substance abuse and drug overdose - dr austin

1 hour: 5 questions

which of the following is decreased effect with continued use, larger doses required to produce same response, and opposite of sensitization?

a. tolerance

b. dependence

c. addiction

d. pseudoaddiction

a.

which of the following is a biological adaptation caused by chronic use and withdrawal is generally reverse of normal effect?

a. tolerance

b. dependence

c. addiction

d. pseudoaddiction

b.

T/F tolerance and dependence are results of chronic therapy and are predictors of addiction

FALSE — NOT predictors of addiction

which of the following is a chronic neurobiological disease and has drug seeking behavior?

a. tolerance

b. dependence

c. addiction

d. pseudoaddiction

c.

which of the following is drug seeking behavior with preoccupation with getting the medication due to inadequate disease state management or fear/anxiety associated with condition/past experiences?

a. tolerance

b. dependence

c. addiction

d. pseudoaddiction

d.

what part of the brain connects executive functioning to the experiences of reward/aversion, pleasure, incentive, and reinforcement?

key projection in addiction

mesocorticolimbic

what NT is responsible for most of the signaling in addiction?

other NTs involved?

most: dopamine

others: glutamate and GABA

what key structure is involved with the cortico-basal ganglia-thalamo-cortical loop and the reward pathway?

basal ganglia

what neurotransmitters does heroin mimic? (SATA)

a. endorphin

b. enkephalin

c. anandamide

d. acetylcholine

a. b.

what neurotransmitter does marijuana mimic?

a. endorphin

b. enkephalin

c. anandamide

d. acetylcholine

c.

what neurotransmitter does nicotine mimic?

a. endorphin

b. enkephalin

c. anandamide

d. acetylcholine

d.

what substance alters NTs by attaching to the dopamine transporter?

a. heroin

b. marijuana

c. nicotine

d. cocaine

e. benzodiazepines

d.

what substance alters neurotransmission by enhancing receiving neurons’ responses to GABA —> produces relaxation?

a. heroin

b. marijuana

c. nicotine

d. cocaine

e. benzodiazepines

e.

various substances cause ________-like effect and “hijack” the reward pathway

superagonist-like

what is the progressive change in baseline activity of reward pathway independent of acute withdrawal?

allostasis

what genes are associated with decreased threshold for compulsive and reward seeking behavior, reinforce psychological dependence, and can cause significant changes in thought patterns and personality?

• FOSB

• CREB

• NF-kB

what are the requirements for a substance to be addictive?

• must have extensive BBB penetration (lipophilic)

  • or able to trigger a response directly interpreted by CNS

• rapid absorption

  • important for elevation of Cmax and reinforcement of activity

  • administered by routes such as injection, inhalation, or snorting (gets to brain faster)

  • extended-release formulations are usually safer bc they slow down absorption

  • rapid elimination can drive repeated use

idk if important

what is the “tiger analogy”?

basically drug use becomes a “survival response”

idk if important

what is the graph analogy (disposition vs time)?

basically drug RESETS brain’s reward system baseline

why is concurrent abuse common?

decr. avoidant behavior and executive functioning

basically one drug will impact your judgment and impulsivity —> more likely to mix drugs

T/F multiple addictive substances are often additive or synergistic increase in toxicity

TRUE

when taken together, cocaine and ethanol create a new, toxic metabolite called _________ by a ______ reaction

cocaethylene by a transesterification reaction

what is traditional pharmacological treatment of addiction good for?

a. acute detox/management of withdrawal

b. benefit for long-course of disease

c. target craving

d. prevent relapse

a.

what do newer pharmacological strategies also target and prevent?

target craving

prevent relapse

list psychosocial/non-pharm tx options

• CBT

• aerobic exercise

• mutual support self-help

what is generally the most effective treatment?

a. pharmacological

b. psychosocial

c. non-pharmacological

d. combination of pharm and psychosocial/non-pharm

d.

what is the greatest prognostic indicator of treatment outcomes?

patient attitude towards treatment

what is the MOA of disulfiram (antabuse)?

inhibitor of acetaldehyde dehydrogenase

what does the enzyme acetaldehyde dehydrogenase usually do?

converts acetaldehyde to acetic acid

what happens if you have a small amount of ethanol while on disulfiram?

hangover-like symptoms!!!!

• headache

• N/V

• thirst

• confusion

• dysphoria

what do we have to consider when administering disulfiram?

wait until pt has been abstinent from alcohol for ≥ 12 hours

review: idk if we need to know, just listing some important ones

what medications can cause a disulfiram-like reaction?

metronidazole

sulfonylureas

ketoconazole

isoniazid

what are the general principles of substance (drug) toxicology?

• dose-dependent

• allergic

• interactions

• intent

what are the toxicokinetics considerations?

• how long does an asymptomatic patient need to be monitored

  • absorption/PD

• how long will it take for condition to improve

  • elimination/PD

• delayed reactions

what is the most important principle for treatment of overdose?

must act quickly

list the general principles for treating overdose

1. stabilize poisoned patient

2. identify toxidrome

3. decontamination

   1. prevent further exposure (if possible)

   2. GI: activated charcoal, whole bowel irrigation/cathartics

   3. enhance elimination: urinary alkalinazation, multi-dose activated charcoal, hemodialysis

   4. antidote administration

4. prevent re-exposure

what antidote is used for acetaminophen poisoning?

a. acetylcysteine

b. bromocriptine

c. digoxin immune Fab

d. ethanol

a.

what antidote is used for neuroleptic malignant syndrome?

a. acetylcysteine

b. bromocriptine

c. digoxin immune Fab

d. ethanol

b.

what antidote is used for cardiac glycosides poisoning?

a. acetylcysteine

b. bromocriptine

c. digoxin immune Fab

d. ethanol

c.

what antidote is used for methanol or ethylene glycol poisoning? (SATA)

a. acetylcysteine

b. bromocriptine

c. fomepizole

d. ethanol

c. d.

what antidote is used for benzodiazepine poisoning?

a. fomepizole

b. flumazenil

c. leucovorin calcium

d. naloxone hydrochloride

b.

what antidote is used for methotrexate poisoning?

a. fomepizole

b. flumazenil

c. leucovorin calcium

d. naloxone hydrochloride

c.

what antidote is used for opioid poisoning?

a. fomepizole

b. flumazenil

c. leucovorin calcium

d. naloxone hydrochloride

d.