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Substance use disorders Flashcards

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1
Q

_ is a liver enzyme that is elevated in alcoholism; very sensitive but non-specific

A

GGT is a liver enzyme that is elevated in alcoholism; very sensitive but non-specific

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2
Q

Alcoholics will often have 2:1 ratio of liver enzymes, _ > _

A

Alcoholics will often have 2:1 ratio of liver enzymes, AST > ALT

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3
Q

Alcoholics may have reduced _ and _ production

A

Alcoholics may have reduced albumin and platelet production
* Hypoalbuminemia and thrombocytopenia

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4
Q

Neurologic effects of alcohol include _ and _

A

Neurologic effects of alcohol include degeneration of cerebellar vermis and peripheral neuropathy
* Drunken sailor ataxia

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5
Q

Cardiac effects of alcohol include _ and _

A

Cardiac effects of alcohol include dilated cardiomyopathy and atrial fibrillation

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6
Q

Oral/esophageal complications of alcohol include:

A

Oral/esophageal complications of alcohol include:
* Dental caries
* Aspiration pneumonia
* Mallory-Weiss tears
* Esophageal varices
* Squamous cell carcinoma

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7
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A
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8
Q

GI complications of alcohol use include _ , _ , and _

A

GI complications of alcohol use include pancreatitis , gastritis , and liver cirrhosis
* Liver cirrhosis can lead to poor synthetic function of the liver and portal congestion

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9
Q

Nutritional complications of alcohol use can include [deficiency], [anemia], [anemia/deficiency], gout

A

Nutritional complications of alcohol use can include thiamine (B1) deficiency, sideroblastic anemia, B12/folate deficiency (macrocytic anemia), gout

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10
Q

Reproductive complications of alcohol use include _ and _

A

Reproductive complications of alcohol use include erectile dysfunction and testicular atrophy

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11
Q

Acute management of alcohol misuse includes administration of [nutritional support] , airway protection, antiemetics, hydration

A

Acute management of alcohol misuse includes administration of thiamine before glucose, airway protection, antiemetics, hydration

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12
Q

_ or _ are drug options for reducing the cravings for alcohol

A

Naltrexone or Acamprosate are drug options for reducing the cravings for alcohol

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13
Q

Acamprosate is a drug with [MOA] that can help to reduce alcohol cravings

A

Acamprosate is a central glutamate receptor antagonist that can help to reduce alcohol cravings

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14
Q

_ is a drug that blocks the conversion of acetaldehyde to acetic acid, inducing unpleasant hangover symptoms with alcohol use

A

Disulfiram is a drug that blocks the conversion of acetaldehyde to acetic acid, inducing unpleasant hangover symptoms with alcohol use
* Increases alcetaldehyde
* Causes headache, nausea, flushing

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15
Q

General somatic symptoms of alcohol withdrawal include:

A

General somatic symptoms of alcohol withdrawal include:
* Tremors
* Diaphoresis
* Agitation
* Insomnia
* Nausea
* Emesis

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16
Q

Seizures and hallucinations can occur in [time frame] after alcohol withdrawal

A

Seizures and hallucinations can occur in 12-48 hours after alcohol withdrawal
* Seizures are typically tonic clonic and hallucinations are typically visual

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17
Q

_ is a life threatening complication of alcohol withdrawal that involves AMS, seizures, hallucinations, autonomic instability after 48+

A

Delirium tremens is a life threatening complication of alcohol withdrawal that involves AMS, seizures, hallucinations, autonomic instability after 48+

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18
Q

First line management for alcohol withdrawal is _

A

First line management for alcohol withdrawal is benzodiazepines
* Anxiolysis and antiepileptic activity

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19
Q

_ opiod receptor has the strongest analgesic effect

A

Mu opiod receptor has the strongest analgesic effect

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20
Q

_ opiod receptor is the only receptor type responsible for sedation

A

Kappa opiod receptor is the only receptor type responsible for sedation

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21
Q

_ is the opiod receptor type responsible for tolerance

A

Delta is the opiod receptor type responsible for tolerance

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22
Q

Opiods cause [change] in adenylyl cyclase and [change] in cAMP

A

Opiods cause decrease in adenylyl cyclase and decrease in cAMP
* Leads to change in K+ and Ca2+ conductance and decreased presynaptic NT release

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23
Q

Opiods _ K+ conductance and _ Ca2+ conductance

A

Opiods increase K+ conductance and decrease Ca2+ conductance

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24
Q

_ is the only opioid that cause mydriasis

A

Meperidine is the only opioid that cause mydriasis

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25
Side effects of opioid use include:
Side effects of opioid use include: * Respiratory depression * Somnolence/coma * Miosis * Pruritus (histamine release) * Sphincter of oddi spasm * Constipation
26
Respiratory depression in opioid use is due to a blunted CNS response to _
Respiratory depression in opioid use is due to a blunted CNS response to **hypercarbia**
27
Acute opioid overdose is treated with _
Acute opioid overdose is treated with **Naloxone**
28
Yawning and flu-like symptoms are classic for _ withdrawal
Yawning and flu-like symptoms are classic for **opioid** withdrawal * *Lacrimation, rhinorrhea, sweating, diarrhea, salivation, muscle pain and spasms, CNS pain*
29
Repeated opioid exposure will result in _ of mu opioid receptors and tolerance
Repeated opioid exposure will result in **downregulation** of mu opioid receptors and tolerance (delta)
30
Neonatal abstinence syndrome is managed with _ or _
Neonatal abstinence syndrome is managed with **methadone** or **morphine**
31
Tramadol is indicated for _
Tramadol is indicated for **chronic pain** * *Has SNRI activity*
32
_ is a full opioid agonist indicated for maintenance
**Methadone** is a full opioid agonist indicated for maintenance * *Has a slow onset, long half-life*
33
_ is an opioid antagonist that is used to prevent opioid relapse
**Naltrexone** is an opioid antagonist that is used to prevent opioid relapse * *Also reduces alcohol and nicotine cravings*
34
_ and _ are opioids with antitussive properties
**Codeine** and **Dextromethorphan** are opioids with antitussive properties
35
_ and _ are opioids indicated for treatment of diarrhea
**Loperamide** and **Diphenoxylate** are opioids indicated for treatment of diarrhea
36
Benzos: GABAa agonism --> increased Cl- channel _ --> decreased neuronal firing
Benzos: GABAa agonism --> increased Cl- channel **opening frequency** --> decreased neuronal firing
37
Short acting benzos include:
Short acting benzos include: **ATOM** * Alprazolam * Triazolam * Oxazepam * Midazolam
38
Long acting benzos include:
Long acting benzos include: * Flurazepam * Lorazepam * Diazepam * Chlordiazepoxide
39
Benzos that are metabolized outside the liver include:
Benzos that are metabolized outside the liver include: **LOT** (safe for people who drink a lot) * Lorazepam * Triazolam * Oxazepam
40
Name some clinical uses of benzos:
Name some clinical uses of benzos: * Anxiety and panic disorders * Insomnia and sleep walking * Alcohol withdrawal * Status epilepticus * Muscle relaxation
41
_ acting benzos have an increased risk of dependence
**Short** acting benzos have an increased risk of dependence
42
_ is a competitive GABA receptor antagonist and is the antidote to benzo overdose
**Flumazenil** is a competitive GABA receptor antagonist and is the antidote to benzo overdose * *Avoid it in patients with benzos dependence because it can cause acute withdrawal and induce seizure*
43
_ increase Cl- channel opening duration
**Barbiturates** increase Cl- channel opening duration * *Phenobarbital, thiopental, pentobarbital, secobarbital, primidone*
44
Barbiturates are cytochrome P450 _
Barbiturates are cytochrome P450 **inducers** * *Decreases concentration of other drugs* * *Contraindicated for patients with porphyria*
45
Compared to benzos, barbiturates have a _ therapeutic index
Compared to benzos, barbiturates have a **more narrow** therapeutic index * *Risk of respiratory and cardiovascular depression, there is no antidote*
46
Primidone is a barbiturate often used for _
Primidone is a barbiturate often used for **essential tremors**
47
Inhalants like glue, nitrous oxide, paint thinner, poppers, solvent cleaners, etc are most commonly used by [population]
Inhalants like glue, nitrous oxide, paint thinner, poppers, solvent cleaners, etc are most commonly used by **adolescents** * *Causes transient euphoria, confusion, blurry vision, impaired judgement*
48
Peri-oral and peri-nasal dermatitis should raise concern for [substance misuse]
Peri-oral and peri-nasal dermatitis should raise concern for **inhalant misuse**
49
Amphetamines have dual action. 1. _ 2. _
Amphetamines have dual action. 1. **Release stored catecholamines** 2. **Inhibit reuptake of catecholamines**
50
Amphetamines are used for medical treatment of _ and _
Amphetamines are used for medical treatment of **ADHD** and **Narcolepsy**
51
Presentation of amphetamine intoxication:
Presentation of amphetamine intoxication: * Mydriasis * Tachycardia * Fever * Hypertension * Coronary vasospasm * Skin excoriation * Euphoria * Inflated sense of self * Agitation * Paranoia
52
[Treatment] may be considered for amphetamine intoxication to control agitation/ seizures
**Benzodiazepines** may be considered for amphetamine intoxication to control agitation/ seizures * *Otherwise just monitor for withdrawal sx and control hyperthermia/dehydration/arrhythmias*
53
Caffeine is structurally similar to _ and will _ cAMP levels
Caffeine is structurally similar to **adenosine** and will **increase** cAMP levels * Adenosine receptor antagonist --> increases cAMP --> increases sympathetic response
54
Cocaine is an inhibitor of [NT transporter]
Cocaine is an inhibitor of **NET** *thus increasing NE concentrations* * alpha >>> beta agonism
55
In addition to inhibiting NET, cocaine also has local anesthetic properties via _
In addition to inhibiting NET, cocaine also has local anesthetic properties via **inhibition of Na+ channels** --> decreasing action potential transmission
56
Use of [drug] during pregnancy poses a risk of low birth weight, preterm birth, and placental abruption
Use of **cocaine** during pregnancy poses a risk of low birth weight, preterm birth, and placental abruption * *Due to vasoconstriction*
57
If a patient presents with perforated nasal septum, you may be concerned for [drug abuse]
If a patient presents with perforated nasal septum, you may be concerned for **cocaine use** * Vasoconstriction --> ischemic necrosis of the nasal septum
58
Cocaine may cause [effects on the heart]
Cocaine may cause **coronary vasospasm, dilated cardiomyopathy, tachyarrhythmia**
59
How does cocaine intoxication present?
Cocaine intoxication... * Impaired judgement * Elevated energy * Anxiety, paranoia * Mydriasis * Diaphoresis * HTN, tachycardia * Hallucinations
60
Management of cocaine intoxication may include [sedative] or [autonomic drugs]
Management of cocaine intoxication may include **benzos** or **labetalol or alpha blocker** * *Note that labetalol can only be used bc it is a non-selective beta blocker*
61
[Drugs] should be avoided in cocaine intoxication
**Strict beta blockers** should be avoided in cocaine intoxication * *Can lead to unopposed alpha agonism --> increased BP*
62
_ is a drug that reduces NET and DAT activity, helping with smoking cessation
**Bupropion** is a drug that reduces NET and DAT activity, helping with smoking cessation
63
[Drug] is a 5HT2a serotonin-receptor agonist
**LSD** is a 5HT2a serotonin-receptor agonist
64
[Drug] intoxication presents with depersonalization, distorted perception of time and space, and flashbacks
**LSD** intoxication presents with depersonalization, distorted perception of time and space, and flashbacks * *Also hallucinations (visual and auditory), anxiety, mydriasis*
65
Cannabis exerts its actions by binding to _ and _ receptors
Cannabis exerts its actions by binding to **CB1** and **CB2 cannabinoid** receptors
66
How does cannabis intoxication commonly present?
Cannabis intoxication... * Impaired judgement * Euphoria * Distorted perception of time * Hallucinations * Paranoia * Increased appetite * Dry mouth * Conjunctival injection * Sleep disturbances
67
A patient who is vomiting uncontrollably after smoking weed may have _
A patient who is vomiting uncontrollably after smoking weed may have **cannabinoid hyperemesis syndrome**
68
Cannabis withdrawal may present with _
Cannabis withdrawal may present with **anxiety, restlessness, depression, decreased appetite, insomnia**
69
[Drug] is a 5HT2a serotonin receptor *and* D2 receptor agonist
**MDMA (ecstasy)** is a 5HT2a serotonin receptor *and* D2 receptor agonist * *Increases serotonin and dopamine in synaptic cleft*
70
Euphoria, hallucinations, distorted perception of time, bruxism, and hyperthermia is suggestive of [drug intoxication]
Euphoria, hallucinations, distorted perception of time, bruxism, and hyperthermia is suggestive of **MDMA (ecstasy) intoxication** * *Bruxism = ecstasy* * *Can also cause hyponatremia and serotonin syndrome*
71
Phencyclidine (PCP) exerts its effect as an _
Phencyclidine (PCP) exerts its effect as an **NMDA antagonist** * *Also inhibits the reuptake of dopamine, NE, serotonin*
72
[Drug intoxication] can present with violence and rotary nystagmus
**PCP intoxication** can present with violence and rotary nystagmus * *Also erratic behavior, impulsivity, delirium, psychosis, agitation, miosis, tachycardia, HTN*
73
Name (5) drugs that are classified as depressants
1. **Alcohol** 2. **Barbiturates** 3. **Benzodiazepines** 4. **Opioids** 5. **Inhalants**
74
Name (4) substances that are considered stimulants
1. **Amphetamines** 2. **Caffeine** 3. **Cocaine** 4. **Nicotine**
75
Name (4) hallucinogenic drugs
1. **Lysergic acid diethylamide** 2. **Cannabis** 3. **MDMA** 4. **Phencyclidine**
76
[Category of drugs] cause mood elevation, reduced anxiety, sedation, behavioral disinhibition, respiratory depression
**Depressants** causes mood elevation, reduced anxiety, sedation, behavioral disinhibition, respiratory depression
77
(3) drugs that are positive allosteric modulators of the GABA-a receptor
(3) drugs that are positive allosteric modulators of the GABA-a receptor 1. **Alcohol** 2. **Barbiturates** 3. **Benzos**
78
Individuals who use alcohol will have elevated _ >> _
Individuals who use alcohol will have elevated **AST** >> **ALT**
79
General symptoms of alcohol withdrawal present in [time duration] and include *tremors, insomnia, diaphoresis, agitation, GI upset*
General symptoms of alcohol withdrawal present in **4-36 hours** and include *tremors, insomnia, diaphoresis, agitation, GI upset*
80
Withdrawal from alcohol may cause _ or _ in the first 12-48 hours
Withdrawal from alcohol may cause **hallucinosis** or **seizures** in the first 12-48 hours
81
After 48+ hours of alcohol withdrawal, there is a risk of _
After 48+ hours of alcohol withdrawal, there is a risk of **delirium tremens**
82
Flumazenil is medical management for _
Flumazenil is medical management for **benzos intoxication**
83
Inhalants act via [MoA]
Inhalants act via **enhanced GABA signaling** * *Effects often have rapid onset and resolution*
84
Piloerection is a symptom of withdrawal from [drug]
Piloerection is a symptom of withdrawal from **opioids**
85
Nonspecific symptoms of [drug category] use include *mood elevation, reduced appetite, psychomotor agitation, insomnia, cardiac arrhythmias, tachycardia, anxiety*
Nonspecific symptoms of **stimulant** use include *mood elevation, reduced appetite, psychomotor agitation, insomnia, cardiac arrhythmias, tachycardia, anxiety*
86
Anxiety, tremor, seizures, insomnia are nonspecific signs of [drug category] withdrawal
Anxiety, tremor, seizures, insomnia are nonspecific signs of **depressant** withdrawal
87
[Stimulants] induce reversal of monoamine transporters
**Amphetamines** induce reversal of monoamine transporters * *This increases NT release* * *Transporters include VMAT, DAT, SERT, NET*
88
Euphoria, grandiosity, mydriasis, prolonged wakefulness, hyperalertness, hypertension for several hours is indicative of _
Euphoria, grandiosity, mydriasis, prolonged wakefulness, hyperalertness, hypertension for several hours is indicative of **amphetamine use** * *As opposed to cocaine which is shorter acting*
89
General stimulant withdrawal symptoms include _
General stimulant withdrawal symptoms include **post-use "crash", depression, lethargy, increased appetite, sleep disturbance, vivid nightmares**
90
Cocaine blocks the reuptake of _ , _ , and _
Cocaine blocks the reuptake of **dopamine** , **serotonin** , and **norepinephrine**
91
_ -acting benzodiazepines have active metabolites
**Long**-acting benzodiazepines have active metabolites * Most benzos fall into this category except for the "ATOM" drugs
92
Name the benzos that are short-acting
Name the benzos that are short-acting: **Alprazolam** **Triazolam** **Oxazepam** **Midazolam** *These have a higher addictive potential*
93
[Drug] is a competitive antagonist at the GABA benzo receptor
**Flumazenil** is a competitive antagonist at the GABA benzo receptor * *But can precipitate seizures*
94
Zolpidem, Zaleplon, Eszopiclone work by [mechanism]
Zolpidem, Zaleplon, Eszopiclone work by **BZ1 subtype of GABA receptor** * Used to treat insomnia
95
ZZZ drugs (nonbenzo hypnotics) have relatively _ duration and _ dependence risk
ZZZ drugs (nonbenzo hypnotics) have relatively **short** duration and **low** dependence risk * *Short duration because of rapid metabolism by liver enzymes*
96
Opioids inhibit the release of 5-HT, substance P, _ , _ , _
Opioids *inhibit* the release of 5-HT, substance P, **glutamate** , **NE** , **Ach**
97
Tolerance to opiods does not exclude an individual from experiencing _ or _
Tolerance to opiods does not exclude an individual from experiencing **constipation** or **miosis**
98
Prevent opioid relapse with _
Prevent opioid relapse with **naltrexone** * *Once detoxified*
99
Butorphanol is a k-opioid receptor _ and mu-opioid receptor _
**Butorphanol** is a k-opioid receptor **agonist** and mu-opioid receptor **partial agonist**
100
**Pentazocine** is a k-opioid receptor _ and mu-opioid receptor _
**Pentazocine** is a k-opioid receptor **agonist** and mu-opioid receptor **weak antagonist or partial agonist**
101
[Drug] is a very weak opioid agonist; it also inhibits the reuptake of NE and serotonin
**Tramadol** is a very weak opioid agonist; it also inhibits the reuptake of NE and serotonin * *Used for chronic pain*
102
Risks of tramadol include decreased _ and _ syndrome
Risks of tramadol include **decreased seizure threshold** and **serotonin syndrome**
103
Define precontemplation, comtemplation, and preparation
1. **Precontemplation**- denying problem 2. **Contemplation**- acknowledging problem but unwilling to change 3. **Preparation**- preparing for changes

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