Reading...
Play button
Play button
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;
89 Cards in this Set
- Front
- Back
|
What % of males have alcohol abuse problems? % of females?
|
males: 20%
females: 10% |
|
|
What % of males are alcohol dependent? females?
|
males: 10%
females: 5% |
|
|
What is the % lifetime prevalence of illicit substance abuse?
|
20%
|
|
|
What % of people use one or more illicit substances in their lifetime?
|
40%
|
|
|
What % of people used in the past year?
|
15%
|
|
|
How many Americans require treatment for alcohol abuse?
|
13 million
|
|
|
How many Americans require treatment for drug use?
|
27% of the population > 12 years of age
|
|
|
What % of hospital admission have drug/EtOH as a factor?
|
40%
|
|
|
What % of all deaths are related to drug/EtOH addiction?
|
25
|
|
|
What number of deaths per year are from drug/EtOH use?
|
100,000
|
|
|
Intoxication is associated with __ % of all MVAs, ___% of al DV cases and ___% of all murders.
|
50
50 50 |
|
|
What is intoxication?
|
a specific syndrome of maladaptive behavioral or psychological changes due to the recent ingestion of or exposure to a substance that acts of the CNS
|
|
|
What does neuroadaption refer to?
|
refers to the underlying CNS canges that occur following repeated use of a drug such that the person develops tolerance and/or withdrawal
|
|
|
Define tolerance as it relates to substances:
|
the need to use greatly increase amount of a substance in order to achieve the desired effect OR
a markedly diminished effect being associated with continued use of the same amount of the substance the degree to which tolerance develops varied greatly between |
|
|
Define withdrawal as it relates to substances:
|
maladaptive behavioral change with physiological and cognitive effect that occurs
when concentration of a substane declines in the body |
|
|
How do you Dx substance abuse?
|
a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one or more of the following
1. failure to fulfill role obligations or poor work performance 2. use on hazardous situations 3. substance related legal problems 4. persistent or recurrent social or interpersonal problems and never met criteria for dependence |
|
|
How do you Dx substance dependence?
|
a maladaptive pattern of substance use leading to clinically signficant impairment or distress, manifested by 3 or more of the following occuring at any time within the same 12 month period
tolerance - need for more to achieve the same effect - decreased effect with the same amount withdrawal - characteristic withdrawal syndrome - using substance to avoid withdrawal sx substance taken in larger amount for longer time than intended persistent unsuccessful attempts to cut down or control use great deal of time spend obtaining, using, or recovering from use important social, occupational, recreational activities given up or reduced use is continued despite knowledge that has persistent or recurrent phyical or psychological problems that were caused or exacerbated by use |
|
|
What is the learning and physiological basis for dependence?
|
reinforcing behaviors/pleasure circuit/reward circuit/hippocampal and limbic memory circuit
acute increases of levels of neurotransmitters in brain |
|
|
What % of patients are eventually able to abstain or decrease use criteria for substances?
|
70%
|
|
|
What are the five main elements of treating substance related disorders?
|
address the behavior
treat medical complications address comorbid psychiatric conditions address internal & external reinforcers treatment in the abmulatory setting and relapse prevention |
|
|
What is the indication for hospitilization for substance related disorders?
|
drug OD
risk of severe withdrawal medicla comorbidities requires restricted access to drugs psychiatric illness with SI |
|
|
What % of people with substance related disorders have another mental disorder?
|
50%
|
|
|
What are the clincal signs and symptoms of intoxication of alcohol?
|
blood alcohol level 0.08 or 1.0 g/dl (legal definition)
mood lability, impaired judement, ataxia. at higher doses see nystagmus, slurred speech, decreased concentration, anterograde memory loss "blackouts" |
|
|
Patient with mood lability, impairmend judgment, and ataxia has?
|
alcohol intoxication
|
|
|
What are some early signs of alcohol withdrawal?
|
anxiety
irritability tremor decreased con insomnia N/V |
|
|
What does delirium tremens look like?
|
confusion
alternating level of consciousness hallucinations HTN tachycardia diaphroesis vascular collapse |
|
|
When do delirium tremens usually appear?
|
within 72 hours of stopping alcohol
|
|
|
When do seizures usually occur in alcohol withdrawal?
|
48-72 hours
|
|
|
What does the clinical insitute withdrawal assessment for alcohol (CIWA) consist of?
|
assigns numerical values to things such as orientation, N/V, tremor, sweating, anxiety, agitation, tactile/auditory/visual disturbances and HA. VS checked but not recorded. Total score of >10 give meds and re-check in 1 hour.
|
|
|
Benzodiazepines agonist of ___ and cross tolerant with alcohol reduce risk of?
|
GABA
Seizures and provide comfort and sedation |
|
|
The use of anticonvulsants in alcohol withdrawal are?
|
reduce the risk of seizures, may reduce kindling, helpful for protracted withdrawal
|
|
|
Which anticonvulsants are used in alcohol withdrawal?
|
carbamazepine
valproic acid |
|
|
What is the mechanism of action of disulfram?
|
inhibits aldehyde dehydrogenase and dopamine beta hydroxialse
|
|
|
What happens if you take disulfram with alcohol?
|
adverse reaction - vasodilation, flusiong, N/V, hypotension/HTN, coma/death
|
|
|
What labs should you check prior to administering disulfram?
|
hepatoxocity
check LFT's and h/o help C |
|
|
What are the main side effects of disulfram?
|
neurologic with polyneuropathy/paresthesias that will slowly increase over time and increased risk at higher doses
psychosis depression confusion anxiety dermatologic rashes, itching watch our for diguised forms of alcohol |
|
|
What is the mechanism of action of naltrexone?
|
opioid antagonist thought to block mu receptors reducing intoxication euphoria and cravings
|
|
|
What is the main side effect of naltrexone?
|
hepatotoxicity at high dose
check LFTs |
|
|
What is the mechanism of action of acamprosate?
|
unkown mechanism of action but thought to stabilze neuron exicitation and inhibition
may interact with GABA and Glu receptor cleared renally |
|
|
What does benzodiazepine/barbiturate intoxication look like?
|
similar to alcohol but less cognitive/motor impairment
|
|
|
With regard to benzodiazepine/barbiturates, the more ________ and shorter the __________, the more 'addictive' they can be.
|
more
shorter the duration |
|
|
What does benzodiazpine withdrawal look like?
|
similar to alcohol with anxiety, irritability, insomnia, fatigue, HA, tremor, sweating, poor concentration
|
|
|
What is the most common detox mistake with benzodiazpeine withdrawal?
|
tapering too fast
symptoms worse at end of taper |
|
|
What three benzodiazapines are metabolized only through glucuronidation in liver and not affected by age/hepatic insufficiency?
|
lorazepam
oxazepam temazepam |
|
|
What is the mechanism of action of opioids?
|
bind the mu receptors in the CNS to modulate pain
|
|
|
What does opioid toxicity look like?
|
pinpoint pupils
sedation constipation bradycardia hypotension decreased respiratory rate |
|
|
What does opioid withdrawal look like?
|
not life threatening unless severe medical illness, but extremely uncomfortable
dilated pupils lacrimation goosebumps n/v diarrhea myalgias arthralgias dysphoria or agitation |
|
|
What is the treatment for opioid withdrawal?
|
symtomatically with antiemetic, antacid, antidiarrheal, muscle relaxant such as methocarbamol, NSAIDS, clonidine and maybe BZD
|
|
|
What is the neuroadaption when using opioids?
|
increased DA and decreased NE
|
|
|
What medications are used in the treatment of opiate dependence?
|
naltrexone - opiate blocker, mu antagonist
Methadone - opiate substitution therapy, mu agonist burenorphine - partial mu agonist/antagonist; low doses act a an agonist with pain control; at higher doses no increased effect and may behave like an antagonist |
|
|
What does acute intoxication with stimulants look like?
|
euporia, enhanced vigor, gregariousness, hyperactivity, restlessness, interpersonal sensitivity, anxiety, tension, anger, impaired judgement, paranoia
tachycardia, papillary dilation, HTN, diaphoresis, chills, N/V, weight loss, chest pain, cardiac arrhythmias, confusion, seizures, coma |
|
|
What does chronic intoxication with stimulants look like?
|
affective blunting
fatigue sadness social withdrawal hypotension bradycardia muscle weakness |
|
|
What is stimulant withdrawal treated with?
|
not severe but have exhaustion with sleep
treat with rest and support |
|
|
What are some SE of cocaine usage?
|
vasocontrictive effects taht may outlast use and increase risk for CVA and MI
rhavdomyolsis with compartment syndrome from hypermetabolic state psychosis associated with intoxication that resolves |
|
|
What is the neuroadpation with cocaine usage?
|
prevents reuptake of DA
|
|
|
What may be helpful in the cravings for cocaine?
|
disulfiram by inhibiting dopamine-beta-hydroxylase, increasing CNS dopamine levels
|
|
|
What does chronic use of amphetamines lead to?
|
neurotoxicity possibly from glutamate and axonal degeneration
can see permanent amphetamine psychosis with continued use |
|
|
What is the treatment for amphetamine use?
|
treatment similar to cocaine but no known substance to reduce cravings
|
|
|
What neuroadaption is associated with amphetamine use?
|
inhibit reuptake of DA, NE, SE and greatest effect by increased release of DA
|
|
|
What % of deaths in the US are associated with nicotine?
|
20%
|
|
|
What may be helpful in the cravings for cocaine?
|
disulfiram by inhibiting dopamine-beta-hydroxylase, increasing CNS dopamine levels
|
|
|
What does chronic use of amphetamines lead to?
|
neurotoxicity possibly from glutamate and axonal degeneration
can see permanent amphetamine psychosis with continued use |
|
|
What is the treatment for amphetamine use?
|
treatment similar to cocaine but no known substance to reduce cravings
|
|
|
What neuroadaption is associated with amphetamine use?
|
inhibit reuptake of DA, NE, SE and greatest effect by increased release of DA
|
|
|
What % of deaths in the US are associated with nicotine?
|
20%
|
|
|
What may be helpful in the cravings for cocaine?
|
disulfiram by inhibiting dopamine-beta-hydroxylase, increasing CNS dopamine levels
|
|
|
What does chronic use of amphetamines lead to?
|
neurotoxicity possibly from glutamate and axonal degeneration
can see permanent amphetamine psychosis with continued use |
|
|
What is the treatment for amphetamine use?
|
treatment similar to cocaine but no known substance to reduce cravings
|
|
|
What neuroadaption is associated with amphetamine use?
|
inhibit reuptake of DA, NE, SE and greatest effect by increased release of DA
|
|
|
What % of deaths in the US are associated with nicotine?
|
20%
|
|
|
What percent of smokers die of tobacco induced disorder?
|
45%
|
|
|
What % of schizophrenia patients smoke?
|
75-90%
|
|
|
What does nicotine intoxication look like?
|
abdominal pain
dizziness HA N/V palpitations |
|
|
What neuroadaption is associated with nicotine?
|
nicotine acetylcholine recpetors on DA neurons in ventral tegmental area release DA in nucleus accumbens
|
|
|
What does withdrawal of nicotine look like?
|
dysphoria
irritability anxiety decreased concentration insomnia increased appetite/weight gain cravings |
|
|
What is the treatment for nicotine?
|
CBT
agonist substituation therapy - nicorette gum, transdermal patch, nasal spray medication: bupropion |
|
|
What are the symptoms of MDMA intoxication?
|
enhanced empathy
personal insight euphoria increased energy |
|
|
What are some of the SE of MDMA?
|
parkinsons in animals
hyperthermia dehydration seizures CV renal failure coma death |
|
|
What does MDMA intoxication look like?
|
illusions
hyperacusis sensitivity to touch taste/smell altered synesthesia 'oneness with the world' tearfulness euphoria panic paranoia impairment of judgement |
|
|
What is a deterant to MDMA addiction?
|
teeth grinding
|
|
|
What neuroadaption happens with MDMA?
|
affects serotonin, DA, NE but predominatly former
|
|
|
What neroadaption happens with cannabis use?
|
CB1, CB2 cannabinoid receptors in brain/body
coupled with G proteins and adenylate cyclase to CA channel inhibitng calcium influx neuromodulator effect; decrease uptake of GABA and DA |
|
|
What are the symptoms of cannabis withdrawal?
|
not in the DSM
insomnia irritability anxiety poor appetite |
|
|
What is PCP?
|
dissociative anesthetic
similar to ketamine |
|
|
What does PCP intoxication look like?
|
severe dissociative reactions - paranoid delusions, hallucinations, and can become very agitated/violent with decreased awareness of pain. do not try ot talk down - needs quiet and low stimulation
|
|
|
What are some cerebellar symptoms of PCP intoxication?
|
ataxia, dysarthria, nystagmus (vertical and horizontal)
|
|
|
With severe OD on PCP, you can see?
|
mute
catatonic muscle rigidity hyperthermia rhabdomyoisis seizures coma death |
|
|
What is the treatment of PCP?
|
antipsychotic drugs or BZD if required
acidifiy urine with IV ammonium chloride if sever toxicity/coma |
|
|
What neuroadaption is seen with PCP?
|
opiate receptor effects
allosteric modulator of the glutamate NMDA receptor |
