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30 Cards in this Set
- Front
- Back
What can the pathological use of substances represent?
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Model of dysregulated drive disorders => out of control and self destructive behaviors
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What is the most common psychiatric diagnosis associated with SUD? axis II disorder?
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Bipolar I disorder
Antisocial personality disorder |
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List some general presenting complaints to SUD.
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Chronic or recurrent pain of uncertain etiology
Frequent trauma, accidents, injuries Suicide attempts Insomnia Anxiety, depression, mood swings Sexual problems |
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What are signs that might alert to SUD?
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Carelessness in appearance, dress, personal hygiene
Long sleeves Dramatic weight gain Sunglasses Heavy use of cologne |
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What social history might point to SUD?
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Frequent relationship status changes
Child or spouse abuse Frequent job changes/moving Legal problems |
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What are associated general medical conditions with SUD?
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Labile HTN
Various GI symptoms Enlarged, tender liver COPD Hep B or C HIV infection |
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What number of drinks is concerning in men and women?
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Men: >14/week or 4/occasion
Women: >7/week or 3/occasion |
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What are the 3 direction actions of abused substances?
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Overdose
Organ toxicity Metabolic consequences |
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Give the 5 levels of the drug use pyramid.
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Abstinence
Non-problem use At-risk use Abuse Dependence Any use of an illicit drug is considered problematic use, by definition. |
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What are the symptom clusters (3) in the diagnostic criteria for SUDs?
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Loss of control - taken in larger amount or over a longer period than intended. Attempts to cut down or control.
Salience to the behavioral repertoire - great deal of time spent in activities to obtain, use, or recover from the substance. Neuroadaptation - tolerance or withdrawal, or substance is taken to relieve or avoid withdrawal symptoms |
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What are the 4 criteria for SUD that represent maladaptive use within a 12 month period?
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Failure to fulfill major role obligations
Recurrent use in physically hazardous situations Legal probs Continued use despite persistent or recurrent social or interpersonal problems |
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Define 'differential expression.'
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Whether an individual develops addiction upon exposure to the agent
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What are the 3 categories of risk factors that make an individual vulnerable?
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Biological
Psychological (trauma, parental loss, psychopathology) Social |
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What is the dependence syndrome?
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As a vulnerable individual uses a given drug, significant CNS changes occur, including drug-seeking and neuroadaption, that augment both dose and frequency of subsequent drug use.
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Define intoxication.
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Subjective effects perceived by the individual upon self-administration as well as concomitant changes in the user's behavior observed by others
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CNS depressants: MOA?
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Increase neuronal inhibition by enhancing GABA-a receptor function. Increase chloride ion flux through receptor on binding GABA.
Inhibit excitatory neurotransmission via the NMDA receptor, inhibiting calcium flux into the cell |
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What is the legal BAC in TN?
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0.08
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What depressants are less likely to have respiratory and depression and death during overdose and why?
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Benzodiazepines
Specifically activate GABAa channels Other drugs cause more widespread hyperpolarization of neuronal membranes beyond effects of GABA. |
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Flumenazil: effect?
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Benzodiazepine antagonist that binds with high affinity to specific sites on the GABA a receptor and competitively antagonizes the binding and allosteric effects of benzodiazepines.
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Psychostimulants: MOA
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Block and reverse the direction of reuptake transpoters of monoamines.
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Channels blocked by cocaine? amphetamine?
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Cocaine: DAT (most potent)
Amphetamine: all 3, most effective at norepinephrine |
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What are the overdose effects of stimulants?
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Increased HR and BP
Cocaine - vasospasm leading to stroke, MI, aortic dissection; arrhythmias, seizures Hyperpyrexia, excessive muscle contractions |
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What is the treatment for stimulant overdose?
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Charcoal
Sedation with benzodiazepines |
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What treatment is contraindicated in stimulant overdose and why?
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Beta-adrenergic antagonist therapy due to unopposed stimulation of alpha-adrenergic receptors
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What is the effect of binding opioid receptors?
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Receptors are coupled via inhibition of G proteins to inhibition of adenyl cyclase activity, activation of receptor-linked K currents, and suppression of voltage-gated Ca channels, which results in blockade of neurotransmitter release and pain transmission.
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Describe the central effects of opioids.
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Biphasic
Behavioral activation at low doses Sedation at higher doses |
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What are the 2 pathways through which opioids interact with the brain reward system?
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VTA, where GABAergic interneurons tonically inhibit dopaminergic neurons responsible for activating the NAc (opioids inhibit the GABAergic neurons)
Opioids inhibit GABAergic neurons that project back to the VTA from the NAc, as part of an inhibitory feedback loop. |
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Treatment of opioid overdose
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Airway manage
Naloxone (pure antagonist at all opioid receptors) Activated charcoal via GI tube |
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Naloxone: adverse effects?
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Precipitation of opioid withdrawal syndrome
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Nicotine: MOA
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Activates nicotinic acetylcholine receptors. Cholinergic neurons arising from the laterodorsal tegmental area activate nicotinic and muscarinic receptors on dopaminergic neurons in the VTA.
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