Neurobiology of Addiction
What is the major area of the brain involved in addiction, and what neurotransmitter does it produce?
Ventral tegmental area in the midbrain which releases dopamine (also can inhibit GABA)
What is a PO opioid antagonist that can also be used to curb alcohol craving?
Naltrexone
What information would you want to know before giving anesthesia to a patient in Medication Assisted Therapy
- type and dose of drug
- last dose taken
- what substances were used prior (alcohol, heroin, etc)
- active use or withdrawal
Your mouth has sores, and you're malnourished. You don't have a lot of catecholamine stores.
Long-term, you'll have ILD and pHTN
Methamphetamine
What are the two peak times for CRNAs to abuse substances in their careers?
first 1-5 years of practice
15+ years of practice
about 50%
What are the two components of suboxone?
buprenorphine and naloxone (4:1 ratio)
What vent settings would you expect to see in a patient with EVALI?
low TV, high PEEP
similar to ARDS with lung-protective measures
You have a large amount of norepi, serotonin, and dopamine available since this drug blocks presynaptic uptake of sympathomimetic NTs. you're WIRED.
cocaine
What practice do hospitals take to reduce the diversion of drugs?
monitoring of administration habits
How does chronic exposure to addictive substances affect receptors and neurotransmitters?
- down-regulates dopamine receptors
- creates less dopamine
- creates less serotonin
Which is worse?
Giving buprenorphine to a methadone patient
OR
Giving methadone to a buprenorphine patient?
Buprenorphine to a methadone patient
- limited efficacy d/t partial agonist and crazy intense opioid receptor affinity
What chronic effects from cocaine use can impact anesthesia?
Cardiac issues
- LV hypertrophy
- systolic dysfunction
- dilated cardiomyopathy
You can see sounds and hear colors. You have high BP, RR, and temp. Who knew paper tasted so good?
LSD (synthetic)
Psilocybin (natural)
What are some signs that a colleague is abusing drugs?
- Death (often the first sign)
- volunteering for extra shifts
- using excessive meds for a simple case
- consistently arrives early or leaves late
- frequent patients with uncontrolled pain
What are the three phases of the addiction cycle?
1. Binge / Intoxication
2. Withdrawal / Negative Mood
3. Preoccupation / Anticipation
What is the elimination half-time of Methadone?
30-60 hours
What is the biggest concern when administering anesthesia to a patient acutely intoxicated with cannabis?
CV complications (5x greater risk of MI)
also potentiation of non-depolarizing muscle relaxants
You have an irregular and rapid heart rate, increased BP, and excessive sweating with chills. Your elevated body temp could kill you.
Acute Ecstasy Intoxication
(MDMA)
What are the most common classes/types of drugs for CRNAs to abuse?
Opiates
Propofol
Nitrous/Midazolam
List the areas of the brain involved with each of the three stages of addiction
What are some anesthetic considerations for a methadone patient? (pre, intra, post-op)
- prolonged QT-interval
- increased opioid needs
- most often times need multimodal anesthesia
- if patient is sick: decreased efficacy of methadone d/t increase of alpha-1 glycoprotein
What would cause bradycardia when giving anesthesia to a pt with chronic stimulant usage?
decreased reserve of endogenous catecholamines (norepi and dopamine) to have the appropriate SNS response
You took something that was based on a substance found in the khat plant
Bath salts (synthetic cathinones)
What phone number do you call if you think your friend is diverting drugs?
800-654-5167