Etoh Abuse; Drug Abuse 1, 2; Addiction Epidem

Front 1

In general ____ drink(s)/hour is metabolized

Back 1

1

Front 2

___ drink(s)/hour produce legally defined intoxication

Back 2

3-4

Front 3

What characterizes fetal alcohol syndrome?

Back 3

1) Pre and post natal growth retardation

2) Distinctive facial morphology

3) CNS dysfunction

Front 4

Most important site of absorption for alcohol

Back 4

small intestine

Front 5

What is the apparent volume of distribution of alcohol similar to?

Back 5

body water

Front 6

What order kinetics does EtOH metabolism follow?

Back 6

zero-order: rate is constant with time and is not altered much by concentration

Front 7

What are the two routes of alcohol metabolism?

Back 7

1) Alcohol dehydrogenase (ADH) converts ethanol to acetaldehyde then to acetyl CoA by acetaldehyde dehydrogenase (ALDH) where it enters citric acid cycle.

2) Microsomal mixed function oxidase system (minor)

Front 8

What is the rate limiting step in alcohol metabolism?

Back 8

alcohol dehydrogenase

Front 9

What is the importance of the Microsomal mixed function oxidase system?

Back 9

While a minor player in metabolism of EtOH, the importance is that alcohol can modify activity of this impt. enzyme for metabolism of other drugs.

Front 10

At what BAC is there usually lethality?

Back 10

0.40% due to respiratory arrest from brainstem impairment.

Front 11

What is the legal limit for driving under the influence in Virginia?

Back 11

0.08%

Front 12

How does alcohol affect the liver?

Back 12

Increases the concentration of fat deposited in liver by increasing fat synthesis and causing mobilization of fat from peripheral stores. Initial accumulation is reversible but over time can become irreverisble scarring (cirrhosis)

Front 13

What does it mean that the alcohol curve is J-shaped for CV health?

Back 13

It means there is evidence that moderate alcohol consumption decreases CV risk but higher doses increase risk.

Front 14

How is alcohol thought to work via GABA?

Back 14

EtOH has distinct interaction sites on proteins and can disrupt the function of ion channels and signaling molecules.

Suggests that a binding pocket of a distinct size must exist for the alcohol action.

Alcohol produces an increase in the Chloride current through GABA receptors.

Front 15

What does alcohol due to the NMDA glutamate receptors?

Back 15

acutely inhibits NMDA mediated calcium current, producing CNS depressant effects.

Front 16

Wernicke-Korsakoff syndrome is a CNS disorder resulting from severe ___ deficiency, often seen with protracted ethanol use in alcoholics.

Back 16

thiamine

Front 17

Distinct pattern of permanent physical and behavioral abnormalities in children of women who drank heavily during pregnancy

Back 17

fetal alcohol syndrome

Front 18

T/F Tolerance develops to the toxic effects of alcohol as well as the behavioral effects

Back 18

F. The behavioral effects only. Thus heavy drinkers are more likely to encounter toxic effects.

Front 19

What are symptoms of early withdrawal?

Back 19

Sympathetic NS hyperactivity:

elevated vital signs, tremulousness, anxiety, diaphoresis.

Appear within a few hours of the last drink.

Front 20

When do symptoms of EtOH withdrawal peak?

Back 20

24-48 hours.

Front 21

Drug that inhibits acetaldehyde dehydrogenease, resulting in acetaldehyde poisoning

Back 21

Disulfiram

Front 22

What is the alcohol-disulfiram (antabuse) reaction?

Back 22

Flushing
Nausea
Thirst,
Chest pain
palpitations
dizziness

Front 23

How is relapse prevented/abstinence maintained?

Back 23

naltrexone is used as an adjunct pharmacotherapy for alcoholism.

Front 24

What is the risk of alcoholism for twins?

Back 24

40-50%

Front 25

What genetic factors are protective against alcoholism?

Back 25

ALDH polymorphisms (esp in Asians) can reduce rate of acetaldehyde metabolism, mimicking treatment with disulfiram.

Front 26

What does Depressive drug OD look like?

Back 26

Pupils are sluggish and miotic

Respiration shallow and slow

Deep tendon reflexes absent or attenuated and patients are unresponsive.

Front 27

What reverses benzo intoxication?

Back 27

benzodiazepine antagonist flumazenil.

Front 28

what is acamprosate?

Back 28

drug used for treating alcohol dependence.

Acamprosate is thought to stabilize the chemical balance in the brain that would otherwise be disrupted by alcoholism, possibly by blocking glutamatergic N-methyl-D-aspartate receptors, while gamma-aminobutyric acid (GABA) type A receptors are activated

Front 29

PCP and ketamine are what class of drugs?

Back 29

dissociative anesthetics

Front 30

reduced drug effect with repeated use and the requirement of higher doses to produce the same effect

Back 30

tolerance

Front 31

What happens to withdrawal symptoms if an antagonist is administered?

Back 31

withdrawal signs become even more intense but of shorter duration.

Front 32

Giving opiate-dependent people antagonists like naloxone, naltrexone is an example of what type of withdrawal?

Back 32

precipitated.

Front 33

Cross-dependence: defn

Back 33

phenomenon by which different drugs within a pharmacological class generally support physical dependence produced by drugs in the same class.

Front 34

Heroin withdrawal blockage by other opioids is an example of

Back 34

cross-dependence.

Front 35

intense craving and drug-seeking behavior are characteristics of what?

Back 35

psychological dependence

Front 36

Why can crack be inhaled but cocaine cannot?

Back 36

Crack become volatile at a lower temperature than does the salt, so that crack can be inhaled after heating in a pipe.

Front 37

The amphetamine and amphetamine-like stimulants usually are used by what method of administration?

Back 37

orally

Front 38

What metabolizes cocaine and where?

Back 38

blood and liver esterases to a common final product with metabolites found in urine for some time.

Front 39

Signs and Symptoms of stimulant OD

Back 39

Hyperactivity
Diaphoresis
Dilated pupils
Tremor
Tachycardia
Hypertension
Hyperpyrexia
Stereotypical behavior
Seizures
Paranoia

Within 24-36 hours: hypersomnolence, hyperphagia, EEG changes.

Several weeks later: may complain of insomnia and depression.

Front 40

What are the symptoms of the stimulant let-down/crash?

Back 40

Dysphoria, tiredness, irritability, and mild depression often follow a stimulant intoxication episode.

Front 41

What are personality changes that commonly occur in stimulant abusers?

Back 41

Persecutory delusions

Preoccupation with self, hostility, suspiciousness.

Front 42

Menthol cigarettes are disproportionately preferred by what race group?

Back 42

African-Americans

Front 43

T/F The rates of smoking initiation among 12-17 year olds have declined since 1960s

Back 43

F. They've increased.

Front 44

What is the most important age group to target anti-smoking measures?

Back 44

adolescence

Front 45

Where does nicotine act?

Back 45

nicotinic class of ACh receptors

Front 46

What are nicotine receptors classified as?

Back 46

pentamers in ligand gate ion channel family.

Front 47

T/F Low-tar cigarettes are safer

Back 47

F

Front 48

What are the most significant carcinogens in tobacco smoke?

Back 48

nitrosamines

benzoapyrene

polycyclic aromatic hydrocarbons (PAHs)

Front 49

CO delivery results in formation of _______ which in smokers can reduce oxygen-carrying capacity of blood

Back 49

carboxyhemoglobin

Front 50

When are blood nicotine levels at a maximum?

Back 50

durng the completion of smoking

Front 51

What is plasma half-life of nicotine?

Back 51

about 2 hours

Front 52

T/F Regular smokers have a very predictable inter-cigarette interval triggered by the fall in nicotine levels below a preferred level

Back 52

T

Front 53

70-80% of nicotine is converted to _________, which is monitored by researchers for tobacco use.

Back 53

cotinine

Front 54

Useful biomarkers for nicotine use

Back 54

cotinine (major metabolite of nicotine)

expired CO - is increased in smokers

Front 55

Nicotine withdrawal symptoms

Back 55

craving for nicotine

anger

anxiety

depression

restlessness

difficulty with concentration

impatience

insomnia

Front 56

What problem areas for abused substance does nicotine rank mostly highly in?

Back 56

Dependence

Front 57

refers to the strength of the psychological and behavior effects produced by use of the drug

Back 57

intoxication

Front 58

term used by scientists to refer to the pleasurable effects produced by drugs of abuse in many people

Back 58

reinforcement.

Front 59

T/F brief interventions can very significantly alter tobacco use

Back 59

T

Front 60

What is varenicline?

Back 60

nicotine receptor partial agonist

Front 61

MOA of bupropion

Back 61

DA-uptake inhibitor, but it's unclear how this relates to smoking cessation.

Front 62

partial agonist at nicotine receptors with possible selectivity for α4β2 subtype, possibly conferring some selectivity for nicotine craving.

Back 62

varenicline.

Front 63

What slows absorption of alcohol?

Back 63

Presence of food in stomach

Front 64

What are FAS facial features?

Back 64

Short palpebral fissures
Smooth philtrum
Thin upper lip

Front 65

T/F Even among heavy drinkers, serious liver injury is rare

Back 65

t

Front 66

It is likely that alcohol and ______ combine to produce liver injury

Back 66

TNFα

Front 67

What kind of antagonist is EtOH to NMDA-r?

Back 67

non-competitive

Front 68

The water-filled cavities of proteins provide binding sites for alcohols and anesthetics
Such sites have been characterized for the ___ and ___ subunits.

Back 68

GABAa; glycine alpha1

Front 69

3 drugs used to treat alcohol addiction

Back 69

Disulfiram, alcohol flush reaction (ALDH2)
Naltrexone
Acamprosate

Front 70

MOA of naltrexone

Back 70

mu opioid receptor antagonists

Front 71

T/F Naltrexone Reduces Alcohol Stimulation of Dopamine Release and Decreases Alcohol Intake

Back 71

t

Front 72

arises from an increase in the rate at which the body is able to metabolise and get rid of a drug. Repeated drug may increase the action of an enzyme the body uses to destroy the drug.

Back 72

metabolic tolerance

Front 73

arises from an adaptation in receptor function, number or messengers

Back 73

pharmacodynamic tolerance

Front 74

arises when an animal, through experience with a drug, learns to decrease the effect that the drug is having. This learning can involve both instrumental learning and conditioning processes.

Back 74

behavioural tolerance

Front 75

Which psych disorders have the highest incidence of concurrent nicotine addiction?

Back 75

Cocaine and opiate dependence (80-90%)

Schizophrenia: 70%

Front 76

what % of population have problems with substance abuse

Back 76

10%

Front 77

Alcohol and prescription drug abuse affect ____% of older adults

Back 77

17

Front 78

Which medical specialties have highest addiction rates?

Back 78

high stress/performance expectation specialties have higher rates of addiction.

Anesthesiology (16%), Emergency Med, Psych

Front 79

What are the Virginia reporting requirements for impaired physicians

Back 79

1) Health care instition must report impaired physician to VDH professions within 30 days

OR

2) impaired physician may voluntarily report to Health Practitioners Monitoring program

Front 80

What is SBIRT??

Back 80

Screening
Brief Intervention
Referral to Treatment

A way of addressing addiction in medical practice

Front 81

__% of americans are current illicit drug users

Back 81

8

Front 82

What are the 5 As for brief intervention?

Back 82

ASK
ADVISE
ASSESS
ASSIST
ARRANGE

Front 83

Illegal drug most often associated with Emergency Department visits

Back 83

Cocaine