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132 Cards in this Set
- Front
- Back
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what is the role of genetics (percentage of likelyhood) in the variability of developing a drug addiction?
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contributes 40-60% of the variability in addiction
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what is the physical etiology that causes drugs to elicit an addictive response?
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increases dopamine release in the nucleus accumbens
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what are the two most prevelant personality disorders associated with drug abuse?
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1. antisocial
2. borderline |
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which personality disorder has been particulary associated with cocaine abuse?
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narcissistic personality disorder
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what percentage of the american population between the ages of 15-54 has had an alcohole or drug addiction at some point?
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27%
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what percentage of daily abusers have a comorbid psychiatric disorder?
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75%
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who is more likely to develope a substance abuse disorder, men or women?
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men
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which ethnic group drinks the least in america?
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Asian-Americans
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what percentage of patients seen in hospital/out patient settings are drug abusers?
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25-50%
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Primary care physicians miss what percentage of drug abusing patients?
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50-90%
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if a patient presents with a mood disorder does that mean you should test them for drug use?
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Actually yes, with alterations of mood or behavior should be tested for drug use with either a blood or urine test
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to determine if a maladaptive pattern is developing, one must present _#_ of symptoms during a _#_ time period
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1. 3 symptoms
2. 12 month period |
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what percentage of alcohol in a beer can be absorbed directly by the stomach?
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20%
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what percentage of consumed alcohol leave the body un-metabolized?
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5%
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who is more adversely effected by alcohol consumption, men or women?
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women, less body water, less ADH, greater volnurability to liver disease
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describe the process of alcohole metabolism?
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1. alcohole is converted into acetaldehyde by Alcohole Dehydrogenase
2. Acetaldehyde is converted into acetate, CO2, and H2O by Aldehyde Dehydrogenase |
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what unique enzyme abnormality protects up to 50% of the asian population from alcoholism?
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ALDH2 variant which makes aldehyde dehydrogenase much less efficient causing nausia, headache, and flushing from build of of aldehyde
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Describe the prototypical person with type II alcoholism?
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Male, early and rapid onset, impulsive, anti-social personality, family member with alcoholism, does not respond well treatment
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describethe prototypical person with type I alcoholism?
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Adult onset, slow progression, introverted, feelings of guilt and worry, no family history of alcoholism
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which type of alcoholism is more prevelant?
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Type II (75%)
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what ranking does death from alcohole consumption rank in America?
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3rd leading cause
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chronic alcoholism can reduce lifespan by what length?
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up to 15 years
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what percentage of car crashes involve alcohol?
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50%
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what is a facial skin disorder resulting from chronic inflammation of the cheeks, nose, chin, forehead and/or eyelids; often demonstrated by increased redness or acne-like eruptions?
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Acne rosacea - seen with chronic alcoholism
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what causes palmer erythema in alcoholics?
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high estrogen levels associated with liver dysfunction
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what is a painless thickening and contracture of the tissue beneath the skin on the palm of the hands and fingers which may result in deformity and loss of function?
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Dupuytren's contractures
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what test, when elevated can indicate that a person has been drinking at least 4-6 drinks per day?
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Mean Corpuscular Volume
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what enzymatic assay can be 40-60 % sensitive and 80% specific for chronic alcoholism?
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gamma-glutamyltransferase (GGT) greater than 30 U/L
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describe the unique blood chemistry you might find in a chronic alcoholic?
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increase blood lipids and uric acid
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what is the very sensitive and specific test which evaluates levels of carbohydrate-deficient form of iron transport protein?
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carbohydrate deficient transferrin (CDT) assay
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why are levels of uric acid increased in chronic alcoholism?
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alcohole metabolism increases lactic acid production which competes with uric acid metabolism causing it to build up
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in alcohol related liver disease what will be more elevated, AST or ALT?
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AST
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why are alcoholics more likely to get infectious diseases?
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alcohole causes bone marrow suppression
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what percentage of people who commit suicide were abused alcohole?
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25-50%
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when does alcohole withdrawal begin?
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6-8 hours after drinking
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when does alcohole withdrawal peak?
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24-48 hours
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when will alcohole withdrawal be complete?
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5-7 days
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when do "rum fits" begin?
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7-38 hours after stopping alcohole consumption
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when do rum fits peak?
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24-48 hours
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what type of alcoholics are prone to rum fits?
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those who are chronic, long-term drinkers
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rum fits are considered to be what kind of seizure?
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Grand Mal
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when does alcoholic hallucinosis begin?
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48 hours after sessation of alcohole consumption
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how long do alcoholic hallucinations last?
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about 1 week
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what are the most severe complications of alcohole withdrawal?
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delirium tremens - if not treated can cause death
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describe the time-frame of onset and duration for delirium tremens?
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starts 2-3 days after stopping drinking and lasts for up to 3 days
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what is the mortality rate with delerium tremens?
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20%
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what causes Wernicke-Korsakoff Syndrome?
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lack of thiamine (vitamin B1)
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what are the two severe complications of Wernicke-Korsakoff Syndrome?
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1. Wernicke's Encephalopathy
2. Wernicke's Psychosis |
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why does wernicke's encephalopathy cause opthalmoplegia, nystagmus, and diplopia?
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it involves lesions of the motor nuclei of the oculomotor, trochlear, abducens, and vestibular nerves
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aside from the opthalmoplegia, what other symptoms to individuals with Wernicke's encephalopathy present with?
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Ataxia and acute confusional state manifested by memory impairment and apathy
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loss of short-term memory, reduced initiative or spontaneity, and confabulation in a chronic alcoholic indicate?
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Korsakoff's Psychosis
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what percentage of patients with Wernicke's encephalopathy go on to develope Korsakoff's Psychosis?
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80-90%
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what is the increase in risk for developing alcoholism when a parent is an alcoholic?
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4x greater risk
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what are the two mechanisms by which alcohol might induce addiction?
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1. releases endorphins
2. increases mu-opiate receptors in the ventral striatum |
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what is the DOC for alcohol withdrawal?
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Benzodiazepines - because effectiveness is not compromised with chronic alcohole use like a barbituate would be, also safe for detox physical symptoms
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when is inpatient treatment required with alcohol withdrawal?
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when seizures are present
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which two benzodiazepines, because of their long half-life tend to make withdrawal smoother and minimize rebound withdrawal symptoms?
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1. Diazepam (Valium)
2. Chlordiazepoxide (Librium) |
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which BZ's (2) are better for the elderly and those with hepatic dysfunction and why?
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1. Oxazepam (Serax)
2. Lorazepam (Ativan) They are short-acting |
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which is the only BZ with predictable IM availibility?
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Lorazepam
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What are the "LOT" drugs that are better for use in elderly and those with hepatic dysfunciton?
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1. Loraxepam
2. Oxazepam 3. Temazepam |
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describe the metabolism of LOT drugs?
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conjugation with glucoronic acid by glucuronosyltransferase
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what percentage of alcoholics relapse?
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50%, most within the first 6 months
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what drug therapy can be given to make patients sick when they drink alcohol?
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Disulfiram by inhibition of aldehyde dehydrogenase
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what are three drugs which can decrease cravings with alcoholism?
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1. Naltrexone
2. Acamprosate 3. Topiramate |
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how long does the alcohole disulfiram reaction last once the drug has been stopped?
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up to 2 weeks
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what is the mechanism by which naltrexone stops alcohol cravings?
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blocks opiod receptors - blocks euphoria experienced by alcohol users
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what is one thing to be careful about when giving naltrexone to drug users?
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it can precipitate opiate withdrawal
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how does acamprosate work?
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it mimics the effects of GABA thereby decreasing the euphoria felt by alcoholics
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why are BZ's preferably compared to barbituates?
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mare larger margin of safety including
-no respiratory depression - large ration of lethal to effective dose |
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what is the main indication for phenobarbital?
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anticonvulsant
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what is the most likely cause of death with overdose of a hypnotic?
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respiratory depression
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what happens on day 2-3 of withdrawal from hypnotic drugs?
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Grand Mal seizures
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describe the treatment regimen with barbituates, Benzos, and alcohol?
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Barbituates>Benzos>Alcohole
Barbs only with barbs Benzos with barbs and benzos Alcohol can be treated with all 3 |
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up to 50% of opiate abusers may have what co-morbid psychiatric diagnosis?
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Antisocial Personality Disorder
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describe the rate of relapse with opiate use disorders?
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up to 98% relapse
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what type of co-morbid physical findings would opiate abusers have?
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Those with IV drug abuse, hepatitis, HIV, pneumonia, skin ulcers, and cellulitis
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These signs and symptoms describe which type of drug abuse?
Psychological: euphoria, sense of well being, drowsiness (“on the nod”), inactivity, psychomotor retardation, impaired concentration Physical: flushing, pupillary constriction, slurred speech, respiratory depression, hypotension, hypothermia, bradycardia, constipation, nausea, vomiting |
opiate drug abuse
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how soon after stopping opiate drug intake can signs of withdrawal become evident?
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10 hours
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symptoms of withdrawal from opiate use resembe which type of autonomic response?
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sympathetic
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describe methadone treatment in opiate abuse?
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helps to gradually wean patients off opiates or can simply replace opiates for long term therapy
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what is the role of clonidine in controlling opiate withdrawal symptoms?
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It is a alpha2-adrenergic agonist which helps reduce signs of withdrawal - esp. hypertension (must monitor blood pressure to prevent hypotensive crisis)
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what is the mechanism of action for Naltrexone?
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it is a long acting opioid antagonist which resets or desensitizes opiate receptors facilitating withdrawl
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what is the mechanism of action for bupronorphine in treatment of opiate abuse?
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opiate agonist-antagonist which is more practical than methadone because it came perscribed in the doctor office
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what is the drug that is used in acute opiate overdose, is short acting, and is administered IV?
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Naloxene
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what are the 5 CNS stimulants?
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1. Methylphenidate
2. Phenmetrazine 3. Cocaine 4. Amphetamine / dextroamphetamine 5. Methamphetamine |
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how does methamphetamine produce its stimulating effect?
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increases extracellular levels of dopamine, serotonin, and norepinephrine by promoting their release
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what causes the cardiovascular activation seen with methamphetamine use?
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release of NE from sympathetic nerve endings
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what causes "meth mouth"?
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xerostoma, grinding and clinching of teeth, periodontitis due to reduced blood flow to gums and teeth, neglect of hygiene
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These are symptoms one would see in what kind of substance abuse?
Tachycardia Hypertension Mydriasis Diaphoresis Nausea/vomiting, anorexia Psychomotor agitation Transient psychosis Hypersexuality Flushing Bruxism |
Stimulant Use Disorder
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why would a person abusing cocain be more likely to have an MI?
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coronary artery constriction -
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what causes coccain induced seizures?
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anoxic brain injury
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the following are symptoms of withdrawal from which type of substance abuse?
Anxiety Dysphoria Lethargy and fatigue Headache Muscle cramps Stomach cramps Hunger Profuse sweating |
stimulant use disorder
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when do symptoms of stimulant withdrawal peak?
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2-4 days after stopping
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what is a unique symtom of cocaine use that differes from other stimulants?
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tactile hallucinations "coke bugs"
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what drug therapy must be given to aid patients undergoing stimulant withdrawal?
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TRICK!! stimulant withdrawal is self-limiting thus no drugs are needed, some are still given to alleviate side effects
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what antidepressant has been used in an attempt to treat cocaine withdrawal?
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Desipramine
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what dopamine agonists have been used in an attempt to treat cocaine withdrawal?
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1. Bromocriptine
2. Amantadine |
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what drug is important for use as a cognitive-behavioral therapy for stimulant abuse?
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Disulfiram
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what type of drug abuse is described below?
Psychotic-like experiences: -Hallucinations and Illusions -Perceptual disturbances -Trailing -Intensified colors -Heightened senses -Synesthesias -Feelings of unreality Sympathomimetic symptoms: -Tachycardia -Hypertension -Sweating -Blurry vision -Pupillary dilation -tremors |
Hallucinogen Use Disorders: Intoxication
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describe flashbacks with LSD?
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Brief reexperiencing of the drug’s effects
Consist of visual disturbances, geometric hallucinations, and misperceptions |
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what is the official term used to describe flashbacks?
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Hallucinogen Persisting Perception Disorder
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describe the withdrawal syndrome seen with LSD use?
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TRICK!! there is no known withdrawal syndrome associated with LSD use
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What would cause a "high" like the one described below?
Intense feelings of attachment and connection, altered time perception, heightened sensory perceptions, peacefulness, euphoria High energy, increased desire for sex |
Methylenedioxymethamphetamine (MDMA), “Ecstasy”
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what drug could lead to the following effects?
Can lead to anxiety, depression, and even psychosis Chronic users develop cognitive and memory deficits, related to a disturbance in serotonin neurotransmission |
Methylenedioxymethamphetamine (MDMA), “Ecstasy”
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Deaths associated with ecstasy use are often actually caused by which two similar drugs which cause major dysthermoregulation?
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PMA (paramethoxyamphetamine) and PMMA (paramethoxymethamphetamine)
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what are the alternate names for PCP?
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angel dust or crystal
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how long is the onset of pcp effects?
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5 minutes
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when do pcp effects peak?
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30 minutes
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dissociative anesthetic that is abused and has similar effects as PCP—mostly used by vets now?
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ketamine
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the only drug of abuse that causes a characteristic vertical nystagmus (it can also cause horizontal or rotatory nystagmus), which helps to identify it as the cause when a patient presents with intoxication by an unknown drug?
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PCP
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why can it be hard to arrest a PCP user?
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they have dulled sensation to pain
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what is the most effective treatment for PCP overdose?
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acidifying the urine with ammonium chloride or ascorbic acid
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what ph should the urine be kept at during urine acidification for treatment of PCP overdose?
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5.5
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what patient should never get urine acidification?
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the patient who has myoglobinuria (indicating rhabdomyolysis)
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what antihypertensive can be given to people with PCP overdose?
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Phentolamine - emergency antihypertensive that is a nonselective alpha-adrenergic antagonist (main effect is vasodilation)
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what is the cough suppressant in a variety of over-the-counter cold and cough medications which acts as an NMDA receptor antagonist similar to PCP/ketamine?
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Dextromethorphan ("DXM" or "robo")
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what is the active ingredient in cannabis?
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THC
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A young male presents to the ED with the following symptoms, what does he have?
-Red eyes -Dry mouth -Increased appetite (“munchies”) -Orthostatic hypotension -Depersonalization -Derealization -Transient psychosis/paranoia -Sensation of time slowed -Heightened senses -Decreased motor coordination |
Cannabis Use Disorder
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describe the prototypical inhalent user?
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Users are typically male; Latinos and Native Americans are overrepresented
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the intoxicating effects of inhalents are similar to what other drug?
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alcohole
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what is the duration of the high from use of inhalents?
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5-45 minutes
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what are the two serious side effects of using inhalents?
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1. Heavy metal toxicity leads to permanent neuromuscular and brain damage
2. Serious risk of hepatic and renal damage from benzene and other hydrocarbons |
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what type of drug is described below?
Produce an intoxicated state characterized by: -Fullness in the head -Mild euphoria -Change in time perception -Relaxation of smooth mm -Possible increased sexual feelings Negative effects include: -Immune system impairment -Respiratory system irritation -Toxic reaction |
Nitrate Inhalants
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how does Vareniclinem, a drug for stopping a nicotine addiction work?
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Agonizes and blocks nicotinic ACH receptors
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what treatment works best to prevent cocaine addiction relapse?
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group and individual psychotherapy
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describe the prototypical inhalent user?
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Users are typically male; Latinos and Native Americans are overrepresented
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the intoxicating effects of inhalents are similar to what other drug?
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alcohole
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what is the duration of the high from use of inhalents?
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5-45 minutes
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what are the two serious side effects of using inhalents?
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1. Heavy metal toxicity leads to permanent neuromuscular and brain damage
2. Serious risk of hepatic and renal damage from benzene and other hydrocarbons |
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what type of drug is described below?
Produce an intoxicated state characterized by: -Fullness in the head -Mild euphoria -Change in time perception -Relaxation of smooth mm -Possible increased sexual feelings Negative effects include: -Immune system impairment -Respiratory system irritation -Toxic reaction |
Nitrate Inhalants
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how does Vareniclinem, a drug for stopping a nicotine addiction work?
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Agonizes and blocks nicotinic ACH receptors
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what treatment works best to prevent cocaine addiction relapse?
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group and individual psychotherapy
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