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85 Cards in this Set

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