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30 Cards in this Set

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  • Back
What can the pathological use of substances represent?
Model of dysregulated drive disorders => out of control and self destructive behaviors
What is the most common psychiatric diagnosis associated with SUD? axis II disorder?
Bipolar I disorder

Antisocial personality disorder
List some general presenting complaints to SUD.
Chronic or recurrent pain of uncertain etiology
Frequent trauma, accidents, injuries
Suicide attempts
Insomnia
Anxiety, depression, mood swings
Sexual problems
What are signs that might alert to SUD?
Carelessness in appearance, dress, personal hygiene
Long sleeves
Dramatic weight gain
Sunglasses
Heavy use of cologne
What social history might point to SUD?
Frequent relationship status changes
Child or spouse abuse
Frequent job changes/moving
Legal problems
What are associated general medical conditions with SUD?
Labile HTN
Various GI symptoms
Enlarged, tender liver
COPD
Hep B or C
HIV infection
What number of drinks is concerning in men and women?
Men: >14/week or 4/occasion
Women: >7/week or 3/occasion
What are the 3 direction actions of abused substances?
Overdose
Organ toxicity
Metabolic consequences
Give the 5 levels of the drug use pyramid.
Abstinence
Non-problem use
At-risk use
Abuse
Dependence

Any use of an illicit drug is considered problematic use, by definition.
What are the symptom clusters (3) in the diagnostic criteria for SUDs?
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
What are the 4 criteria for SUD that represent maladaptive use within a 12 month period?
Failure to fulfill major role obligations
Recurrent use in physically hazardous situations
Legal probs
Continued use despite persistent or recurrent social or interpersonal problems
Define 'differential expression.'
Whether an individual develops addiction upon exposure to the agent
What are the 3 categories of risk factors that make an individual vulnerable?
Biological
Psychological (trauma, parental loss, psychopathology)
Social
What is the dependence syndrome?
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.
Define intoxication.
Subjective effects perceived by the individual upon self-administration as well as concomitant changes in the user's behavior observed by others
CNS depressants: MOA?
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
What is the legal BAC in TN?
0.08
What depressants are less likely to have respiratory and depression and death during overdose and why?
Benzodiazepines
Specifically activate GABAa channels
Other drugs cause more widespread hyperpolarization of neuronal membranes beyond effects of GABA.
Flumenazil: effect?
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.
Psychostimulants: MOA
Block and reverse the direction of reuptake transpoters of monoamines.
Channels blocked by cocaine? amphetamine?
Cocaine: DAT (most potent)
Amphetamine: all 3, most effective at norepinephrine
What are the overdose effects of stimulants?
Increased HR and BP
Cocaine - vasospasm leading to stroke, MI, aortic dissection; arrhythmias, seizures
Hyperpyrexia, excessive muscle contractions
What is the treatment for stimulant overdose?
Charcoal
Sedation with benzodiazepines
What treatment is contraindicated in stimulant overdose and why?
Beta-adrenergic antagonist therapy due to unopposed stimulation of alpha-adrenergic receptors
What is the effect of binding opioid receptors?
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.
Describe the central effects of opioids.
Biphasic
Behavioral activation at low doses
Sedation at higher doses
What are the 2 pathways through which opioids interact with the brain reward system?
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.
Treatment of opioid overdose
Airway manage
Naloxone (pure antagonist at all opioid receptors)
Activated charcoal via GI tube
Naloxone: adverse effects?
Precipitation of opioid withdrawal syndrome
Nicotine: MOA
Activates nicotinic acetylcholine receptors. Cholinergic neurons arising from the laterodorsal tegmental area activate nicotinic and muscarinic receptors on dopaminergic neurons in the VTA.