Substance Use Disorder Flashcards Preview

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Flashcards in Substance Use Disorder Deck (66):
1

Illicit substances

Substances that have been obtained illegally or prescription medications used to get high (or alter the sensorium in some way)

2

Abuse

Taking a prescribed, non-prescribed prescription, OTC med, or illicit substance with the INTENT TO CAUSE ephoria, enhanced sensorium, "escape", or other changes in mood/emotion

3

Misuse

Taking prescribed or nonprescribed medication (s) for non-prescribed purposes with intent to treat
Taking/sharing another person's medications for intent to treat
Taking the medication outside the boundaries of the prescription: dosage, frequency, routes (intent to treat)

4

Addiction

Craving
Compulsion to use
Continued use despite known consequences
Loss of control
Chronic dz
Frequently characterized by relapse

5

Pseudo-addiction

A healthcare induced condition in which health professionals misinterpret a pt's request for more medication due to inadequate treatment of a condition. The pt's request for more medication is misinterpreted as "drug seeking behavior" similar to that seen in addicts not in recovery

6

Physiological dependence

The nl functioning of the body with prolonged drug or chemical exposure such that rapid removal or cessation of the drug produces withdrawal sx frequently characterized by:
Tachycardia
Anxiety
Nausea
Diaphoresis
Irritability

7

Physiological dependence s/sx in opioids

Myoclonus
Jerking

8

Physiological dependence s/sx with alcohol

Seizures
Tremors
Hallucinations

9

Tolerance

An increased dose is required to achieve the same desired physiologic response

10

Cross-tolerance

A pharmacological phenomenon that may be characterized as an inability to achieve a specific pharmacological effect d/t prolonged exposure of a similar pharmacological substance

11

Examples of cross-tolerance

Benzos-alcohol-anticonvulsants (gabapentin, carbamazepine, phenobarb)
All opioids to other opioids
Antihistamines-phenothiazines-TCAs-antipsychotics

12

What are these substances/medications doing for the abuser/addict?

Inducing euphoric/dissociative effects
Self-medicating underlying psychological disorders frequently undiagnosed
Additive or synergistic effects
Treatment of "abused" drug's side effects
Treatment of diseases or disease processes caused by abused substances

13

Additive or synergistic effects

Sedation
Euphoria
Dissociation

14

Treatment of "abused" drug's side effects

Itching
N/V
Anxiety
Erectile dysfunction

15

Tx of diseases or disease processes caused by abused substances

Depression
Anxiety
Bipolar

16

Drug diversion

Any time a medication moves in a direction it's not prescribed for or not allowed by federal or state law

17

Opiates that are abused

Hydrocodone
Oxycodone
Hydromorphone
Morphine
Codeine
Fentanyl
-IV
-Patches
Methadone
Buprenorphine

18

Benzos that are abused

Clonazepam
Alprazolam
Diazepam
Lorazepam

19

Stimulants that are abused

Methylphenidate
Armodafanil
Phentermine

20

Antipsychotics that are abused

Quetiapine
Olanzipine
Haloperidal
Risperidone

21

Muscle relaxants that are abused

Cyclobenzoprine
Metaxalone
Carisoprodal
Tizanidine

22

Anticonvulsants that are abused

Gabapentin
Carbamazepine
Pregabalin
Lamotrigine

23

Other analgesics that are abused

Tramadol
Butalbital/actaminophen

24

Antiemetics that are abused

Promethazine
Ondansetron

25

Performance enhancing drugs that are abused

Steroids
Epogen

26

Others that are abused

Tamoxifen

27

Sex enhancers that are abused

Sildenafil
Tadalafil
Vardenafil

28

Classic behaviors regarding prescription meds

Doctor shopping
Pharmacy shopping
Poly practitioner use
Early refills
Polypharmacy
Brand names only across the board
Reporting multiple thefts/losses
Persistently running out of controlled substances on weekends

29

Peculiar med behaviors

Changing dosage forms
Changing pharmacists to request an early refill
Changing" requestor of" "early refill"

30

Common features of addiction to a chronic disease

Lifelong
Remissions/exacerbations occur
Results in poor response to behavioral interventions alone
Effectively managed pharmacologically
Untreated, it results in morbidity/mortality

31

Principal neurotransmitters

Dopamine
Nor/epinephrine
Serotonin
Acetylcholine
GABA

32

EtOH and the neurotransmitter correlates

Me-enkephalin
GABA
5HT

33

BZDs and the neurotransmitter correlates

GABA
Glycine

34

THC and the neurotransmitter correlates

Ach

35

Heroin and the neurotransmitter correlates

Enkephalin
Endorphin
DA

36

Cocaine/amphetamine and the neurotransmitter correlates

NE
5HT
DA
Ach

37

Nicotine and the neurotransmitter correlates

NE
Endorphin
Ach

38

LSD and the neurotransmitter correlates

Ach
DA
5HT

39

Rewards

Humans, as well as other organisms, engage in behaviors that are rewarding
The pleasurable feelings provide positive reinforcement so that the behavior is repeated.

40

The reward pathway

The ventral tegmental area is connected to both the nucleus accumbens and the prefrontal cortex and it sends information to these structures via its neurons. The neurons of the VTA contain the neurotransmitter dopamine which is released in the nucleus accumbens and in the prefrontal cortex

41

MOA of heroin

Once in the brain, it's converted to morphine by enzymes; the morphine binds to opiate receptors in certain areas of the brain.
Morphine also binds to areas involved in the pain pathway (including the thalamus, brainstem and spinal cord).

42

Which types of neurons participate in opiate action?

One that releases dopamine
A neighboring terminal containing a different neurotransmitter (probably GABA)
The post-synaptic cell containing dopamine receptors

43

Drugs and the reward pathway

They increase the activity of the reward pathway by increasing dopamine transmission

44

S/sx of opioid withdrawal

N/V
Diarrhea
"Goose flesh"
Yawning
Pupil dilation
Chills
Flu-like sx
Algias/myalgias

45

How to tell if someone taking buprenorphine or methadone is not in recovery

Continued use
Noncompliance
Continued negative behaviors
Minimal behavior/environment

46

How to tell when someone taking buprenorphrine and methadone is in recovery

Sx controlled
Counseling
Behavior changes
Environmental changes
Minimized drug use

47

How does medication assisted tx fit into the picture?

Only 5% of the big picture
Screening/assessment/motivational interviewing
Goal setting/target setting
Counseling
Support group

48

What are the goals of tx?

Abstinence from substance abuse/recovery
Social stability lost by substance abuse
Establish mental well being
Decrease aberrant behaviors (prostitution, injection of substance)
Decrease HIV, hep C, STIs
Decrease domestic violence
Decrease criminal behavior

49

What are the surrogate markers of SUD recovery?

Med compliance
Counseling compliance
Urine drug screen compliance
Return to work
Positive relationship development

50

Goals of pharmacotherapy- opioid addiction

Reduce cravings and compulsion to "use" while trying to "normalize" behaviors and lifestyles
Minimize withdrawal
Minimize risky abuse behaviors like IV drug abuse, aberrant sexual behavior, criminal behavior
Minimize or prevent relapse

51

Drugs used to treat opioid addiction

Methadone
Buprenorphrine or buprenorphrine//naloxone (Suboxone)
Naltrexone

52

How do meds used to treat opioid addiction work?

Stimulate reward receptors in the brain but don't cause a huge dopamine surge

53

Methadone

Regulated by SAMHSA and the medication is distributed in certified clinics. The critical part of methadone tx occurs during the induction.
Typically, pt is started on about 30 mg/day with Day 1 max of 40 mg PO

54

Common side effects of methadone

Dry mouth
Constipation
Nausea or loss of appetite
Feeling anxious or restless
Insomnia
Weakness or drowsiness
Decreased sex drive

55

Goal of methadone dosage

Establish the dosage that will keep the pt free from withdrawal sx for a 24-hr period

56

Average daily dose of methadone

70-120 mg/day

57

What to avoid with methadone

Use of current benzos due to risk of overdose and death

58

Characteristics of methadone

Oral/IM
Long-acting
Pharmacokinetics DO NOT correspond to pharmacodynamics
Daily doses (acute vs chronic)
Tapering compared to buprenorphine

59

Buprenorphine

Only approved office-based MAT for opioid dependence. Physician must have DEA waiver in order to prescribe buprenorphine products
Combo buprenorphine/naloxone should be used for induction, stabilization, and maintenance
The mono product buprenorphine should be reserved only for use in pregnant women who need maintenance tx and the rare individual who is allergic to buprenorphine/naloxone

60

Average daily dose of buprenorphine

12-16 mg
90% of the mu receptors are occupied at 16 mg
A pt on more than 16 mg/day should generate a serious re-evaluation of the pt's tx status

61

Side effects of buprenorphine

HA
Nausea
Sweating
Constipation
Stomach pain
Problems sleeping
Sublingual irritation

62

What to avoid with buprenorphine

Use of concurrent benzodiazepines d/t risk of overdose and death

63

How does buprenorphine work in treating addiction when it is 50-80x more potent than morphine?

It stimulates the receptors in the reward center of the brain
That diminishes cravings, compulsions, etc

64

MOA of naltrexone

Long-acting oral opioid antagonist.
When taken correctly it completely blocks the reinforcing properties of ingested opioids
Pt must be opioid free for several days before starting naltrexone in order to avoid precipitating withdrawal

65

Oral dose of naltrexone

50 mg daily

66

Side effects of naltrexone

N/V
HA
Anxiety
Fatigue
Insomnia
Elevated LFTs
Injection site reactions