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143 Cards in this Set
- Front
- Back
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tx of etoh
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disulfiram
diazepma ondansetron naltrexone acamprosate topiramate |
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punishes etoh drinking
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disulfiram
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disulfiram inhibits --- -----
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acealdehyde dehydrogenase
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prob w/ disulfiram
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not a good way to stop a learned behavior
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diazepam decreases incidence of etoh --- ---
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withdrawal seizures
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only diazepam good for etoh withdrawal seizures
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f
any long acting bdz |
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t/f
diazepam used for acute withdrawal |
t
then slowly withdraw can cause abuse |
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decrease withdrawal-associated anxiety
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ondansetron
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ondansetron is a 5HT antagonist/agonist
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antagonist
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ondansetron will relieve neg/pos reinforcement
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neg
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naltrexone will decrease ----reinforcing effects
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positive
blocks mu receptors |
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acamprosate decreases neg/pos effects
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both neg and positive
(increase taurine and decrease glutamate) |
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topiramate is an -----
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antiepileptic
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topiramate decreases/increase cravings and decreases/increases abstinence
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decreases
increases |
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how will acamprosate decrease neg reinforcing effects
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long term etoh users have an elevated glutamate levels which causes anxiety
so if it's removed then that's neg reinforcement |
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what will hep derease # of drinks per day
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acamprosate
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acamprosate is synergistic w/
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naltrexone
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t/f
etoh contributes aa |
f
contributes calories, but not essential aa. . . malnutrition |
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toxicities of etoh include serious -- and --- disorder
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neuro
mental |
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wernicke-korsakoff's psychosis due to
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vit b deficiency
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toxicites of etoh will cause atrophy of the ---, --- and ---
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cerebellum
hippocampus prefrontal cortex |
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there will be less folds in the ---due to etoh toxicity
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cerebellum
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what part of the brain is very sensitive to toxic effect
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prefrontal cortex
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why is there's an increase risk to stroke and htn w/ etoh tox
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damages all vascular tissue
there's an increase in sys and diastolic bp |
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gi probs w/ etoh tox
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esophageal refluz
gastritis chronic diarrhea pancreatitis |
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etoh tox decreases the absorption of
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vit A
Vit D thiamine |
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liver induces cyp ---
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2E1
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gluthathione depletion enchances:
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apap tox
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cirrhosis due to increased --- and -- accumulation in the liver
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fat
protein |
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-- accumulation causes liver damage; this is worsened w/ an increase in ----
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NADH
acetaldehyde |
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increased --- stress causes necrosis and fibrosis in the liver
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oxidative
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increased oxidative stress causes ---- and ---- in the liver
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necrosis
fibrosis |
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etoh tox is ---suppressant
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immunosuprresant
decrease wbc, t cells, IGg production |
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ca can be cause by both ---, -- related, and ---- related
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direct
smoking contaminant |
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etoh can also cause damage to the --- muscle
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skeletal
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impotence, sterility due to induced --- ---
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induced testosterone metabolism:
decreased testosterone, decrease sperm, decrease fertility increased estrogen |
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teratogenic 1-3/1000 liver births are ---
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fas
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usu 10-15 g toxic for apap, but w/ etoh it's only --- --- g
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1-3g
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teratogenic
1st trimester = |
fas
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teratogenic
2nd trimester = |
spontaneous abortions
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teratogenic
3rd trimester |
low birth weight
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fas caused by --- mg/day
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75 mg/day
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fas causes cns dysfunction:
low --- ---cephaly |
low IQ
microcephaly |
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fas causes --- in growth
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slowness:
bone, muscle, organ malfunction |
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fas causes extensive impairment of the --- ---
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immune system
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fas causes --- abnormalities
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facial
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facal characteristes of an fas baby
-- folds flat --- lowe -- bridge -- nose indistinct ----- thin --- -- ---ganathia |
epicanthal
flat midface low nasal bridge short nose indistinct philitrum thin upper lip micrognathia (small chin) |
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arnd -- x faster than fas
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3
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arnd
poor --- skills and ---- |
motor
coordination |
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arnc
-- and --- processing prob |
auditory
visual |
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arcd
cog defects |
memory
abstractions - math, money, time integrating new skills language skills |
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arcd
executive fx: -- skills ----, ADHD -- skills increased risk for ----, ---- |
predictive
impulsivity social alcoholism addiction |
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barbs
anxiolytic: too much ---, increase in -- sensitivity |
sedation
pain |
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anticonvulsant effects of barbs
too much ---- |
sedation
used for er tx |
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which barb has less sedative action
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phenobarbital
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sedation/hypnosis of barbs
very low --- --- |
tx index
so rapid tolerance |
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barbs decrease sleep --- and increase --- -----
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sleep latency
sleep time |
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barb increase
stage -- in sleep decrease in |
increase in stage 2
decrease in stage 1, 3, 4 and REM sleep |
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anesthetic barbs are --- acting
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short
xbbb quickly so usu combined w/ other full anesthetics |
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-- and --- at high doses of barbs
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coma
death |
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barb toxicity tx
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supportive tx only
dialysis hemoperfusion |
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barbs work by enchancing --- receptor activation
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GABAa
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barbs increase affinity of --- and --- binding site for agonist
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BDZ
GABA |
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barbs prolong --- open time
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channel
is stuck open |
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subunits that barbs require
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alpha
beta (of any type) |
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t/f
barbs cannot open gaba w/o gaba |
f
very high doses can directly open gaba channels |
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bicuculline is a noncompetitive antag at -- barb doses
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low
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picrotoxin is a noncomptetitve antag at --- barb doses
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high
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t/f
bicuculline and picrotoxin are antedotes for barbs |
f
no cuz they'll block everything this can lead to seizures |
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barb effects due to decreased ---- --- receptor binding
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glutamate AMPA
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barb effects due to inhibitio of --- ----- channels
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voltage-gated ca channels
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barb effects due to membrane ----
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fluidization
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barbs cause decreased
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resp
bp |
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decreased resp due to
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decreased resp drive in brain stem
decreased CO2 response |
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t/f
barbs have low oral absorption |
f
most orally absorbed |
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t/f
no metabolization for barbs |
f
hepatically metabolized/conjugated then renally excreted |
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t/f
ok to take barbs if pregnant |
f
will x placenta |
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barbs additive w/
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cns depressants:
bdz sedatives anethethics antipsychotics opiates antihistamines maoi tca |
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initially barbs will inhibit cyp
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cyp2 an 3 activity
increase drug conc also cyp 1A2 |
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chronically barbs ----- cyp 2/3 levels to ---- drug conc
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induce
decrease |
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what drugs will decrease w/ chronic barb use
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sedative/hypnotics
anesthetics opiates steroids dig oral anticoagulants b antag quinidine phenytoin etoh haldol vit D/K bile salts cholesterol |
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phenobarb is a partial ---- agonist, less --- inhibition
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GABA
Ca |
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phenobarb has less ------ se
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sedative
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why does pheno have less se
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due to less ca channels
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short acting anesthetics
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thiopental
methohexital thiamylal |
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seldom used
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amobarbital
aprobarbital butabarbital pentobarbital secobarbital thalbutal |
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structural analog of gaba
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pre-gabalin
gabapentin |
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t/f
pregaba and gaba has high affinity at gaba receptors or transporters |
f
no activity |
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tx effects of pregaba and gabapen
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anticonvulsant
relieves neuropaic pain fibromyalgia |
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pregaba and gabapen blocks ---- to decrease -----
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VGCC
pain neurotransmission |
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pregaba and gabapen does --- se
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sedative
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off label use of pregaba and gabapen
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depression
mania anxiety insomnia |
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t/f
pregaba and gabapen has little tolerance/dependence |
t
so used for chronic pain ci w/ opiate |
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ketamine inhibits --- receptor, binds to ------ site
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NMDA
phencyclidine |
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t/f
ketamine used as anesthesia cuz has complete loss of consciousness |
f
used as anesthesia cuz no complete loss of consciousness. . . "dissociative anesthesia" |
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ketamine used as --- anesthesia
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general
IV |
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ketamine decreases/increase bp
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increases
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t/f
ketamine can cause resp depression |
f
no resp depression so combines well w/ other anesthetics |
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ketamine has less --- distortion and -- than phencyclidine
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distortion
euphoria |
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ketamine has some ---- during recovery, less in ----
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dysphoria
kids |
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low doses of ketamine abused w/ --- as a sedative
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etoh
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GHB is a naturally occuring --- ---
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fatty acid
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ghb is dose dependent/independent sedation and anesthesia
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dependent
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ghb is synthesized, stored and released like a ----
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NT
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ghb metabolized from
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gaba
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ghb has low/high affinity
-- dependent transporter specific for ghb |
Na
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ghb highest in the ----, --, and ----
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hippocampus
basal ganglia hypothalamus |
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ghb high in the periphery but no -------
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receptors
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ghb acitvates --- receptor
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ghb
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ghb activates
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ghb receptor
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w/ ghb
g protein coupled to --- and ----- production |
IP3
DAG |
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ghb is a selective ---
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antagonist
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high doses of ghb activat the ----- receptor
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GABA -B
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ghb used for
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narcolepsy
restores natural sleep cycle |
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ghb cns effects
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catalepsy
sedation euphoria |
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ghb cns
decreased --- DA release |
nigrostriatal
so inhibition of motor fx. . . catalepsy |
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ghb cns
increase in --- da release at higher doses |
mesolimbic
so, euphoria |
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ghb cns effects:
increase in --- hormone release |
growth
(body builders use) however, sleep increase GH release. . .so is it GHB or sleep that increases GH |
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ghb clinically approved to tx
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narcolepsy
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ghb will decrease/increase sleep latency, decrease/increase sleep time
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decrease
increase |
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t/f
ghb interuppts sleep cycle |
f
does not, so more natural sleep. . . sleep longer; fall asleep faster |
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ghb alleviates ----- ----
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daytime drowsiness
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ghb shows some --- after repeated high dose use
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tolerance
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t/f
ghb shows evidence of dependence |
f
no evidence |
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what will increase abuse liability of ghb
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etoh
other sedatives |
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se of ghb
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dizziness
mental clouding |
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when is there overdose w/ ghb
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in association w/ other drug use
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why's there an increase in abuse potential
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due to smoking. .. . lungs. . . directly to the brain. . . then to body to be eliminated, etc
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there's a 5% success w/ which nicotine tx
|
cold turkey
decrease dose every several days |
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nicotine delivery systems
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substitution detox
20% successful |
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two nicotine antagonist/partial agonists
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mecamylamine
varenicline |
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prob w/ nicotine antag/partial agonist
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increase suicide rate
|
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subunits of varenciline
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alpha 4
beta 2 |
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partial agonist (varenicline) will increase DA to relieve cravings, but not enough for ----
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addiction
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what will offset adrenergic stimulation during nicotine withdrawal
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clonidine
decrease NE. . .decrease autonomic stimulation |
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da and ne uptake inhibitor use to tx nicotine withdrawal
|
bupropion
(zyban) |
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gamma-vinl gaba is an ---- inhibitor of gaba-t
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irreversible
|
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gamma-vinyl gaba increases/decreases gaba levels after release
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increases
|
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gamma-vinyl gaba activates gaba ---- receptors on mesolimbic da neurons
|
B
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gamma-vinyl gaba will inhibit ----
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cravings
|
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gamma-vinyl gaba will also be used for -- and --- addictions
|
etoh
opiates |
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t/f
ssri's can be used for nicotine addiction |
t
|
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tx for stimulants addictions:
|
cold tx
sub detox: bupropion gamma-vinyl gaba sertonin 2 subtypes |
