Neurobiology of Addiction
Medication assisted treatments
Anesthetic Considerations
What drugs did you take?
Provider Substance Use
100

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)

100

What is a PO opioid antagonist that can also be used to curb alcohol craving?

Naltrexone

100

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

100

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

100

What are the two peak times for CRNAs to abuse substances in their careers? 

first 1-5 years of practice

15+ years of practice 

200
What percentage of risk of addiction is genetic? 

about 50% 

200

What are the two components of suboxone? 

buprenorphine and naloxone (4:1 ratio)

200

What vent settings would you expect to see in a patient with EVALI? 

low TV, high PEEP 

similar to ARDS with lung-protective measures

200

You have a large amount of norepi, serotonin, and dopamine available since this drug blocks presynaptic uptake of sympathomimetic NTs. you're WIRED.

cocaine

200

What practice do hospitals take to reduce the diversion of drugs? 

monitoring of administration habits 

300

How does chronic exposure to addictive substances affect receptors and neurotransmitters? 

- down-regulates dopamine receptors 

- creates less dopamine

- creates less serotonin

300

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

300

What chronic effects from cocaine use can impact anesthesia? 

Cardiac issues 

- LV hypertrophy 

- systolic dysfunction

- dilated cardiomyopathy

300

You can see sounds and hear colors. You have high BP, RR, and temp. Who knew paper tasted so good? 

LSD (synthetic)

Psilocybin (natural)

300

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 

400

What are the three phases of the addiction cycle? 

1. Binge / Intoxication

2. Withdrawal / Negative Mood

3. Preoccupation / Anticipation 

400

What is the elimination half-time of Methadone? 

30-60 hours 

400

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 

400

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)

400

What are the most common classes/types of drugs for CRNAs to abuse? 

Opiates

Propofol

Nitrous/Midazolam

500

List the areas of the brain involved with each of the three stages of addiction

Binge: basal ganglia, nucleus accumbens, thalamus, VTA


Withdrawal: nucleus accumbens, amygdala


Preoccupation: frontal cortex, hippocampus
500

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 

500

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

500

You took something that was based on a substance found in the khat plant

Bath salts (synthetic cathinones) 

500

What phone number do you call if you think your friend is diverting drugs? 

800-654-5167