Psy 201 Pharm Ch 14

Front 1

_________ is a significant health social economic an legal problem. It is often associated with substantial damage to the abuser and society.

Back 1

Substance abuse

Front 2

Most drugs of abuse are those that affect the ___________ and alter the state of consciousness.

Back 2

CNS

Front 3

Most drugs of abuse are also associated with ___________ if used repeatedly.

Back 3

Tolerance

Front 4

Many drugs of abuse activate the _____ system in the brain by altering neurotransmission systems.

Back 4

pleasure or reward

Front 5

Characteristics of drug ______________ include craving a drug often with unsuccessful attempts to decrease its use and compulsive drug seeking behavior.

Back 5

dependence

Front 6

Useful for treating delirium tremors because doses can be easily titrated to manage symptoms.

Back 6

midazolam or propofol

Front 7

Blocks euphoria produced by heroin acts longer and reduced preoccupation with drug use.

Back 7

Methadone

Front 8

Opiate antagonist that reduces craving for alcohol and increases abstinence rates.

Back 8

Naltrexone

Front 9

Given to reduce symptoms associated with excessive stimulation of the sympathetic nervous system.

Back 9

Clonidine

Front 10

Specific antidote that can reverse benzodiazepine induced sedation, coma, and respiratory depression.

Back 10

Flumazenil

Front 11

Define substance abuse.

Back 11

Substance abuse is defined as self administration of a drug for prolonged periods or in excessive amount to the point of producing physical or psychological dependence; impairing functions of body organs; reducing the ability to function in usual activities of daily living; and decreasing the ability and motivation to function as a productive member of society.

Front 12

List commonly abused drugs

Back 12

Commonly abused drugs include CNS depressants ex alcohol, anti-anxiety and sedative hypnotic agents, opioid analgesics. CNS stimulants such as cocaine, methaphetamine, methylphenidate, nichotine and other mind altering drugs ex marijuana, ecstasy.

Front 13

What physical or emotional effects are sought by those who use drugs of abuse?

Back 13

Although these drugs produce different effects theyare associated with feeling of pleasure positive reinforcement, and compulsive self administration.

Front 14

Discuss methods used to obtain drugs of abuse by the general population.

Back 14

Drugs of abuse seem to be readily available. Internet websites have become an important source of the drugs. In some instances instructions for manufacturing particular drugs are available. Although patterns of drug abuse vary in particular populations and geographic areas continuing trends seem to include increase use of methamphetamine "club drugs" prescription drugs, and using multiple drugs at the some time.

Front 15

What are some of the characteristics of drug dependence?

Back 15

Characteristics of drug dependence include craving a drug often with unsuccessful attempts to decrease its use; (withdrawal symptoms if drug is used to decreased or stopped) and continuing to take a drug despite adverse consequences and continuing to take a drug despite adverse consequences (ex drug related illnesses, metal or legal problems, job loss, or decreased ability to function in an occupation, impaired family relationships).

Front 16

As an adjunct to Mr. Wilsons alcohol withdrawal management program the physician order disulfiram. You are responsible for his education program. When he arrives home after discharge, the pours himself a beer. Which of the following symptoms would he expect to experience? (select all that apply)

a. Flushing, tachycardia, bronchospasm

b. Hypotension, anemia, and confusion.

c. Sweating, nausea and vomiting

d. Paranoia, mania, and depression.

Back 16

a, c

Rationale: With disulfiram (Antabuse) alcohol produces significant distress (flushing, tachycardia, bronchospasm, sweating, nausea and vomiting. This reaction may be used to treat alcohol dependence.

Front 17

Mr. Weiss returns home after a coronary artery bypass graft and celebrates his survival my overindulging in alcohol. He does not have a history of alcohol abuse. His drug regimen includes warfarin. Which of the following adverse reactions related to the combination of the drugs would your expect?

a. Decreased anticoagulant effects and increased risk of clot formation.

b. No significant drug reaction related to only one incident.

c. Increased anticoagulant effects and decreased risk of bleeding

d. Increased anticoagulant effects and risk of bleeding.

Back 17

d.

Rationale: With oral anticoagulants alcohol interactions vary. Acute ingestion increases anticoagulant effects and the risk of bleeding.

Front 18

Mrs. Song has a history of chronic alcohol usage and subsequent liver damage. She develops a deep vein thrombosis and is sent home from the hospital on warfarin. Which of the following adverse reaction related to the combination of the drugs would you expect?

a. Decreased anticoagulant effects and increased risk of clot formation.

b. No significant drug reaction related to only one incident.

c. Increased anticoagulant effects and decreased risk of bleeding.

d. Increased anticoagulant effects and risk of bleeding.

Back 18

d.

Rationale: Chronic ingestion decreases anticoagulant effects by inducing drug metabolizing enzymes in the liver and increasing the ratio of warfarin metabolism. However, if chronic ingestion has caused liver damage metabolism of warfarin may be slowed. This increases the risk of excessive anticoagulant effect and bleeding.

Front 19

With oral anti-diabetic drugs that decrease blood sugar, alcohol has which of the following effects?

a. It diminishes hypoglycemic effects.

b. It exacerbates hyperglycemic effects.

c. It potentiates hypoglycemic effects.

d. It causes polyuria, and subsequent dehydration.

Back 19

c

Rationale: With oral anti-diabetic drugs that decrease blood sugar alcohol potentiates hypoglycemic effects.

Front 20

With antihypertensive agents alcohol has which of the following effects?

a. It diminishes vasodilation and hypotensive effects.

b. It protentiates vasodilation and hypotensive effects

c. It potentiates vasoconstriction and hypotensive effects

d. It causes euphoria, and mania and confusion.

Back 20

b.

Rationale: With anti-hypertensive agents, alcohol potentiates vasodilation and hypotensive effects.

Front 21

Mrs. Smalls physician prescribes anti-anxiety medication. You are responsible for her education plan. She asks if she can take the anti-anxiety medication when she drinks socially with her friends. Which of the following should be your response?

a. If you limit alcohol consumption to two drinks you should be safe.

b. Combining alcohol with anti-anxiety medication may be lethal and should be avoided.

c. The drug and alcohol may be co administered safely.

d. The anti-anxiety medication will increase your blood alcohol level rapidly; you should use a designated driver.

Back 21

With other CNS depressants alcohol potentiates CNS depression and increase the risk of excessive sedation, respiratory depression, and impaired metal and physical functioning. Combining alcohol with these drugs may be lethal and and should be avoided.

Front 22

Because they are rapidly absorbed from the large surface area of the lungs smoking or inhaling the vapors is a preferred route of administration for which of the following drugs? (select all that apply)

a. Cocaine

b. Marijuana

c. Ativan

d. Heroin.

Back 22

a, b

Rationale: Smoking or inhaling drug vapors is a preferred route of administration for cocaine, marijuana, and nicotine because the drugs are rapidly absorbed from the large surface area of the lungs. Then they rapidly circulate to the heart and brain without dilution by the systemic circulation or metabolism by enzymes.

Front 23

When questioned about her alcohol usage Ms. Askew states that she drinks three martinis a night. Which of the following assumptions can you make?

a. This is the correct amount consumed.

b. She normally consumes for to six martinis a night.

c. She is giving you information you expect to hear.

d. She may have understated the amount of alcohol consumed.

Back 23

d

Rationale: Abusers of alcohol and other drugs are not reliable sources of information about the types or amount and frequency of substance abuse.

Front 24

You work at a hospital based methadone clinic. When interviewing heroin users which of the following assumptions can you make?

a. Heroin addicts may overstate the amount used in attempts to obtain higher doses of methadone.

b. Heroin addicts may understate the amount used due to the adverse effects fo the methadone.

c. Heroin addicts will understate the amount used so that they will experience increased euphoria from an increased dosage of methadone.

d. Heroin addicts will identify the correct amount of drug abused to maintain the sense of euphoria similar to their current drug.

Back 24

a.

Rationale: Heroin addicts may overstate the amount used in attempts to obtain higher doses of methadone.

Front 25

_________, _____________, __________and __________ are often used to combat the anxiety and nervousness induced by cocaine, methamphetamine, and other CNS stimulants.

Back 25

Alcohol, Marijuana, opioid, and sedatives

Front 26

Health care professionals are considered to be at high risk for development of substance abuse disorders at least partly because of which of the following factors?

a. Easy access

b. Low cost

c. Lax regulations related to use

d. None of the above; health care professionals are considered low risk.

Back 26

a.

Rationale: Health care professionals are considered to be at high risk for development of substance abuse disorders at least partly because of easy access.

Front 27

Which of the following statements is true about psychological rehabilitation efforts?

a. They do not make an inpact on addiction treatment because it is a physical dependence.

b. They should be part of any treatment program for a drug dependent person.

c. They are rarely covered by health insurance.

d. They are successful when used in facility based rehabilitation programs.

Back 27

b.

Rationale: Psychological rehabilitation efforts should be part of any treatment program for a drug dependent person.

Front 28

Mrs. Johnson presents to the physicians office with her son James age 12. She found him in the garage this morning sniffing gasoline to get high. You are assigned the education plan for the family. Which of the following would you include as areas of the body where damage might occur?

a. Heart and lungs.

b. Pancreas and gallbladder

c. Vascular system

d. Liver, Kidneys, and bone marrow.

Back 28

d.

Rationale: Inhalants can harm the brain, liver, heart, kidneys, and lungs and abuse of any drug during adolescence may interfere with brain development. Substances containing gasoline, benzene or carbon tetrachloride are especially likely to cause serious damage to the liver kidneys, and bone marrow. Inhalants can also produce psychological dependence, and some produce tolerance.

Front 29

Ms. Keizer presents to the ER confused and disheveled and states that she was raped. She attended a party earlier in the evening. Which of the following substances often called the date rape drug, might have been added to her drink?

a. THC

b. Cocaine

c. Ketamine

D. GHB

Back 29

d

Rationale: Usage of GHB has increased in recent years mainly in the party or dance club setting, and GHB is increasingly involved in poisonings overdoses, date rapes, visits to hospital ERs and fatalities.

Front 30

Mr. Angus age 19 arrives at the ER with his friend. His friend states that they were smoking marijuana and Mr. Angus suddenly began having hallucinations becan exhibiting bizarre behavior, then became unconscious. You find that Mr. Angus is hypertensive and suspect that the marijuana was laced with which of the following substances?

a. Ketamine

b. GHB

c. THC

d. PCP

Back 30

d.

Rationale: Phencyclidine (PCP) produces excitement, delirium, hallucinations, and other profound psychological and physiological effects, including a state of intoxication similar to that produced by alcohol; altered sensory perceptions; impaired through processes; impaired motor skills; psychotic reactions; sedation and analgesia; nystagmus and diplopia; and pressor effects that can cause hypertensive crisis, cerebral hemorrhage, convulsions, coma, and death. Death from overdose also has occurred as a result of respiratory depression. Bizarre murders, suicides, and self mutilations have been attributed to the schizophrenic reaction induced by PCP, especially in high doses. The drug also produces flashbacks.

Front 31

Mr. Jones age 54 recently suffered from myocardial infraction. His medical history indicates that he has been smoking 2 pks of cigarettes per day since the age of 16. He asks the physician for the nicotine patch. Which of the following would you expect the physician to do?

a. Order the patch

b. Suggest other methods of nicotine withdrawal

c. Order a reduced dosage of the patch.

d. State that nicotine cessation at this time may cause further cardiac damage.

Back 31

b.

Rationale: Nicotine is available in trans-dermal patches chewing gum and an oral inhaler and nasal spray. These products are contraindicated in people with significant cardiovascular disease.

Front 32

Ms. Ellis began using cocaine for the energy rush and uses on a daily basis. She presents to her physician with symptoms of anxiety and psychosis and is referred to a concaine withdrawal program. Which of the following treatment methods does such a program include? (select all that apply)

a. psychotherapy

b. Cessation therapy

c. Behavioral therapy

d. 12 step program

Back 32

a,c,d

Rationale: Dug therapy for cocaine dependence is largely symptomatic. Agitation and hyperactivity may be treated with benzodiazepine anti-anxiety agent; psychosis may be treated with haloperidol (haldol) or another anti-psychotic agent; cardiac dysrhthmias may be treated with usual antidysrhythmic drugs; myocardial infraction my be treated by standard methods ; and so forth. Initial detoxification and long term treatment are best accomplished in centers or units that specialize in substance abuse usually involves psychotherapy behavioral therapy and 12 step programs.

Front 33

Which of the following is an accurate statement about heroin addicts?

a. They inject upon waking and cycle throughout the day until sleep.

b. They inject approximately every 4 to 6 hrs to maintain the high.

c. They inject several time a day cycling between desired effects and symptoms of withdrawal.

d. They experience withdrawal symptoms based on the route of administration.

Back 33

c.

Rationale: Heroin may be taken by IV injection, smoking, or nasal application. IV injection lasts a few minutes and is followed by a period of sedation. Effects diminish over approximately 4hrs depending on the dose. Addicts may inject several times daily, cycling between desired effects and symptoms of withdrawal. Tolerance to euphoric effects develops rapidly leading to dosage escalation and continued use to avoid withdrawal. Like other opioids heroin causes severe respiratory depression with overdose and produces a characteristic abstinence syndrome.

Front 34

The physician orders hospitalization for the patient who withdrawals from benzodiazepines. Which of the following is the rationale behind this order?

a. Withdrawal can cause cardiac arrhythmias and subsequent cardiac arrest.

b. Withdrawal can precipitate renal failure.

c. Convulsions are more likely to occur during the first 48 to 72hrs.

d. Liver failure is a risk for such patients.

Back 34

c.

Rationale: Convulsions are more likely to occur during the first 48 hours of withdrawal and delirium after 48hrs to 72 hrs for clients with benzodiazepine dependence.

Front 35

___________ is metabolized at the same rate regardless of the amount present in the body tissues.

Back 35

Alcohol