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Behavioral Medicine > Substance Use Disorder 3 > Flashcards

Substance Use Disorder 3 Flashcards

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1
Q

Sedative-hypnotics and anxiolytics: indications: General anesthesia, muscle relaxant, ______ (3)

(GABA receptor agonist)

A
  1. Anxiety
  2. Sleep
  3. Seizures

(produce physical and psychological dependence. Do not prescribe if they have been addicted to other drugs)

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2
Q

_____ is one of the oldest known naturally occurring anxiolytic drugs

A

Valerian

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3
Q

Classes of sedative hypnotics: meprobamate, Quaaludes, ______(4)

A
  1. Barbiturates
  2. Benzodiazepine
  3. Sleep drugs: Zolpidem (Ambien) and eszopiclone (Lunesta)
  4. Valerian
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4
Q

Benzodiazepine can be deadly when combined with _____. Widely prescribed and are usually the culprit of _____.

A
  • Other depressant drugs
  • escilation to physical dependence
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5
Q

Benzodiazepine signs of abuse: Cognitive dysfunction, self-neglect, ______ (4).

A
  1. Disinhibition
  2. Lethargy
  3. Blackouts
  4. Accidents

(High intoxication→ poor coordination, slurred speech)

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6
Q

Long-acting benzodiazepines

A
  1. chlordiazepoxide (Librium)
  2. diazepam (Valium)
  3. flurazepam (Dalmane)
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7
Q

Medium action benzodiazepines

A
  1. alprazolam (Xanax)
  2. clonazepam (Klonopin)
  3. temazepam (Restoril)
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8
Q

Short-acting benzodiazepines

A
  1. lorazepam (Ativan)
  2. oxaxepam (Serax)
  3. triazolam (Halcion)

(midazolam)

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9
Q

Very short action benzodiazepine

A

midazolam (Versed

(picmonic: “Maid-Z-Lamb”)

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10
Q

Treatment of sedative hypnotic dependence: ______ should be used to monitor for over/mis-use.

A
  • Rx monitoring program
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11
Q

Treatment of sedative hypnotic dependence: Consider _____ program. ______ may prevent seizures – use for a brief time.

A
  • an inpatient detox (outpatient less sucessful)
  • Anticonvulsants
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12
Q

Stimulants elevate mood, increase ______ & _____ and decrease ______.

A
  • energy
  • alertness
  • appetite
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13
Q

Stimulants cause autonomic hyperarousal including elevated _____ (3).

A
  1. blood pressure
  2. heart rate
  3. pupil dilation

(Can make individuals irritable, paranoid, euphoric, and experience hallucinations)

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14
Q

Stimulants medical indications (4)

A
  1. ADHD
  2. Depression: dextroamphetamine, methylphenidate
  3. Weight loss
  4. Sleep disorders
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15
Q
  1. methylphenidate
  2. dextroamphetamine

are used to treat which 2 disorders?

A
  1. ADHD
  2. Depression
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16
Q

Pseudoephedrine type drugs, useful for cold congestion, are precursors to _____ and are now restricted

A

methamphetamine

(you can buy it but you must talk to the pharmacist)

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17
Q

Common problem with stimulants: teenagers may _______. College/graduate students ______

A
  • steal their younger siblings Ritalin and use it or sell it
  • use it to study
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18
Q

What is the difference between Cocaine and Methamphetamine mechanisms of action?

A

Both increase dopamine in the synapse

  • Cocaine blocking reuptake → rapid sense of intense pleasure
  • Meth increased dopamine release at the synapse
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19
Q

Methamphetamines (aka “speed” or “meth”) are easily synthesized & instructions readily available. Method of administration:

A
  • smoked
  • injected
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20
Q

Nevada has the _____(lowest/highest) use of meth.

A

lowest

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21
Q

Medical complications of stimulant drugs (5)

A
  1. MI
  2. Psychosis
  3. Strokes
  4. Seizures → anoxic brain damage
  5. Infections : HIV, Hep C & B
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22
Q

Treatment of stimulant intoxication:

  1. Psychosis: antipsychotics
  2. Irritability: _____
  3. Depression: _____
A
  • Benzodiazepines
  • No trmt, unless it lasts >2 weeks, then antidepressants

(CBT recommended; acute withdrawal may cause depression assoc. w/the “crash”)

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23
Q

Substitution drug for stimulants

Study These Flashcards
A

No “substitute” medication is available, but …

bupropion (Welbutrin XL) with naltrexone (Vivitrol) may diminish use

24
Q

List the hallucinogens (4)

Study These Flashcards
A
  1. LSD
  2. Mescaline
  3. MDMA (Ecstasy)
  4. Peyote
25
Hallucinogens cause psychotic-like experiences along with _____ symtpoms (5).
1. **Increased HR &BP** 2. Sweating 3. *Miosis* 4. Blurry vision 5. Tremors (stimulants cause mydriasis, increased BP & HR)
26
"Bad Trips" from hallucinogens can lead to \_\_\_\_\_. Some may develop ______ (2)
* to severe anxiety and paranoia 1. flashbacks 2. chronic psychosis (Ecstasy can cause intense feelings of attachment and energy during high but cognitive and memory deficits in chronic use)
27
\_\_\_\_\_ may calm a patient high on hallucinogens.
BZD
28
PCP MOA (Originally an anesthetic for animals)
1. Antagonist of NMDA receptors 2. Activates dopamine neurons (Easily synthesized and is often added to other drugs)
29
PCP induces
1. Euphoria 2. Derealization 3. Tingling 4. Warmth (PCP, cannabis, meth, opioids & inhalants cause euphoria)
30
PCP Moderate doses → PCP Higher doses →
* bizarre behavior, myoclonic jerks, confusion * coma, seizure, respiratory depression (Can produce delirium, psychosis, mood disorders, flashbacks, agitation and violence)
31
Which 2 drugs can cause psychosis & flashbacks?
1. hallucinogens 2. PCP (Cannabis can produce psychosis also, but not flashbacks)
32
THC is the active ingredient in marijuana contains many \_\_\_\_\_\_.
Carcinogens
33
Marijuana is used medicinally for :
1. Nausea 2. Anorexia ("gateway drug")
34
Cannabis can precipitate \_\_\_\_\_in vulnerable population.
psychosis (PCP and hallucinogens also)
35
Intoxication of marijuana last for approximately\_\_\_\_\_ and gives a sense of \_\_\_\_.
* 2-4 hours * euphoria and serenity, slowed time, heightened senses (PCP, cannabis, meth, opioids & inhalants cause euphoria)
36
Heavy use of marijuana can lead to anxiety, paranoia _____ (5)
1. Decreased motivation 2. Memory problems 3. Perceptual disturbances 4. Poor attention 5. Poor coordination
37
Caffeine stimulant effects include increased\_\_\_\_\_. Higher doses can cause \_\_\_\_\_\_\_\_. Massive dose can cause \_\_\_\_\_\_.
* alertness and improved verbal and motor performance * restlessness, irritability and insomnia * Seizures and coma
38
Caffeine Withdrawal from heavy use causes
1. Depression 2. Headaches 3. Irritability 4. Lethargy
39
Caffeine can aggravate _____ (4 conditions)
1. Insomnia 2. Gastric & esophageal ulcers 3. Anxiety
40
Abstinence Based and Psychosocial Treatments (4)
1. Inpatient **detox & rahab**: inpatient or intensive outpatient (IOP) 2. **12 Step Programs** 3. **Counseling** (Cognitive Behavior based, family) 4. Sober Living **Residences**
41
Why patients don't seek substance abuse treatment?
1. Not ready to stop using 2. No money/insurnace 3. Negative effect on job 4. Worried what others think 5. Didn't know where to go 6. Want to do it on their own
42
Co-occurring psychiatric disorders and substance use are most common with \_\_\_\_\_\_
Common w/alcohol abuse (78% of alcohol dependent men and 86% of women met lifetime criteria for another psychiatric disorder including drug dependence)
43
Treatment of co-occurring disorders (Integration of services is very important)
1. CBT: anxiety disorders and substance abuse 2. Meds (avoid in addictive personality) 3. SSRI’s very helpful in depression and may require higher doses as alcohol may have induced hepatic microsomal activity (Do not wait for extended abstinence to treat )
44
Gambling disorder criteria: persistent and recurring problematic Behavior leading to impairment or distress: ***_4 or more of the following in 12 months_***
1. _Spending more to achieve desired excitement_ 2. _Try to get $ from others to gamble_ 3. _“chasing” one’s losses (return to "win it back")_ 4. **Unsuccessful attempts to quit** 5. **Restless or irritable when they stop** 6. *Preoccupied with gambling* 7. *Gambles when feeling distressed* 8. Lies about gambling 9. Jeopardized or lost a significant relationship, job, or educational or career (bold, underline, itilics to group the symptoms: _money_, **quitting**, *distress*, lies & losses)
45
Gambling disorder frequently Co-occurs with _____ disorders (6)
1. lifetime alcohol use disorder 2. drug use 3. nicotine dependence 4. mood disorder 5. anxiety 6. personality disorder
46
Treatment of gambling disorder
1. Gamblers Anonymous – high dropout rate 2. Treat co-occurring disorders 3. CBT – psychoeducation, challenge beliefs, acquire skills, facilitate lifestyle changes, restructure environment 4. Marital and Family Treatments (Medication – studies ongoing but none approved)
47
Inhalants produce feelings of ______ (3).
1. Excitation 2. Euphoria 3. Disinhibition
48
Inhalants AE
1. Dizziness 2. Slurred Speech 3. Ataxia
49
What are used as inhalants (5)
1. airplane glue 2. gasoline 3. laboratory solvent 4. nail polish remover 5. paint thinner
50
Nicotine withdrawal sx
1. **Decreased HR** 2. Anxiety 3. Craving 4. Irritability 5. Restlessness
51
Nicotine cessation tx (important to encourage and assess quitting)
1. Bupropion 2. Varenicline/Chantix (partial nicotine agonist) 3. Nicotine replacement (patches, gum, lozenges, inhalers)
52
Cathinones (aka "bath salts") are naturally occurring \_\_\_\_\_\_derived from the leaves of Catha edulis
amphetamines
53
Synthetic cannabinoids (street names: spice and K2) are \_\_\_\_\_\_\_agents that bind to the cannabinoid receptor
cannabimimetic
54
Describe the general intoxication profile of cathinones & synthetic cannabinoids
55
Difference between synthetic cannabinoid and cathinone complications
* cannabinoids: rhabdo, nephrotoxicity, cardiac arrest * cathinones: suicidality, respiratory depression, paranoia (both have psychosis)
56
Why is it difficult to treat novel psychoactive substances?
Inability to know the potency, chemical composition and added adulterants in each batch of street drugs
57
Novel psychoactive substances are difficult to treat to do to not knowing the composition. How would you treat it?
1. Supportive care 2. IV fluids 3. Electrolyte repletion 4. End-organ evaluation of: kidneys, lungs, heart, and brain 5. BZD, antipsychotics, nalaxone (if opioid toxidrome)

Behavioral Medicine (35 decks)

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