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116 Cards in this Set
- Front
- Back
Where are the changes in the brain associated with addiction?
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Addiction causes changes in the orbital frontal lobes that are permanent in addicts
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Where are the changes in the brain associated with addiction
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There are changes in the orbital frontal lobes that are permanentinaddicts
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What is the main reinforcer of addiction?
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Dopamine is the main reinforcer of addiction.
There are increased concentrations in the limbic system. It does not in itself cause addiction |
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What is the main reinforcer of addiction?
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Dopamine is the main reinforcer of addiction.
There are increased concentrations in the limbic system. Dopamine does not in itself cause addiction |
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How does dopamine cause addiction?
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Addictive drugs either cause reuptake inhibition of dopamine or increased sensitivity to dopamine.
Can produce 5-10 times greater effect |
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How does dopamine cause addiction?
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Addictive drugs either cause reuptake inhibition of dopamine or increased sensitivity to dopamine.
Can produce 5-10 times greater effect |
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Is addiction genetic?
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40-60% of the vulnerability to addiction is genetic.
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Risk factors for addiction.
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Stress.
Low income status. Drug availability. Mental illness |
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Is addiction genetic?
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40-60% of the vulnerability to addiction is genetic.
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Risk factors for addiction.
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Stress.
Low income status. Drug availability. Mental illness |
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Define
PREVALENCE |
Prevalence = number cases/number in total population
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Define
INCIDENCE |
Incidence = number of new cases/number in total population
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Define
RELATIVE RISK |
Relative risk = number of people with disease plus special condition/number number with disease without special condition
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Prevalence of alcoholism
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Prevalence of alcoholism 1980 was
13% lifetime 3% in a month |
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Relationship of age to alcoholism
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One third of adolescent drinkers will develop dependence.
Alcoholism generally declines with age |
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Prevalence of drug use
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Lifetime prevalence equals 0.2%.
Males 2 times more likely than females. Half of adolescent users develop dependence |
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Risk factors for drug use.
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Risk factors for drug use.
Cohabitation. Nontraditional jobs. Childhood sexual abuse. |
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Highest Hazzard age for drug and alcohol abuse
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19 years old
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Alcoholism by race
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Whites began heavy drinking younger than blacks.
Blacks have lower drinking rates Than Whites But are more likely to be chronic drinkers. Heavy drinking among Whites is declining. Blacks have more problem with alcohol than Whites. Hispanic alcohol use is lower than Whites. Hispanic alcohol use increases with acculturation. Hispanic cirrhosis rate is higher than Whites |
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What parts of the brain are involved in addiction and what is their function
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Limbic system is involved in addiction.
----Subcallosal area. ----Cingulate. ----Parahippocampal gyri These areas deal with emotions, identity and fight or flight |
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Name opiate receptors
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There are 3 opiate receptors.
---mu. ---kappa ---Delta there are opiate receptors throughout the brain, especially limbic system |
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Effects of mu agonists
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Selective MU agonist (e.g. heroin morphine)
Produces : analgesia and euphoria. respiratory depression emesis antidiuretic action |
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Effect of opioid Kappa Agonist
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Kappa Agonists produce.
Dysphoria. Diuresis. Analgesia. NO respiratory depression |
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cannabinoid receptors
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There are 2 cannabinoid receptors.
CB1, CB 2. They are acted upon by endogenous and/or exogenous cannabinoids. CB 1 is found in much of brain. CB 2 is found in the lower levels of brain |
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What is physical dependence?
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Physical dependence causes individual to become physically sick and drug administration ceases.
Physical dependence is neither necessary nor sufficient to cause addiction. |
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kappa agonists produce
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kappa Agonists produce
dysphoria Diuresis Analgesia. No respiratory depression |
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List impulse control disorders
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impulse control disorders
Explosive disorder. Kleptomania. Pathologic gambling. Pyromania. Trichotillomania DSM 5 will include. Excessive intranet use. Excessive shopping. Sex addition. Skin picking. Nailbiting |
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Criteria for pathologic gambling
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PATHOLOGIC GAMBLING HAS 5 OR MORE THE FOLLOWING.
Gambling with greater amounts of money to achieve same experience. Unsuccessful attempt to reduce or quit gambling. Restless or irritable while trying to stop gambling (withdrawal). Gambling to escape dysphoric state. Gambling to regain gambling losses. Lies in significant relationships about gambling. Engages in illegal activity to fund gambling. Has risked or lost the job or significant other because of gambling. Relies on others to fund gambling |
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Paraphilia sexual behavior versus
non-paraphilia sexual behavior |
PARAPHILIA SEXUAL BEHAVIOR = uses abnormal selection e.g. animal, unwilling person, and an object.
NON-PARAPHILIA SEXUAL BEHAVIOR engages in socially normative behavior and excessive, obsessive or compulsive manner without a disturbance of object twice |
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Examples of non-paraphilia sexual behavior
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Compulsive cruising and multiple partners.
Compulsive multiple love relationships. Compulsive sexuality in a relationship. Compulsive autoeroticism. Compulsive use of Internet. Compulsive fixation on unobtainable partner. Repetitive sexual fantasies causing distress or associated with loss of control. Repeated sexual urges causing distress or associated with loss of control. Repetitive engagement in sexual behavior causing distress or associated with loss of control |
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Neurotransmitters that contribute to sexual behavior
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Neurotransmitters that contribute to sexual behavior
Dopamine. Serotonin. Norepinephrine. Opioid system |
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Described problematic intranet use
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PROBLEMATIC INTERNET USE
Reduced face-to-face social activity. Withdrawal, tolerance. Pre-occupational with Internet. Longer than intended time on the Internet. Risks significant other relationships or employment. Lying about Internet use. Repeat unsuccessful attempts to stop Internet use. Associated with decreased social involvement and increased loneliness and depression |
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Describe
INTERMITTENT EXPLOSIVE DISORDER |
INTERMITTENT EXPLOSIVE DISORDER.
Failure to in inhibit aggressive impulses that out of proportion to any precipitating stressor resulting in destruction of property or physical assault. Stressors may be internal/external. 7% on Americans meet lifetime criteria. 4% of Americans meet 12 months criteria |
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Define
PHARMACOKINETICS |
PHARMACOKINETICS = movement of the drug within the body.
What the body does to the drug |
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Define
PHARMACODYNAMICS |
PHARMACODYNAMICS = biochemical and physiologic effects of the drug mechanism of action.
What the drug does to the body |
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First-pass metabolism
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First-pass metabolism = Metabolism before the drug reaches systemic circulation.
Particularly important in oral and rectal routes. Usually occurs in the liver. Not significant in intervenous, sublingual, transdermal, injected routes |
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Define
VOLUME OF DISTRIBUTION |
VOLUME OF DISTRIBUTION =
amount of serum, plasma, blood required for culture of all the drug of the body if uniformly dispersed. Drugs with a small VD are confined to the intravascular space of approximately 5 L. Drugs with large VD (up to 50,000 L) are tightly bound to tissue sites or are lipophilic |
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Define
FIRST-ORDER ELIMINATION KINETICS |
FIRST-ORDER ELIMINATION KINETICS =
exponential decay caused by eliminating fixed percentage of the drug |
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Define
ZERO ORDER ELIMINATION KINETICS |
Zero Order Elimination Kinetics =
linear decay of concentration. Fixed amount of drug as eliminated per unit of time. |
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Define
pharmacokinetic tolerance |
Pharmacokinetic tolerance =
increase metabolism resulting from repeated exposure |
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Defined
LEARNED TOLERANCE |
Learned tolerance =
reduction of effects of drugs because of compensatory mechanism that are learned. EG roofers can walk a straight line despite alcohol intoxication |
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Define the class alcohol
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Alcohol is a chemical name for a group of related compounds to contain a hydroxyl group bound to a carbon atom
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List standard drinks
Absolute alcohol Beer Wine distilled spirits |
Standard alcoholic drink =
0.6 fluid ounces of absolute alcohol. 12 ounces of beer. 5 ounces of wine. 1.5 ounces of distilled spirits |
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Percentage of 21-25-year-old using alcohol
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70% of 21-25-year-old use alcohol
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Economic costs of alcoholism
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Loss of productivity and healthcare from alcohol usage is estimated 185 billion-dollars annually
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Volume distribution of alcohol is
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Volume distribution of alcohol is all tissues
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Metabolism of alcohol
where. Excretion enzymes affecting alcohol. Zero order or first-order elimination kinetics |
Most alcohol is metabolized rather than excreted.
Alcohol metabolized by alcohol dehydrogenase primarily. Zero order kinetics means alcohol is metabolized as a constant rate |
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How long does it take to metabolize alcohol?
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Adults can metabolize 1 ounce of absolute alcohol per 3 hours
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Early Effects of rising alcohol level
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Early Effects of Rising Alcohol Levels =.
Relief of anxiety. Increase talkativeness. Feelings of confidence and euphoria Increase assertiveness |
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Effects of rising blood alcohol at moderate levels
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Moderate levels of alcohol =
impaired judgment. Impaired reaction time. Increases emotional outbursts. Ataxia |
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Alcohol at higher levels produce
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Higher levels of alcohol...
Acts as a sedative and hypnotic. Reduce quality of sleep. Increases frequency and severity of apenic episodes in OSA. Potentiates other sedative hypnotic products May provoke violent behavior |
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Define
Wernicke's psychosis |
Wernicke psychosis =
encephalopathy ophthalmoplegia ataxia caused by vitamin B-1 deficiency |
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Define
Korsakoff's psychosis |
Korsakoff psychosis =
Extension of Wernicke psychosis. Anterograde amnesia. Retrograde amnesia. Confabulation. Meager content in conversation. Lack of insight. Apathy |
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Mechanism of action of all addicting drugs
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Mechanism of addiction of all addicting drugs is to affect reward pathways by enhancing releases of dopamine from midbrain dopaminergic projections that regulate expiratory glutamatertic neurotransmission within the knee is Olympic and meso cortical areas of the forebrain
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What is on compulsive buying disorder?
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Compulsive buying disorder = oniomania
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Discuss kleptomania
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Diminished ability to inhibit impulses steel.
Has increased tension prior to theft. Has subjective pleasure or relief associated with this. Generally begins in adolescence or early adulthood. Incidence equals 1%. More common in women |
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What disorders are associated with kleptomania?
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Kleptomania is associated with.
Mood disorders. Obsessive compulsive disorder. Panic disorder. Separation anxiety disorder. Body dysmorphic disorder other impulse control disorders |
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Drug Treatment of kleptomania
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Fluoxetine 80 mg per day.
Naltrexone. Topiramate. Nonwork 100% |
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Discuss trichotillomania
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Trichotillomania = pulling out of hair
Trichophagia = eating hair. Onset usually in adolescence. Often associated with other impulse control disorders or substance abuse disorders especially OCD |
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Drug treatment of trichotillomania
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Naltrexone we'll treat trichotillomania
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Discuss skin picking
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Skin taking.
Classified as a stereotypic movement disorder. 25% of institutionalized retarded people have stereotypic behaviors. Using done in isolation. Often comorbid with suicide ideation. More common in females. Occurs and 4% of college students. 2% of dermatology patient's meet criteria for skin taking |
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Drug treatment of skin picking
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The treatment for skin picking is SSRIs
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Define intermittent explosive disorder
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Intermittent explosive disorder = failure to in inhibit aggressive impulses that out of proportion to any precipitating stressor resulting in destruction of property or physical assault
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Define
Bioavailability |
Bioavailability = fraction of unchanged drug reaches systemic circulation
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Which routes of drug administration are subject to first-pass metabolism?
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Oral and rectal routes are subject to first pass metabolism
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Effects of concurrent cocaine and alcohol
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Concurrent cocaine and alcohol. Enhances effects of cocaine and inhibits metabolism of cocaine
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Define
Potency |
Potency = amount of drug to induce a given effect
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Define
Tolerance |
Tolerance = reduction in response to a drug after repeated use
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Define
Sensitization |
Sensitization = increase in drug response after repeated administration
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Define
Cross tolerance |
Cross tolerance = tolerance to one drug generalized by other drugs in the same category
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At what rate will blood alcohol drop?
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Blood alcohol level will drop about 20 mg/dL per hour
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Define
Sedative |
Sedatives are diverse group a chemical agents that suppress CNS activity.
Includes anxiolytics. Hypnotics. Anticonvulsants. Muscle relaxants. Anesthesia induction agents |
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What are the classes of sedatives?
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Classes a sedatives.
Benzodiazepines. Non-benzodiazepine hypnotics (zopiclone, eszopiclone, zaleplon, zolpidem). Barbiturates. Miscellaneous compounds |
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What drug use used to treat sedative withdrawal.?
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Phenobarbital is used to treat sedative withdrawal
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Which benzodiazepines are most commonly abused?
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Zolpidem (Ambien) is the most commonly abused benzodiazepine
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How many Americans use benzodiazepines
in one month In one year |
7-17% of Americans use benzodiazepines for up to one month
1% of Americans use benzodiazepines for greater than one year |
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What are some long-term users of benzodiazepines?
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Long-term users of benzodiazepines:
Older woman. High anxiety persons. Persons with chronic health problems. Alcoholics 20%. Methadone users 70-90% |
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Benzodiazepines and suicide
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Benzodiazepines are involved in a great number of suicide.
Abuse to benzodiazepines as a solitary drug is rare |
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How are benzodiazepines metabolized?
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Benzodiazepines I metabolized by CT wife for 50 enzyme and liver
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What drug characteristics affect euphoria?
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Euphoria is affected by.
Drug. Lipid solubility. Protein binding. Rate of entry into brain |
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What neurotransmitter is affected by benzodiazepines?
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Benzodiazepines mediate GABA, which is the main inhibitory neurotransmitter of the brain
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What drug gives the most serious sedation when taken with benzodiazepines?
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Alcohol gives the most serious sedation when combined with benzodiazepines
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Benzodiazepines are inhibited by?
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Benzodiazepines are inhibited by.
ketoconazole Itraconazole. Macrolide antibiotics. Fluoxetine. Nefazodone |
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What drugs may enhance benzodiazepine effect?
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Birth control pills may enhance benzodiazepine effect
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Barbiturates will decrease the activity of what drugs?
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Barbiturates will decrease the effect of.
Anticoagulants. Birth control pills. Steroids. And others |
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benzodiazepines and hedonic effects?
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Benzodiazepines alone are rarely used for hedonic effects.
Usually mixed with methadone |
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Discuss
tolerance to benzodiazepines |
Tolerance to benzodiazepines.
Causes escalation of the dose to get same effect. Is rapidly developed for sedative effect. Tolerance does not occur to anxiolytic effects therefore patient likely to reduce the dose |
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Benzodiazepines with the least risk of addiction
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Benzodiazepines with the least risk of addiction.
Clonazepam. Chlordiazepoxide. Oxazepam |
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Benzodiazepines with the highest risk of addiction?
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Highest risk of addiction with benzodiazepines with highest risk of addiction.
Diazepam. aprazolam Lorazepam |
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Benzodiazepine toxicity produces
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Benzodiazepine toxicity symptoms are.
Sedation. Anterograde amnesia. Difficulty acquiring new learning. Difficulty concentrating. Chronic heavy benzodiazepine users can suffer cognitive impairment which is often permanent |
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What drug is associated with sleep walking?
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Zolpidem is often associated with complex nocturnal activities such as sleepwalking or sleep driving.
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Taking benzodiazepines during pregnancy may produce the following syndromes.
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Benzodiazepines taken during pregnancy.
May increase cleft palate risk. Floppy baby syndrome |
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What is
GHB? |
GHB = Gamma hydroxybutyrate.
Club drug. Can induce absence seizures. Can treat catalepsy and narcolepsy |
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What are the effects of GHB?
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Effects of GHB.
Slurred speech. Feelings of increase sexual intimacy. Drowsiness. Depression after use. Physical dependence and addiction. Withdrawal if used for >one week. |
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Treatment for GHB intoxication?
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GHB intoxication is treated with high dose benzodiazepines followed by a taper
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List endogenous opioid peptides
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Endogenous opioid peptides are.
Beta endorphin. Enkephalins. Dynophins |
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Decay products of heroin are
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Decay products of heroin are.
morphine. 6 mono acetyl morphine |
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List synthetic Opioid agonists
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Synthetic opioids are.
Hydrocodone. Oxycodone. Hydromorphone. Heroin |
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Synthetic opioid antagonists
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Synthetic opioid antagonists include.
Naloxone. Naltrexone. Nalmefene |
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Discuss
Oxycodone |
Oxycodone.
Semisynthetic compound derived from thebaine. Structurally similar to codeine but pharmacodynamics similar to morphine |
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. Discussed codeine
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Codeine = methyl morphine.
More lipophilic than morphine. Less first-pass metabolism therefore greater bioavailability than morphine. Less potent than morphine |
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What is Talwin NX?
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Talwin NX is pentazocine plus naloxone to reduce abuse
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What is L AAM?
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LAAM = levo-alpha methanol.
Is a 48 hour congener of methadone |
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What are the side effects of LAAM
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The side effects of LAAM are.
Prolonged QT intervals. Torsades de points |
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How many people have used heroin?
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Number of heroin users =.
1 million in the United States. 3.5 million worldwide. 100,000 new users annually. 15% of substance abuse treatment is for heroin |
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Heroin pharmacokinetics
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Heroin pharmacokinetics.
Liposoluble and water-soluble. More potent than morphine. Is prodrug, no intrinsic opioid activity. |
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What is the half-life of heroin in the blood
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The half-life of heroin and blood is 3 minutes!
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Why is heroin not used orally?
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Oral heroin is metabolized by first-pass metabolism to liver. Has very limited bile availability when given orally
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When do peak blood levels of heroin occur after using?
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Heroin peaks and the blood within 5 minutes of intranasal, intramuscular, or subcutaneous use
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What is the half-life of morphine?
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The half-life of morphine is 3 hours but analgesia last longer
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How is morphine eliminated from the body?
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90% of morphine as excreted in urine within 24 hours
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What is the half-life of immediate release oxycodone?
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The half-life of immediate release oxycodone is 3-4 hours
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Technical name for codeine
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Codeine is also known as methyl morphine
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Meperidine analgesia.
Begins. Peaks were metabolized? |
Meperidine analgesia begins in 15 minutes.
Peaks in one to 2 hours. Mostly metabolized in the liver |
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Methadone pharmacokinetics
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Methadone pharmacokinetics.
Is a full mu opioid agonist. Oral methadone is rapid absorption but delayed onset of action. Half-life of methadone is 24 hours |
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What is the half -life of methadone?
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The half life of methadone is 24 hours
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