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Pharm III > Substance Use Disorder > Flashcards

Substance Use Disorder Flashcards

(66 cards)

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1
Q

Illicit substances

A

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

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2
Q

Abuse

A

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

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3
Q

Misuse

A

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)

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4
Q

Addiction

A 
Craving
Compulsion to use
Continued use despite known consequences
Loss of control
Chronic dz
Frequently characterized by relapse
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5
Q

Pseudo-addiction

A

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

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6
Q

Physiological dependence

A 
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
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7
Q

Physiological dependence s/sx in opioids

A

Myoclonus

Jerking

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8
Q

Physiological dependence s/sx with alcohol

A

Seizures
Tremors
Hallucinations

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9
Q

Tolerance

A

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

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10
Q

Cross-tolerance

A

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

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11
Q

Examples of cross-tolerance

A

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

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12
Q

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

A

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

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13
Q

Additive or synergistic effects

A

Sedation
Euphoria
Dissociation

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14
Q

Treatment of “abused” drug’s side effects

A

Itching
N/V
Anxiety
Erectile dysfunction

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15
Q

Tx of diseases or disease processes caused by abused substances

A

Depression
Anxiety
Bipolar

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16
Q

Drug diversion

A

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

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17
Q

Opiates that are abused

A 
Hydrocodone
Oxycodone
Hydromorphone
Morphine
Codeine
Fentanyl
-IV
-Patches
Methadone
Buprenorphine
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18
Q

Benzos that are abused

A

Clonazepam
Alprazolam
Diazepam
Lorazepam

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19
Q

Stimulants that are abused

A

Methylphenidate
Armodafanil
Phentermine

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20
Q

Antipsychotics that are abused

A

Quetiapine
Olanzipine
Haloperidal
Risperidone

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21
Q

Muscle relaxants that are abused

A

Cyclobenzoprine
Metaxalone
Carisoprodal
Tizanidine

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22
Q

Anticonvulsants that are abused

A

Gabapentin
Carbamazepine
Pregabalin
Lamotrigine

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23
Q

Other analgesics that are abused

A

Tramadol

Butalbital/actaminophen

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24
Q

Antiemetics that are abused

A

Promethazine

Ondansetron

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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 ```

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