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41 Cards in this Set

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  • Back
Define Denial
Family members and the substance abuser often behave like there is no problem
T/F: Family members of drug abusers may self protect drug abuser and take the blame/responsibility for the drug abuser.
TRUE
What are the 4 principles of behavior therapy theory of substance abuse?
Positive reinforcing effects, adverse effects, Discriminate substance of abuse from other substances, Substance seeking behavior is associated with cue that becomes connected with the experience
T/F: alcohol abuse has a genetic component
TRUE
Describe the neurobiological mechanism of addiction
Chronic, Compulsive, relapsing, disorder
What are the 3 stages of Neurobiological Mechanisms of Addiction?
1. Binge/Intoxication stage
2. Withdrawal/Negative affect stage
3. Preoccupation/Anticipation stage

All these help transition pt into an addict
Increases in what hormones make you feel good when abusing drugs? ie positive hedonic effects?
Inc. Dopamine, Inc. Opioid peptides, Inc. serotonin, Inc. GABA
Decreases in what hormones make you feel bad when abusing drugs ie negative hedonic effects = withdrawal
Dec. Dopamine, Dec. opioid peptides, Dec. serotonin, Dec GABA
What are the main neurotransmitters implicated in the binge/intoxication stage?
dopamine, opioid peptide, GABA and endocannabinoids
What two areas of the brain are essential in making the patient crave the drug again and again?
Nucleus acumbens and amygdala
What neurotransmitters are associated with drug withdrawal ie brain stimulation reward in the negative effect stage?
dec dopaminergic and serotonergic transmission in the nucleus acumbens during withdrawal
Describe the neurotransmitters and what role they play in the withdrawal phase of drug addiction
Dec Dopamine = Dysphoria
Dec Serotonin = Dysphoria
Dec GABA = Anxiety, panic attacks
Dec NPY = anti-stress

Inc Dynorphin = Dysphoria
Inc. CRF = stress
Inc. Norepinephrine - stress
Inc. Glutamate = hyperexcitability
Whats the key element in relapse in humans?
Preoccupation/Anticipation stage
T/F: research studies show that up to 50% of addicts have a co-morbid psychiatric disorder
TRUE - they're all in jail womp womp
T/F: pts with substance abuse problems are 20 times more likely to die by suicide
TRUE
Define Dependence
Essential feature = a cluster of cognitive, behavioral and physiological symptoms indicating that the pt continues use of the substance despite significant substance-related problems

for ex tolerance in seen, withdrawal symptoms are seen, unable to quit substance, much time spent obtaining substance etc.
How do you tell Alcohol (EtOH) Intoxication from withdrawal?
Intoxication = Inappropriate sexual activity, agressive bahavior, mood lability, impaired judgement PLUS one ore more of the following: slurred speech, incoordination, unsteady gait, nystagmus (eye movement), impaired attention/memory, stupor or coma

Withdrawal = 2 or more of the following occuring several hrs or a few days: Autonomic hyperactivity (sweating etc), hand tremor, insomnia, N/V, Hallucinations, psychomotor agitaion, anxiety, grand mal seizures
Delerium tremens manifests as what symptoms and occurs during withdrawal of what substance?
Delirium tremens = one week after alcohol cessation

HTN, Tachy, diaphoresis, fever, anxiety, insomnia
How do we treat delirium tremens (HTN, tachy, diaphoresis, fever, anxiety, insomnia)
Tx = Benzos oral or parenteral
T/F: Delirium tremens carry mortality rate of 20%
TRUE
How do we treat alcohol dependence?
Disulfram = inhibits aldehyde dehydrogenase
Naltrexone = opioid receptor blocker = reduced cravings
Acaprosate = affects glutamate and GABA NTs (stabilizes chemical balance in brain)
Whats the most widely used ILLICIT substance (ie NOT alcohol bc lets be honest we're all alky's....) in the world?

(vs cannabis sativa = the most COMMONLY used illicit drug in the US)
Amphetamines (ie ADHD meds)

= Methamphetamines = wakefulness, inc. physical activity, dec. appetite, inc. respiration, hyperthermia, euphoria, irritability, insomnia, confusion, tremors, convulsions, anxiety, paranoia and aggresiveness
What are the affects of methamphetamines on the body?
inc. HR and BP, irreversible damage to blood vessels = strokes, respiratory probs = irregular HR, CV collapse, Hyperthermia and convulsions can result in death
How do we tell Intoxication from Withdrawal with Amphetamines?
Intoxication = 2 or more: tachy/brady, pupil dilation, Inc or Dec BP, Persperations/chills, N/V, Weight loss, psychomotor agitation/retardation, Muscle weakness/respiratory depression/chest pain, confusion/seizures/dyskinesia/dystonia, coma

Withdrawal = 2 or more: fatigue, vivid/unpleasant dreams, insomnia/hypersomnia, inc. appetite, psychomotor agitation or retardation. Peak within 2-4 days but resolve within a week with MOST symptoms being depression
How do we treat a pt who when on a certain drug has pupillary dilation, tachy, wt. loss and psychomotor agitation and when OFF The drug experiences fatigue, bad dreams, inc appetite?
Think Amphetamines

Tx= abstinence from drug, individual/group/family psychotherapy

TREAT THE DEPRESSION
How do we tell the difference between Intoxication and Withdrawal from THC ie the refer?
Intoxication = 2 or more: Impaired motor coordination, euphoria, anxiety, slowed time, impaired judgement, social withdrawal (conjunctiva injection, inc appetite, dry mouth, tachy)

Withdrawal: NONE!!!!!
MOA of cocaine?
blocks the removal of Dopamine from the synapse of neurons in the nucleus accumbens - these neurons originate in the ventral tegmental area

Ie it blocks D1 and D2 receptors = blocks reuptake of Norepi and serotonin
T/F: Cocaine only lasts 30-60 min.
TRUE
How do we tell Intoxication from Withdrawal with cocaine?
Intoxication = 2 or more: Tachy/brady, PUPILS DILATED, inc or dec BP, Persperation/chills, N/V, weight loss, psychomotor agitation, retardation, muscle weakness/respiratory depression/chest pain/arrhythmias, confusion/seizures/dyskinesia/dystonias, coma

Withdrawal =2 or more: fatigue, vivid/unpleasant dreams (like amphetamines), insomnia or hypersomnia (like amphetamines), inc. appetite, psychomotor agitation or retardation
T/F: Amphetamines and cocaine have exactly the same Intoxication and Withdrawal symptoms?
TRUE:

Intoxication = 2 or more: Tachy/brady, PUPILS DILATED, inc or dec BP, Persperation/chills, N/V, weight loss, psychomotor agitation, retardation, muscle weakness/respiratory depression/chest pain/arrhythmias, confusion/seizures/dyskinesia/dystonias, coma

Withdrawal =2 or more: fatigue, vivid/unpleasant dreams (like amphetamines), insomnia or hypersomnia (like amphetamines), inc. appetite, psychomotor agitation or retardation
What are the adverse effects of cocaine?
Cerebrovascular non-hemorrhagic infarctions most common (MOA = vasoconstriction)

Seizures, MIs, death can occur
Whats the treatment goal for treating a pt that's been on cocaine?
Abstinence from a drug that is powerfully reinforcing and induces cravings

TREAT THE DEPRESSION
Which opioid is most associated with abuse and dependence
Heroin
What are the classes of opioid receptors and their actions?
u-receptor = regulation and medication of analgesia, resp. depression, constipation and dependence
k receptor = analgesia, diuresis, sedation
sigma receptor = analgesia
T/F: 90% of pts with opioid dependence have a concurrent psychiatric disorder
TRUE

major depressive disorder most common
alcohol use disorder
antisocial disorder
anxiety
How can we tell the Intoxication and Withdrawal symptoms apart with Opioids like heroin?
Intoxication = euphoria, apathy, dysphoria, psy. agitation/retardation (pupil CONSTRICTION (vs cocaine/amphetamines = pupil dilation), drowsiness, slurred speech (like alcohol), impaired attention/memory

Withdrawal = cessation of use and 3 or more: Dysphoric mood, N/V, muscles ache, D, yawning, fever, insomnia, lacrimation/rhinorrhea, PUPILS DILATE (piloerection, sweating)
Use of which drugs results in pupils DILATING? Constriction?
Dilate = Cocaine, Amphetamines, (withdrawal from opioids)

Constrict = Opioids (Heroin)
Difference between sedatives, hypnotics and anxiolytics?
Sedatives = reduce subjective tension and mental calmness
Hypnotics = induce sleep
Anxiolytics = alleviate nervousness
How do we tell Intoxication from Withdrawal with Benzos and Barbiturates?
Intoxication = inaprop. sexually aggressive behavior, mood lability, impaired judgement and 1 or more: slurred speech, incoordination, unsteady gait, nystagmus, impaired attention/memory, stupor/coma

Withdrawal = 2 or more over several hrs/days: autonomic hyperactivity ie sweating/pulse rate etc, hand tremor, insomnia, N/V, Hallucinations, psychomotor agitation, anxiety, grand mal seizures
T/F: cocaine and amphetamine intox/withdrawal symptoms are the same, and Alcohol/Benzos/Barbiturate intox/withdrawal symptoms are the same
TRUE
How do we treat a pt who has sweating, inc. pulse rate, hand tremor, insomnia, grand mal seizures?
Thinking either alcohol OR benzos/barbiturate withdrawal

IF benzo/barbiturate withdrawal, treat with:

IF OD = Tx with gastric levage, activated charcoal, ICU if comatose w/ airway protection

IF Detox needed = Tx with dec dose over SEVERAL WEEKS (think about how you had to come off Ambien when you stopped it...)