Asam test – Chemistry – Flashcards
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mechanism of alcohol
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NMDA antagonist
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mechanism of opiate withdrawal
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related to locus ceruleus
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mechanism of alcohol withdrawal
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Upregulation of the NMDA receptor complex leading to neuronal hyperexcitability
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C77G allele in rhesus monkeys that is analogous to the A118 G allele in humans display what behavior?
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drink more alcohol
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receptor for benzodiazepine
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GABA A
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receptor for GHB
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GABA B
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receptor for baclofen
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GABA B
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ketamine mechanism of action
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NMDA antagonist
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endogenous ligand for cb2 receptor
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anandamide
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opioid tolerance mechanism
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protein kinase c phosphorylation of opiate receptors
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The negative reinforcement theory of opioid dependence postulates a state of which of the following in the neural system of the addict, leading to continued abuse of opioids
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allostasis
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cocaine mechanism of action
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inhibits presynaptic reuptake of dopamine
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number of subunits in GABA A
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5
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neurobiological pathway most likely involved in relapse in cocaine and meth dependence
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cingulate cortex to the nucleus accumbens
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legal limit of alcohol for driving in mmol/L
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17
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legal limit of alcohol for driving in mg/dL
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0.08
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caffeine consumption lowest among which population of substance dependent people
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cocaine
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animal model for the subjective effects of drugs
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drug discrimination
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which addiction related drug has no effect on the cytochrome p450 system?
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chantix
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location of CB1
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presynaptic in the CNS
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rate of metabolism of alcohol
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0.015 mg/dL/hr or .02g/dL/he for heavy drinker
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neurotransmitter systems involved in alcohol
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serotonin system, opioid system, adenyl cyclase, cholinergic system
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Acetaldehyde Dehydrogenase form that protects against alcohol dependence
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low activity isoform
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Percentage heritability of alcohol dependence based on twin studies
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50-60%
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alcohol metabolite detected in hair
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ethyl glucoronide
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Cloninger Type 2 Alcoholics are characterized by
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Drinking in youth, often before age 12
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Cloninger Type 1 Alcoholics are characterized by
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Gradual onset, harm avoidance, reward dependency, and liver failure at age 50
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Gastrointestinal absorption of alcohol occurs where?
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Primarily jejunum of the small intestine
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Chemical reaction metabolizing alcohol in the liver
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oxidation
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rate of metabolism of alcohol in ml/hour
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10mL/hour
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typical findings in acute alcoholic myopathy
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weakness, asymmetric swelling, involvement of proximal muscles. NOT fever.
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sleep problems from alcohol persist up to
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18 months
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alcohol related birth defects
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microcephaly, small palpebral fissures, flat philtrum, flat nose
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older man, unkempt, with bilateral rectus palsies and absent DTRs from the knees down
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Wernicke's syndrome
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with a small intake of ethanol, develop a transitory disturbed state with a dramatic and sudden onset are experiencing:
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idiosyncratic alcohol intoxication
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elevated triglycerides in heavy drinker: next steps
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stop drinking and recheck triglycerides in a few months
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worst disulfiram side effect
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psychosis
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chromosome involved in alcholism
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chromosome 4
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weird substance used for alcohol withdrawal
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paraldehyde
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legal limit of alcohol in gm%
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0.10 gm%
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molecular basis for potentiation of depressant effects of barbiturates by alcohol
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alcohol inhibits cytochrome p450 which leads to less hydroxylation of barbiturates
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unique metabolic effect of Librium
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doesn't induce smooth endoplasmic reticulum catabolic enzymes or microsomal Ethanol oxidizing systems
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relative contraindications for antabuse
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cardiac history, impaired renal fxn, impaired liver, past psychotic reaction
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age group with highest rate of benzo dependence
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50-80 years old
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ghb action at receptor
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indirectly at gaba b
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benzo with the longest half life excluding metabolites
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flurazepam
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Meprobamate pharmacokinetics
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short acting
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barbiturates are particularly risky for overdose because
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chronic use elicits incomplete tolerance to respiratory depression effects
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nordiazepam half life
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5 days
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most reliable way to identify barbiturate dependence
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give a trial dose of nentobarbital
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barbiturate challenge test: give Barb's until the patient
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is mildly intoxicated
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barbiturate detox from barbiturate dependence
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decrease dose by no more than 10% of Max dose per day
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convention governing international approach to opiates
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the single convention on narcotic drugs
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HIV med that reduces methadone levels
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efavirenz
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antipsychotic that decreases methadone level
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risperidone
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psychotropics that increase methadone level
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fluoxetine, sertraline, fluvoxamine
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medicine that increases buprenorphine levels
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ritonavir boosted atazanavir
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antibiotic that reduces methadone level and what that treats
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rifampin for TB or chronic staphylococcus infection
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seizure risk with overdose of which opiates
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meperidine and tramadol
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Buprenorphine mechanism
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mu partial agonist kappa antagonist
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federation of state medical boards doesn't require
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urine drug screen
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Which of the following statements is false? tamper resistant forms of Opiates prevent abuse or 99% of oxycodone is used in US
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tamper resistant prevents abuse
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heroin pharmacodynamics
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heroin crosses BBB, acetylated into 3- monoacetylmorphine, then rapidly into 6-MAM, then into morphine which binds to mu receptors
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heroin became illegal in what year?
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1924 in US 1925 internationally
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chronic high dose kratom may cause
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primary hypothyroidism
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what are the different opioid receptors
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mu kappa Delta and ORLF
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naltrexone receptor affinity
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high
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buprenorphine schedule
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III
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methadone invented under the direction of
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Farbenkonzern in Nazi Germany
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physicians "must prescribe Opiates as part of professional practice only" because of what act in what year
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1914 Harrison Narcotic Tax Act
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cyt p450 inducers
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rifampin, Dilantin, spironolactone, risperidone, efavirenz
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cyt p450 inhibitors
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cipro, ssri, cimetidine
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gi side effects from buprenorphine
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both diarrhea and constipation are possible
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detox of which opiates should just be with clonidine
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pentazosine and propoxyphene
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difference between nalmefene and naloxone
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nalmefene longer acting
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opioid to be avoided in chronic kidney disease
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meperidine
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methadone dose to annuate withdrawal
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20-40mg
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absorption rate of methadone in the intestine and peak
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peak plasma is 4 hours
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essential part of opioid dependence treatment with naltrexone
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monitored use
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frequency of administration of naltrexone after 2 weeks for opioid dependence
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every other day is okay
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methadone enantiomers
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L form is opioid agonist, D form is NMDA antagonist
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Is nerve degeneration from alcohol/opiates seen at autopsy
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yes
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newborn with heroin addicted mom starts convulsing after given naloxone. What is the treatment?
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morphine
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if appropriate patients can receive enough schedule II med to last how long
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3 months
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propoxyphene structure
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ester of methadone
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meperidine conversion from morphine
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10 morphine is 100 demerol
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most common side effect of long term percodan
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GI bleeding
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how often does physical dependence occur in appropriately treated chronic pain with opiates?
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always
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dextromethorphan mechanism of action
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kappa receptor antagonist
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complications of smoking in pregnancy: preeclampsia?
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no
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antidepressants for smoking cessation
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bupropion and nortriptyline
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interventions for decreasing smoking that have evidence (what doesn't help?)
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media campaigns, increase price, ban it in public places (no evidence that bans on sales to minors helps)
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nicotine replacement vs cbt effectiveness
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equally effective. combo works best
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nicotinic ACh receptor structure
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2 alpha and three beta subunits
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nicotine ACh receptor related ions
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Na and Ca
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location of nAChR
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throughout CNS presynaptically
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metabolite of tobacco products that can be tested for
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cotinine
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fagerstrom test of nicotine dependence
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how many cigs per day? how soon after waking is 1st cig? smoke if sick in bed? hard to refrain when it's forbidden? smoke more in the morning? which would you hate to give up most?
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chantix mechanism of action
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partial nAChR agonist
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smokers are more likely to succeed in quitting if they are
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able to ask others not to smoke around them
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cannabis suppress emotions in what brain area
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basolateral nucleus of the amygdala
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endocannabinoids are synthesized how
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from postsynaptic cell membranes
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in the Iowa gambling task, marijuana smokers
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fail to respond to nagative consequences and only respond to large immediate reward
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telltale sign of volatile hydrocarbon abuse
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exogenous pigmentation of hands and face
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GHB has what effect on the hypothalamo-pituitary axis?
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stimulates Growth hormone release
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LD50 of GHB
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five times the intoxicating dose. (low therapeutic index)
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psylocibin and LSD mechanism of action
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5HT-2A receptor agonists
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salvia divinorum mechanism of action
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Opioid kappa-receptor agonist
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K2, spice, and JWH-018
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CB1 receptor agonist
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Mephedone, 3,4-methylenedioxypyrovalerone (MDPV), ("bath salts") type of chemical
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cathinone derivatives
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Death from acute intoxication from phencyclidine is most likely the result of
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violence
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ketamine time of peak effect
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first hour
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LD50 of ketamine
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30 times the intoxicating dose, high therapeutic index
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True/false: Acute adverse reactions to LSD are dose dependent.
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false
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true/false: MDMA may cause permanent damage to the CNS
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true
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effect of MDMA on sexual desire, arousal, and performance
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desire is increased, arousal and performance are impaired
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One of the largest classes of hallucinogens is derived from the parent compound _________, and includes many designer drugs.
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phenylisopropylamine
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what type of compound is mescaline?
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phenylalkylamine
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what type of compound is LSD?
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indolealkylamine
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The primary reason for the failure of phencyclidine as a general anesthetic for humans is that the patients:
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Experienced delirium when they emerged from
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Danger of Nitrous oxide
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B12 Deficiency (inhalant that causes)
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Danger of amyl nitrate
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methemoglobinemia (inhalant that causes)
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danger of toluene
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distal renal tubular acidosis (inhalant that causes)
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danger of benzene
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non-glomerular hematuria (inhalant that causes) and bone marrow suppression
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danger of ethylene glycol
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anion gap metabolic acidosis (inhalant that causes)
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chronic use of nitrous oxide commonly causes
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sensorimotor polyneuropathy
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Inhalants' effects on the pupils
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Dilation of pupils (mydriasis)
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Cross tolerance between different inhaled substances
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no cross tolerance exists
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inhalant induced dementia attacks what part of the brain
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white matter rather than gray matter changes
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steroids' most common side effect
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irritability and aggression
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"stacking" refers to
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taking more than one kind of anabolic steroids
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alleged but not consistently proven benefit of steroid use
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increased muscle mass
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cardiovascular effect of steroids
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increase LDL
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does steroids cause a euphoric effect?
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yes
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Prepubertal use of steroids: effects
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increase in penis size, hirsutism, skin pigmentation, early closure of growth plates
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hepatic toxicity with steroids is consistent with what?
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oral administration. IM use is less likely to cause toxicity of the liver
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cyproheptadine is used by athletes to
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increase weight.
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personality disorder associated with the most addiction
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aspd
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antipsychotic effects are known for which controlled substance?
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opiates
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mechanism of disulfiram causing psychois
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disulfiram blocks dopamine beta hydroxylase
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natural course of substance use in ADHD
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earlier onset of substance use. requires more treatment
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psychiatric diagnosis with the highest rate of co-occuring substance use disorder
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bipolar disorder
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in bipolar with a substance use disorder, which medication is least likely to be effective?
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Lithium
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rate of substance use disorder in adolescents with conduct disorder
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50-80%
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psychiatric disorder that most often precedes adolescent drug use
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mood disorders, most often depression, can be more than 50% of adolescent substance users
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What proportion of people who meet criteria for substance abuse or dependence receive specialty addiction treatment each year?
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10%
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all the stages of change
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precontemplation, contemplation, preparation, action, maintenance, relapse
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proportion of alcoholics who achieve remission without any treatment
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20%
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what type of behavior underlies dating violence (what does not underlie it?)
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controlling behavior (addictive behavior.)
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what is an essential component of drug treatment services
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drug use monitoring
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Key words from step 1 of the 12 steps
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powerlessness--our life became unmanagable
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Key words from step 2 of the 12 steps
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we came to believe that a power greater than ourselves could restore us to sanity
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step 3 of the 12 steps
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Made a decision to turn our will and our lives over to the care of God as we understood God. (relinquish will)
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step 4 of the 12 steps
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moral inventory
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step 9 of the 12 steps
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made amends except when it causes harm
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Tradition 3
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the only requirement is a willingness to stop drinking
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which comes first, inhalants or marijuana?
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inhalants
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what psychological traits are associated with adolescent drug use
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ADHD type symptoms: impulsive, hyperactive, short attention, and also irritability
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most appropriate behavioral aspect of treaemt for adolescent drug use
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stimulus control
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highest rate of preterm labor associated with what street drug class
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opiates
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risk of mother to baby vertical transmission of hep c infection
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2%
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method to decrease vertical transmission of hep c
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there is none
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test baby for vertical transmission of hep c at what age
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12-18 months
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what to do if stable Suboxone user gets pregnant
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switch to Subutex
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treatment of newborn in opiate withdrawal on the first day
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swaddle, feed frequently in a quiet room
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newborn to Mom on methadone showing symptoms of diarrhea, vomiting, muscle tone poor, etc. what is the first step
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check cmp, tsh, head ct
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treatment for neonatal abstinence syndrome when conservative measures fail
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morphine taper
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excess fetal mortality from alcohol is associated with what time period
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first trimester
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needlestick risk of HIV seroconversion
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0.3%
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treatment of iv drug user with osteomyelitis of the spine, epidural abscess, and neurological changes less than 36 hrs
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urgent laminectomy
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treatment of kidney failure due to liver failure ( hepatorenal syndrome)
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liver transplant
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weakness in alcoholic that develops a few days into hospitalization is due to
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hypophosphatemia
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alcoholic with ck 7500 and hyperkalemia. lethargic and dry. Dx? initial Tx?
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Rhabdomyolysis. IV fluids rescusitation
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urine drug screening in the ED: importance
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low importance for acute treatment
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medication to avoid in hepatic encephalopathy
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benzodiazepines
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alcohol that affects vision
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methanol
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opiate withdrawal: little known symptom. symptom you never see
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ejaculation. convulsions
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overdose: convulsions then unconscious and hyponatremia. dx? tx?
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Ecstasy (mdma). hypertonic saline
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shortest action hallucinogens
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salvia divinorum
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first treatment of vertical nystagmus
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Diazepam for PCP intoxication
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urine cr of
substituted
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Diazepam for PCP intoxication
