13 Abuse drugs Flashcards
Withdrawl
- Cessation of prolonged use
- Specific physiological correlates
- Significant distress or impairrment in social, occupational, or other areas of functioning
- Not due to other medical condition or explained by another disorder
Substance abuse disorder features
- Impaired control: 1)more or longer use than directed, 2) unsuccessful stoppage, 3)great expenditure in obtaining, using, stopping 4)cravings
- Social impairment: 5)failure to fulfill obligations, 6) continued use despite problems, 7)important activities given up
- Risky use: 8) recurrent use in hazardous situations 9)use dispite problems caused
- Pharmacologic dependance: 10) tolerance, 11) Withdrawl symptoms
Mild: 2-3 Moderate: 4-5 Severe: 6+
Induced disorders
- Anxiety, panic attacks, or compulsions
- Evidence of :
- symptoms starting within 1 month of intoxication or withdrawl
- Medication use etiologically related to disturbance
- not better accounted for by other disorder
- not during Delirium
- Significant distress in social, occupational, or other functioning
Dopamine and addiction
- Involved in pleasure pathways including:
- Food
- Sex
- Excitement
- Comfort
- Acts on nucleus accumbens
- is deficient when use is stopped causing cravings and or dysphoria
Biological reinforcement
- not necessarily euphoric
- level of initial tolerance predicts addiction likelihood
- Most abused drugs will be self administered by rats (not LSD or cannabis
- Most addictive drugs have limbic effects
Non dopamine transmitter modulators and abuse
Naltrexone: Opiate antagonism (also reduces alcohol cravings)
Campral: Gaba action
Chantax: Nicotinic ACHr agonist
Classical conditioning
Like pavlov’s dogs
- association of conditioned stimulus (bell) with unconditioned stimulus (food)
i. e. drug periphrenalia brings back idea of drug euphoria
Operant conditioning
Result linked with action
- positive reinforcement- reward (drinks alcohol- becomse more socible)
- negative reinforcement- removal of adversive stimulus (using more BZD removes withdrawl smptoms)
- Punishment- adversive stimulus applied in conjunction
- Extinction- removal of reinforcement eliminates behavior (unlearned)
Psychodynamic and personality factors in addiction
- Personality disorders
- affective dysregulation: emotional
- imppulse control deficits: rely on reward
- Ego deficits: dont know who they are and cant cope with bad effects
- Family dynamics:
- codependence/enabling
- multigenerational drug dependence
- parental loss
Stage 1 treatment for addictions
Detox:
- can have risks (i.e. alcohol waithdrawl)
- usually many attempts
- inpatient more successful
- meds may be helpful or necessary
- range of settings- and expense
- Business model - rapid detox (anesthesia for a day and a shot of naltrexone- then deal on your own.
Detox meds
Alcohol: BZD, Phenobarbital, folate and thiamine
Opiates: Clonidine (a2 antagonist), Loperamide(peripheral mu receptor/ anti diarrheal), analgesics
Stimulats: Sleep food water
Stage 2 treatment for addictions
Active treatment:
- separation form substance
- conversion
- lifestyle changes
- family and relationship work
Stage 3 for addiction treatment
Maintainence:
- Often neglected
- Never curative (always a recovering alcoholic, never “normal” again)
- Change and stay changed!
- Meds and aftercare needed
- Personal commitment necessary
Relapse
Common
Often worse than former use- changes in tolerance
High morbidity
Motivational enhancement therapy stages
- Precontemplation: rapport and support of positive changes in progress
- Conetmplation: Encourage ambivalence: show pros and cons of use and treatment. Education
- Preparation: encourage work towards a specific goal
- Action: Continue to encourage and support, possibly recruit family if necessary
- maintainence: Relapse prevention, education, preparation, vigilance
Motivational enhancement therapy
Actions based on stage of abuser, but generally:
*recognize stage, create conditions to enhance patient efforts, Support intrinsic motivation of patient
*Express empathy, develop discrepancy, avoid argumentation, roll with resistance, support self efficacy
12- step approach
- residental centers use this
- confrontation used initially, emphasis on change and personal responsibility: boundries, limits, conseequences
*groups to help with reality testing, vigilence though emphasis is on acceptance not confrontation.
Self help
- can help, can confound
* Most commonly use 12 step model and “smart recovery”
How long should drug abuse treatment last
- Usually >30 days for effectiveness
* Controlled by insurer
Harm reduction approach
- Variety of interventions
- Do not demand sobriety
- Moderation management
- CBT approach; moderate intake- drink by counting
Abuse help medications
Alcohol: Naltrexone, Disulphram, acamprosate, topiramate, baclofen
Opiates: Naltrexone, methadone, buprenorphrine
Nicotine: Nicotine gum, Buproprion, chantax
Cocaine: ???, stimulants?
Opioid intoxication signs
- pupillary constricton
- drowsiness/coma
- slurred speech
- memory and attention impairment
Opioid withdrawl
3 or more within minutes to several days of cessation:
- Dysphoria
- N/V
- Muscle aches
- Pupillary dilation
- Piloerection/ Diaphoresis
- Diarrhea
- yawning
- fever
- insomnia
Bupenorphrine
"suboxone" Given with naloxone orally- naloxone orally inactive *partial mu agonist*** Mixed agonist Effective in pain and addiction SE: nausea and constipation
May need to discontinue for post surgery etc. severe pain and replace with opioids
Types of tolerance
Dispositional/phamacokinetic (cyp inducement)
Pharmacodynamic (organ sensitivity changes/receptors)
Behavioral- Brain learns to act more normal under influence
Cross tolerrance- between drugs of same class
Cannabidiol
- TCH receptor bnding but without psychoactive effects
* anti seizure
Cannabinoid receptors
CB1 in brain- high in cerebellum, basal ganglia, and hippocampus
CB2 in periphery
*Gi- inhibits adenylyl cyclase and neurotransmitter release
Endogenous cannabinods
2-arachidonylglycerol
anandamide
THC effects
- Euphoria
- Memory impairment
- perceptual motor alterations
- CV- tachycardia, angina, orthostasis
- pulmonary- bronchodilation and irritant (can constrict) decrease alveolar macs and ciliary activity
- reproductive- lowers T, increased gonad weight, decreased LHRH, decreased prolactin - affects marginally fertile
- psychopathological- anxiety/paranoia, exacerbation of schizophrenia, consciousness clouding memory, perceptual and sleep disorders, amotivational syndrome
Cannabis Withdrawl
Restlessness irritability and mild agitation sleep difficulties decreased appetite and nausea cravings
Dronabinol
Oral THC in sesame oil
*controls nausea in cancer and improves appetite in AIDS wasting
Sativex
THC/cannabidiol- MS and Cancer pain
Rimonabant
CB1 antagonist (thought to be weightloss drug) pulled d/t CV problems
Phencyclidine
*PCP
*NDMA receptor antagonist
*T1/2 12-24 hours (OD T1/2 is 72 hours)
*OH and conjugated in liver
Excreted in urine
- Sympathomimetic
- CNS: small doses- drunkenness, moderate -analgessia anesthesia, Large-Convulsions
- crudely resembles sensory isolation
- Cataleptoid motor phenomenon
PCP overdose
- anxiety, agression, hallucnations, dysphoria, convulstions, delirium
- Tachycardia and hypertensive crisis
Tx:
- Supportive
- Gastric lavage
- Urine acidification
- Diazepam/antihypertensives
- Halperidol
Ketamine
Less potent and shorter duration than PCP
LSD
- <1% crosses BBB but small dose needed
- 15-20 minute onset 12 hout duration
- SYMPATHOMIMETIC
- hallucinations, mood lability, impaired judgement
- 5HT agonist causes sensory effects
LSD toxicity
*hallucnations, anxiety, panic, depersonalization
Tx: BZD and quiet environment
MDMA
- Ecstasy
- feelings of well being and connection
- 20-40 minute onset, 3-4 hour duration
- Psychomotor stimulation, restlessnes, bruxism, anorexia, sweating, tremor
- Ahedonia hangover
- neurotoxicity of serotonin neurons
GHB
- GABA precursor and metabolite
- 1-3 hour depressant- relaxation and tranquility
- interacts with EtOH
- OD causes drowsiness N/V, higher ODcauses loss of bladder control, amnesia, seizures
Salvia divinorum
Psychedelic oral use
20-45 minute activity with visual dream like experience
*Salcinorin-A is a Kappa opioid agonist
Drugs of abuse presentation and intoxication and wthdrawlTx
*Stimulant:
Presentation: euphoria, hallucinations, sympathetic activation. Tx: Benzos, B-clockers, cooling. Withdrawl: depression, suicidality, hyperphagia, hypersomnolent, fatigue, malaise, craving Tx: Food, water, sleep
*EtOH: Presentation: Stupor/coma, severe intoxication Tx: Saline with thiamine. Withdrawl: Benzos and carbemazepine
Opiates:
Hallucinogens:
