Drug Abuse And Dependence

Front 1

Between 1991 and 2001, __% of Anesthesiology residency programs reported impaired residents*

Between 1991 and 2001, __% of Anesthesiology residency programs reported at least one fatality*

Back 1

Between 1991 and 2001, 80% of Anesthesiology residency programs reported impaired residents*

Between 1991 and 2001, 19% of Anesthesiology residency programs reported at least one fatality*

Front 2

The total costs of drug abuse and addiction due to use of tobacco, alcohol and illegal drugs are estimated at $_______ a year.

Back 2

The total costs of drug abuse and addiction due to use of tobacco, alcohol and illegal drugs are estimated at $524 billion a year.

Front 3

Drugs that reduce craving

Back 3

Acamprosate
Modafinil
Clonidine
Rimonabant (d/c'd by FDA)
Baclofen

Front 4

Drugs that substitute for other substances

Back 4

Methadone (for heroin)
Diazepam (for alcohol)
Nicotine (for smoking)
Buprenorphine (for heroin)

Front 5

Useful competitive Antagonists (reversal agents)

Back 5

Naloxone
Flumazenil
Naltrexone

Front 6

The _____'s mission is to lead the nation in bringing the power of science to bear on drug abuse and addiction.

Back 6

NIDA's (nat. institute of drug abuse) mission is to lead the nation in bringing the power of science to bear on drug abuse and addiction.

Front 7

Define addiction

Back 7

A primary, chronic, neurobiological disease with genetic, psychosocial, and environmental factors that influence its development and manifestations. It is characterized by compulsive drug seeking and use, despite harmful consequences.

Four C's of Addiciton
Loss of Control over drug use
Continued use despite harmful Consequences
Compulsive use and Cravings.

Addiction Alters the Brain - changes brain activity and circuits...this has long lasting effects.

Addiction is influenced by a multitude of highly entangled factors. No single factor determines whether someone will or will not become addicted to drugs. Adolescents are at the highest risk for addiction. There is a genetic component to risk for addiction, and a genetic association to development of other diseases with addiction. Other factors are avaliability to the drug and your environment. While dependence will invariably occur with chronic exposure, only a fraction of subjects will develop a habit, lose control, and become addicted.

Front 8

Define Physical Dependence

Back 8

Comprised of Tolerance and Withdrawal.

Tolerance = needing more of a drug to get the same effect.

Withdrawal - A syndrome that begins w/n 2 hours after stopping a drug due to a down regulation of receptors for the drug. These receptors take weeks to normalize with abstinence, creating a constellation of symptoms and signs that are often OPPOSITE to the drug's main effect.

ACUTE Withdrawal:
ONSET: One half-life of the drug
PEAK: 3-5 halflives
DURATION: 1-2 weeks

After withdrawal is over, pt can still have intense cravings, dysphoric mood, and other symptoms.

Front 9

Self Administration of a drug that deviates from approved medical or social patterns w/n culture is known as....

Back 9

Drug Abuse/ Substance Abuse

Front 10

A substance whose pharmacological effects drive the user to continue its use.

Back 10

Drug Reinforcer.

Front 11

Any drug subject to legal restriction is referred to as a....

Back 11

Narcotic.

Front 12

Substance abuse is a component of ____ and _____ reinforcements.

Back 12

Clearly, substance abuse is a composite of both positive (dopamine hits) and negative (CRF withdrawal) reinforcements.

Front 13

What is most addictive after heroin and cocaine?

Back 13

Tobacco.

Front 14

Explain the classes of federal regulation of durgs

Back 14

Class 1: High Abuse Potential, no accepted medical use.

Class 2: High abuse potential, accepted medical use.

Class 3: Less abuse potential

Class 4: Low abuse potential

Class 5: NO abuse potential.

Front 15

THC in marijuana mimics what endogenous substance?

Opoids mimic what endogenous substances?

Back 15

THC mimis Anandamine

Opiods mimic Endorphins and Enkaphalins

Front 16

Nearly all drugs of abuse directly or indirectly work by what CNS pathway?

Back 16

Increase dopamine in the pleasure and motivation pathways of the brain.

Called the MESOLIMBIC PATHWAY.

Some also work via Serotonin Increase...which effects sleep and mood functions.
OR
Glutamate Increase , which regulates learning and memory.

Front 17

Explain the mesolimbic dopamine system

Back 17

Originates in the ventral tegmental area (VTA).

Then goes to the Nucleus Accumbens, then to the amygdala, and then to the prefrontal cortex.

"Many Violent Nuns and Preachers"

Front 18

What are two other NT receptors by which some addiction occurs?

Back 18

Some also work via Serotonin Increase...which effects sleep and mood functions.
OR
Glutamate Increase , which regulates learning and memory.

Front 19

Explain the exact mechanism by which Addiction alters brain chemistry.

Back 19

Chronic drug use decreases D2 receptors in the Striatum of the brain to compensate for overactivity of dopamine pathways.

This can cause depression, which causes reuse and addiction.

Front 20

Explain methamphetamine's effects on the brain.

Back 20

Methamphetamine abuse decreases dopamine TRANSPORTER activity. The magnitude of the decline in the dopamine transporter binding is positively correlated with the extent of MOTOR and MEMORY impairment: thus, the greater the decline, the greater the impairment in memory and motor reaction time.

Front 21

Tolerance due to pharmacoKINETIC differences that reduce plasma levels of a drug faster after chronic use, so that an equivalent dose leads to less drug at the receptors (ie CYP450 induction) is referred to as....

Back 21

Tolerance due to pharmacokinetic differences that reduce plasma levels of a drug faster after chronic use. (ie CYP450 induction) is referred to as DISPOSITIONAL TOLERANCE.

Front 22

Tolerance due to an adaptive change at the drug sites of action (receptors) such that higher concentrations are required to get the same response.

Back 22

Pharmacodynamic Tolerance

Here the final conc. of the drug at its receptor is UNCHANGED after equivalent dosing.

(Ex: Dopamine increasing drugs).

Front 23

Tolerance due to a drug's decreased potency in affecting a specified behavior after repeated or continuous exposure to the drug....Ex: getting good at driving while drunk.

Back 23

Behavioral/ Learned Tolerance.

This is a learned behavior that occurs once someone realizes that there is a behavioral cost to their habit.

Front 24

Explain withdrawal/ Abstinence Syndrome and what causes it.

How long does it last?

Back 24

Severe Withdrawal caused by:

1) when a drug is discontinued or when abstinence is enforced (abrupt withdrawal)

Front 25

Define withdrawal syndrome and what causes.

What determines it's intensity/ duration?

Back 25

Severe Withdrawal caused by

1) when a drug is discontinued or when abstinence is enforced (abrupt withdrawal)

2) can become manifest shortly after administration of an antagonist that displaces the dependent drug from its receptor(s), so-called PRECIPITATED WITHDRAWAL.

Following abrupt withdrawal, the duration of the syndrome is directly proportional to the duration of action of the dependent drug or its active metabolites.

Conversely, intensity of withdrawal symptoms is greater for shorter-acting drugs and especially severe after precipitated withdrawal.

Front 26

How can you avoid Withdrawal Syndrome?

Back 26

Replace the drug with a cross tolerant one that has a longer duration of action (longer withdrawal time). This drug will have a less intense withdrawal that will last longer. Then you slowly wean the pt off of that drug.

Ex: Methadone for heroin.

Front 27

Name the cross tolerant meds to decrease withdrawal for each of these drugs:

Ethanol
Heroin

Back 27

Ethanol - Diazepam
Heroin - Methadone (opiod agonist) or Buprenorphine (partial mu agonist).

Front 28

Factors that Cause Drug Abuse

Back 28

1) Route of Administration - (IV/ Inhalational faster addiction)
2) Dose of the Drug (smaller doses..more addiction)
3) Lipid Solubility (lipid soluble more addicitive) ex: diacetyl morphine
4) Environmental Setting (assoc with past drugs use...more addiction).

Front 29

What is the most difficult aspect of addiction /drug dependence

Back 29

Preventing relapse.

Front 30

Substance abuse treatment addresses what?

Back 30

Substance abuse treatment should address the whole person and can include medications, behavioral therapies, and ancillary social support services.

Front 31

What three things trigger relapse?

Back 31

1) Stress
2) Re-exposure to the drug of abuse
3) (Triggers) A context that recalls prior drug use

Front 32

What drugs do you give to tx a drug overdose of a user?

Back 32

Antagonists:
Naloxone - Opiod overdose

Flumazenil - Benzo overdose

Naltrexone - a long acting version of naloxone (pvts short term relapse)(can also reduce cravings) -causes malaise though.

Front 33

________ is predictive of sustained recovery.

Back 33

Extended abstinence is predictive of sustained recovery.

After 3 years, recovery odds are high or stable. After 5 years, less likely to relapse at all.

Front 34

What is the best way to treat addiction?

Back 34

Pharmacological interventions combined with non-drug approaches like group therapy, psychotherapy, vocational rehabilitation, and family support.