Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
39 Cards in this Set
- Front
- Back
|
Substance Abuse
defined |
(LOSS OF CONTROL)
Maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by Failure to fulfill obligations at work, home, school Use in situations in which it is physically hazardous Recurring substance-related legal problems Continued substance use despite persistent recurrent social or interpersonal problems caused or exacerbated by the substance |
|
|
Addiction
defined |
(MANIFESTATION of subs abuse)
Maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by Tolerance *****Withdrawal Use in greater amounts or over a longer period than intended Desire to continue use or inability to quit Significant effort to procure substance Important social, recreational or occupational activities are impacted Continued use despite knowledge of physical or psychological problems induced or exacerbated by the substance |
|
|
Factors of Substance Abuse
3 |
-Substance (Reinforcing qualities (pleasure, euphoria),cost access..)
-Individual (genetics, personality...) -Environment (peers,roles,econ, society views...) |
|
|
Tolerance
defined |
Reduction in the response to a drug following repeated administration
Biochemical or pharmacokinetic Behavioral Functional--driving Conditional--police |
|
|
Tolerance
acute cross reverse |
-Acute Tolerance (tachyphylaxis ish)
Rapid tolerance with repeated use in a single session “Binge” Reduced response to subsequent doses during the binge (Stimulants, Ethanol) --Cross Tolerance Tolerance to a drug will be conferred onto other drugs of that same class (same mechanism of action) --Reverse Tolerance (Sensitization) Increased response to subsequent doses (cocaine/amphetamine)(makes them very ADDIctive) |
|
|
Physical Dependence
defined |
An alteration of the physiological state of the subject which has been produced by ******repeated administration of the drug.
*****Continued administration (CONSTANT AND ADEQUATE DOSE)of the drug is needed in order to maintain normal function Discontinuation of administration results in an abstinence (withdrawal) syndrome (doesn't require complete absence of drug...just below needs) |
|
|
Physical Dependence
Rate of development is a function of: cross dependence Psychological dependence |
Rate of development is a function of:
Sufficient amount of drug at the site of action Sufficient period of exposure Sufficient consistency of drug exposure Cross-dependence Ability of a second drug of the same class (similar mechanism of action) to maintain the dependence of an original drug (methadone program) Psychological dependence Subjective need or compulsion to use the drug in order to maintain a feeling of well being. May be present even in the absence of physical dependence (can be distracted) |
|
|
Abstinence Syndrome
defined |
A group of physiologically abnormal signs and symptoms which occur upon cessation of drug administration to a physically dependent subject.
**Characteristic for the drug class Symptoms tend to be opposite of the typical effects of the drug******(like clonidine rebound HTN)----direct acting don't fade as well = much worse Rate of development is a function of: Half-life of the drug at site of action Receptor blockade (antagonist) |
|
|
Drugs of Abuse: Stimulants
eg tolerance |
Examples
Cocaine, Amphetamine ,Methamphetamine MDMA Tolerance Rapid |
|
|
Drugs of Abuse: Stimulants
effects acute chronic |
Acute intoxication
Euphoria Increased alertness Increased motor activity Chronic use outcome Depression Toxic psychosis Sexual dysfunction Cerebrovascular/cardiovascular accidents |
|
|
Drugs of Abuse: Stimulants
patterns of abuse |
--Rush
Intense pleasure as drug is administered --Run (duration of rush) Periods of intense drug use, also called Binge --Crash The end of a run, characterized by prolonged sleep, depression, hunger and weakness. (is it a true withdrawal ?)--crack, meth yes bigtime physical |
|
|
Drugs of Abuse: Stimulants
Abstinence syndrome Tx strategy |
Drug craving
Dysphoria Sleepiness Fatigue Bradycardia Treatment strategies Behavioral strategies Withdrawal |
|
|
Drugs of Abuse: Opioids
e.g. tolerance |
Examples
Morphine, Heroin, Methadone, Hydrocodone Tolerance Tolerance rate varies but is relatively fast Little tolerance to gastrointestinal and miosis effects Cross-tolerance within class There is always a lethal dose*** |
|
|
Drugs of Abuse: Opioids
acute intox chronic outcomes |
Acute intoxication
Euphoria Relaxation and sedation Anxiolytic Rush Pleasant warm feeling likened to orgasm Nod Dream-like state associated with feeling of euphoria and serenity Analgesia Chronic use outcome Increased risk of infections, including HIV, among intravenous users Decreased life expectancy (narcotism---problem related to dilution |
|
|
Drugs of Abuse: Opioids
abstinence syndrome Treatment strategies |
Opioid craving
Restlessness, Hypergesia, Tachycardia Cramps, naus/vomit/diarrhea Muscle aches, Dysphoria,Fever -Treatment strategies Abstinence syndrome is rarely life-threatening Behavioral therapy Maintenance therapy using methadone Opioid antagonists as antagonist therapy Successful only in motivated addicts |
|
|
Drugs of Abuse: Tobacco
tolerance |
Tolerance
Rapidly develops to some effects (nausea) Slowly develops to other effects (stimulation) |
|
|
Drugs of Abuse: Tobacco
Acute intoxication Chronic use outcomes |
Acute intoxication
Stimulation Increased alertness Anxiolytic Chronic use outcomes Cancer Cardiovascular and respiratory diseases |
|
|
Drugs of Abuse: Tobacco
Abstinence syndrome Treatment strategies |
Abstinence syndrome
Drug craving, Anxiety, Restlessness Bradycardia, Weight gain May persist for months Treatment strategies Behavioral therapy Nicotine replacement therapy Bupropion (Zyban) Varenicline (Chantix), Nicotine mixed agonist (these are effective but treatement may last a long time) |
|
|
Drugs of Abuse: Alcohol
drinker styles tolerence |
Examples
Ethanol Light drinker has one drink or less each day Moderate drinker has about three drinks per day Heavy drinker has five or more drinks each day or binge drinks at least once each week Tolerance Develops slowly |
|
|
Drugs of Abuse: alcohol
p-kinetics |
Pharmacokinetics
Complete absorption by oral route (stomach) Body water distribution Readily crosses blood-brain and blood-placental barriers Biotransformation in liver Alcohol to aldehyde Ethanol to acetaldehyde Methanol to formaldehyde ***Alcohol dehydrogenase** Zero order (SAY one drink /hr constant) Primary route Not inducible --Cytochrome P450 First order kinetics Minor route ***Induced by ethanol and other drugs (but still a minor player) Point of interaction Aldehyde to acid Acetaldehyde to acetic acid Formaldehyde(TOXIC) to formic acid--Aldehyde dehydrogenase Point of “disulfiram-like” inhibition Aldehyde buildup is toxic -Aldehyde oxidase |
|
|
Drugs of Abuse: Alcohol
moA |
Mechanism of action
Disrupts membrane fluidity Ligand-gated channel interactions GABA activation NMDA glutamate receptor inactivation (just like four stages of anesthesia) |
|
|
Drugs of Abuse: Alcohol
Acute intoxication |
--Acute intoxication
Stimulant at low doses Depressant at high doses Ataxia, slurred speech, decreased motor skills Hypothermia Excessive intoxication can be life-threatening Disturbed sleep Hangover Headache, tremor, nausea, sweating |
|
|
Drugs of Abuse: Alcohol
Intoxication and blood levels |
0.03% (about 2 drinks)
Euphoria 0.05% Central depression Decreased motor coordination Ataxia and cognitive defects 0.08% - legal intoxication 0.25%-Confusion, unstable consciousness, hypotension, bradycardia, slowed respiratory rate, acidosis, coma 0.4%-Death |
|
|
Drugs of Abuse: Alcohol
Chronic use outcome |
Chronic use outcome
Liver disease Shorter life expectancy Fetal alcohol syndrome Microcephaly Pre- and post-natal growth deficiency Short palpebral fissures Alcoholism Direct organ cytotoxicity Malnutrition and vitamin deficiency Gastrointestinal inflammation Wernicke’s encephalopathy and Korsakoff's psychosis |
|
|
Drugs of Abuse: Alcohol
Withdrawal |
Withdrawal
Severity directly related to length and severity of consumption period Complete cessation not necessary for withdrawal to begin Often triggered by unrelated events Early---Anxiety, drug seeking behavior, tremor, anorexia, unease Later----Hypotension, tachycardia, fever, vomiting, muscle cramps, convulsions Peak--Delirium (point of no return), hallucinations, agitation, cardiovascular collapse (DT is a point of no return) |
|
|
Drugs of Abuse: Alcohol
Treatment strategies |
Treatment strategies
Behavioral therapy Detoxification and management of withdrawal Benzodiazepines should be used to transfer dependence and slowly titrate patient off benzodiazepines Aversion therapy with disulfiram Anti-craving drugs Naltrexone (methanol poisoning is treated with ethanol--to compete for Aldehyde dehydrogenase....to stop meth to formaldehyde.....) |
|
|
Drugs of Abuse: Benzodiazepines and Barbiturates
e.g. tolerance |
( all cns depress also anticonvulsants---still same issues risks --not quick discontinue)
Examples Diazepam Chlordiazepoxide Pentobarbital ----Tolerance Develops slowly (quick sedation) Tolerance is incomplete Tolerance to respiratory depression is slow to develop and has a ceiling |
|
|
Drugs of Abuse: Benzodiazepines and Barbiturates
acute intox chronic outcomes |
Acute intoxication
Similar to alcohol for barbiturates Intoxication by benzodiazepines is relatively mild (hard to get to medullary depression) Greatly exaggerated by other depressants Chronic use outcomes Higher incidence of death by drug overdose or drug interactions Higher incidence of suicide***** quick to underestimate dependance OD often by automatism----forget took take again ( |
|
|
Drugs of Abuse: Benzodiazepines and Barbiturates
Abstinence syndrome Treatment strategies |
Abstinence syndrome
Drug craving Similar to alcohol Potentially life-threatening for patients to experience withdrawal Treatment strategies Behavioral therapy Gradual discontinuation of drug (THESE DRUGS have long t1/2s)----still withdrawal but less severe Withdrawal may be life-threatening. |
|
|
Drugs of Abuse: Inhalants
eg tolerence |
Examples
Gasoline Paint thinner Solvents Tolerance Uncertain |
|
|
Drugs of Abuse: Inhalants
Acute intoxication Chronic use outcomes withdrawal/Tx |
Acute intoxication
Intoxication Impairment of judgment and sense of reality Hallucinations Chronic use outcomes Cardiac arrhythmias..sensitize to catecholamines) Liver and kidney damage Cancer Gateway use to other drugs of abuse Abstinence syndrome Uncertain, possibly alcohol-like syndrome (but not continuous enough) Drug craving Treatment strategies Behavioral therapy |
|
|
Drugs of Abuse: Hallucinogens
eg tolerance |
Examples
LSD Psilocybin Mescaline Phencyclidine (PCP)(ketamine is analog) MDMA (ecstasy) Tolerance Develops rapidly to hallucinogenic actions High degree of cross-tolerance |
|
|
Drugs of Abuse: Hallucinogens
moA actions |
Hallucinogens
Drug produces a change in sensory perception Generally also change mood and thought patterns Mechanism of action Activation of serotonin-2 (5-HT2) receptors either directly or indirectly |
|
|
Drugs of Abuse: Hallucinogens
Acute intoxication Chronic use outcome abstinence syndrome |
Acute intoxication
Distortion of perception, mood and thought Depersonalization Mild stimulant action Feelings of closeness to others (especially the MDMA class of hallucinogens) Severe depression (phencyclidine) ---Chronic use outcome Neurotoxicity Flashbacks Toxic-psychosis Death (phencyclidine over dosage) Abstinence syndrome None Drug craving is noted in some individuals |
|
|
Drugs of Abuse: Hallucinogens
Tx |
Treatment strategies
Behavioral therapy During use Limit sensory stimulation Place the patient in a safe environment Treat symptoms as they appear |
|
|
Drugs of Abuse: Marijuana
Tolerance Acute intoxication |
Tolerance
Evident in heavy users Unlikely in occasional users Acute intoxication Euphoria Drowsiness and sedation Distortion of time and sensory inputs Hallucinations are rare Cognitive impairment |
|
|
Drugs of Abuse: Marijuana
chronic abstinence Tx |
Chronic use outcome
Amotivational syndrome Partially related to psychosocial problems Worsening of existing mental disorders Bronchitis Abstinence syndrome Restlessness Irritability Agitation Sleep disturbances Drug craving Tx-none |
|
|
Drugs of Abuse: Steroids
eg tolerance |
Examples
Testosterone Nandrolone Tolerance None reported |
|
|
Drugs of Abuse: Steroids
acute intox abuse pattern |
Acute intoxication
No syndrome reported Abuse pattern Cycling is repeating pattern of abuse for a period of time Stacking is using multiple steroids at one time to enhance effect --Chronic use outcomes Liver damage Disturbed growth patterns Altered sex drive Psychological problems Aggression Treatment strategies None |
