Neuro/Psych-quiz 2-substance abuse

continue/recurrent substance use resulting in:failure to fullfill major role obligations, substance-related legal problems, or use in situation in which it is physicall hazardous, continued use despite social or interpersonal problems due to the effects of the substance

maladaptive substance use as manifested by (3 or more)-tolerance(need for incrased amt or substance to get same effect), withdrawal, use of larger amts or over a longer period than intended, desire or unsuccessful efforts to cute down, time spent on obtaining, recovering, important activities given up or reduced, continued sue despite physical or pshyco problems

mesolimbic dopamine pathway, motivational system regulated response to natural reinforcers and all drugs of abuse, activation can lead to: increased firing of dopamine neurons into the ventral tegmental area, incrase release of dopa into the nucleus accumbens, pleasure, modulators are: ACh, GABA, gultamate, sero, NE, opioid, and cannabinoid

GABA mimetic, releases endogenous opioids and dopamine in nucleus accumbens

sx related to excessive glutamine in CNS

tremor, diaphor, techy, htn, anxiety, n/v, develop as blood alcohol drops, resolves in 2-3 days w/out add etoh consumed

seziure, arrh, hallucination(develops later but resolve in same time), develops 12-72 hrs after last drink

life threatening-mortality rate 5%, fluctuating course of severe agitation, gross tremulousness, hyperactivity and global confusion, 3-5 days after last drink, can't be predicted solely on amt of alcohol a person drinks but on duration of alcohol consumption, only way to prevent is give adequate dose of BZ, CIWA scale

bz substitution therapy-diaz, lora, chlordia, bzs treat all SEs assoc with BZs, cross-tolerance with alcohol(reduces sx of withdrawal), reduce risk of seizure and DT's, fixed dose schedule vs. sx-triggered regimen

2nd line, carb, val, topira, similar efficacy as bzs, no abuse potential(may aid in getting GABA receptors back to pre-addiction state, reducing risk of relapse)

propran, atenolol or clonidine (for elev HR, BP, tremor, sweating), haloperidol(for halluc and agitation)

100 mg IM then 100 mg Po x 3 days, thiamine deficiency-diffuse decrease in cerebral glucose use, prevention of Wernicke's encephalopathy(ataxia, confusion, and eye movement disorders) caused by thiamine deficincy

antabuse, inhibits liver aldehyde dehydrogenase, flushing, tachy, throbbing, HA, N/V, possible MI, arrh, begins 24 hours after last drink, caution with increased liver enzymes, up to 2 weeks after stopping the drug, drowsiness, garlic taste

revia, as long as will take, goal is 1 year, generally 1st line, once daily, mu opioid rec antagonist, thought to block endogenous opioids released with alcohol consumption(blocks euphoria), reduces cravings and the reinforcing properties of alcohol, must be opioid free for 7-10 days(more than 24 hours foro prevention/maintenance), vivitrol(long-acting, CONTRA in acute hepatitis or liver failure, can use if LFTs are improving

campral, only maintenance, helps decrease alcohol craving via effects on glutamate NT, must be abstinent from alchol four or more days prior to initi, requires TID dosing, Crcl<30 contra, does not effect liver

short acting(meperidine) more intense withdrawal, long acting(methadone) longer, less intense withdrawal

6-12 hours, yawning, sialorrhea, rhiorrhea, lacrimation, diaphoresis, and shaking chills, GI symptoms, seizures don't occur with opiate withdrawal

12-14 hours, CNS hyperactivity, restlessness, insomnia, increased BP and pulse, muscle spasm, pain (flu-like), dilated pupils, sx can last 3-14 days

tx of opiate addiction, central alpha2 agonism(inhibits noradrenergic activity), not an opioid won't supress withdrawl symptoms completely, works best when low-mod opiate dose has been used, detox over 10-14 days or d/c narcotic at once, taper clonidine when done (to prevent severe HTN)

must be FDA licensed facility, long half life reduces severity of withdrawl sx, 40-50mg/d will prevent w/drawal in most people no matter what they were taking, 10-30 will have some withdrawal sx, taper dose over 30 days or less, taper by 5-10 mg/d

subutex, partial mu ag, suppresses withdrawl sx but is assoc with few withdrawal sx itself, may be sup to clonidine in some pts, esp if concern of brady or hypo

ibu for pain, dicyclomine for crams(antimuscarinic that relieves spasms of Gi tract)

suboxone, opioid partial ag, lower risk of CV or resp depres vs full opioids, lower abuse potential?, treats withdrawal sx and cravings, ODT, combo to guard against IV abuse of buprenorphine, physicina must have special training and DEA number to prescribe

mu receptor ag (long-acting), TIW, alt to methadone(if refractory to other tx b/c of risk of cardiac arrhythmias)