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This Concept Map, created with IHMC CmapTools, has information related to: Addiction Medicine, Addiction Medicine Stimulants MOA-increase monoamine activity -inhibit presyn transporters DA-reward, psychosis- acute:coke, meth: inhibit xporter chronic: deplete DA NE-physiological arousal 5-HT-mood elevation, psychosis (halls) Tolerance -develop tolerance to euphoric effects -sensitization to toxic effects, Addiction Medicine Hallucinogens Intoxication: anx, depression, EUPHORIA, ideas of reference, paranoia, poor judgment Perceptual changes-illusions, halls, synesthesias -intact reality testing ->can "talk down" Sympathomimetic: -mydriasis, tachy, diaphoresis, palps, blurred vision, Addiction Medicine Dependence is: >=3: 1 Tolerance 2 W/drawal Sx 3 Longer time, Increased amts 4 Fail to cut down 5 Spend lots of time to obtain drug 6 Social/Occupational impairment 7 Intuition of problem, but continue, Addiction Medicine Opiate/Opioids W/drawal Tx: -Clonidine + Sx Tx -pref'd by psychiatrists -Methadone-pref'd by addicts, Addiction Medicine Dissociatives MOA-block thalamus NMDA Rs ->sensory overflow ->noise psychosis -sympathomimetic ->inc'd HR, BP, Temp, Addiction Medicine Alcohol Chronic Use -> Neuropathies Cerebellar degen Dementia Wernicke-Korsakoff W-Confusion, Ataxia, Nystagmus Ophthalmoplegia, Neuropathy K-dementia-anterograde amn, Addiction Medicine Dissociatives DSM Intoxication: A. Recent use B. belligerence, impulsivity, impaired social/occup fcning C. 2+: nystagmus, HTN, tachy, numb, dec'd pain response, ataxia, dysarthria, rigidity, Sz/coma, hyperacusis -detachment, floating, distortion -inner/outer world -hallucinations, Addiction Medicine Alcohol Increased: GGT in dependence MCV if 4-6 wks at a time AST ALT AST:ALT > 2 ɯ is diagnostic, Addiction Medicine Alcohol Tx: Benzodiazepines-DOC ->inc'd GABA_A-R fcn ->dec'd Sz, delirium Long T1/2- chlordiazepoxide diazepam Short T1/2- lorazepam, oxazepam -dec'd oversedation risk -safer in elderly-conj OR -quiet, nutrition/hydration, (thiamine, folate) -orient to reality -brief interventions, change -AA, relapse prevention, Addiction Medicine Hallucinogens MARIJUANA -delta9-THC is psychoactive -metabolite also active Receptors-CB1 (brain), CB2 (immune) -none at brainstem though Withdrawal-only in HEAVY users -anx, restless, depression, irritable -begin 1day after use, last 4-14 d, Addiction Medicine Opiate/Opioids W/drawal: T1/2 2-3hrs -onset 8-12 hrs -peak 28 hrs -duration 5-10 days -mm. pain, cramps -insomnia -dysphoria -chills, piloerection -mydriasis -yawn, sneeze, rhinorrhea -N/V/D, cramping -hypertension, tachycardia, Addiction Medicine Alcohol Withdrawal Stages: I - 24-48hrs - peak at 36 hrs -90% of AW Sz, mostly self-limited II - 48-72 hrs - inc'd stage I Sx III- 72-105 hrs - DTs IV- ɳdays - protracted w/drawal, Addiction Medicine Benzodiazepines ????, Addiction Medicine Hallucinogens Medical Pot: -CTX-induced nausea -app stimulant for AIDS wasting -glaucoma -anticonvulsant -M5-related spasticity, Addiction Medicine Stimulants Cocaine-2nd most widely used illicit drug -#1 cause of ER Sz, visits, Addiction Medicine Barbiturates ????, Addiction Medicine Stimulants Coke W/drawal -cessation/reduction of heavy/prolonged use -dysphoric mood and 2+: Fatigue, vivid bad dreams, insomnia, hypersomnia, inc'd appetite, psychomotor retardation Tx-most resolve w/in 2 wks unTx -hospitalize if psychotic, suicidal, Addiction Medicine Dissociatives PCP Ketamine-vet, kids anesthesia -minimal OD risk DM (Dextromethorphan) -inhibit med cough centers ->mydriasis, Addiction Medicine Opiate/Opioids Effects: -Miosis -Sedation -Temp changes -Resp depression -hormone axes -GNRH, CRF, ADH -dec'd secretions, mot -constipation Block locus ceruleus (NE): -periph vasodilation-HYPOtn -baroreceptor reflexes inhbited -histamine release, Addiction Medicine Alcohol AW Dx: Begins after few days/hrs + distress/impairment and 2+: Increased autonomics (sweat, HR), Hand tremor, insomnia, N/V, hallucinations, illusions, agitation, anxiety, grand mal Sz