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Lecture 87: Overview of Addictive Disorders
Nervous System Part III
21
Medical
Professional
03/22/2011

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Term
A need for markedly increased amounts of substance to achieve intoxication or desired effect

or

markedly diminished effect with continued use of the same amount of substance
Definition
tolerance
Term
The characteristic withdrawl syndrome for the substance

the same substance is taken to relieve or avoid withdrawl symptoms
Definition
manifestations of withdrawl
Term
psychological dependence
physical dependance and tolerance
drug-seeking behavior
associated deterioration in mental and physical health
Definition
addiction
Term
Characteristics of Type I alcoholics
Definition
adult onset
gradually increasing consumption
little or no family history of alcoholism
75% alcoholics
better response to treatment
Term
Characteristics of Type II alcoholics
Definition
early onset
strong family history of alocholism
male gender
poor treatment response
25% alcoholics
Term
Wernicke syndrome
Definition
Wernicke-thiamine deficiency, nystagmus, ataxia, mental confusion, reversible
Term
Korsakoff's
Definition
necrotic lesions of mamillary bodies and thalmus, cognitive and memory impairment, anterograde amnesia, confabulation, more permanent
Term
Other complications of alcohol
Definition
cortical atrophy, ventricular dilation, cerebellar damage, peripheral neuropathy, depression:suicide
Term
Treatment for alcohol
Definition
uncomplicated: outpatient benzodiazepenes
delirious patients:antipsychotics (haloperidol)
Term
medications for alcohol dependence
1. inhibits aldehyde dehydrogenase, irreversible inhibitor, works via negatie reinforcement

2. mu-opiod antagonist, reduces drinking and increases abstinence by decreasing pleasure of alcohol

3. glutamate receptor modulator, reduces craving and amount an alcoholic drinks
Definition
1.Disulfiram
2.Naltrexone
3.Acamprosate
Term
Treatment for Sedative
1. intoxication
2. withdrawl
Definition
1. flumazenil
2. long-acting benzodiazepines
Term
respiratory depression
psychomotor retardation
pupillary constriction
hypotension
bradycardia
decreased GI motility/constipation
nausea/vomiting
death by respiratory arrest
Definition
opiods
Term
Withdrawl symptoms of Opiods
Definition
larimation
rhinorrhea
sweating, yawning, piloerection, hypertension, pupillary dilation, tachycardia
hot and cold flashes
nausea/vomiting
severe anxiety, restlessness, insomnia
Term
Treatment of Opiods
1.Intoxication
2. Withdrawl
Definition
1. Naloxone
2. Methadone, Clonidine, Naltrexone, Buprenorphine
Term
tremor, tachycardia, pupillary dilation, elevated BP, anorexia/weightloss, convlsions, impotene
Definition
intoxication signs for stimulants
Term
What are the withdrawl signs for stimulants?
Definition
"the crash"
fatigue/lethargy, anxiety, depression/suicidal, nightmares, headache, hunger
Term
belligerence, assaultiveness, impulsiveness, unpredictability, nystagmus, diminished response to pain, death due to respiratory depression
Definition
intoxication signs for PCP
Term
Treatment for PCP
Definition
Benzos for agitation
Antipsychotics
Phentolamine (reduce BP)
Ammonium chloride (promote drug elimination)
Term
What is the first sign of alcohol withdrawl? Time?
Definition
"the shakes"
anxiety, tremors, n/v
begins 12-48 hrs
peaks 24-48 hrs
Term
What is the second sign of alcohol withdrawl? Time?
Definition
"rum fits"
sing burst of 1-6 generalized seizures
7-38 hrs
Term
What is the 3rd sign of alcohol withdrawl? Time?
Definition
delirium tremens "DT's"
delirium, mild fever, autonomic arousal, shakes/tremors, sweating/diaphoresis
2-3 days
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