What's the Substance?
A patient presents with lacrimation, yawning, piloerection, nausea, and dilated pupils after leaving jail.
Opioid withdrawal
_________ is the main neurotransmitter in the brain that produces feelings of pleasure when activated because of its action in the reward pathway, having an active role in the development of addiction.
Dopamine
Drugs like heroin and oxycodone relieve pain and cause euphoria by activating these receptors, which are also targeted by our body’s natural painkillers like endorphins.
Mu-opioid receptors
________ and _______ are medications used for the treatment of opioid use disorder.
Methadone and Buprenorphine
This counseling style avoids arguing with patients and helps them find their own reasons to change.
Motivational interviewing
People with cannabis use disorder compulsively smoke marijuana becoming dependent on the main chemical_________ ,known for producing the main effects of cannabis and intoxication
THC
Normal neurobiological event characterized by the need to increase the dose over time to obtain the original effect. A state in which a drug produces a diminishing biological or behavioral response; in other words, higher doses are needed to produce the same effect experienced initially.
Tolerance
Mention the receptors involved in cannabis use:
CB1 and CB2
Mention pharmacotherapy used for patients with alcohol use disorder:
1. Naltrexone
2. Acamprosate
3. Disulfiram
Things like income, education, and where you live—these factors influence health and are called ________.
Social Determinants of Health
A 19-year-old male is brought to the ED by campus security after he was noted disoriented, shouting out loud that people are following him to kill him. On exam, he is diaphoretic, tachycardic, and exhibits bizarre behavior alternating with lethargy. Urine tox screen is negative.
Synthetic cannabis intoxication leading to psychosis
Mention at least 2 brain regions affected by addiction:
Prefrontral cortex, Basal ganglia, Amygdala, Ventral tegmental region, Nucleus accumbens
________ blocks the dopamine transporter.
HINT: intoxication may induce euphoria, energy, dilated pupils, increase BP and pulse, and should not be combined with beta blockers.
Cocaine
This medication used for nicotine cessation may increase risk of seizures in patients with eating disorders.
Bupropion
When people assume someone with addiction is "weak" or "bad" and use terms such as "drug abuser", "clean", or "dirty", this harmful attitude can stop patients from seeking help and cause ______.
Stigma
A 62-year-old woman with generalized anxiety disorder presents with tremors, severe insomnia, and episodic confusion. She was recently switched from medications but daughter is unable to tell you which. On day 3 post-discontinuation, she becomes diaphoretic, hypertensive, and experiences a generalized tonic-clonic seizure.
Benzodiazepine withdrawal
Mention the 3 stages of developing addiction:
1. Binge intoxication
2. Withdrawal/negative affect
3. Preoccupation/Anticipation
Benzodiazepines work by making this brain chemical, which slows down nerve activity, even more effectively.
GABA
______ is a full antagonist at the mu opioid receptors.
Naltrexone and Naloxone
In the 1800s, this painkiller was sold over-the-counter—even to kids—before people realized how addictive it was.
Morphine!
Mention at least 5 criteria considered in the COWS Score for Opioid withdrawal:
COWS Score: 11 criteria -> Pulse, Sweating, Restlessness, Pupil size, Bone/Joint aches, Runny nose or tearing, GI upset, Tremor, Yawning, Anxiety/irritability, Gooseflesh skin
What are the 2 main neurotransmitters involved in the development of alcohol intoxication and withdrawal?
1. GABA
2. Glutamate
_______ is a major inhibitory neurotransmitter in the brain that gets a big boost when you drink, slowing down brain activity and making you feel relaxed.
In turn, _______ is the other neurotransmitter that blocks this excitatory neurotransmitter, which can lead to sluggish reflexes and slurred speech.
GABA - Glutamate
This antidote can reverse a life-threatening benzo overdose by blocking GABA receptors—but use it carefully to avoid seizures!
Flumazenil
Mention at least 2 harm reduction strategies:
Needle exchange programs, Fentanyl test strips, Narcan