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62 Cards in this Set

  • Front
  • Back
what is the definition of "substance?"
psychoactive agent having the potential to cause abuse or dependence
what is the definition of "addiction?"
chronic disorder associated w/ use of a substance
what are the two parts of dependence?
physical
psychological
what is the criteria for abuse?
use over 12 months associated w/:
difficulty meeting obligations at work, school, and home due to substance use
continued use in situations which could physically be dangerous
frequent legal problems secondary to use
continued use despite social or interpersonal problems
**abuse leads to dependence!!! once a pt has been diagnosed w/ dependence, they cant be diagnosed w/ abuse***
what is the criteria for dependence?
pattern of use over 12 months associated w/ at least 3 of:
tolerance
w/drawl
larger amts used over longer period of time
desire/effort to reduce use
time spent seeking/using/recovering
give up important activities
continued use despite negative consequences
what are the four parts of the clinical presentation of alcohol use disorder?
intoxication
w/drawl
dependence/abuse
medical complications
what is the average per person annual consumption of alcohol?
2.77 gallons
describe the propsed effect alcohol has on various NTs
increase GABA
decrease glutamate
increase serotonin, DA, opioid
what is the CAGE screen for diagnosis of alcoholsim?
have you ever:
thought you should CUT back on drinking?
been ANNOYED by criticism of your drinking?
felt GUILTY about drinking?
had a morning EYE-OPENER to relieve hangover/nerves?
describe the general characteristics of w/drawl from a substance
usually the opposite of acute effects of the drug
goals of therapy: prevent complications, provide support, reduce sx
what are some non-pharm methods to tx dependence or abuse?
cognitive therapy
individual/group therapy
family therapy
what types of pharmacotherapy are available for dependence/abuse?
aversion therapy
substituion therapy
true or false: alcoholism is as high of a risk factor for suicide as depression
true
what laboratory findings are consistent w/ EtOH abuse?
BAL
+ breathalyzer
elevated MCV, AST, ALT, LDH
decreased B12, folic acid, albumin
incrased uric acid, elevated amylase, bone marrow supression
list some alcohol induced disorders
intoxication
w/drawl
DTs
wenicke's encephalopathy
medical complications
what is the treament for alcohol intoxication?
time
protective environment
when is the typical onset for alcohol w/drawl?
several hours after last drink
what are the clinical features of alcohol w/drawl?
tremor, N/V, anxiety, HA, insomnia, HTN, tachycardia, sweating, possible seizure, hallucination
3-5 days later: DTs
what sx are associated w/ DTs?
occurs 3-5 days after cessation of EtOH: confusion, hallucination, agitation, fever, autonomic instability; 5% mortality if untx
what is the tx for alcohol w/drawl?
BZDs
thiamine
what "triad" characterizes wenicke's encephalopathy?
abrupt onset of: ataxia, nystagmus, mental confusion
what can happen to pts who don't recover from wernicke's?
progression to korsakoff's psychosis (chronic amnestic disorder)
what is the treatment for wernicke's?
thiamine prior to glucose then daily until normal diet resumed
what are some medical complications associated w/ EtOH use?
hepatic: fatty liver, hepatitis, cirrhosis, esoph varices
wern/kors
periph neurop
stroke
cardiomyop, arrhyth
cancer
sex dysfx
what is nonpharm tx of EtOH dependence?
individual counseling
group therapy
family eval/tx
12-step program
list some possible tx for EtOH dependence
disulfiram**
naltrexone**
acamprosate**
SSRI, odansetron, TCAs, buspirone, baclofen, topiramate
what is the MOA of disulfiram?
interferes w/ aldehyde dehydrogenase - causes a buildup of acetaldehyde
what will happen if EtOH is taken w/ disulfiram?
drowsiness, rash, peripheral neuropathy, metallic/garlic-like aftertaste, hepatotoxic, N/V, flushing, tachycardia, palpitaions, possible death from CV collapse
what pt counseling point should be emphasized w/ pts using disulfiram?
using ANY alcohol containing product will cause a rxn (topical, mouthwash, etc.)
do not take for at least 12 h after drinking
SERIOUS CONSEQUENCES of disulfiram-EtOH rxn
what is naltrexone's moa?
how does it help w/ EtOH abuse?
opioid antagonist
may be effective in reducing # of drinks consumed/craving for EtOH
good for binge drinking
what ADRs are associated w/ naltrexone?
**hepatotoxicity
nervousness, HA, abdominal cramping, N/V, arthralgia, anxiety
what pt counseling points should be emphasized w/ naltrexone?
do not use any opioid containing products - w/drawl w/ occur
what is the MOA of acamprosate?
GABA agonist, glutamate antagonist
what ADRs are associated w/ acamprosate?
anxiety, depression (these may be a prob w/ some pts)
insomnia diarrhea nausea
what drug interactions are significant w/ acamprosate?
drug is in a calcium salt form, so will bind quinolones and tetracycline
what signs of intoxication are seen w/ opioid use?
pupillary constriction
decreased GI motility
sedation
slurred speech
memory impairment
apathy
motor retardation
IV heroin produces what pleasurable effect?
what happens w/ continued use?
euphoria
tolerance
what are the signs of opioid w/drawl?
flulike
anxiety, dysphoria
disrupted sleep
pupillary dilation
true or false: opioid w/drawl is life-threatening?
false
true or false: EtOH w/drawl is life-threatening?
true
what is used to treat acute opioid intoxication?
naloxone
what is naloxone's MOA?
opioid anagonist
what agents are used to treat opioid w/ drawl and how do they work?
clonidine: reduces autonomic sx (central alpha2 agonist)
may cause depression, dizziness, orthostasis, dry mouth, hypotension, somnolence, nausea
substituion therapy: methadone
buprenorphine
what drugs are used to treat opiod dependence?
methadone
buprenorphine
buprenorphine/naloxone
sometimes naltrexone
describe the restrictions of methadone use
methadone maint programs are req'd to be registered and follow many regulations
what is the MOA of methadone and how does it help w/ opioid dependence?
opioid agonist
blunts euphoric response to heroin
what pts are eligible for methadone maintenance?
current evidence of tol/w/drawl
h/o dependence >1 year
failed prior tx attempts
>18 yo
pregnant
true or false: pt who will use methadone should be detoxed first
false
what ADRs are associated w/ methadone?
euphoria, dysphoria, sedation, constipation, resp depression, dizzy, decreased HR
what is the MOA of buprenorphine?
partial opioid agonist/antagonist
what is the benefit of using buprenorphine?
less abuse potential - high doses = antag - will induce w/drawl
true or false: pts who will use buprenorphine should be detoxed first
false
what are the ADRs of buprenorhpine?
N/V, HA, sweating, sleep difficulties, hypotension, sedation, flu-like sx, dizziness, resp depression
what restrictions are associated w/ buprenorphine?
dr.s must be registered and trained, receive special DEA#, can only have 30 pts at a time. "office based"tx
when is buprenorphine & naloxone used and what are its benefits
used for maintenance (bup alone for induction)
naloxone component diverts IV use
true or false: pts who will use naltrexone should be detoxed first?
true
which drug used to treat opioid dependence is associated w/ compliance issues and requires detoxification prior to tx?
naltrexone
what pleasurable feelings are associated w/ cocaine use? what physical sx?
euphoria, alertness, grandiosity, impaired judgement, sexual arousal
tachycard, pupillary dilation, increased BP, sweating/chills, N/V, visual/tactile hallucination
to which effects of cocaine use does tolerance develop?
which effects have decreased tolerance?
euphoria
decreased tol to anxiety/panic
describe the three phases of cocaine abstinence
phase 1 (the crash): dyphoria, anxiety, intense craving, suicidal, anhedonia
phase 2: low level craving, irritable, anxiety, decreased capacity for pleasure
phase 3: mild craving, some pts will have major depressive d/o
what is treatment for cocaine dependence?
psychotherapy
what is tx for cocaine w/drawl?
no meds effective
if delusions/paranoia: APs or BZDs