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Psychiatry pro +1700 > Substance Abuse > Flashcards

Flashcards in Substance Abuse Deck (78):
1

What is considered risky drinking for men and women under 65 yo? Those over 65?

Men = more than 14 drinks / week
Women, and those over 65 = More than 7 drinks/day

2

What, generally, is meant by the term risky use?

Health consequences may arise from using

3

What is the definition of physical dependence?

A state of adaptation that is manifested by withdrawl syndrome produced by an abrupt cessation

4

What is unhealthy use?

Spectrum from risky use to addiction

5

What is meant by the term abuse in terms of drug use?

Any use or amount that deviates from social norms

6

What is misuse in the context of drugs?

Prescription drugs that are taken in an amount greater than prescribed

7

What is cross-tolerance in the context of drug use?

The ability of one drug to be substituted for another to produce the same effects

8

How, generally, do drugs work?

Activation of the reward system based on:
-Reinforcement of behaviors
-Changes to Memory production

9

True or false: the pathway of reward is difference for each drug, but the mechanism is the same

False-mechanism different, but the pathway is the same

10

What is the pathway of reward activation?

Prefrontal cortex to ventral tegmental area nucleus accumbens, to ventral tegmental area

11

What is the role of the nucleus accumbens?

Motivation and goal-directed behavior

12

What is the area of the brain that produces dopamine?

Ventral tegmental area

13

What is the major neurotransmitter involved in the reward pathway?

Dopamine

14

What are the four major functions of serotonin?

-mood
-Memory processing
-Sleep
-Cognition

15

What are the major functions of dopamine (5)

-Reward
-Pleasure
-Motor function
-Compulsion
-Perseveration

16

What is the MOA of cocaine?

Ester--blocks dopamine reuptake

17

What BP drugs should never be combined with cocaine?

Beta blockers

18

How long must drug use continued for to be called a disorder?

12 months

19

What are the mild, moderate, and severe drug use disorder?

Mild = 2-3
Moderate = 4-5
Severe = 6+

20

What are the "impaired control" diagnostic criteria for abuse disorder (4)?

-Taking substance over longer period, or in larger amounts
-Desire to cut down or unsuccessful efforts
-Spend too much time
-Craving

21

What are the "social impairment" diagnostic criteria for abuse disorder (3)?

-Failure to fulfill role
-Social problems
-Social concerns giving up for use

22

What are the "Risky use" diagnostic criteria for abuse disorder (2)?

-Using when physically hazardous
-Using despite negative health consequences

23

What are the "Pharmacological" diagnostic criteria for abuse disorder (2)?

-tolerance
-Withdrawal

24

True or false: either tolerance or withdrawal are needed for a diagnosis of substance abuse disorder

False

25

What are the major ocular changes with: EtOH?

Nystagmus

26

What are the major ocular changes with: sedatives, hypnotics, anxiolytics

Nystagmus

27

What are the major ocular changes with: inhalents

Nystagmus

28

What are the major ocular changes with: hallucinogens

Dilated pupils

29

What are the major ocular changes with: PCP

Nystagmus

30

What are the major ocular changes with: stimulants

Dilated pupils

31

What are the major ocular changes with: Cannabis

Conjunctival reddening

32

What are the major ocular changes with: opioids

Constricted pupils

33

What are the criteria for withdrawal?

-Syndrome caused by cessation
-Clinically significant or impairment
-Cannot be attributed to anything else

34

A short acting substance affects what part of withdrawal?

Intensity

35

A long acting substance affects what part of withdrawal?

Duration

36

What are the following for stimulant use:
-BP changes
-HR changes
-Temp
-Ocular findings
-DTRs
-Ataxia
-Hallucinations
-Delusions

-BP changes = increased
-HR changes = increased
-Temp = increased
-Ocular findings = dilated
-DTRs = increased
-Ataxia = none
-Hallucinations =yes
-Delusions = yes

37

What are the following for PCP use:
-BP changes
-HR changes
-Temp
-Ocular findings
-DTRs
-Ataxia
-Hallucinations
-Delusions

-BP changes = increased
-HR changes = Increased
-Temp = increased
-Ocular findings = nystagmus
-DTRs = increased
-Ataxia = yes
-Hallucinations = yes
-Delusions = yes

38

What are the following for opioid overdose:
-BP changes
-HR changes
-Temp
-Ocular findings
-DTRs
-Ataxia
-Hallucinations
-Delusions

-BP changes = none
-HR changes = none
-Temp = none
-Ocular findings = pinpoint
-DTRs = no changes
-Ataxia = none
-Hallucinations = none
-Delusions = none

39

What are the following for opioid withdrawl:
-BP changes
-HR changes
-Temp
-Ocular findings
-DTRs
-Ataxia
-Hallucinations
-Delusions

-BP changes =no change
-HR changes = no change
-Temp = increased
-Ocular findings = dilated
-DTRs = normal
-Ataxia = none
-Hallucinations = none
-Delusions = none

40

What are the following for sedative intoxication:
-BP changes
-HR changes
-Temp
-Ocular findings
-DTRs
-Ataxia
-Hallucinations
-Delusions

-BP changes = decreased
-HR changes = no changes
-Temp = decreased
-Ocular findings = nystagmus
-DTRs = no changes
-Ataxia = none
-Hallucinations = none
-Delusions = none

41

What are the following for sedative withdrawal:
-BP changes
-HR changes
-Temp
-Ocular findings
-DTRs
-Ataxia
-Hallucinations
-Delusions

-BP changes = variable
-HR changes = increased
-Temp = increased
-Ocular findings = none
-DTRs = normal
-Ataxia = none
-Hallucinations = none
-Delusions = none

42

What are the following for LSD, ecstasy, shrooms:
-BP changes
-HR changes
-Temp
-Ocular findings
-DTRs
-Ataxia
-Hallucinations
-Delusions

-BP changes = increased
-HR changes = no changes
-Temp = increased
-Ocular findings = dilated pupils
-DTRs = increased
-Ataxia = none
-Hallucinations = none
-Delusions = Yes

43

What are the following for THC use:
-BP changes
-HR changes
-Temp
-Ocular findings
-DTRs
-Ataxia
-Hallucinations
-Delusions

-BP changes = none
-HR changes = none
-Temp= decreased
-Ocular findings = red
-DTRs = none
-Ataxia = none
-Hallucinations= yes
-Delusions - yes

44

What are the following for inhalant use:
-BP changes
-HR changes
-Temp
-Ocular findings
-DTRs
-Ataxia
-Hallucinations
-Delusions

-BP changes = none
-HR changes = none
-Temp = none
-Ocular findings = nystagmus
-DTRs = decreased
-Ataxia = yes
-Hallucinations = none
-Delusions = none

45

What are the criteria of substance induced psychosis?

appearance of mental disorder within one month of intoxication or withdrawal of a substance that is capable of producing psychosis

46

What are the drink equivalents in terms of beer, wine and hard liquor?

12 oz
5 oz
1.5 oz

47

True or false: males have higher rates of substance use disorders and intoxication relative to females

Partly false--higher rates yes, but females more likely to be intoxicated

48

Where does EtOH fall in terms of preventable causes of death in the US?

Third

49

What is the positive affect regulation theory of alcohol use?

Feels good, so do it

50

What is the negative affect regulation theory of alcohol use?

Takes away the bad

51

What is the pharmacological vulnerability theory of alcohol use?

Some are more prone to use disorders than others

52

What are some skin changes associated with alcoholism?

Red palms
Caput medusae

53

What type of hematological problems can EtOH cause? (2)

Macrocytosis
Anemia

54

What are the two, non obvious cancers that smoking increases the risk for?

Cervical
Pancreatic

55

What are the characteristics and causes of Mallory Weiss tears? How do these present?

Linear streaks 2/2 chronic vomiting.

Painful hematemesis

56

How can you differentiate between mallory weiss tears and esophageal varices?

Mallory weiss tears = painful hematemesis

Esophageal varices - painless hematemesis

57

What type of seizures are had with EtOH withdrawal? When do they usually occur?

-Tonic clonic
-6-48 hours from last drink

58

What is the classic triad of Wernicke-Korsakoff syndrome?

-Confusion
-Ataxia
-Ophthalmoplegia

59

What is the classic symptom of Wernicke-Korsakoff syndrome?

Confabulation

60

What is the level of BAC for the Buzzed feeling?

30-50 mg/dL

61

What is the level of BAC for the euphoric feeling?

50 mg/dl

62

What is the level of ataxia/slurred speech for the Buzzed feeling?

100 mg/dL

63

What is the level of BAC for the drowsy/confused?

200 mg/dL

64

What is the level of BAC for stupor?

300 mg/dL

65

What is the level of BAC for progression to coma/death?

more than 400 mg/dL

66

When does alcohol withdrawal usually present following the last drink?

4-72 hours

67

What are the s/sx of alcohol withdrawal?

-Insomnia
-Palpitations
-Diaphoresis
-Anxiety
-HAs
-Tremors
-Hallucinations
-Szs

68

What type of hallucinations are more common with substance use: visual or auditory?

Visual

69

When do DTs usually present? How long do they last for?

-begin with 72 hours
-can persist for 7 days

70

What are the lab changes that can occur with DTs? (3)

-Elevated cardiac markers
-Respiratory alkalosis
-Lyte abnormalities

71

What are the risk factors for DTs? (besides obvious)

-presence of concurrent illness
-age over 30
-Withdrawal effects seen while still intoxicated, but at a lower level

72

What is the CIWA scoring system, and what score indicates that you're all good?

Predictor for the development of withdrawal

Less than 10 = no withdrawal

73

What is the treatment for DTs?

Ativan (lorazepam)

74

What is the difference between the MOA of barbiturates and benzos?

Barbiturate = prolong GABA channel opening

Benzos = increase frequency of GABA opening

75

What is the MOA of naltrexone, and what is it used for?

Opioid antagonist
reduced reward from drinking

76

What is the MOA of disulfiram?

Inhibition of acetaldehyde dehydrogenase

77

What are the three components of maintenance therapy for alcohol use disorder?

-Naltrexone
-Acamprosate
-Disulfiram

78

What are the 7 components of CIWA?

-Paroxysmal sweats
-HA
-Agitation
-N/v
-Tremors
-Anxiety
-Tactile hallucination
-Sensorium
-Auditory hallucinations