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61 Cards in this Set
- Front
- Back
What are three phases of motivated behavior
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Craving
Consummatory behavior Decrease in drive, and replacement |
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What percentages of men and women have Alcohol Abuse in their lifetime?
What about Alcohol Dependence? |
20% men, 10% women (Abuse)
10% men, 5% women (Dependence) |
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Decline in what induces withdrawal?
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Decline in blood or tissue concentrations
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No significant withdrawal is seen after use of what drugs (2)?
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Hallucinogens
Marijuana |
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What is relapse?
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A condition returning after discontinuation of medication
(Assumes that pt. had a pre-existing medical condition that was under control) This does NOT tend to get better without treatment |
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What is rebound?
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When an underlying condition becomes WORSE than baseline
(due to abrupt stoppage of meds) Unlike relapse, this tends to get better, even without treatment |
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Narrow DSM-IV definition of physiologic dependence
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Development of tolerance and/or withdrawal
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Substance Abuse is manifested by one or more of the following (4)
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Failure to fulfil major role obligations
Use in situations in which physically hazardous Recurrent substance-related legal problems Use despite persistent/recurrent substance-related problems |
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What is the time window for something to qualify as substance abuse?
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One or more of the requirements must occur within a 12 month window
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What component of the nervous system does withdrawal depend upon?
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Noradrenergic output from the locus ceruleus
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What is positive reinforcement?
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A pleasurable reward following a behavior
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What is negative reinforcement?
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Removal of an unpleasant state following a behavior
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What part of life does substance dependence typically begin in?
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Adolescence
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What is the time "hump" to get over when fighting substance dependence?
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2 years
Of those abstinent for 2 years, 90% are substance free at 10 years |
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In what time frame is the highest rate of relapse when trying to quit drinking?
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In the first 12 months
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What effect does Naltrexone have in treating substance dependence?
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Blocks the euphoria of alcohol and opiates
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What effect does Disulfiram have in treating substance dependence?
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Makes it so that it is physically miserable to drink
Blocks negative reinforcement |
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What are some of the symptoms/signs of a BAC @ 0.03? (2)
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Mild euphoric effects
Slowing of motor performance |
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What are some of the symptoms/signs of a BAC @ 0.05?
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Mild coordination problems
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What are some of the symptoms/signs of a BAC @ 0.08 - 0.1? (3)
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Mood lability
Impaired judgments Ataxia |
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What are some of the symptoms/signs of a BAC @ 0.2 - 0.3? (3)
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Nystagmus
Slurred speech Decreased levels of consciousness |
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What are some of the symptoms/signs of a BAC @ > 0.3?
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Beginning of anesthesia
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What are some of the symptoms/signs of a BAC @ > 0.4?
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Coma and death
(in non-tolerant people) |
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When does UNcomplicated alcohol withdrawal begin?
How long does it last? |
Several hours after the last drink
Lasts about a week (Some symptoms last several weeks) |
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In uncomplicated alcohol withdrawal, when does postural tremor begin?
When does it peak? |
6-8 hours
Peaks at 24 - 48 hours |
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In COMPLICATED alcohol w/d, when do seizures usually onset?
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24 hours (range 8-40 hours)
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In COMPLICATED w/d, when does psychosis usually onset?
How long does it last? |
8-12 hours
Lasts about a week |
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Complicated alcohol w/d-induced psychosis responds to what meds (2)?
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BDZs
Antipsychotics |
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How long after the last drink to DTs usually take to set in?
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3 days
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What part of life are DTs most common in?
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30s - 40s
(After 5-15 years of drinking) |
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What type of drugs are most commonly used for alcohol withdrawal?
Which ones? |
BDZs
Librium Ativan (when liver injury expected) |
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How are clonidine and beta-blockers used in treating alcohol withdrawal?
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For autonomic symptoms
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How does Topiramate work to maintain abstinence from alcohol?
(mechanism of action) |
Acts on both GABA and glutamate systems
Facilitates GABA Antagonizes excitatory effects of glutamate |
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Pupillary response to opioid intoxication vs. OD
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Intoxication -- pupillary constriction
OD -- pupillary dilation |
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Complications of opioid use from opioid itself
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Dry mouth/nose
Constipation Pupillary constriction (can decrease visual acuity) |
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How long does it take for opioid withdrawal to kick in?
When does it peak? How long does it last? |
Only takes about 10 hours after the last dose (short-acting agent)
Peaks within 1-3 days Gradually subsides over 5-7 days |
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Presentation of opioid withdrawal can mimic what other ailment?
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The flu
(it presents as the opposite of opioid intoxication) |
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This drug is used to ease opioid withdrawal symptoms
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Clonidine
NOTE: can be mixed with naltrexone to provide rapid detox |
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Differences between methadone and heroin (3)
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Methadone doesn't have euphorogenic effects
Has slower onset Has longer half-life NOTE: methadone still has withdrawal |
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Mechanism of Buprenorphine
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PARTIAL opiate receptor agonist
Blocks withdrawal and satisfies cravings Less likely to cause OD Withdrawal is very mild and short Antagonizes effects of other opiates |
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What is "speedball"
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Cocaine mixed with heroin
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What is free-basing?
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Heating cocaine with a volatile solvent to extract the "free base"
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What is "crack" cocaine?
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Alkaloid form of cocaine extracted from the hydrochloride salt
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What is cocaine's DOA?
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Short, only 15 - 30 minutes
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Physiological responses to cocaine intoxication (7)
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Tachycardia
Pupillary dilatation Elevated BP N&V Weight loss Respiratory depression Arrhythmias NOTE: some people have paranoid delusions |
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What are the 3 phases of cocaine withdrawal?
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Acute "crash"
Depression lessens, craving returns Chronic "abstinence syndrome" |
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How long does the acute "crash" of cocaine withdrawal last?
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Up to 3 days
Pts. can become suicidal Pts. have an intense urge to sleep |
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What is the mechanism of action of amphetamines?
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Inhibit catecholamine reuptake
Also, lead to increased catecholamine release |
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How is amphetamine intoxication different than cocaine intoxication (2)?
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Lasts longer
Has lower risk of arrhythmias or seizures |
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Two main components of Substance dependence
(in addition to neuroadaptation) |
Impaired control over use of drug
Increased salience of drug |
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What is the mechanism of action of nicotine?
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Activates ACh receptors on DA neurons in ventral tegmental area
Causes mesolimbic DA release Receptors activated, then quickly desensitized (limits "rush") Receptors recover after a few seconds |
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Which cigarette in a given day is usually the "best"?
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The first one
Smokers develop acute tolerance for each cigarette and over the course of a day |
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How long after stopping does nicotine withdrawal start?
When does it peak? |
Within 12 hours of stopping
Peaks within 3 days |
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What nicotine withdrawal treatment is best for preventing craving?
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Nicotine patch
(substitution therapy) |
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Long-term hallucinogen dependence can lead to a syndrome resembling what?
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Negative symptoms of schizophrenia
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What is the most commonly used illicit drug in America?
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Weed
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How long does cannabis intoxication last?
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2 - 4 hours
NOTE: metabolites of THC are very fat soluble (half-life of ~50 hours) |
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What PE signs may show up when intoxicated by cannabis (3)?
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Tachycardia
Dry mouth Conjuctival injection ("bloodshot") |
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PE signs of PCP intoxication may be suggestive of what type of injury?
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Cerebellar injury
Signs -- ataxia, dysarthria, nystagmus |
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How is PCP intoxication treated?
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Antipsychotics, BDZs for sedation
Activated charcoal Acidifying urine |
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What is the mechanism of action of PCP?
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Effects at opiate receptor
Negative allosteric modulator of glutamate(NMDA) receptor |