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111 Cards in this Set

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Management of alcoholism: diet supplement.

What are the three types of nutritional supplements?
- thiamine
- folic acid
- multi-vitamines
Alcohol detoxification:

What is the main drug used?
chlordiazeperoxide: long acting, need to slowly tape off.
Alcohol detoxification:

What drug should be used for patients with liver damage?
short acting BZ: lorazepam or oxazepam
Alcohol detoxification:

What drug should be used for patients with seizures or delirium?
diazepam
Alcohol detoxification:

What drug should be used for patients with hallucinosis?
haloperidol
If an alcoholic patient also requires glucose loading, when should you give them the dietary supplements which contain thiamine and folic acid?
Before glucose loading because glucose depletes thiamine.
What is the next step after achieving alcohol detoxification?
rehabilitation
What are the goals for rehabilitation? (2)
- help patient remain sober
- identify and treat coexisting disorders
Rehabilitation:

Is SSRI necessary for patients after completing alcohol detoxification since many of them develop depression?
Not if they remain depressed after 2-4 wks of sobriety. Because sobriety lift depression on its own.
What is the most important step in leading the alcoholic patient to change?
receiving a diagnosis.
Rehabilitation: therapies

Types of therapies. (6)
- AA(alcoholic anonymous)
- group therapy
- individual therapy
- family therapy
- inpatient programs
- motivational therapy
Rehabilitation: treatment of alcohol dependence.

Name the 3 FDA approved medications and their mechanism of action.
- disulfiram: inhibit aldehyde dehydrogenase
- naltrexone: mu-opioid antagonist
- acamprosate: glutamate receptor modulator
Rehabilitation: treatment of alcohol dependence.

These are the symptoms of ___.
- nausea, vomit
- palpitations
- hyppotension
disulfiram
Rehabilitation: treatment of alcohol dependence.

These are the side effects of ___.
- nausea, headache
- diarrhea, flatulence
acamprosate
Rehabilitation: treatment of alcohol dependence.

This drug decreases reinforcing pleasurable effects of alcohol by reducing person's craving for alcohol, thus reduce the risk of relapse.
naltrexone
Rehabilitation: treatment of alcohol dependence.

This drug help restore the biochemical system involved in alcohol dependence. Helps patient to maintain abstinence and reduce the risk of relapse.
acamprosate: act through glutamate to reduce craving and withdrawal.
Classes of sedative, hypnotic, and anxiolytic drug abuses. (3)
- barbituates
- non-barbituate sedative-hypnotics
- BZ
Classes of sedative, hypnotic, and anxiolytic drug abuses: non-barbituate sedative-hypnotics.

Name some drugs in this class.
meprobamate
methaqualone
2 groups of abusers of sedative, hypnotic, and anxiolytic drugs.

- teens or 20s
- obtain drug illegally
- recreational use
- coexist with psychopathology
Type I
2 groups of abusers of sedative, hypnotic, and anxiolytic drugs.

- mid-aged women
- obtain drug from physician
- use for nervouseness and become dependent
- no psychopathology
Type II
Misuse of sedative, hypnotic, and anxiolytic drugs can lead to ____. (3)
- intoxication
- withdrawal
- withdrawal delirium
Symptoms caused by misuse of sedative, hypnotic, and anxiolytic drug: name and time.

- lethargy
- impaired mental functioning
- poor memory
- irritability
- self-neglect
- emotional disinhibition
intoxication
early symptoms
Symptoms caused by misuse of sedative, hypnotic, and anxiolytic drug: name and time.

- slurred speech
- ataxia
- impaired coordination
intoxication
late symptoms
Symptoms caused by misuse of sedative, hypnotic, and anxiolytic drug: name and time.

- anxiety, restless, spprehensive
- coarse tremors
- hyperreflexia
- orthostatic hypotension
- autonomic hyperarousal: eg sweating
withdrawal
1st day
Symptoms caused by misuse of sedative, hypnotic, and anxiolytic drug: name and time.

- grand mal seizure
- delirium
- visual, somatic hallucination
withdrawal
2nd day
Withdraw process of sedative, hypnotic, and anxiolytic drug misuse/abuse should be supervised. Describe the process.
- tolerance test using pentobarbital/diazepam
- start withdrawal and taper off pentobarbital/diazepam
Which drug cause these effects?

- euphoria and sense of wellbeing, "orgasmic" initially
- drowziness, inactivity, psychomotor retardation, impaired concentration, "on the nod" follows.
- normal function until next dose necessry before withdrawal.
opioids
Symptoms of what kind and severity. What drug can be used to treat these?

- lacrimation, rhinorrhea
- sweating
- yawning
- piloerection, HTN, tachycardia
minor withdraw symptoms of opioids.

to treat: alpha2 agonist clonidine
Symptoms of what kind and severity.

- hot and cold flashes
- muscle and joint pain
- nausea, vomit, abdominal cramps
- severe anxiety, restlessness, irritability, insomnia, loss of appetite
severe withdrawal of opioids
to treat:
- methadone
- LAAM
- buprenorphin
What are the main drugs used to help detoxify(withdraw) opioid abuse? (4)
- methadone: long acting opiate
- clonidine; stop if BP<60
- naltrexone: mu-opioid antagonist, long acting
- buphrenophine: mixed agonist-antagonst of opioid receptors
- buphrenophine+naloxone/LAAM
What drug can be used to help anxiety and insomnia related to opioid withdrawal symptoms?
BZ
What drug can be used to help muscle and joint pain related to opioid withdrawal symptoms?
NSAIDs
What drug can be used to help GI symptoms related to opioid withdrawal symptoms?
dicyclomine
What are the two drugs used for opioid maintanence program?
- methadone
- LAAM
- buprenorphin
Which drug produces these effects?

- elevated mood, increased energy
- alertness
- decreased appetite
- improved task performance
CNS stimulants
Side effects of CNS stimulants.
- tachycardia
- HTN
- pupil dilation
These are symptoms of intoxication of ____.

- aggression, agitation
- impaired judgement
- transient psychosis
- tachycardia, hypertension
- mydriasis
- sweating
stimulants
These are withdrawal symptoms of ____.

- fatigue
- depression, dysphoria
- sleepiness
- hunger
- profuse sweating
- headache
- muscle cramps, stomache cramps
stimulants
Is there specific medications to detoxify stimulant abuse?
No. only treat target symptoms
- BZ for aggression,agitation
- antipsychotics for psychosis
- antidepressants if depression last more than 2 wks.
Which drug intoxication produces tactile hallucination called "coke bugs"?
cocaine
Name 2 hallucinogens.
LSD
MDMA(ecstacy)
What is this?

- profound alterations in perception: brighter color, more intense
- intense emotion
- more introspective
hallucinogen intoxification
What is this?

flashbacks consists of
- visual distortions
- geometric hallucinations
- misperceptions
hallucinogen persisting perception disorder
Which 2 drugs can incude schizophrenia?
- hallucinogen
- cocaine
Which intoxification is this?

- feeling of attachment, connection to others
- high energy
- altered time perception
- peacefulness
- increased desire for sex
ecstacy (MDMA)
Which substance adverse effets are these?

- anxiety
- depression
- psychosis
- cognitive, memory deficits
ecstacy

*cognitive and memory deficits are caused by disturbance in 5-HT transmission.
Which 2 drug abuse causes flashbacks?
LSD (hallucinogen)
PCP
Which drug abuse does not cause pupil dilation?
PCP
Which substance is this?

Effect:
- euphoria
- derealization
- tingling
- warmth
PCP
Which substance is this?

moderate dose:
- myoclonic jerks
- confusion
- disorientation
PCP
Which substance is this?

at high dose:
- coma
- seizure
- death (respiratory depression)
PCP
Difference between smoking marijuana and oral intake.
oral intake: slower onset and more powerful intoxification.
Does marijuana induce psychosis?
NO.
Which substance abuse is this?

- euphoria, serenity
- increase appetite, thirst
- self confidence
- conjunctivitis
- tachycardia
- dry mouth (cotton mouth)
- coughing fits
- impaired conversion from immediate to long term memory
- decreased REM sleep
marijuana (cannabis)
Compare alcohol and inhalant intoxification.
Similar, but inhalant toxification has shorter duration.
What is this substance abuse?

withdrawal symptoms:
- anxiety, irritability, restlessness
- decrease in HR
- hypotension
- depression
- increased appetite
- difficulty concentrating
nicotine
What is this substance abuse?

after cessation:
- weight gain
- depression
- mental cloudiness
nicotine
What are some treatment for nicotine addiction?
- nicotine patches and gum
- bupropion: antidepressant, decreases craving
- chantix (varenicline): competitive antagonism for nicotinic ACh receptor
Which drug intoxification is this?

- restlessness, irritability
- insomnia
caffeine
Which drug withdrawal is this?

- lethargy
- headache
- irritability
- depression
caffeine
Chronic use of which substance may cause the following:

- increase gastric acidity
- aggrevate esophageal and gastric disease
- worsen anxiety disease
- exacerbate fibrocystic breast disease in women
caffeine
Which drug intoxification is this?

- anergy
- dysphoria
- irritability
anabolic steroids
Drug effects of nitrou inhalants.
- fullness in the head
- mild euphoria
- change in time perception
- relaxation of smooth muscle
- increase sexual feelings
Which substance increases risks of immune suppression and respiratory irritation?
nitric inhalants ("poppers?)
Which drug intoxification is this?

- vomit
- severe headache
- hypotension
nitric inhalants
Which substance is called the "langhing gas"?
nirtic oxide
Which drug intoxification is this?

- lightheadedness, floating sensation
- temporary confusion or paranoia
nirtic oxide
Which type of alcohol related disorder is this?

- adult onset
- gradual increase in consumption
- guilt, worry, dependency, introversion
- no family history
- better response to treatment
Type I
Which type of alcohol related disorder is this?

- early onset
- gradual increase in consumption
- impulsivity, distractability, recklessness, antisocial personality disorder
- family history
- poor response to treatment
Type II
What symptoms of alcohol intoxification might you see at 150mg/dl serum level?
- slurred speech
- ataxia
What symptoms of alcohol intoxification might you see at 250mg/dl serum level?
- passing out
- unconsiousness
A patient presents with acne rosacea, palmar erythema, unexplained respiratory infections, bruises, amnesia. What would you suspect?
alcohol abuse
What is the clinical presentation for advanced alcohol abuse?
- liver disease
- jaundice, ascites
- testicular atrophy, gynecomastia
Withdrawal symtoms of alcohol:

- shakes
- 12-18hrs after cessation
- pk at 1-2 days
uncomplicated alcohol withdrawal
Withdrawal symtoms of alcohol:

- seizures
- 7-38 hrs after cessation
- pk at 1-2 days
alcoholic withdrawal seizures
Withdrawal symtoms of alcohol:

- hallucination with clear sensorium
- 48hrs after cessation
- lasts 1 wk
alcoholic hallucination
Withdrawal symtoms of alcohol:

- delirium
- 2-3 days after cessation
- pk at 4-5 days
alcohol withdraw delirium
"Reward circuit" is centered in what neurons in what area of the brian?
DA neurons in ventral tegmental area
Reward circuit:

DA neurons in ventral tegmental area project to what areas of the brain?
neucleus accumbens
prefrontal vortex
Reward circuit:

DA neurons in ventral tegmental area can be inhibited by ____.
GABA

GABA is inhibited by endogenous opioids, modulated by 5-HT.
What type of dependence is this?

Compulsively use drug when it is not pleasurable and there is a strong will to quit.
Psychological dependence.
What type of dependence is this?

unconscious learning that drug is survival.
Psychological dependence.
Psychological dependence: function of this brain structure.

orbitofrontal cortex
cravings, related to OCD
Psychological dependence: function of this brain structure.

prefrontal cortex
decreased inhibition of behavior via reasoned thought.
Psychological dependence: function of this brain structure.

limbic region
increased input to choices
What is protracted abstinence?
After discontinuation, long lasting HPA activation (NE, CRH) results in morphological neuronal changes which dampens reward circuit, resulting in anhedonia. So when cues are present, craving is reinstated but no physical signs are evident.
What receptor is being investigated to reduce protracted craving?
NMDA glutamate receptor

memantine is the drug being studied to manipulate this receptor.
What type of dependence is this?

Altered physical state from drug presence so that tissue function depends on drug preesnce.
physical dependence
What type of dependence is this?

Drug removal produces receptor-specific organ malfunction.
Withdrawal syndrome.

This is physical dependence.
T/F: Physical and psychological dependence each may occur without the other.
T.
Which 3 of the following peoduce strong psychological dependence?

- opioids
- stimulants
- depressants
- hallucinogens
- cannabinoids
- PCP
- anticholinergics
- opioids
- stimulants: weak physical dependence
- depressants
Which 4 of the following peoduce weak psychological dependence?

- opioids
- stimulants
- depressants
- hallucinogens
- cannabinoids
- PCP
- anticholinergics
- hallucinogens: no physical dependence
- cannabinoids: weak physical dependence
- PCP: no physical dependence
- anticholinergics: weak physical dependence
Which 3 of the following produce no physical dependence?

- opioids
- stimulants
- depressants
- hallucinogens
- cannabinoids
- PCP
- anticholinergics
- hallucinogens
- PCP
Which 3 of the following produce weak physical dependence?

- opioids
- stimulants
- depressants
- hallucinogens
- cannabinoids
- PCP
- anticholinergics
- stimulants
- cannabinoids
- anticholinergics
Which 2 of the following produce strong physical dependence?

- opioids
- stimulants
- depressants
- hallucinogens
- cannabinoids
- PCP
- anticholinergics
- opioids
- depressants
What type of drug are these?

- LSD
- MDMA
- mescaline (peyote)
- mushrooms (psilocybin)
hallucinogens
Types of tolerance:

results from changes in absorption, distribution, metabolism, or excretion that diminish concentrations of a drug at effector sites.
Dispositional tolerance (metabolic)
Types of tolerance:

results from adaptive changes in drug-sensitive systems that diminish the initial effects of a drug.
Pharmacodynamic tolerance (functional)
Types of tolerance:

results from practicing behavior under the influence of the drug when the effects of the drug results in a deficit in performance leading to some negative consequences.
Behavioral tolerance.
What is this drug?

- help prevent opioid relapse
- may reduce alcohol cravings
- may decrease cocaine abuse
naltrexone: long lasting opioid antagonist.
Which drug intoxication is this?

- psychological: initial euphoria, then drowziness
- physical: flushing, pupil constriction, hypotension, bradycardia, hypothermia
opioid
How to treat acute opioid overdose?
naloxone: short acting, quick effect.
Which drug intoxication is this?

- memory enhancement
- tremor
- nausea, vomit
- high dose convulsant
- calming, decreased aggression
- increase plasma levels of catecholamines and stress hormones.
nicotine
Which drug will produce withdrawal only 1hr after taking it?
nicotine
mechanism of amphetamines.
release NE(awake, increase BP, HR), DA (reward, talkativeness, stereotypy), 5-HT
mechanism of cocaine.
NE, DA, 5-HT reuptake blocker
short acting
mechanism of methylphenidate.
release NE, DA.
Which form of cocaine is smokable?
base form
What is this?

- can be synthesized from paint-thinner, pseudo-ephedrine.
- cadiovascular activation
- "meth mouth"
methamphetamine
What is this?

- made from plant
- tactile hallucinations ("coke bugs")
cocaine
What is this?

- distributed in body water
- zero order kinetics
- intoxication: ataxia, stupor, vasodilation, hypothermia
alcohol