Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
41 Cards in this Set
- Front
- 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...) |