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38 Cards in this Set
- Front
- Back
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What's drug abuse?
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Use of a drug in a fashion inconsistent w/medical or social norms
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What's addiction?
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A disease process characterized by continued use of psychoactives despite physical, psychological, or social harm
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What's tolerance?
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The inability of a particular dose to get the response that was previously achieved. Higher doses needed to achieve this state. Regular use drug leads to drug tolerance.
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What's cross-tolerance?
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Tolerance to one drug confers tolerance to another (within the same drug class)
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What's psychological dependence?
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Intense subjective need for a drug
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What's physical dependence?
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Abstinence syndrome due to neuro-adaptive processes will occur if drug use is discontinued
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What's cross-dependence?
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One drug will support physical dependence to another drug and prevent withdrawal (example: methadone & heroin)
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What's withdrawal syndrome?
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Many signs & symptoms occurring in the physically dependent individual stopping drug use. Use & disuse act in opposition: Discontinuation of a CNS depressant can cause CNS excitation, for example.
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What is the diagnostic criteria for substance abuse & dependence?
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DSM-IV published by the American Psychiatric Assn
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What is more severe, substance abuse or substance dependence?
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Substance dependence = Addiction IS a more severe disorder than substance abuse
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Which criteria help define substance dependence?
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Tolerance & withdrawal
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Are tolerance & withdrawal sufficient for substance dependence to exist?
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NO! THIS IS AN IMPORTANT DISTINCTION:
An individual can have a pattern of drug use consistent w/substance dependence w/o being physically dependent or having developed tolerance. |
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Is being physically dependent on a drug the same as being addicted?
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NO! Many people are physically dependent, but don't meet the criteria for substance dependence. They don't display the behavior pattern. (Ex: Terminal cancer pts ARE physically dependent, but their lives are NOT disrupted BUT aided by their meds)
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What's the relationship between physical dependence & addiction?
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Physical dependence contributes to addictive behavior.
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How do reinforcing properties of drugs contribute to drug use?
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Pleasure & reduction of anxiety + stress
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How does physical dependence contribute to drug use?
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Physical dependence is greatest in people who take large doses for a long time. The more dependent, the worse the withdrawal syndrome. Avoidance of withdrawal stimulates continued use.
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How does psychologic dependece contribute to drug use?
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Cravings & belief that sense of well-being depends on continued drug use
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How do social factors contribute to drug use?
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Peer approval and social status are common reasons to initiate drug use
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How does drug availability contribute to drug use?
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Availability increases drug use
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How does individual vulnerability contribute to drug use?
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Individuals have different predispositions towards use. Some of this predispositions include genetics, depression & anxiety disorders, among others.
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How does addiction affect the brain?
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Repeated use causes molecular changes in the brain that lead to more drug use.
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Where does synaptic remodeling tied to addiction take place in the brain?
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In the Dopaminergic reward circuit in charge of reinforcing behaviors essential for survival
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How does the Dopaminergic reward circuit work?
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Reward circuit neurons originate in the ventral tegmental area of the midbrain. They project to the nucleus accumbens. Their major transmitter is dopamine. Sex & eating activate the circuit.
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How do drugs affect the Dopaminergic reward circuit?
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They turn the system on (Euphoria), promote synapse remodeling and changes in brain function. This leads to compulsive behavior to keep turning the system on.
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Can the brain of a junky or an alcoholic revert from its synaptic remodeling?
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NO! Remodeling stays even if drug use has stopped. That's why "once an alcoholic, always an alcoholic"
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Is drug addiction treatable?
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Yes, 40-60% of addicts can reduce drug use
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What are successful outcomes for addiction treatment?
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- Complete cessation
- Drug use from compulsive to moderate (to increase individual's productivity, health, etc.) Most individuals require complete abstinence as they are unable to sustain moderation |
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Is addiction recovery simple?
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No, it's a Chronic Relapsing Illness needing multiple treatment episodes. The treatment must be individually tailored & comprehensive + multifaceted
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What techniques have been successful in treating addiction? (4)
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1. Therapy resolving emotional problems related to drug use
2. Substitution of alternative rewards for the rewards of drug use 3. Threats and external pressure to discourage use 4. Use of pharmacological agents to modify the effects of the drugs abused |
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What is the main federal legislation addressing drug abuse?
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The Comprehensive Drug Abuse Prevention & Control Act of 1970 regulates handling of controlled substances by distributors, pharmacists, RN's & MD's
DEA enforces legislation |
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How are controlled substances tracked?
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Records of transactions & inventories involving these drugs must be kept & reported to DEA every 2 yrs.
Hospitals require floor stocks to be counted at start & end of each RN shift |
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What are DEA schedules?
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I: High potential for abuse & no proven medical use
II - V: All approved for medical use. However, lower numbers mean a higher potential for physical/psychological dependence Prescribers must register w/DEA |
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How are Schedule I drugs prescribed?
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They are not prescribed & are illegal.
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How are Schedule II drugs prescribed?
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- Typed or ink & signed by prescriber
- Oral instructions can be made only for emergencies, but require a written one within 72 hrs. - Refills can be written on the same day for a 90-day supply to be filled sequentially. |
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How are Schedule III & IV drugs prescribed?
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- Oral or written
- Refills up to 5x within 6 mos of original order |
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How are Schedule V drugs prescribed?
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- Oral or written, however they can be dispensed w/o a prescription if: a. dispensed by a pharmacist, b. limited amount, c. pt is 18 yrs, d. pharmacist keeps a record, & e. state & local laws allow it.
- Refills up to 5x within 6 mos of original order |
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How are controlled substances labelled?
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Label must read: "Caution - Federal law prohibits the transfer of this drug to any person other than the pt" along with indication of Schedule (C-II, C-III, etc)
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Which regulations to follow when federal and state laws differ?
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The more restrictive law takes precedence
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