Treatment Of Substance Abuse

Front 1

Substance Abuse or dependence plus an additional psychiatric diagnosis; Have a DSM axis I as well as a well documented substance abuse or dependence problem

Back 1

Dual Diagnosis

Front 2

% of adults have a serious problem with substance abuse or dependence

Back 2

15 %

Front 3

What is the most common drug of abuse?

Back 3

Alcohol

Front 4

What defines heavy drinking for a male?

Back 4

> 5 Drinks per night

Front 5

What defines heavy drinking for a female?

Back 5

>4 drinks per night

Front 6

What is the rule not the exception in substance abuse?

Back 6

Comorbidity is the rule not the exception

Front 7

This used to be treated by two separate parties who were they? We are talking about substance abuse.

Back 7

A non-professional such as AA, and a mental health professional

Front 8

AA was founded by who?

Back 8

Bill Morrison

Front 9

The consumer used to be responsible for seeing both providers why did that change?

Back 9

Because we started recognizing dual diagnosis, we actually code 2 different diagnoses right now but DSM V will probably have dual diagnosis as one diagnosis.

Front 10

Dear stop treatment if they relapse?

Back 10

No because u will be treating both diagnoses

Front 11

What are the comorbidities with substance abuse? 6

Back 11

– Affective disorders
– Psychotic disorders
– Attention Deficit-Hyperactivity disorders
– Anxiety disorders
– Conduct disorders
– Antisocial personality disorder

Front 12

What are both disorders considered, with the mental health condition and the substance-abuse condition?

Back 12

Both are treated as primary and treated accordingly

Front 13

How is pharmacological treatment negotiated with the patient?

Back 13

Pharmacologic treatment is negotiated collaboratively with the client – without the threat of loss of the treatment relationship if relapse!

Front 14

In substance abuse, what is the exception to standard pharmacologic treatment?

Back 14

Agents with the potential for abuse, stimulants, benzodiazepines

Front 15

What is the standard pharmacologic treatment of SUD?

Back 15

It's a part of a comprehensive program of recovery

Front 16

Treatment of co-occurring disorders: what is psychosis treated with?

Back 16

Aggressively with antipsychotics

Front 17

Treatment of co-occurring disorders: what is the treatment for substance induced psychosis?

Back 17

This should also be treated with anti-psychotics

Front 18

Treatment of co-occurring disorders: what is major depression treated with?

Back 18

SSRIs & SNRIs

Front 19

Treatment of co-occurring disorders: with major depression disorder, what medication do you have to be cautious of when treating substance abuse?

Back 19

bupropion or Wellbutrin

Front 20

Treatment of co-occurring disorders: when treating major depression with substance abuse, why do you have to be cautious of Wellbutrin?

Back 20

Because they can lower the seizure threshold

Front 21

Treatment of co-occurring disorders: why is Wellbutrin good for treating major depression with substance abuse?

Back 21

You have to use it with caution because it lowers the seizure threshold but it decreases the cravings

Front 22

Treatment of co-occurring disorders: what do you use with bipolar disorder and substance abuse?

Back 22

Mood stabilizers and anticonvulsants, which may prevent seizures

Front 23

Treatment of co-occurring disorders: what states are more common with bipolar disorder and substance abuse?

Back 23

Rapid cycling and mixed states

Front 24

Treatment of co-occurring disorders: in bipolar disorder and substance abuse, what would you treat rapid cycling and mix tapes with?

Back 24

Valproate (depakote), oxycarbamazepine (Trileptal), carbamazepine (Tegretol), atypical antipsychotics

Front 25

Treatment of co-occurring disorders: well if you treat anxiety disorders with substance abuse with?

Back 25

– SSRIs
– Venlafaxine (Effexor)
– Buspirone (buspar)
– Clonidine (Catapres_
– Vistaril (hydroxizine)
– Mood stabilizers (gabapentin (Neurontin), topiramate- topimax

Front 26

Treatment of co-occurring disorders: when treating anxiety disorders with substance abuse, what do you want to avoid?

Back 26

Benzodiazepines

Front 27

Treatment of co-occurring disorders: an anxiety disorders with substance abuse, what would you do if the patient has pain, panic attacks, or insomnia?

Back 27

Do a urine drug screen or refer to a pain management specialist

Front 28

Treatment of co-occurring disorders: what would you treat ADHD with substance abuse with? 3

Back 28

--Atomoxetine (Strattera)
– Bupropion (Wellbutrin)
– Stimulants

Front 29

Treatment of co-occurring disorders: what do you have to be careful of when treating ADHD with substance abuse if you order them stimulants?

Back 29

You have to have careful monitoring, monthly visits because the prescription can't be called and, the prescription has to be hand delivered

Front 30

What is the final common pathway for substance use disorders?

Back 30

Dopamine (DA) Mesolimbic pathway

Front 31

Why is the Dopamine (DA) Mesolimbic pathway the final common pathway for substance use disorders?

Back 31

Because it is the reward or pleasure center of the brain which is what causes the dependence

Front 32

What is dependence?

Back 32

The physiological state of neuro-adaptation

Front 33

What happens in dependence?

Back 33

Desensitization and down regulation of dopamine receptors due to repeated administration of substances of abuse, this happens in substances and nicotine.

Front 34

What happens with substance abuse & nicotine ?

Back 34

Pt wants more DA! build up a tolerance and requires more and more to satisfy the DA receptors)

Front 35

What is A behavioral pattern of drug abuse that includes overwhelming and compulsive use, efforts to secure its supply, and high rates of relapse with discontinuation?

Back 35

Addiction

Front 36

Dopamine release is in what pathway?

Back 36

Mesolimbic pathway

Front 37

Where is the reactive re-ward system located?

Back 37

The amygdala

Front 38

What does the reactive reward system in the amygdala do?

Back 38

provides motivation and behavioral drive for drug seeking behaviors

Front 39

The amygdala is the storehouse for what?

Back 39

For emotional experiences

Front 40

The amygdala has these for emotional experiences?

Back 40

Internal and external cues

Front 41

What are the internal cues?

Back 41

are the pleasure of the high, where it was at, who it was with, what the person was enjoying, patients remember the first experience so vividly

Front 42

What are the internal cues responsible for?

Back 42

responsible for craving that starts to develop & the withdrawal that starts to develop

Front 43

What are the external cues?

Back 43

people, places, paraphernalia (if they even see it they want it)

Front 44

The internal and external cues does what the process of drug or alcohol addiction?

Back 44

It keeps the process going

Front 45

What is the reflective reward system?

Back 45

CSTC loops- This corticostriatal pathway is the first leg of cortico-striatal-thalamic-cortical (CSTC) loops, which are the brain's engines for behavioral and functional outputs

Front 46

In the reflective reward system, what does it provide motivation for?

Back 46

for will power and choosing beneficial goal-directed behavior

Front 47

What does the reflective reward system allow the patient to think about?

Back 47

consequences

Front 48

Is the reflective reward system fast or slow?

Back 48

must be built overtime; neurodevelopment; "I know how good it feels but I have to be rational here and not go down this path"

Front 49

The reactive reward system equals?

Back 49

(amygdala) = Temptation and has to deal with dopamine craving

Front 50

The reflective reward system is the?

Back 50

(CSTC loops) = Brakes; this is what we try to work with with CBT & meds

Front 51

continued self-administration of a substance despite adverse consequences (DSM-diagnosis)

Back 51

Abuse

Front 52

pleasurable response that occurs when a drug is taken

Back 52

Reinforcement

Front 53

an increased dose of the drug is needed to gain pleasurable effects

Back 53

Tolerance

Front 54

one drug will suppress the withdrawal symptoms of another drug (we use this a lot!)

Back 54

Cross-tolerance

Front 55

a reversible clinical syndrome of maladaptive behavior or physiological changes due to the CNS activity of the drug

Back 55

Intoxication

Front 56

slow tapering of a drug that if discontinued rapidly would cause WD; replacement with another drug (benzodiazepine, anti-hypertensives)

Back 56

Detoxification

Front 57

What drugs do you use for detoxification?

Back 57

Benzodiazepines or antihypertensives

Front 58

physiological and psychological syndrome that occurs when substance is not administered

Back 58

Withdrawal

Front 59

What happens if a patient has dependence on the drug and they stop using it?

Back 59

Withdrawal

Front 60

What happens with withdrawal?

Back 60

Receptors are craving drug and pt will experience physiological side effects if the drug is not available

Front 61

What can happen with the abrupt discontinuation of a benzodiazepine?

Back 61

They can have rebound anxiety that they will have the worst panic attack of their life

Front 62

recurrence of substance use after a period of sobriety

Back 62

Relapse

Front 63

Substances of abuse and dependence 9

Back 63

Benzodiazepines
• Alcohol
• Opiates- morphine, heroin, darvon, methadone, demerol, dilaudid, oxycontin, oxycodone, hydrocodone, codiene
• Heroin
• Nicotine
• Cocaine
• Hallucinogens
• Marijuana
• Newer- spice, bath salts

Front 64

Pharmacologic treatment of SUD: alcohol dependence 2

Back 64

– Disulfram (Antabuse)
– Acamprosate (Campral)

Front 65

Pharmacologic treatment of SUD: used for ETOH & opioid abuse

Back 65

Opioid receptor antagonists
Naltrexone (ReVia)

Front 66

Pharmacologic treatment of SUD: opiate maintenance treatment

Back 66

– Methadone (Dolophine)
– Buprenorphine (Buprenex); Suboxone

Front 67

Other agents used for alcohol dependence?

Back 67

Topiramate (topimax), SSRIs

Front 68

When the patient is addicted to benzodiazepines, how can you get them off?

Back 68

Taper slowly on an outpatient basis, ideally three months & with an SSRI, but it can take up to 6 to 9 months

Front 69

What is the ideal way to taper patient off a benzodiazepine?

Back 69

Write out a schedule for the patient with the timeline and tell them they can break the tablets in half

Front 70

What happened to the patient taking a benzodiazepine rebounds?

Back 70

They usually will never want to taper off again

Front 71

What schedule is a benzodiazepine?

Back 71

Schedule IV

Front 72

Which medication is some of the most prescribed medications?

Back 72

Benzodiazepines

Front 73

Which medication type has been called the "opium of the masses"

Back 73

Benzodiazepines

Front 74

What is the standard for treating a person addicted to benzodiazepines?

Back 74

Time-limited treatment tapering

Front 75

What must you monitor for when a person is addicted to benzodiazepines?

Back 75

Escalating use

Front 76

What can increased dosages of benzodiazepines cause?

Back 76

A euphoric feeling

Front 77

What happens when a person withdrawals from benzodiazepines?

Back 77

– Opposite of substance effects
– Dysphoria, anxiety, insomnia, muscle tension, seizures

Front 78

What kind of depressant is alcohol?

Back 78

CNS depressants

Front 79

What is alcohol metabolized by?

Back 79

The liver

Front 80

What does alcohol inhibit, and what does it enhance?

Back 80

Enhances GABA and inhibits glutamate

Front 81

What kind of irritant is alcohol?

Back 81

It is a gastric irritant

Front 82

What is all called toxic to?

Back 82

Liver cells and neurons

Front 83

If alcohol is toxic to neurons but then you have over time?

Back 83

Dementia related to chronic alcoholism

Front 84

If alcohol is toxic to liver cells what happens?

Back 84

cirrhosis of the liver

Front 85

If alcohol is a gastric irritant what can happen?

Back 85

GI bleeding

Front 86

What are the symptoms about the alcohol withdrawal?

Back 86

– Craving, tremors, irritability, nausea, sleep disturbances, tachycardia, HTN, diaphoresis, perceptual distortions

Front 87

When will you start to see alcohol withdrawal?

Back 87

Within 12 to 48 hours after the last drink; you may see seizures

Front 88

What are the symptoms of delirium tremens?

Back 88

severe agitation, confusion, hallucinations, fever, profuse sweating, diarrhea, dilated pupils

Front 89

Can delirium tremens kill you?

Back 89

Yes

Front 90

What does alcohol do to your brain cells?

Back 90

It reduces excitation at the GABA receptors

Front 91

Alcohol can make you?

Back 91

Amnesic and ataxic

Front 92

Alcohol treatment: what is an old medication that's been around for a while?

Back 92

Antabuse (disulfram)-

Front 93

Alcohol treatment Antabuse (disulfram)- what is the mechanism of action?

Back 93

aldehyde dehydrogenase (the enzyme that breaks down acetaldehyde/alcohol when you drink it)

Front 94

Alcohol treatment Antabuse (disulfram)- with this drug you want to avoid what?

Back 94

All alcohol

Front 95

Antabuse (disulfram)-what kind of reaction is caused by Antabuse? Test question

Back 95

Causes disulfram-ethanol reaction when client drinks alcohol; or cold medications, tonics; mouthwashes, topicals, ciders

Front 96

Antabuse (disulfram)- how long can patient stay on this drug?

Back 96

Months or years or until they have control

Front 97

As a nurse practitioner what would you want to know from the patient before starting Antabuse?

Back 97

How much they drink per day and for how long they've been drinking. This will tell you the intensity of their addiction.

Front 98

Typically what will alcoholism due to the system as far as lab values go?

Back 98

Destroys the liver so you want to check LFTs

Front 99

Anytime you have an axis I substance abuse problem, you want to notate that you monitor what?

Back 99

LFTs, ALT, and AST

Front 100

What are the contraindications of Antabuse (disulfram)?

Back 100

Alcohol ingestion, heart disease, severe pulmonary insufficiency, renal insufficiency, disorders of cognitive impairment, neuropathy, psychosis, difficulty with impulse control, suicidal ideation's. This is why this is a hard drug to use, you have to have someone that is really willing to give up alcohol.

Front 101

Antabuse (disulfram)- what is the dosing?

Back 101

250 to 500 mg a day

Front 102

Antabuse (disulfram)- you have to scream for what first?

Back 102

Liver disease so you have to make sure that you have to have these values at baseline and then monitor throughout

Front 103

Antabuse (disulfram)- this causes an increase in acetaldehyde which causes what?

Back 103

causes uncomfortable symptoms this is what makes them throw up and get violently sick; up to 2 weeks after drinking alcohol
N/V, flushing, SOB, tachycardia, decreased BP

Front 104

Alcohol treatment Campral (acamprosate) what is one of the drawbacks of this drug?

Back 104

666 mg three times a day

Front 105

Alcohol treatment Campral (acamprosate) what is the mechanism of action?

Back 105

GABA agonist/glutamate antagonist

Front 106

Alcohol treatment Campral (acamprosate) is considered what?

Back 106

Like an artificial alcohol that they take

Front 107

Alcohol treatment Campral (acamprosate) can a patient take this drug if they're still detoxing or having withdrawals from alcohol?

Back 107

No, it should only be used after their stable

Front 108

Alcohol treatment Campral (acamprosate) what is the purpose of this drug?

Back 108

It helps the client to maintain abstinence from alcohol

Front 109

Alcohol treatment Campral (acamprosate) is this drug metabolized?

Back 109

It is not metabolized it is excreted in the urine as an unchanged drug so it has no drug to drug interactions

Front 110

Campral (acamprosate) what helps with the G.I. effects or diarrhea that this drug causes?

Back 110

Yogurt

Front 111

The four opiates that are addictive?

Back 111

Codeine, morphine, OxyContin, heroin

Front 112

What kind of effect do opiates give

Back 112

Analgesic effect therapeutic use for pain

Front 113

Why half and overtime with opiates

Back 113

Higher doses are needed over time

Front 114

What kind of sense does this give the patient when they are on opiates

Back 114

Euphoria, a rush, a sense of tranquility

Front 115

What kind of side effects are associated with opiates- 3

Back 115

Drowsiness
mental clouding
apathy

Front 116

What are some other side effects of the opiates 2

Back 116

Slowed muscle movements
mood swings

Front 117

How do opiates act on opiate receptors

Back 117

They act as agonists on opiate receptors

Front 118

Opiate addiction treatment ReVia (naltrexone)- what is the mechanism of action

Back 118

Opioid antagonist

Front 119

Opiate addiction treatment ReVia (naltrexone)- what is this medication do?

Back 119

It blocks the effects of opioids so it decreases the cravings because they don't feel like their getting that much of a high

Front 120

Opiate addiction treatment ReVia (naltrexone)- can this medicine precipitate withdrawal

Back 120

Yes

Front 121

Opiate addiction treatment ReVia (naltrexone)- what are the signs and symptoms of opiate withdrawal 5

Back 121

Anxiety, agitation, sweating, tremors, pinpoint pupils

Front 122

Opiate addiction treatment ReVia (naltrexone)- you want to use caution with this medication because it can cause what

Back 122

Liver toxicity (hepatotoxicity)

Front 123

Opiate addiction treatment
ReVia (naltrexone)- why do you have to do a urine screen with this patient

Back 123

Because they have to be free of the opioids for 7 to 10 days

Front 124

Opiate addiction treatment
ReVia (naltrexone)- this medication can also be used in what?

Back 124

Alcohol withdrawal

Front 125

Opiate addiction treatment
ReVia (naltrexone)- what does this medication do in alcohol withdrawal

Back 125

It decreases cravings and can cause headache and nausea so it decreases the desire for the patient to drink

Front 126

Opiate addiction treatment
ReVia (naltrexone)- this medication cannot be used along with what

Back 126

Opiates, you must do a UDS after 10 days of being clean and then you can start this medication

Front 127

Opiate addiction treatment
ReVia (naltrexone)- what is another medication that is similar to this one and what does it do?

Back 127

Revex, it's an antagonist that blocks the receptor which does not allow the patient to get as much of a high with the meds that they are taking

Front 128

Opiate Overdose Treatment and Dependence • Narcan (naloxone) what is this drug used for

Back 128

Treatment of opiate or narcotic overdose

Front 129

Opiate Overdose Treatment and Dependence • Narcan (naloxone) how does the drug work

Back 129

To reverse respiratory depression and coma so in the ER they go from being unconscious to waking up and they are very upset because you messed with their high

Front 130

Opiate Overdose Treatment and Dependence • Narcan (naloxone) how do you give this drug

Back 130

IV push over 30 seconds or IV in saline; IM

Front 131

Opiate Overdose Treatment and Dependence • Narcan (naloxone) where do the side effects come from

Back 131

Inducing withdrawal after you give this drug

Front 132

Opiate Overdose Treatment and Dependence • Narcan (naloxone) what about infants

Back 132

This drug is used with infants born with opiate intoxication including premature infants

Front 133

Opiate Overdose Treatment and Dependence • Narcan (naloxone) this is a medical ----------

Back 133

Emergency

Front 134

Opiate Overdose Treatment and Dependence • Narcan (naloxone) what do patients not realize when they take opiates

Back 134

That they are going to need more and more and more in this causes central nervous system depression and can kill them

Front 135

Heroine addiction what happens with tolerance and dependence

Back 135

It occurs rapidly

Front 136

Heroine addiction what is the half-life

Back 136

2 to 6 minutes. Short

Front 137

Heroine addiction eventually there is a slight difference between what

Back 137

The dose needed for euphoria and a toxic dose

Front 138

Heroine addiction what happens with this drug over time

Back 138

You lose the forked feelings over time but still take the drug to avoid withdrawal

Front 139

Heroine addiction with this withdrawal syndrome is it lethal?

Back 139

No just extremely uncomfortable

Front 140

Heroine addiction what happens with withdrawal syndrome, what kind of symptoms will you see

Back 140

Craving, irritable, dysphoria, chills, goosebumps

Front 141

Heroine addiction what kind of autonomic response will you see in withdrawal syndrome

Back 141

Hyper arousal, tachycardia, tremors, sweating

Front 142

Heroine addiction what is the treatment

Back 142

Cross tolerance treatment with methadone which is a synthetic form of heroin it blocks the receptors and decreases the cravings

Front 143

Heroine addiction when the person loses the euphoric feeling over time and takes the drug to avoid withdrawal the drug becomes what to the patient

Back 143

No longer pleasurable

Front 144

Treatment of Heroin Dependence
• Buprenex (buprenorphine)- treatment with this drug should be done where

Back 144

In a special clinic because it is a controlled substance and we can't prescribe it

Front 145

Treatment of Heroin Dependence
• Buprenex (buprenorphine)-

what does this treat

Back 145

Withdrawal in adults and infants

Front 146

Treatment of Heroin Dependence
• Buprenex (buprenorphine)-
how do you give it after heroin use

Back 146

Give 4 mg after heroin use to avoid withdrawal

Front 147

Treatment of Heroin Dependence
• Buprenex (buprenorphine)-
one of the routes of administration

Back 147

Sublingual, IV, IM

Front 148

Treatment of Heroin Dependence
• Buprenex (buprenorphine)-
what is important about this treatment

Back 148

It is time-limited, should be limited to supervised use

Front 149

Dependence
• Buprenex (buprenorphine)-
with this treatment being time-limited you must switch them quickly to what drug

Back 149

suboxone, this should be done quickly

Front 150

Dependence
• Buprenex (buprenorphine)-
this drug is better tolerated than what drug

Back 150

Methadone

Front 151

Dependence
• Buprenex (buprenorphine)-
this drug helps stop the craving and helps the patient and get into what

Back 151

Long-term management

Front 152

Treatment of heroin dependence Suboxone this drug is the combination of what do drugs

Back 152

(buprenorphine and naloxone)

Front 153

Suboxone (buprenorphine and naloxone) why did they add Narcan to this

Back 153

So it can be used as a drug of abuse

Front 154

Suboxone (buprenorphine and naloxone) used for the treatment of

Back 154

Opioid dependence

Front 155

Suboxone (buprenorphine and naloxone) what route of administration

Back 155

Sublingual place under tongue until dissolved do not swallow

Front 156

Suboxone (buprenorphine and naloxone) what happens if you need to doses because it comes in 8 mg tablets so this would be 16 mg

Back 156

Place of both tablets under the tongue at the same time because the bioavailability must be distributed all at once

Front 157

Suboxone (buprenorphine and naloxone) what can this drug caused as a symptom 3

Back 157

Nausea vomiting or constipation

Front 158

Suboxone (buprenorphine and naloxone) when should this drug not be used

Back 158

During the induction period

Front 159

Suboxone (buprenorphine and naloxone) what is the target dose

Back 159

16 mg

Front 160

What drug will help with the physiological signs and symptoms of withdrawal which is increased heart rate and increased blood pressure, pounding heart. What is the dose?

Back 160

Clonidine which is a beta blocker. You want to give 0.1 mg to 0.3 mg

Front 161

Maintenance treatment for Heroin addiction
• Methadone (dolophine)
this drug must be prescribed through a

Back 161

Methadone program

Front 162

Maintenance treatment for Heroin addiction
• Methadone (dolophine)
what type of drug is this

Back 162

A cross tolerated drug

Front 163

Maintenance treatment for Heroin addiction
• Methadone (dolophine)
what happens when this is used for detoxification

Back 163

It slows down the withdrawal syndrome

Front 164

Maintenance treatment for Heroin addiction
• Methadone (dolophine)
can this drug be used for maintenance

Back 164

Yes it can be used for maintenance of sobriety even for years

Front 165

Maintenance treatment for Heroin addiction
• Methadone (dolophine)
how does that minimize the euphoric affects

Back 165

Heroin has a peak of 2 to 6 minutes were methadone has a peak of six hours so they don't get that euphoric feeling

Front 166

Maintenance treatment for Heroin addiction
• Methadone (dolophine)
the management of this drug is

Back 166

Very hard its extreme but it allows a better quality of life

Front 167

Treatment of Heroin Dependence
• Methadone (dolophine)
if the person has a relapse what might be happening?

Back 167

You need to make sure that they're taking the correct dose, are they going to the clinic, are they taking their meds like they're supposed to. Obviously whatever they tell you doesn't have to be the truth

Front 168

What is the most common comorbidity among mentally ill patients?

Back 168

Nicotine

Front 169

Half of all cigarettes are consumed by patients with what

Back 169

A psychiatric disorder

Front 170

What is the percentage of patients with ADHD that smoke

Back 170

Between 60 to 85%

Front 171

How many of the smokers would like to quit

Back 171

Two thirds

Front 172

What is the percent that succeed in stopping smoking

Back 172

2 to 3%

Front 173

How long does it take to build an addiction to nicotine

Back 173

About a month of chronic use

Front 174

Nicotine or smoking a cigarette effects what receptors?

Back 174

Alpha and beta receptors

Front 175

What happens to alpha and beta receptors when you smoke

Back 175

The receptors are resting and quiet then they wake up and become desensitized and dopamine is released

Front 176

How long does it take when you smoke a cigarette for the alpha and beta receptors to go back to the resting state?

Back 176

About 45 minutes

Front 177

What happens when the alpha and beta receptors go back to the resting state?

Back 177

They start craving the dopamine release again

Front 178

How long does it take between cigarettes to make a one pack a day smoker?

Back 178

45 minutes there are 20 cigarettes a pack

Front 179

When a smoker reaches for the cigarettes what happens?

Back 179

It becomes a repetitive behavior that is hard to break

Front 180

Nicotine affects what type of receptor's?

Back 180

Nicotinic

Front 181

What pathway to nicotinic receptors mildly affect?

Back 181

The mesolimbic dopamine pathway

Front 182

What is the response when nicotine affects the nicotinic receptors? 4

Back 182

Elevates mood
enhances cognition
decreases appetite
provides a mini rush

Front 183

What happens when a person withdrawals from nicotine?

Back 183

Craving and agitation
cocaine like; but less severe

Front 184

How can withdrawal from nicotine be prevented?

Back 184

With transdermal patches or gradual discontinuation

Front 185

Treatment of Nicotine Addiction how do we normally treat this, with what three things?

Back 185

Nicotine patches, gum, nasal spray

Front 186

With the nicotine patches, nasal spray what happens with the nicotine

Back 186

Delivering the nicotine but on a lower level it doesn't decrease the cravings but keeps the body on a lower functioning nicotine level

Front 187

What drugs can we use that is purely a dopamine replacer to reduce the cravings during abstinence of nicotine

Back 187

Bupropion (Zyban) (Wellbutrin)- NDRI
it has been shown to have the same effectiveness as the patches

Front 188

How does the pattern of drug abuse go?

Back 188

From nicotine to alcohol to substances of abuse

Front 189

Treatment of Nicotine Addiction
• Chantix (varenicline) what is the mechanism of action

Back 189

(1st nicotinic partial agonist)-

Front 190

Treatment of Nicotine Addiction
• Chantix (varenicline)
does this drug provide nicotine

Back 190

No- Non-nicotine prescription medication

Front 191

Treatment of Nicotine Addiction
• Chantix (varenicline)
if this drug does not provide nicotine what does it do

Back 191

It blocks the nicotine receptors in the brain by binding to them so the reward centers in the brain are not activated; it does decrease the cravings

Front 192

Treatment of Nicotine Addiction
• Chantix (varenicline)
is this drug and agonists or antagonists

Back 192

Nicotine receptor agonist

Front 193

Treatment of Nicotine Addiction
• Chantix (varenicline)
what happens when this drug blocks the nicotine receptors

Back 193

It provides some nicotine affects to help with withdrawal symptoms while blocking receptors

Front 194

Treatment of Nicotine Addiction
• Chantix (varenicline)
is this drug metabolized

Back 194

No it is not metabolized; it's excreted unchanged

Front 195

Treatment of Nicotine Addiction
• Chantix (varenicline)
how is this drug dosed?

Back 195

Doses titrated over a week: 0.5mg daily for days 1, 2, and 3; then BID days 4 to 7;

Front 196

Treatment of Nicotine Addiction
• Chantix (varenicline)
what is the maximum dose for the 12 weeks

Back 196

1 mg BID for 12 weeks; can repeat

Front 197

Treatment of Nicotine Addiction
• Chantix (varenicline)
what is the post marketing correlation after using this drug

Back 197

Depression
agitation
suicidal ideation's

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Treatment of Nicotine Addiction
• Chantix (varenicline)
what must a person have if they are going to use this drug

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A mental health referral

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Treatment of Nicotine Addiction
• Chantix (varenicline)
why did they have to have a mental health professional while using this drug

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So they can be monitored for suicidal ideation

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Treatment of Nicotine Addiction
• Chantix (varenicline)
what are some side effects of this drug

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Nausea
nightmares
very vivid dreams

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Cocaine abuse has seen more in the form of what?

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cocaine
Crack and crystal meth

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What will you seen in cocaine crack or Crystal meth abuse?

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Poor dentition especially with crystal meth

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Cocaine abuse what is the fastest way it is absorbed

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Intranasally or by smoking it because it bypasses the liver system altogether

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Cocaine abuse with some people they say that they feel that it creates what?

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Creates mental acuity for people they say they feel sharp and on their game

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Cocaine abuse this works in a similar way to what other drugs

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Stimulants

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How is cocaine similar to stimulants

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Triggers the reward system and causes a release of dopamine

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Cocaine abuse/crack use/crystal meth why will people tell you they can remember their first experience with the drug

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Because these drugs are extremely pleasurable

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What does cocaine do in the brain

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It is a Dopamine reuptake inhibitor

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Cocaine abuse/crack use/crystal meth is a Dopamine reuptake inhibitor, what happens in low doses

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Euphoria
reduced fatigue

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Cocaine abuse/crack use/crystal meth is a Dopamine reuptake inhibitor, what happens in high doses

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Paranoia
irritability
tremors

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Cocaine abuse/crack use/crystal meth is a Dopamine reuptake inhibitor, what happens in the highest doses

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Psychosis
hyperthermia
tachycardia

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Cocaine abuse/crack use/crystal meth is a Dopamine reuptake inhibitor, what happens in overdose

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Heart failure
stroke
seizures

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When a person is withdrawing from cocaine abuse what can you put them on to help with agitation

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Benzodiazepine such as Valium or Librium but this is the subject of a lot of debate

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Cocaine withdrawal is referred to as what

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Crashing

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What are the first symptoms of cocaine withdrawal

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Craving and agitation

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What are the other signs of cocaine withdrawal? 7

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Anxiety
fatigue
dysphoria
anhedonia
exhaustion
hyperphagia
and more craving

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Our hallucinogens associated with dependence or withdrawal?

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Not necessarily

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What do hallucinogens produce?

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A transient state of psychotic delusions where they can hear auditory hallucinations or see visual hallucinations

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Can hallucinogens push people over the edge?

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Yes with too much stimulation again this can be treated with a benzodiazepine or a beta blocker

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What do you hallucinogens affect? 3

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Serotonin
norepinephrine
dopamine

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Most of the other drugs only affect what neurotransmitter

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Dopamine

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What are the hallucinogens? 4

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LSD, methyl amphetamine
MDMA or ecstasy
mescaline
PCP

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What kind of drug is MDMA or ecstasy?

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It is a designer drug people have the feeling of being in touch with themselves and it provides an inner place of empathy towards themselves and others

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Where is in him MDMA or ecstasy used a lot

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In dancing clubs

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What is mescaline and what culture usually uses it?

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Mushrooms or peyote, American Indian

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Which hallucinogenic taken too much of can cause a medical emergency?

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PCP

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PCP can cause the medical emergency of what

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Seizures it's really dangerous and runs its course in about 24 hours

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Marijuana is also called what

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Cannabis or THC

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An overdose of marijuana can mimic what

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A panic attack

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Marijuana can cause what kind of syndrome

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Amotivational syndrome

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What are the symptoms of amotivational syndrome?

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Poor insight
poor judgment
introversion
depersonalization
distractibility/short attention span

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The marijuana used now has 10 times the what

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THC used in it for addiction

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Marijuana can produce a dependence because of what

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The calming effect

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When does amotivational syndrome occur?

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There's a huge difference between music once a month versus chronic use this happens in chronic use

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Marijuana has caused what in some patients

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Delirium and anxiety and paranoid they can have the opposite of the calming effect

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60% of patients with bipolar disorder also have what?

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substance abuse with a lifetime prevalence of 50%

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People with bipolar disorder and substance abuse have what? 4

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Poor treatment compliance
more mixed episodes
more hospitalizations
and more suicide attempts greater than 15%

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People with bipolar disorder usually have more than one axis I disorder what are they

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GAD
PTSD

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Bipolar usually start out with alcohol and it's usually poly substance especially in?

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Females

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What is the highest morbidity in bipolar disorder and substance abuse?

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Hepatitis C

Front 241

What should you do if you have a client with substance abuse that has a lot of tattoos that they either got in jail or made themselves?

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Run a hepatitis C panel

Front 242

What is the treatment for hepatitis C?

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Interferon

Front 243

Interferon leads to a higher incidence of what?

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Depression and suicidal ideation's so they will usually be referred to a mental health provider for monitoring

Front 244

Why does this population of substance abusers usually have hepatitis C. or HIV?

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Because of the risky behaviors associated with drug use and prostitution associated with females

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If a person comes to you with a diagnosis of bipolar disorder and they have a substance use problem what do you do

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Find out who diagnosed him with it, if they were clean at the time, because if they were withdrawing or on a substance that can look like mania

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If the patient comes to you and says they have bipolar disorder with substance use what do you treat first

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The substance use the VA will not make any diagnosis until three months after they are sober they say that's how long it takes to see a true axis I or II disorder; so you have to go with no mood so disorder NOS than to label a diagnosis you are not sure about

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What drugs have been known to decrease cravings when a person has substance use?

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SSRIs except for Paxil

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How do you have to treat the symptoms of people with substance abuse

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Treat symptoms you are seeing!

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If you have a young person come in that tells you that they have bipolar disorder, what do you need to get as far as information from them?

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Get a clear history like what was the age of onset, when did you start using chemicals drugs or alcohol, did you feel manic before you used any substances.

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If a young person that has bipolar disorder tells you they felt manic before they used substances of abuse what is the prognosis?

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Very poor prognosis probably the worst prognosis

Front 251

Treated symptoms that you are seeing, if you are seeing bipolar disorder then treat that with?

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An antipsychotic such as risperdal or symbiax (prozac + zyprexa)

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What is symbiax good for when treating bipolar disorder?

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Depression
anger
irritability
and agitation