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85 Cards in this Set
- Front
- Back
basic addiction pathway
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dopamine pathway
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addiction dopamine pathway follows what path?
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VTA -> MFB -> NAC
(his slides say something different than book, i'm going with the book) |
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serotonin's part in addiction pathway is due to its regulation of what?
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impulse control
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what characteristic must be associated with addiction?
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loss of control
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refers to legal and appropriate consumption of a psychoactive substance
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use
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refers to use of a psychoactive substance in a way other than intended
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misuse
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pattern of behavior with abnormal use of psychoactive substance
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abuse
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dx criteria for abuse of substance
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use needs to be for at least 1 mo
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pt with legitimate pain problem but not being treated adequately may show:
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pseudoaddiction
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addiction to a substance is characterized by
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psych and physical dep
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characterized by continuous or intermittent craving of substance producing drug seeking behavior
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psych dependency
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inability to stop using the drug because of tolerance to its effects and devel of withdrawal sx
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physical dependency
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can dependency and tolerance occur without addiction?
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yes
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psychoactive substance use disorder requires the following criteria for dx:
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pattern of pathological use (inability to reduce or stop use, intoxicated for majority of day for at least a mo)
use persists despite impairment in life |
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category used when for a period of at least 6 mo a person repeatedly uses at least 3 categories of psychoactive substances (not nicotine)
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polysubstance dependency
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some use and sx in past 6 mo
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partial remission
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no use or sx for past 6 mo
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full remission
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repeated use of certain drugs results in pharm induced biochem changes and adaption of brain resulting in need for more drug
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tolerance
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development of tolerance to substance or class of substance b/c of tolerance to another substance
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cross-tolerance
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devel of physical and/or psych sx that occur with reduction/cessation of intake of substance
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withdrawal
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when should in patient acute care hospitals be used for addiction?
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when there are medical complications (usually doesn't provide addiction tx)
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private psych systems should only be used for these pts:
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difficult, complicated, poorly controlled, dual dx
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most abused substance in the world
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alcohol
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MOA of alcohol
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enhances activity of GABA-a receptor and inhibits NMDA receptor
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psycho theory of alcoholism
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tension reduction, fulfills diff emotional needs
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sociocultural theory of alcoholism
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people of certain backgrounds drink more
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biological theory of alcoholism
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relieving or satisfying a physio craving or deficit
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who is at greatest risk for becoming alcoholic?
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son of an alcoholic, esp if drinking starts before 20
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describe metabolism of EtOH
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EtOH -> acetaldehyde by ADH
-> acetyl CoA + acetate by aldehyde dehydrogenase -> FAs + CO2 and H20 |
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how many grams of EtOH are metabolized an hr?
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7 g
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1 drink produces BAC of
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30 mg/dl
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alcohol withdrawal is exhibited by rebound in sx of what nervous system?
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sympathetic
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when must medication be given to tx alcohol withdrawal?
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before withdrawal sx begin
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are DTs life threatening?
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yes
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main drug to admin during detox?
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ativan (also atenolog and clonidine)
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this medication inhibits alcohol metabolism by ADH
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disulfiram (Antabuse)
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medication that reduces alcohol cravings, makes alcohol not taste good
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naltrexone (Trexan, ReVia)
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medication that may help restore balance between glutamate and GABA that had been disturbed during alcohol abuse; decreases # glutamate receptors
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acamprosate Ca (Campral)
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which drug has been more successful in achieving abstinence? more effective at reducing cravings?
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acamprosate Ca (Campral); naltrexone
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leading cause of mental retardation
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fetal EtOH syndrome
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from where are opioids derived?
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poppy plant - papaver somniferum
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kappa opioid receptor causes what sx?
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sedation, sleep, mood, diuresis
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sigma opioid receptor causes what sx?
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dysphoria and hallucinations
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delta (major) opioid receptor causes what sx?
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CV and analgesia
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mu opioid receptors mediate what sx?
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analgesia, euphoria, reinforcement of use, resp/GI/hormone sx
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major receptor types for opioids
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inhibitory G protein coupled receptors
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most opioids have what MOA?
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agonists
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mixed agonist-antagonist opioids
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pentazocine and nalbuphine
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partial agonist opioids
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butophanol, buprenorphine
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antagonist opioids
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naloxone and naltrexone
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important SE of opioid use in pt with pancreatitis
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causes constriction of sphincter of Oddi
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grade 1 opioid withdrawal
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lacrimation, rhinorrhea, diaphoresis, yawning, restlessness, insomnia
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grade 2 opioid withdrawal
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dilated pupils, piloerection, muscle twitching, myalgia, arthralgia, abd pain
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grade 3 opioid withdrawal
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tachycardia, HTN, tachypnea, fever, anorexia, nausea, extreme restlessness
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grade 4 opioid withdrawal
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diarrhea, vomiting, dehydration, hyperglycemia, hypotension, curled up position
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DATA 200 act allowed:
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some physicians to prescribe opioids to opioid addicts for detox
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mixed mu opioid receptor partial agonist and kappa receptor antagonist
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buprenorphine
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best drug for opioid detox
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buprenorphine with/without naloxone
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best drug for heroin maintenance tx
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methadone
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primary goals for drug abuse tx
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abstinence and recovery
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avoid giving what medication to alcoholics after detox
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benzodiazepines
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most common prescription drug that is abused
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methadone
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what drug should you use to detox someone off xanax?
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xanax
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what muscle relaxer has a metabolite that is very addicting? what is that metabolite?
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soma; meprobamate type compound
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MOA of amphetamines
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indirect catecholamine agonists that release newly synthesized NE and dopamine; block MAO
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cocaine increases or decreases sexual libido? what about amphetamines?
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increases; decreases
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part of brain on which amphetamines act
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reticular activating system, cortex, nucleus accumbens
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speedball =
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mixture of heroin and cocaine
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crank =
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methamphetamine
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ice =
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smokeable meth
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MOA of cocaine
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blocks dopamine reuptake, increases stored catecholamine release, serotonin and dopamine depletion
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what is the prototype for hallucinogens?
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LSD
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hallucinogens interact with what NT?
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serotonin
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what is synesthesia?
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tasting or hearing colors
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what drug was originally used as an animal tranquilizer?
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PCP
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angel dust =
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PCP
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what street drug is similar to PCP?
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ketamine
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MOA of PCP
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bind to sigma opioid receptors and binds NMDA receptors
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SEs of PCP use
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horiz and vert nystagmus and ataxia, violence
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methylenedioxyamphetamine =
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ecstasy
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date rape drug =
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gamma-hydroxybutyrate or rohypnol
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ingredients used for huffing
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toluene and butane, NO, amyl nitrate, tetrachloroethylene and tricholoroethane
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MOA of cannabis
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affects inhibitory G protein GABA and increases serotonin
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MOA of sedatives
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increasing GABA activity
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coexsting dx with these 2 disorders makes substance abuse tx more diff
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bipolar and borderline PDs
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