Term
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Definition
| abnormal use of a substance which leads to impairment - affecting personal lives, occupation and physical health. |
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Term
| what is substance dependence? |
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Definition
| substance abuse and a pattern of tolerance to what is being used and withdrawal symptoms when it is not available. |
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Term
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Definition
| physical and or psychological symptoms after cessation of using the substance, or even reducing the amount of substance used. |
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Term
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Definition
| the need to increase the amount of substance to achieve the same physical and psychological effects - have to keep upping the dose. |
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Term
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Definition
| tolerance developed to one substance through use of another |
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Term
| who does substance abuse affect? |
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Definition
| the social network - close relationships, family members, spouses, etc. they may function as enablers (facilitate pt's inability to discontinue use). |
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Term
| how much of the population has used 1+ illicit substance in their life? |
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Definition
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Term
| why do people develop substance abuse? |
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Definition
| pharmacology, to escape pressures of daily life/stress, self medication, masturbatory (causing pleasure controlled by oneself), oral fixation, positive reinforcement linked to substance acquiring behavior (linked to criminal behavior), and genetics of DA/GABA/opioid/catecholamine pathways. |
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Term
| what areas in the brain interact with drugs/alcohol? |
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Definition
| the DA/GABA/opioid/catecholamine pathways of the ventrolateral tegmentum project to the cortex, then limbic system - of which the nucleus accumbens is most involved (reward center - bypasses judgment centers of the prefrontal cortex) as well as the locus coeruleus (opioid hotspot). |
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Term
| what characterizes alcohol use and abuse? |
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Definition
| 90% of the western world has used alcohol and 30% has had problems related to it. |
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Term
| what is alcohol dependence? |
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Definition
| repeated use of alcohol to the point of impairment along w/a negative effect on multiple areas of a person's life and how they function. they go through the process of intoxication/withdrawal and usually have back up supply. |
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Term
| what characterizes alcohol abusers vs dependents? |
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Definition
| abusers don't necessarily get to the point of tolerance/withdrawal, but do consume increasing amounts which may lead to dependence |
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Term
| when does the blood alcohol level peak? |
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Definition
| 30-90 min after ingestion. faster on an empty stomach. |
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Term
| how quickly does the body metabolize alcohol? |
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Definition
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Term
| what does alcohol do pharmacologically? |
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Definition
| acts on the GABA system to enhance neuronal inactivity - which may lead to a sedative effect. pts may exploit this sedative effect to self medicate if they have a panic disorder. |
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Term
| what is simple alcohol intoxication? |
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Definition
| mild intoxication – may be more relaxed, more talkative, euphoric mood and less inhibited. |
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Term
| what can more serious intoxication cause? |
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Definition
| maladaptive changes to behavior due to suspension of the prefrontal cortex's role: difficulty w/psychomotor ability to drive, impaired judgment, ataxia, nystagmus, and memory impairment. |
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Term
| what is alcohol idiosyncratic intoxication? |
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Definition
| people become very inappropriate, sometimes very aggressive after ingesting a small amount of alcohol - causes a shift in mood: very aggressive and paranoid, a total change in behavior and personality. |
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Term
| what is an alcohol blackout? |
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Definition
| when a person becomes intoxicated and develops anterograde amnesia. when the alcohol effect wears off - cognition is restored. |
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Term
| what is alcohol-induced psychotic disorder w/hallucinations? |
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Definition
| very vivid hallucinations, usually visual and auditory, which starts after alcohol is decreased or eliminated in a person who consumes it regularly (dependent). this is similar to alcohol withdrawal delirium, but does not have any other delirium symptoms. |
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Term
| what can happen if a heavy drinker (6 pack/night) stops or drastically cuts down? tx? |
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Definition
| withdrawal delirium (DTs): autonomic hyperactivity, GABA depletion, the shakes, diaphoresis, shifts in BP, heart function, GI symptoms, delirium, and possibly grand mal seizures. tx: BZDs (which are cross tolerant) |
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Term
| what is wernicke's delirium/syndrome? |
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Definition
| an amnestic disorder with which opthalmoplegia is associated - related to thiamine deficiency |
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Term
| what is korsikoff syndrome? |
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Definition
| when wernicke's delirium/syndrome progresses to a loss of ability to retain any recent information - so the pt creates stories instead. |
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Term
| what can fetal alcohol syndrome cause? what is the risk for FAS in alcohol-dependent women? |
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Definition
| mental retardation, hydrocephaly, craniofacial abnormalities, and developmental limb problems. alcohol dependent women have a 35% greater risk of having children w/birth defects than the avg woman. |
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Term
| how is alcohol dependence treated? |
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Definition
| the pt must be motivated (otherwise go through withdrawal and then go right back to drinking). the pt has to go through a detox period (get through withdrawal delirium) then rehabilitation can be started. rehab is intensive, time consuming, best done inpatient, and is more successful in a group context. 1-1 psychology-based therapy is also helpful in getting pts to adjust to life w/o the substance. there is a very high relapse rate. disulfiram can be taken by pts trying to stop drinking as it will make them sick if they do. naltrexone can be used to stop cravings. acamprosate helps reduce cravings. topiramate has antiseizure/mood disorder effects and can help w/alcohol dependence. |
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Term
| do alcohol dependent pts have a high suicide rate? |
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Definition
| yes, even pts who have have been clean. |
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Term
| what is the most abused opioid? |
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Definition
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Term
| what characterizes incidence of heroin? |
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Definition
| men > women 3:1, lifetime prevalence to becomes a heroin user is ~1% |
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Term
| when did heroin use start? |
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Definition
| soldiers in the civil war would become addicted to morphine and heroin was created (mid 19th century) to help them break their addiction (originally OTC). |
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Term
| what characterizes the pharmacologic effect of heroin? |
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Definition
| heroin has a similar effect on the dopaminergic receptors as alcohol - via the ventral-tegmental area. |
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Term
| is it common for opioid dependent pts to develop a comorbid psychiatric illness? |
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Definition
| yes. suicide is also a common outcome (15% risk). |
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Term
| what are risk factors for opioid dependence? |
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Definition
| lower socioeconomic status, fam hx of substance abuse, and broken families. heroin use will often start in adolescence as self-medication for underlying depression or anxiety and to enhance self-esteem. |
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Term
| what characterizes opioid withdrawal? |
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Definition
| morphine and heroin start symptoms of withdrawal ~6-8 hrs after last dose. if used regularly for 1-2 wks, withdrawal symptoms including nausea/vomiting, myalgias, depression, lacrimation, rhinorrhea, papillary dilatation, piloerection, sweating, diarrhea, fever and insomnia - but not death will occur. |
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Term
| what is methadone used for? |
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Definition
| helping heroin addicts break their addiction. it's withdrawal symptoms are more delayed (1-3 days) due to its longer t1/2. |
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Term
| what characterizes female opioid dependents during pregnancy? |
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Definition
| if they undergo withdrawal from opioids early in pregnancy they may have spontaneous miscarriage or fetal death - therefore they may be put on a low methadone dose throughout their pregnancy. withdrawal is better in the 2nd trimester if determined to be the best tx. if the medication is continued throughout pregnancy the baby will also be opioid dependent (whose withdrawal is controlled with small doses of paregoric). |
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Term
| what characterizes amphetamines? |
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Definition
| these stimulants are used clinically to treat ADD and narcolepsy. they have also been abused to give pts a mood/energy boost. |
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Term
| what is the long term effect of injecting opioids or amphetamines into veins? |
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Definition
| sclerosing effect (pts have to change veins eventually) |
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Term
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Definition
| a derivative of the amphetamine class |
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Term
| what is the primary effect of cocaine? what characterizes its use? |
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Definition
| dopaminergic/adrenergic. rapid onset of action/highly addictive. vasoconstrictive - can cause septal perforation. rebound rhinitis can occur after discontinuance. cocaine can also be used as a topical anesthetic. |
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Term
| what are the risks of cocaine use? |
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Definition
| seizures, MI and cardiac arrhythmias (more than amphetamines) |
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Term
| what are the withdrawal symptoms of cocaine? |
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Definition
| fatigue, hyperphagia, depression and decreased energy |
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Term
| what is tx of cocaine withdrawal? |
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Definition
| largely symptomatic, BZDs and atypical antipsychotics if pt becomes psychotic. |
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Term
| what can any stimulant cause? |
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Definition
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Term
| what characterizes marijuana? |
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Definition
| THC is a euphoriant. some pts may have a panic attack the first time they smoke. dependency tends to be more psychological. THC can be used therapeutically to assist pts w/ADRs due to chemotherapy or to help increase appetite in anorexic or AIDS pts. |
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Term
| what characterizes hallucinogens? |
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Definition
| LSD/mescaline/psilocybin - produce sensory alterations for amusement, but can trigger psychosis. |
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Term
| what is the effect of inhalants such as glue? |
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Definition
| euphoria and also belligerency |
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Term
| what is the most widely used psychoactive substance in the world? |
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Definition
| caffeine, which 80% of the US adult population consumes on a regular basis (most 200 mg/day, but can be >500 mg). can produce motor restlessness – jitters, enthusiasm, energy, dieresis, and GI complaints. |
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Term
| are there nicotine receptors in the brain? |
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Definition
| yes, they are part of the excitatory pathway |
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Term
| what is at the core of getting people to stop smoking cigarettes? |
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Definition
| getting them to control their behavior - with pts who smoke while performing another activity, the behavior becomes associated with other things, and not the basic issue. to address this, dr. mark recommends that pts only smoke a cigarette and not associate any other behaviors w/it. |
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Term
| what are the medical treatments for smoking cessation? |
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Definition
| nicotine replacements or chantix/varenicline (SSRI antidepressant - supposed to eliminate the drive to smoke). |
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