Behavioural Science: Substance Abuse

Front 1

Name the signs of substance dependence. What criteria defines substance dependence?

Back 1

Substance dependence is a maladaptive pattern of substance use defined as three or more of the following signs in one year: tolerance, withdrawal, substance taken in larger amounts/longer periods, desire/attempt to cut down, energy spent recovering from substance, social/occupational/recreational activities reduced due to use, continued use despite recognition of a problem.

Front 2

Substance abuse is a maladaptive pattern of substance use leading to clinically significant impairment or distress. What are the signs substance abuse?

Back 2

Recurrent us resulting in failure to fulfill major obligation (work/home/school).
Recurrent use in physically hazardous situations.
Recurrent substance-related legal problems.
Continued use in spite of persistent problems caused by use.

Front 3

Name the classes of abused substances and the common examples of each.

Back 3

Stimulant: caffeine, nicotine, cocaine, and amphetamines

Sedatives (CNS depressants): alcohol, barbiturates, and benzodiazepines.

Narcotics: opiodis (morphine) and heroin.

Hallucinogens: LCD, PCP, cannabis, psilocybin, mescaline.

Front 4

What is the lifetime prevalence of alcoholism (alcohol dependence)?
What percent of alcoholics die by suicide?

Back 4

10-13%.
15%.

Front 5

What is the mechanism of action of disulfiram?

Back 5

Disulfiram inhibits aldehyde dehydrogenase thus increasing the blood levels of acetaldehyde, the metabolite that causes the symptoms of intoxication.

Front 6

When would naltrexone be given to an alcoholic? Name another drug with the same goals as naltrexone.

Back 6

Recovering alcoholics are given naltrexone which reduces cravings and prevents relapse.

Acamprosate - prevents relapse. Lowers the activity of the receptors for glutamate (chronic EtOH upregulates these receptors).

Front 7

What type of amnesia is evident in alcohol induced blackouts?

Back 7

Anterograde amnesia, not retrograde amnesia.

Front 8

What are the symptoms of alcohol withdrawal?

Back 8

Tremor, tachycardia, hypertension, malaise, nausea, seizures, delirium tremens, tremulousness, agitation, hallucinations, mydriasis, hperreflexia.

Front 9

A patient is undergoing alcohol withdrawal symptoms two days after quitting. The patient is markedly confused, with lack of short term memory, and disorientation. The patient also has marked tremors. What is the diagnosis?

Back 9

Delirium tremens.

Front 10

What are the characteristics of Korsakoffs syndrome (secondary to Wernicke encephalopathy)?

Back 10

Retrograde amnesia, anterograde amnesia, and confabulations are a common feature.

Front 11

What is the classic triad of Wernicke's encephalopathy? Most patients will not present with this triad, but which symptom is normally present?

Back 11

Wernicke is caused by thiamine deficiency. Delirium, nystagmus, and ataxia. Most patients present with delirium only.

Front 12

How does a patient with amphetamine intoxication present?

How does a patient with amphetamine withdrawal present?

Back 12

Euphoria, hypervigilance, anxiety, grandiosity, paranoia, tachycardia, mydriasis, increased BP, increased energy, hyperreflexia.

Withdrawal: depression, fatigue, dysphoria, increased appetite, and sleep disturbances. Delusion of persecution.

Front 13

How does a patient with cannabis intoxication present?

How does a patient with cannabis withdrawal present?

Back 13

Impaired motor coordination, anxiety, slow reaction time, impaired judgment, increased appetite, dry mouth.

Withdrawal: minimal.

Front 14

How do patients with hallucinogen (such as LCD) intoxication present?

How do patients with hallucinogen withdrawal present?

Back 14

Anxiety, hallucinations, mydriasis, tremor, hyperreflexia, tachycardia, HTN. Rarer: delusions of persecution and reference.

Withdrawal: none.

Front 15

What is a common complication associated with LCD abuse?

Back 15

Flashbacks.

Front 16

What is methylenedioxymethamphetamine (MDMA) and what is the long term complication of its use?

Back 16

Ecstasy. Recurrent intoxication with MDMA damages serotoninergic neurons and cause lasting difficulty with short term memory (memory gaps) and increased impulsiveness. Ecstasy intoxication: seizures, fever, rhabdomyolysis, renal failure.

Front 17

How would a patient with inhalant intoxication (glue, paint thinner) present?

How would a patient with inhalant withdrawal present?

Back 17

Belligerent, impaired judgment, nystagmus, uncoordinated, lethargic, drowsy, ataxic.

Withdrawal: none.

Front 18

What are the sings/symptoms of a patient in nicotine withdrawal?

Back 18

Craving, restlessness, irritability, anxiety, depressed mood, hunger, difficulty concentrating, headache, and insomnia.

Front 19

What signs/symptoms would be present in a patient with opioid intoxication?

Back 19

Pupillary constriction, constipation, drowsiness, slurred speech, respiratory depression, bradycardia, coma.

Front 20

What signs/symptoms would be present in a patient with opioid withdrawal?

Back 20

Flu-like muscle aches, nausea, vomiting, piloerection, lacrimation, rhinorrhea, fever, insomnia, pupillary dilation.

Front 21

How do naltrexone, naloxone, clonidine and methadone each aid in the recovery from an opioid addiction?

Back 21

Naltrexone (long half life) and naloxone (short half life/overdose) are both opioid receptor antagonist.
Clonidine is an alpha-2 adrenergic agonist to treat the nausea and diarrhea.
Methadone is a mu-opioid agonist and receptor antagonist to glutamate - decreases cravings.

Front 22

Explain withdrawal from heroin.

Back 22

Intoxication: intense euphoric rush followed by a drowsy euphoria that last hours. Miosis, dysarthria, and constipation are common. Withdrawal: begins with restlessness, lacrimation, rhinorrhea, dysphoria and cravings. After several hours patients fall into a restless sleep. Then gooseflesh, nausea, vomiting, cramping, diarrhea. Then bone pain and spasmodic leg movements.

Front 23

What are some complications of heroin use?

Back 23

Since heroin is normally used via IV, AIDS, hepatitis and bacteremia with endocarditis, osteomyelitis, meningitis, cerebral abscess, and mycotic aneurysms all can occur. TB is becoming increasingly common among opioid addicts.

Front 24

What is phencyclidine?

Back 24

PCP, angel dust, peace pill. Intoxication is characterized by euphoria and a sense of detachment from environment and ones body. Lethargy, agitation, nausea or vertigo can occur. Other sx: increased HR, elevated BP, miosis, nystagmus, dysarthria, ataxia, termor, hyperreflexia, and myoclonus. Greater levels of intoxication are characterized by delirium with hallucinations, catatonia, dystonia, rhabdomyolysis, and renal failure. Severe intoxication can lead to coma, hyperthermia, and hypertension.

Front 25

How does intoxication from the sedatives barbiturates and benzodiazepines present? What is a important pharmacological difference between the two classes of drugs?

Back 25

Intoxication: euphoria, emotional lability, impaired judgment, slowed reaction time, dysarthria, ataxia, and nystagmus. Severe: coma.

Barbituates have a low safety margin (effective dose is close to lethal dose) while benzodiazepines have a high safety margin.

Front 26

Withdrawal from BZs and barbiturates is characterized by....

Back 26

Mood depression, anxiety, tremors, hallucinations, seizures, insomnia, formication (sensation of something crawling on skin), increased cardiovascular activity.

Front 27

What is the principle neurotransmitter involved in substance abuse? How is this NT affected by heroin, cocaine, and amphetmaines.

Back 27

Dopamine (DA).
Heroin: stimulates release of DA.
Cocaine: prolongs the action of DA at its receptors by blocking its reuptake.
Amphetamies: stimulate release and block reuptake of DA.

Front 28

What neurotransmitter is responsible for the actions of sedatives such as alcohol and BZs?

Back 28

GABA, an inhibitory NT, is increased by both these substances.

Front 29

Serotonin is a neurotransmitter that is involved in what class of substance abuse drugs?

Back 29

Hallucinogenic drugs such as lysergeic acid diethylamine.

Front 30

Were does PCP bind to?

Back 30

PCP binds with N-methyl-D-aspartate (NMDA) receptors of glutamate gated ion channels.

Front 31

What neuroanatomic structures are involved in the reward system for all drugs of abuse?

Back 31

Ventral tegmental area (VTA) in the midbrain is the site of origination of DA neurons. This complex projects to the nucleus accumbens and prefrontal cortex.