11. Ancc Pmhnp Cert Review Ch 11 Substance-Related Disorders

Front 1

Substance related disorders are a cluster of disorders in which...

Back 1

1. Cognitive, behavioral, and physical symptoms occur

2. Indicating that an individual is experiencing the effects of a drug of abuse

Front 2

Psychiatric symptom clusters in substance related disorders may be related to...?

Back 2

1. Substance use
2. Discontinuation of substance use
3. Withdrawal from habitual substance use

Front 3

The word substance can describe...?

Back 3

1. Drug of abuse
2. Medication
3. Toxin that produces psychoactivation and alters cognitive, behavioral and affective perceptions

Front 4

Psychodynamic theory of etiology of substance related disorders main points?

Back 4

1. Behaviors of abuse are seated in oral stage fixation
2. Individual seeks gratification through oral behaviors
3. Maladaptive regressive behaviors can become overlearned, fixed and reinforced through dysfunctional family patterns

sociocultural factors attempt to explain population based differences in substance abuse rates
*gender differences
*ethnic differences

Front 5

Maladaptive regressive behaviors can become overlearned, fixed and reinforced through ____________

Back 5

dysfunctional family patterns

Front 6

Behaviors of abuse are seated in ____________

Back 6

Oral-stage fixation

Front 7

Biological theory of etiology of Substance Related Disorders main points?

Back 7

Genetic Loading
1. Individuals with a strong genetic vulnerability to addiction are thouth to have defects in the reward center, predisposing them to stronger than normal positive rewards
2. Also predisposes them to to stronger than normal negative rewards, making it more difficult to stop abuse once it has begun.

Front 8

Negative rewards are aversive such as

Back 8

increased anxiety and dysphoria (mediated bye the GABA pathways)

Reinforcement one of the 2 neurobio processes responsible for sub d/o

Front 9

________ results in "feel good" sensations when a drug of abuse is used and in "feel bad" sensations when the drug exits the body

Back 9

Reinforcement

Front 10

Feel good sensations mediated by

Back 10

DA pathways

Reinforcement results in "feel good" sensations when a drug of abuse is used and in "feel bad" sensations when the drug exits the body.

Front 11

Feel bad sensations mediated by

Back 11

Gamma-amin-butyric acid (GABA) pathways

Reinforcement results in "feel good" sensations when a drug of abuse is used and in "feel bad" sensations when the drug exits the body.

Biological theory of etiology of sub d/o

Front 12

Reinforcement occurs in what areas of the brain

Back 12

Ventral tegmental area
&
nucleus accumbens

Collectively call the reward center

Front 13

Collectively call the reward center

Back 13

Ventral tegmental area
&
nucleus accumbens

Reinforcement occurs in this area of the brain

Front 14

During reinforcement

DA release w/in the reward center (nucleus accumbens & ventral tegmental area) is further enhanced by

Back 14

the release of natural morphine like NTs called neuropeptides (enkephalins, beta-endorphins

neuropeptides further enhance the reinforcing pleasure experienced by the individual

Front 15

________ further enhance the reinforcing pleasure experienced by the individual

Back 15

neuropeptides

natural morphine like NTs called neuropeptides (enkephalins, beta-endorphins)

Front 16

What happens to the DA system with repeated drug use?

Back 16

With repeated drug use, the DA system becomes increasingly sensitized

Eventually associated drug use stimuli (e.g. pictures of drug paraphernalia) can cause DA release, leading to reinforcement of use and often to increased drug use.

Front 17

With repeated drug use, the DA system becomes increasingly sensitized

Eventually associated drug use stimuli (e.g. pictures of drug paraphernalia) can cause DA release, leading to reinforcement of use and often to increased drug use.

Back 17

DA release, leading to reinforcement of use and often to increased drug use.

Front 18

Why does associated drug use stimuli (e.g. pictures of drug paraphernalia) cause cravings?

Back 18

With repeated drug use, the DA system becomes increasingly sensitized

Eventually associated drug use stimuli (e.g. pictures of drug paraphernalia) can cause DA release, leading to reinforcement of use and often to increased drug use.

Front 19

How long to do neuroadaptive changes last?

Back 19

Neuroadaptive changes may be more permanent in some individuals possibly lasting for yrs thus increasing their potential fro relapse

Front 20

Why after a long period of sobriety do individuals who return to sub abuse often pick up at the same level of tolerance & physical impact as experienced before sobriety

Back 20

Neuroadaptive changes (Brain based changes in structure and fxn can lead to tolerance & withdrawal) may be more permanent in some individuals possibly lasting for yrs thus increasing their potential fro relapse

Front 21

Neuroadaptive processes become very significant when the individual ___________

Back 21

stops substance use

Front 22

drug specific alterations in the normal level & fxn of ______ occur as the body adapts to the chronic presence of the substance of abuse

Back 22

Neurotransmitters

Card describes neuroadaption

Front 23

Possibility of relapse is increased by

Back 23

Neuroadaptive changes (Brain based changes in structure and fxn can lead to tolerance & withdrawal) may be more permanent in some individuals possibly lasting for yrs thus increasing their potential fro relapse

this concept helps to explain why after a long period of sobriety do individuals who return to sub abuse often pick up at the same level of tolerance & physical impact as experienced before sobriety

Front 24

Developed country with higest rates of substance abuse

Back 24

USA

Front 25

More than 50% of US clients with a _______ also are experiencing substance abuse or dependence

Back 25

psych disorder

Front 26

Individuals with schizophrenia are _____x more likely to have a substance dependence comorbidity than the general population

Back 26

Schizophrenics are 4x more likely to have substance dependence comorbidity than the gen. pop.

Front 27

Individuals with bipolar affective disorders are _____x more likely to have a substance dependence comorbidity than the general population

Back 27

5 times

Front 28

Most commonly abused illegal drug?

Back 28

Marijuana

Front 29

Most commonly abused drug?

Back 29

Alcohol

Front 30

Rates are ____ in men than women?

Back 30

Higher

90% of men have used EtOH
70% of women have used EtOH

Front 31

Rates of substance disorder highest in what ethnicity?

Back 31

African Americans

Hispanics

Native Americans

Front 32

Rates of sub disorder is lowest in what ethnicity?

Back 32

Asian americans

Front 33

Lifetime risk for alcohol dependence in the general US population?

Back 33

15%

Front 34

Risk factors of substance disorders?

Back 34

1. Family history of substance abuse
2. Association with peer structure with heavy abuse
3. Co-occuring psychiatric disorder
4. Existance of chronic pain

Front 35

Implications of alcohol and other drugs of abuse during pregnancy?

Back 35

1.Birth defects
2. FAS: fetal alcohol syndrome

Front 36

Acute alcohol intoxication in non-tolerant individuals such as teens can lead to:

Back 36

1. Coma
2. Respiratory depression
3. Death

Front 37

Cage screening test

Back 37

Most commonly used screening tool for EtOH abuse

C Have u ever felt u ought to CUT DOWN on your drinking?

A Have people ANNOYED u about ur drinking?

G Have you ever felt bad or GUILTY about your drinking?

E Have you ever has a drink 1st think in the morning to steady your nerves or get rid of a hangover EYE-OPENER?

Front 38

Cage screening test scoring

Back 38

administered by asking the pt 4 questions

each positive answer scored as 1 point; negative answers receive no score

The more positive answers the greater the probability of an EtOH abuse d/o

Pt scoring 0-2 are at mild to moderate risk for alcohol dependency

Pt scoring 3-4 are considered to be at high risk for EtOH dependency

Front 39

Cage screening test scoring

Pt scoring ____ are at mild to moderate risk for alcohol dependency
Pt scoring _____ are considered to be at high risk for EtOH dependency?

Back 39

0-2

3-4

Front 40

Categories of abused agents

Back 40

* EtOH
* Amphetamines or similar sympathomimetics
*caffeine
*cannabis
*cocaine
*hallucinogens
*inhallants
*nicotine
*opioids
*phencylidine (PCP) or similar arylcycloheylamines
*sedatives
*hypnotics
*anxiolytics

Front 41

Substance abuse definition?

Back 41

maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to repeated us of a substance

Is not synonymous with use, misuse, or hazardous use

Front 42

What is the specific criteria needed to identify substance abuse?

Back 42

1. Maladaptive pattern of use occurring for at least a 12 mo period of sustained abuse

2. Must be accompanied by repeated FAILURE TO FULFILL MAJOR ROLE obligation

3. Must be accompanied by use in situation that presents as physically hazardous sucs as drinking and driving

4. Abuse continues despite multiple problems r/t substance use patterns such as legal interpersonal or social

Front 43

____ & ______ use patterns not considered when determining presence of substance abuse

Back 43

Caffeine and nicotine

Front 44

What is early partial remission?

Back 44

One or more criteria (but not full criteria) have been met for substance dependence for at least 1 month but less than 12 months

Front 45

What is sustained partial remission?

Back 45

One or more criteria (but not full criteria) have been met for substance dependence for 12 months or longer

Front 46

What is early full remission?

Back 46

No criteria met for abuse or dependence for at least 1 month but less than 12 months

Front 47

What is sustained remission?

Back 47

No criteria met for abuse or dependence for 12 months or longer

Front 48

What is intoxication?

Back 48

reversible substance specific syndrome due to recent ingestion of a psychoactivating substance

Front 49

What is the diagnostic criteria for substance withdrawal?

Back 49

1. Cessation or reduction in alcohol use that has been heavy or prolonged
2. Two or more of the following symptoms within several hours or days of reduction of cessation:

Hand tremor, Insomnia, Autonomic hyperactivity, N/V, Hallucinations/Illusions, Psychomotor agitation, Anxiety, Seizures

Front 50

What are some gastrointestinal findings that are suggestive of alcohol dependency?

Back 50

1. Abdmonial tenderness
2. Splenomegaly
3. Hepatomegaly

Front 51

What are some dermatological findings that are suggestive of alcohol dependency?

Back 51

1. Diaphoresis
2. Alopecia (especially distal extremity)
3. Spider nevi, telangiectases

Front 52

What are some endocrine findings that are suggestive of alcohol dependency?

Back 52

1. Testicular atrophy
2. Gynecomastia
3. Sexual dysfunction

Front 53

What are some laboratory findings suggestive of alcohol dependence?

Back 53

1. AST elevated 40% or more
2. ALT 20% or more

Front 54

What is withdrawal?

Back 54

Potentially nonreversible substance-specific syndrome due to cessation or significant reduction in heavy prolonged use of a substance

Front 55

What is the clinical management of acute withdrawl?

Back 55

1. Detoxification agents
2. Mutliple daily doses of benzos used according to a fixed schedule and gradually tapered down over a series of several days

Front 56

What are some examples of benzos used for acute withdrawal?

Back 56

1. Lorazepam (Ativan)
2. Chlordiazepoxide (Librium)
3. Diazepam (Valium)
4. OXazepam (Serax)

Front 57

What are the main points of positive and negative reinforcements?

Back 57

1. Brain based changes in structure and function can lead to addictive behavior

2. Changes appear to occur with any drug of abuse

Front 58

The process of positive and negative rewards are physiologically linked to...?

Back 58

memory function

Front 59

Reinforcement results in...?

Back 59

"feel good" sensations when a drug of abuse is used and in "feel bad" sensations when the drug exits the body

Front 60

Positive rewards of reinforcement result in the social rewards commonly associated...?

Back 60

with drug use such as disinhibition, euphoric mood and anxiety reduction (mediated by DA pathways)

Front 61

What is substance dependence?

Back 61

pattern of repeated use that leads to clinically significant impairment or distress with 3 symptoms within a 12 month period

Front 62

What are the symptoms of which substance dependence is diagnosed?

Back 62

3 of the following:
1. Tolerance
2. Withdrawal
3. Using larger amounts than intended
4. Persistent craving
5. Large amount of time spent obtaining, using or recovering from effects
6. Activities decreased or given up because of use
7. Using despite consequences

Front 63

What does not need to be present to meet criteria for substance dependence?

Back 63

symptoms of tolerance or withdrawal

Front 64

What is used to determine likelihood of withdrawal and delirium tremors?

Back 64

Clinical Institute Withdrawal Assessment for Alcohol

-usually occurs within the first 24-72 hours after cessation of alcohol

Front 65

What is sometimes used to decrease the potential of seizures in substance withdrawal?

Back 65

antiseizure medications such as: Tegretol and Depakene

Front 66

What is the clinical management of craving?

Back 66

1. Use anticraving medication such as Revia, Cappral, Zofran, or Buprenex
2. Use behavior treatment to help client learn substitute behaviors

Front 67

What might be used to avoid alcohol in individuals with alcohol dependence?

Back 67

Aversion treatment

Front 68

What patient teaching is done with Disulfiram (Antabuse)?

Back 68

1. Do not administer until alcohol free for at least 12 hours
2. Advise clientto refrain from using anything that contains alcohol and up to 2 weeks after discontinuing Antabuse
3. Antabuse can elevate LFTs, so monitor
4. May potentially induce mania in individuals with Bipolar disorders

Front 69

How is citalopram useful in treating craving and maintaining drugs sobriety?

Back 69

*Celexa*
1. SSRI
2. Augment central serotonergic function
3. Decreases desire and "liking"

Front 70

How is Disulfiram useful in treating craving and maintaining drugs sobriety?

Back 70

*Antabuse*
1. Aldehyde dehydrogenase inhibitor
2. Adversive therapy; inhibits enzyme aldehyde dehydrogenase
3. Causes headache, nausea, vomiting, flushing if alcohol ingested

Front 71

How is Naloxone useful in treating craving and maintaining drugs sobriety?

Back 71

*Naloxone*
1. Opioid antagonist, antidote
2. Blocks effects of opioids

Front 72

How is buprenorphine useful in treating craving and maintaining drugs sobriety?

Back 72

*Buprenex*
1. Binds to opiate receptors in the CNS, causing an analgesic effect
2. Has agonist and antagoinist activity
3. Decreases heroin craving and use of opiates

Front 73

How is methadone useful in treating craving and maintaining drugs sobriety?

Back 73

*Dolophine*
1. Narcotic analgesic
2. Binds to opiate receptors in the CNS, producing an analgesic effect, thus decreasingt withdrawal symptoms
3. Suppresses withdrawal symptoms from opiates
4. Used as detox and maintenance treatment of narcotic addiction
5. Must be part of FDA approved program

Front 74

How would you reduce central nervous system stimulation during inpatient treatment for acute withdrawal?

Back 74

1. Maintain quiet environment
2. Put client in room close to nurses' station to facilitate frequent observation
3. Minimize abrupt changes in environment
4. Decrease bright light and sharp, sudden noises
5. Decrease room clutter
6. Do not restrain

Front 75

Life Span considerations with Children/Adolescents and substance use?

Back 75

1. Most common period to start drug use
2. Significant impact of peer pressure
3. 30-40% report drinking frequently
4. 15% report binge-drinking patterns
5. %0% of high school-age students report at least a one-time use of illicit drugs

Front 76

What is the diagnosis criteria for substance withdrawal?

Back 76

1. Cessation or reduction in alcohol use that has been heavy or prolonged

2. 2 or more ofthe following symptoms within several hours or days of reduction or cessation: Hand tremor, Insomnia,Autonomic hyperactivity, N/V, Hallucinations/Illusions, Anxiety, Seizures

Front 77

What is the Clinical Institute Withdrawal Assessment for Alcohol?

Back 77

1. Used to determine likelihood of withdrawal and delirium tremens (DTs) which usually occur within the first 24-72 hours after cessation of alcohol
2. Assesses 10 common symptoms of withdrawal
3. Each symptom is gaded on 0-7 scale with the exception of orientation (0-4)
4. The higher the score, the more likely the individual will experience severe withdrawal

Front 78

What are the scoring outcomes for Institute Withdrawal Assessment for Alcholo?

Back 78

*Maximum is 67*

0-8 = mild withdrawal
9-15 = moderate withdrawal
> 15 = severe withdrawal with possible DTs

Front 79

The concept of substance abuse implies that the individual is...?

Back 79

Having functional problems related to frequent or excessive substance use

Front 80

To diagnose a person with substance abuse you must determine the current or past presence of what during the assessment?

Back 80

Tolerance and withdrawal signs and symptoms

Front 81

Many abused substances have questionable withdrawal symptoms. Whether or not a person dependent on a particular substance will have withdrawal symptoms depends on.....

Back 81

the nature of the substance

Front 82

Medial detoxification from a substance is required only when the substance is known to produce...

Back 82

Physical withdrawal symptoms