Substance Use Disorders: Neurobiology, Substances, Treatments, and Anesthesia

Question-and-answer flashcards covering key concepts from the lecture notes, including overview of substance use disorders, neurobiology, major substances, treatment approaches, healthcare implications, CNS stimulants and depressants, sleep disorders, anesthesia topics, and action items.

What is Substance Use Disorder?

A legitimate medical condition with neurobiological foundations, not just a behavioral issue; it includes physical, psychological, and social components and addressing stigma improves patient care.

Which social factors contribute to substance use disorders, especially among teenagers?

Family influence, peer pressure, and bullying.

What role does the brain's reward system play in addiction?

Dopamine release and altered reward pathways drive the addictive process.

What neurobiological changes occur in addiction related to dopamine signaling?

Initial flood of dopamine and down-regulation of dopamine receptors requiring more substance for the same effect.

Which brain structures are affected that influence decision-making and impulse control in addiction?

The amygdala and changes in the prefrontal cortex.

What neurotransmitter function is altered in addiction besides dopamine?

GABA neurotransmitter function.

Why can relapse occur years after recovery?

Because the amygdala and prefrontal cortex retain neuroadaptations and do not forget.

Alcohol Use Disorder: what are potential complications and initial treatments?

Dehydration and alcohol toxicity; treatment may include IV fluids and withdrawal management; withdrawal can be life-threatening.

Cannabis Use Disorder: common effects and risks?

Altered sensory perception, learning/focus problems, coordination issues; potential pulmonary issues if smoked; limited medical benefits for glaucoma, chemotherapy side effects, and Crohn's disease.

Opioid Use Disorder: typical initial exposure pattern?

Often begins with legitimate medical use for pain management (post-surgery, injury, chronic pain).

Opioids: what is a major public health issue associated with their use?

The ongoing opioid epidemic driven by misuse and dependence.

Opioid Use Disorder: common acute effects and risks?

Opioids can cause euphoria but also nausea, constipation, and respiratory depression.

Nicotine/Smoking Disorder: what is a key treatment approach?

Various treatment approaches including medication-assisted therapy.

Other substance misuse: which OTC medications are commonly misused?

Dextromethorphan, diphenhydramine, and pseudoephedrine.

Why are inhalants from spray cans dangerous?

Can cause severe harm or death.

What are the main components of Substance Use Disorder treatment?

Pharmacological interventions, psychological approaches (motivational interviewing, CBT, 12-step programs, EMDR), inpatient/outpatient options, readiness to change, support groups, and relapse prevention.

What resources support healthcare professionals with SUD?

Florida Intervention Project for Nurses (IPN) and Physician Health Program (PHP).

What is the purpose of IPN and PHP programs?

To provide treatment and potential return to practice, though these programs can be costly.

What is the recommended clinical approach to SUD in healthcare settings?

Treat substance use disorder as a legitimate medical condition to reduce stigma.

What should clinicians educate patients about in the post-surgical context regarding opioid use?

Pain management and the risks of addiction.

What should clinicians monitor for in patients and colleagues?

Signs of substance misuse.

How should suspected misuse in healthcare professionals be addressed?

Know the proper reporting channels for suspected misuse.

What is methylphenidate primarily used to treat?

Attention-deficit/hyperactivity disorder (ADHD); also used for narcolepsy and respiratory distress reversal.

How does methylphenidate work?

Increases norepinephrine and dopamine by releasing and blocking their reuptake.

What are common side effects of methylphenidate? What are severe side effects?

Tachycardia, hypertension, anorexia, slowed growth, insomnia, dry mouth. Severe: psychosis, heart attack, stroke, seizures.

What adverse drug interactions are important with methylphenidate?

Barbiturates, tricyclic antidepressants, and MAO inhibitors.

What patient education is recommended for methylphenidate use?

Avoid caffeine-containing substances like coffee, tea, and chocolate. Continuous weight monitoring.

What are other uses of methylphenidate beyond ADHD?

Used for narcolepsy and, in some cases, to reverse respiratory distress.

What is the prototype benzodiazepine mentioned?

Alprazolam.

What are typical uses and risks of benzodiazepines like alprazolam?

Used for anxiety and sleep disorders; side effects include respiratory depression, lethargy, constipation, amnesia; high fall risk; caution in COPD due to CO2 retention risk.

What is the prototype barbiturate used in notes?

Phenobarbital.

What is a key safety note about barbiturates when discontinuing?

They are potent respiratory depressants and must be tapered when discontinuing.

What is the prototype non-benzodiazepine used for short-term insomnia?

Zolpidem Tartrate

What are the characteristics of zolpidem tartrate use?

Short-term insomnia treatment (less than 10 days); duration 6-8 hours; side effects include dizziness, fatigue, visual impairment, suicidal ideation; caution in older adults.

What are the two primary sleep phases?

REM and non-REM sleep.

What is insomnia?

Inability to fall asleep or stay asleep.

What is obstructive sleep apnea and a key risk factor?

A sleep disorder with airway obstruction; risk factor is excess weight around the neck.

What are complications of obstructive sleep apnea?

MI, stroke, diabetes, renal failure, and neurocognitive disorders.

What is CPAP used for?

Treatment for obstructive sleep apnea.

What are parasomnias?

Sleepwalking, night terrors, restless leg syndrome, etc

What is Restless Leg Syndrome and what is it associated with?

A sensory-motor disorder associated with iron deficiency; symptoms worsen in the evening or night.

What are the stages of anesthesia?

Stage 1: Induction; Stage 2: Excitement/delirium (don’t want to stay in for long); Stage 3: Surgical anesthesia; Stage 4: Medullary paralysis (respiratory depression + use of ventillator).

Which inhalation anesthetics are listed and what is a key risk?

Halothane and isoflurane; risk of malignant hyperthermia.

What is conscious sedation and which agents are used?

Midazolam (Versed) and propofol; patient can still respond but are sedated and may not remember what they did; propofol has a very short half-life.

What are topical anesthetics and their common additive?

Lidocaine, sprays, ointments; often contain epinephrine as a vasoconstrictor.

What is spinal anesthesia commonly used for and what are its side effects?

Common in obstetric patients; side effects include headache, hypotension, vagal response; monitor catheter site and security.

What respiratory precautions are advised for patients receiving CNS depressants?

Monitor respiratory status closely (breaths + SPO2)

What precautions are recommended for patients on sedatives?

fall precautions.

What should be monitored in PCA (Patient Controlled Analgesia) patients?

Frequent monitoring for respiratory depression via vital signs. Also check for sedation levels and pain relief. .

What vital sign monitoring is important after spinal anesthesia, and what else should be inspected?

Monitor blood pressure and vital signs; inspect spinal catheter site for security and placement.

What is general anesthesia? What is it’s major side effect?

A medically induced coma with loss of consciousness and sensation, used during surgical procedures. Its major side effect is respiratory depression.

What is local anesthesia? What is it’s major side effect?

A type of anesthesia that blocks sensation in a specific area of the body without affecting the patient's consciousness, often used for minor surgical procedures. Its major side effect is transient nerve damage or allergic reactions.

What is the client teaching for Alprazolam?

Clients should be informed about the potential for dependence, the importance of adhering to prescribed dosages, and the need to avoid alcohol and other central nervous system depressants while taking this medication.

What is the client teaching of Zolpidem Tartrate?

Clients should be instructed to take this medication immediately before bedtime, avoid alcohol, and be aware of potential side effects such as drowsiness and amnesia.

What is the client teaching for Methylphenidate?

Clients should be advised to take this medication as prescribed, be aware of potential side effects such as insomnia and loss of appetite, and avoid taking it close to bedtime. Take before meals in the morning is preferred.

Mild SUD & it’s side effects

Short-term effects may include alterations in mood or behavior and cravings/dependence

Severe SUD & it’s side effects

Long-term effects can lead to chronic health issues, changes in brain structure, and persistent cognitive impairments. Can lead to tolerance

Define SUD dependence

Leading to withdrawal when not using substance

Define SUD tolerance

A diminished response to a substance, requiring increased amounts to achieve the same effect.

Define insomnia

A sleep disorder characterized by difficulty falling asleep, staying asleep, or waking up too early, resulting in daytime impairment.

Define central disorders of hypersomnolence

A group of sleep disorders characterized by excessive daytime sleepiness, including narcolepsy and idiopathic hypersomnia, often resulting in unrefreshing sleep.

Define circadian rhythm sleep-wake disorders

Disorders that disrupt the normal sleep-wake cycle, leading to sleep disturbances and impairment in daytime functioning, often due to misalignment with the environmental light-dark schedule.

Define sleep-related movement disorders

Disorders characterized by abnormal movements during sleep, which can lead to sleep disruption and impact overall sleep quality, including conditions such as restless legs syndrome and REM sleep behavior disorder.