIs can be transmitting via injecting street drugs. Which infections can result form injecting street drugs (5)?

A
  1. Abscesses
  2. Cellulitis
  3. Endocarditis
  4. Osteomyelitis
  5. Septic arthritis
32
Q

Endocrine complications opioid dependence (2).

A
  1. Decreased sperm motility
  2. Menstrual abnormalities & amenorrhea
33
Q

GI complications with opioid dependence

A
  1. Constipation
  2. Pseudo-obstruction of the bowel
34
Q

In addition to endocrine, GI and infection, opioid dependence may also lead to _____(4).

A
  1. Liver disease, primarily from viral infections
  2. Respiratory depression
  3. Trauma from accidents, violence, sexual abuse
  4. Depression and suicide
35
Q

Opioid withdrawal varies depending on _______.

A

pharmacokinetic profile or receptor occupancy

36
Q

Opiate withdrawal symptoms

A
  1. Severe bone pain
  2. Chills
  3. Piloerection
  4. Sweating
  5. Extreme restlessness, nervousness, yawning
  6. Rhinorrhea
  7. N/V
  8. Diarrhea

(Opposite of the side effects. Most signs and symptoms abate in 48-96 hours but some persist for months→increases relapse risk)

37
Q

Why is methadone commonly used to treat opioid withdrawal?

A
  1. Cheap
  2. Cross tolerant
  3. Orally effective
  4. Long-acting

(Do not use for withdrawal from the less addictive drugs such as propoxyphene or pentazocine; instead decrease dose or use clonidine)

38
Q

Opioid withdrawal: Short-term detox is less than 30 days and long-term detox is not more than 180 days, usually for methadone. Detoxification avoids _____and provides _____

A
  • some of the withdrawal symptoms
  • a setting for psychosocial rehabilitation
39
Q

Methadone detox for known doses (i.e. pain pills) uses

A

Equivalency tables → Initial dose must be high enough to suppress withdrawal symptoms but not high enough to be life-threatening (40mg can be fatal in some non-tolerant individuals)

(Methadone 1mg = codeine 30mg = 0.5mg hydrocodone = 1.5mg oxycodone = 3-4mg morphine; Illicit drug use must be guessed at)

40
Q

Most detoxes can be done with initial dose of _____ and taper over ____days from there

A
  • 20-30mg
  • 5-7

(if no response in 1 hour, give another 5-10 mg)

41
Q

Signs of too much methadone: (5)

A
  1. drowsiness
  2. motor impairment
  3. miosis
  4. N/V
  5. mild hypothermia
42
Q

Clonidine for opioid withdrawal: starting dose. Decrease by 0.2 mg/day on day _____

A
  • 0.1 – 0.2 mg every 4-6 hours
  • 5

(If tolerated → double that on days 2-4)

43
Q

Clonidine for opioid withdrawal: AE (3)

A
  1. Hypotension
  2. Dizziness
  3. Sedation
44
Q

Clonidine treats opioid withdrawal symptoms, except for _____ (3).

A
  1. irritability
  2. insomnia
  3. muscle aches
45
Q

What can you add to Clonidine (opioid withdrawal) to treat muscle pain, abdominal cramps and n/v ?

A
  1. Muscle pain/cramps: NSAID
  2. Abdominal cramps: dicyclomine
  3. N/V: Ondansetron
46
Q

______can precipitate withdrawal, confirming physical dependence if uncertain

A

Naloxone, 0.2mg sc

47
Q

Opiate Substitution or Medication Assisted Treatment (MAT) uses which 2 drugs?

A
  1. Methadone
  2. Buprenorphine

(goals are to reduce and prevent adverse effect of drug use and improve functioning and quality of life)

48
Q

Continual regular use of methadone and buprenorphine prevents periods of intoxication alternating with withdraw and the need to look for the next dose. Should be partnered with ______ (2).

A
  1. Rehabilitation services
  2. Supportive counseling
49
Q

Methadone is a synthetic, long acting, orally available ____ agonist and _____ antagonist.

A
  • μ and δ
  • NMDA

(Rapidly and nearly completely absorbed)

50
Q

Methadone half-life is _______. Peak plasma levels in ____; pain relief lasts about_____.

A
  • 24
  • 2-6 hours
  • 6 hours

(Highly lipophilic, large volume of distribution and accumulates in solid organs; Metabolized through Cytochrome P450 system)

51
Q

Methadone program management (5).

A
  1. Start about 30mg and increase to lack of withdrawal and cravings
  2. Effective dosages between 60 and 120mg a day
  3. Expect relapses & support return to program
  4. Include counseling
  5. Rewards: clean urines, privilege of take-home doses
52
Q

Methadone metabolism takes place primarily in the liver. Metabolism will be increased by drugs that induce CYP enzymes such as______ (5). What results from this?

A
  1. Anti-HIV meds
  2. Carbamazepine
  3. Dexamethasone
  4. Phenytoin
  5. Spironolactone
  • Withdrawal
53
Q

Methadone metabolism takes place primarily in the liver. Metabolism will be decreased* by drugs that *inhibit CYP enzymes such as______ (3).

A
  1. Macrolide antibiotics
  2. -“azole” antifungals
  3. SRIs → confusion, sedation, resp. depression

(decrease metabolism in liver disease also)

54
Q

Chronic use of methadone is safe when monitored. There is no long-term damage two organ systems, hpa-axis for immune function. What are 3 side effects with chronic use?

A
  1. Constipation
  2. Orgasmic dysfunction in men
  3. Long QT interval (high doses)
55
Q

Buprenorphine is a mixed μ receptor agonist / antagonist available as _______ preparations (5).

A
  1. Parenteral analgesic
  2. Sublingual tablet
  3. Rapidly dissolving film for detox and maintenance
  4. Implant (lasts 6 mo.)
  5. Depot injection (lasts 30 days)

(Tablets and film can also contain naloxone in 4:1 ratio to reduce risk of abuse by injection (Suboxone, Zubsolv))

56
Q

Buprenorphine like methadone, is long-acting and safe, but it can precipitate withdrawal reaction if given _____.

A

too soon after use of opioid agonist

(Effectively blocks the effects of other opiates and therefore the reward qualities. Patients report little cravings or relapses)

57
Q

Pregnancy and opiates: risks with continued use

A
  1. Spontaneous abortion
  2. Stillbirth
  3. Prematurity and developmental anomalies

(they also have poor prenatal care, poor nutrition & drug adulterants)

58
Q

If a pregnant patient uses opiates they need to switch to _____(2).

A
  1. Methadone
  2. Buprenorphine (not FDA approved)

(avoid opioid antagonists)

59
Q

Pregnancy usually increases metabolism, which necessitates

A

Need for increased dose

60
Q

Infants born to mothers who are using methadone are born with ______

A

Physical dependence; may need to be withdrawn with tincture of opium or alternative

(no known birth defects associated with methadone exposure)

61
Q

Why is it important to identify pregnant women who are addicted to opioids?

A
  1. Prenatal care
  2. Resources to get their lives together before the baby comes (otherwise NICU may call CPS)

(In Clark County 60% of OB patients are on medicaid)

62
Q

There is social and political opposition to opiate substitution. This causes limited availability of _____(3).

A
  1. Clinics or spaces
  2. Financial Resources (insurance doesn’t pay much)
  3. Trained professionals

(Buprenorphine has been approved for office use)

63
Q

Prescription monitoring programs (PMP)

A
  • State Board of Pharmacy has developed database so prescribers of controlled substances can have access
  • You can look up individual patients to monitor for “Doctor shopping” or people writing prescriptions in your name

(statewide)

64
Q

Naltrexone mechanism of action

A
  • Binds tightly to the μ (mu) receptor
  • Prevents other opioids from binding

(Patients lose interest in using and no craving)

65
Q

Naltrexone was originally approved for _____

A

alcohol use disorder

(recently approved for opioid use disorder)

66
Q

Naltrexone administration routes:

A

Depot

(could be useful in those leaving detox program, jail or court-order)

67
Q

Naltrexone side effects (4)

A
  1. Anxiety
  2. Headache
  3. Nausea
  4. Sedation

(cannot be prescribed in patients with severe liver disease)

68
Q

Naloxone (Narcan) MOA

A

Pure mu receptor short-acting antagonist

69
Q

Naloxone must be used immediately after breathing has stopped. Brain death starts within _____.

A

4-8 minutes

70
Q

Naloxone routes of administration (3)

A
  1. Injectable solution
  2. nasal spray
  3. one-dose administered injection (no oral use)

(Now available for families, friends and rescue personnel – can buy in pharmacy without a prescription. Laws now protect those who call to report overdose)

Behavioral Medicine (35 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions