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20 Cards in this Set
- Front
- Back
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What are the TWO KEY DETERMINANTS TO A SUBSTANCE EPIDEMIC?
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Decreased perceived risk AND availability/supply.
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What is the addiction cycle?
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DRUG USE --> EUPHORIA (POSITIVE REINFORCEMENT) --> NEUROADAPTATIONS from chronic use --> CRAVING (NEGATIVE REINFORCEMENT) --> Drug use.
Drug use/euphoria and salience ALL INCREASE DOPAMINE RELEASE AND D2 BINDING AND INCREASED GLUTAMATE. Base-line craving both DECREASE DA AND GLUTAMATE. Drug-induced craving (withdrawal) involves DECREASE IN GLUTAMATE. CUE-INDUCED CRAVING INCREASES DA/GLU |
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What is the DA system?
MESOCORTICOLIMBIC! |
Starts in the VTA of thalamus. Connects to the hippocampus (memories attached to brain reward), nucleus accumens, prefrontal cortex.
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What are TOXIC EFFECTS OF COCAINE USE?
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Think stimulant side effects. Hypertension, cardiac arrythmias, seizures, MI/strokes/vasospasm leading to ischemia/necrosis
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What are other problems with cocaine use?
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Heart issues(MI/CVA/angina/arrythmia/vasospasm/cardiomyopathy,myocarditis).
Pregnancy issues - interferes with pregnancy. Hyperpyrexia. Renal failure. Perforated nasal septum. |
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If you a young person comes in with REAL (not perceived) cardiac problems with no risk factors, think?
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STIMULANTS (PRIMARILY COCAINE)
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What is bad about cocaine and alcohol mixing?
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Cocaethylene is a metabolic by-product. can be cardiotoxic and psychoactive. reduced anxiety.
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What is a speedball?
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Heroin/cocaine together. Increases DA in Nuc.Acc. by 1000%. Decreases negative symptoms of cocaine.
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Compare amphetamines and cocaine.
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Amphetamines can have longer half-lives, more euphoria. MORE NEUROTOXICITY THAN COCAINE.
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Mechanism of action of cocaine (and methylphenidate - ritalin)
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DOPAMINE REUPTAKE INHIBITOR by BINDING TO DAT (DA TRANSPORTER)
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What neurotransmitters does the VTA release? where to?
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Among others (?), VTA releases DA and GLU to Nuc.Acc.
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Mechanism of action of amphetamine?
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DA DUMP!
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What is a commonality between drugs of abuse and DA levels in Nuc.Acc?
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Drugs of abuse INCREASE DOPAMINE LEVELS IN NUC.ACC.
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What are the two major areas of the limbic system activated by cue-induced cravings?
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Anterior Cingulate Gyrus, Amygdala.
Test these regions for activity when testing anti-craving medications. |
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What peptides are released in response to stress?
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INCREASED CRF AND NOREPI.
Would NOREPI/CRF antagonists be effective in reducing stress-induced cravings? Stress in cocaine treated animals only releases DA. Stress normally releases DA via GLU that is mediated by CRF increase. |
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What are the neuroadaptations to cocaine use?
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Depletion of DA and GLU. Hedonic dysregulation.
GABA/dynorphin UPREGULATION. |
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What are cocaine withdrawal symptoms? life-threatening?
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Opposite of stimulant effects. Depression, bradycardia, hyperphagia, motor problems.
NOT LIFE THREATENING. Severity of withdrawal symptoms indicate worsening of prognosis. |
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What is significance of hypofrontality in addiction?
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PFC is hypometabolic at baseline in dependent patients. Becomes hypermetabolic during cue-induced craving. PFC involved in conflict registration, behavioral inhibition, motivation, executive function.
DENIAL?? PFC DYSFUNCTION! |
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What area of the brain is involved with denial?
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PFC! DENIAL IS HALLMARK!
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What are best therapies? Are vouchers effective?
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Best therapy looks like Individual counseling. CBT and other psychotherapies can be effective.
Vouchers are effective long-term, but patients return to using once reward is no longer offered. NO MEDICATIONS PROVEN |
