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101 Cards in this Set
- Front
- Back
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neurotransmitter that regulates impulse control
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serotonin (5-HT)
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how long does use need to occur to be diagnosed by DSM as abuse
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1 month
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polysubstance dependency
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at least 6 months using at least 3 categories of psychoactive substances (excluding nicotine)
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what is the mechanism of ETOH?
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enhances the activity of the GABA receptor and inhibits the excitatory NMDA (N-methyl-D-aspartate)
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___ metabolizes ETOH into ____
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alcohol dehydrogenase metabolizes ETOH into acetaldehyde
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___ metabolizes acetaldehyde into ____ and ____
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aldehyde dehydrogenase metabolizes acetaldehyde into Acetyl CoA and acetate
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acetyl coA is metabolized into
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fatty acids
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acetate is metabolized into
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CO2 and H2O
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legal intoxication is __ mg/dL
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80 mg/dL (2-3 drinks)
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ETOH withdrawal is exhibited by
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rebound in sympathetic findings resulting within the ANS and manifesting peripherally
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syndrome seen in ETOH withdrawal
what should you administer? |
Wernicke-Korsakoff
give thiamine before administering glucose |
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people with heavy alcohol history must be hit hard and fast (detox) to avoid
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DT's and withdrawal seizures
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underlying causes of DT's
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sepsis, pancreatitis, pneumonia, subdural hematoma
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what drug is given for mild, moderate, and severe ETOH detox?
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Ativan
Atenolol is also used; both have limited liver metabolism |
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which ETOH treatment drug makes patient's sick (chest pain, tachycardia, hyperventilation, facial flushing, N/V)?
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Antabuse (disulfiram) - results in a build-up of acetaldehyde
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ETOH drug that reduces cravings
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Naltrexone (trexan)
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ETOH drug that restores the balance b/w glutamate and GABA
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Campral (acamprosate calcium)
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ETOH drug most successful at achieving abstinence
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Campral
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leading cause of mental retardation
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fetal ETOH syndrome
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opioids are derived from
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Papaver somniferum (poppy plant)
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which opioid receptor mediates analgesia, euphoria, and reinforcement of use
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Mu
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opioid receptor that mediates sedation, sleep, mood, and diuresis
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kappa
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opioid receptor that mediates dysphoria and hallucinations
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sigma
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opioid receptor that mediates cardiovascular and some analgesia
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delta
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major opioid receptors are
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inhibitory G protein-coupled receptors
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involved in neural transmission and reduce pain
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endorphins
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pt. is drowsy, yawning, has pinpoint pupils, appears out of it, inactive, and scratching
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opioid intoxication
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signs of opioid withdrawal
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diaphoresis, piloerection, dilated pupils, and sweaty palms
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FDA approved drugs for treatment of opioid addiction
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subutex (buprenorphine)
suboxone (buprenorphine/naloxone) |
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why is naloxone added to buprenorphine
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to further prevent diversion, euphoria, and abuse of the narcotic buprenorphine
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what is DATA 2000
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Drug Addiction Treatment Act of 2000 (opioid addiction)
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in order to dispense or prescribe opioids, physicians must get a
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special DEA number
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what must be done before a pt. can be switched from methadone to suboxone (buprenorphine/naloxone)
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pt. dose of methadone must be reduced to 30 mg/day to prevent rapid withdrawal
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only conditions when you can give narcotics to a narcotic addict
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pt. has a very serious pain problem
pt. is in an acute care hospital and the narcotics will prevent complications with acute withdrawal |
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drug is a lifelong addiction. changes brain chemistry to the extent that it is predictable that addicts will relapse on and off their entire lives
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heroin
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best maintenance treatment for long-term heroin addiction
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methadone
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drug used for detox and maintenance of heroin
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buprenorphine
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"protracted abstinence syndrome"
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heroin
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narcotic/heroin addicts often die from
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overdose
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drug used for long-term treatment of heroin
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Naltrexone (trexan)
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why not give buprenorphine and trexan in the office?
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b/c you must be set up to do it!
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what is the most common reason for relapse on crack?
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drinking a beer
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what should you avoid giving after detox to patients with an alcohol history?
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avoid giving benzodiazepines
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# 1 prescription drug of abuse, overdose, and death
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methadone
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detox xanax with
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xanax
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which muscle relaxer should be avoided and why
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soma b/c its metabolite turns into a meprobamate type compound which is very addicting
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indirect catecholamine agonists that achieve their effect by releasing newly synthesized NE and dopamine
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amphetamines
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stimulate the cerebral cortex, brainstem, and reticular activating system (RAS)
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amphetamines
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stimulation of RAS causes
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increased alertness
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adverse affects of amphetamines
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diminishes sexual performance and has a major anorexic affect
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amphetamines stimulate the "reward center" of the brain, particularly in the
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nucleus accumbens within the basal ganglia
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poor dental hygiene
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meth mouth
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hallucinations, psychosis, paranoid ideation, delirium, delusions of persecution, increased irritability, and dysphoria are psychiatric manifestations of
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stimulants including cocaine
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perforated nasal septums are caused by
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snorting methamphetamine and cocaine
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ulcers covering the legs are seen in
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long-term meth use
could also be staph infection |
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speedball
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mixture of heroin and cocaine that is injected
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crank
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methamphetamine
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ice
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smokeable methamphetamine
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causes protracted highs followed by exhaustion, depression, and severe mood swings
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methamphetamine
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stay up for many days at a time. they lose a lot of weight very quickly, look terrible and have poor hygiene, bad breath, bad teeth, & get extremely paranoid
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meth-freaks
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tend to be more violent
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meth addicts
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MOA of cocaine
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blockade of dopamine reuptake,
enhanced release of NE glutamate depletion in the nucleus accumbens use is subsequently associated with serotonin and dopamine depletion |
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pure cocaine is considered to be its
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alkaloid base
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most addictive drug
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crack
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how does cocaine affect sexual behavior and libido
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increases
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cravings are extreme and come in cycles
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cocaine
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triggers are a major problem with relapse
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cocaine
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PET scans measure
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the activity of the brain by measuring the amount of glucose used
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hallucinogen found in mushrooms
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psilocybin
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hallucinogen found in peyote cactus
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mescaline
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MDMA is the hallucinogen known as
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ecstasy
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causes sympathomimetic effects including profound mydriasis, tremors, tachycardia, HTN, sweating, blurred vision, and tremors
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LSD
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causes distortions in body image and a sense of depersonalization
extreme anxiety, panic, confusion, and paranoid rxns. |
hallucinogens
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LSD exerts its effect on which neurotransmitter
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serotonin (5-HT)
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serotonin is derived from
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tryptophan
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synesthesia is especially common with
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LSD
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introspective reflections of self, symbolic forms, religion, ideology, and philosophy are very common with
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LSD
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do physical dependencies or withdrawal to hallucinogens occur?
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no!
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animal tranquilizer
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PCP (phencyclidine)
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street name for PCP
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angel dust
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How is PCP most often used
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sprinkled on parsley or marijuana and smoked
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causes cholinergic effects: sweating, flushing, drooling, and pupillary constriction
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PCP
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"out of it"
distortions of time and space delusions very disorganized thoughts violent horizontal & vertical nystagmus and ataxia |
PCP
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does tolerance occur with PCP
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yes
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causes a significant increase and then depletion of serotonin, dopamine, and NE
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MDMA - Ecstasy
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date rape drug
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GHB (gamma-hydroxybutyrate) or Rohypnol
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found in airplane glue, paint remover, paint thinners, paint sprays
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toluene
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found in fuel, lighters, hair sprays, and deodorants
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butane
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most commonly used illegal psychoactive substance
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THC (tetrahydrocannabinol)
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MOA of THC
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affects GABA and increases serotonin
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responsible for the most deaths relative to substance abuse
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nicotine
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prevalence of psychiatric disorders is higher among
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opioid abusers
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most common disorders of psychiatric comorbidity
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depression
anxiety disorders personality disorders |
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most common co-morbid anxiety disorders
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phobias
generalized anxiety disorder PTSD |
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most common co-morbid personality disorder
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antisocial
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what is an independent disorder
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disorder which presents during times of abstinence; symptoms not related to use of psychoactive substance
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triad of PTSD
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vigilance (startle, anxiety)
re-experiencing avoidance |
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what must you ask about to assess dangerousness
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must ask about:
thoughts intents plans |
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which drug should you avoid when treating anxiety?
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benzodiazepines b/c they're addictive and may interact with buprenorphine
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withdrawal of this drug never results in psychosis
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opioid
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psychiatric co-morbidity is common in
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opioid dependence
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