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Psychiatry > Addiction > Flashcards

Addiction Flashcards

1
Q

What are the two proposed mechanisms for dependence?

A 
Tolerance (physiological dependence) 
Reward centre (basis of craving)
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2
Q

Define tolerance

A

Reduced responsiveness to a drug caused by previous admission

I.e. the drug is becoming less effective which each use

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3
Q

Give examples of drugs which show tolerance

A

Opoids, benzodiazepines, ethanol, barbiturates

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4
Q

What is tolerance an example of?

A

A homeostatic mechanism

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5
Q

What are the two kinds of tolerance? Give examples of each

A

Dispositional tolerance = less drug reaches active site
E.g. less absorption, faster metabolism, increased excretion

Pharmacodynamic tolerance = drug has less effect at active site
E.g. fewer receptors (e.g. due to downregulation/internalisation), less efficient receptors (e.g. due to reduced signalling downstream)

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6
Q

Why does tolerance lead to dependence?

A

Body adjusts to the drug as by the mechanisms mentioned, such that the drug has a lesser effect
These changes mean that when the drug is stopped, symptoms are experienced which are the opposite of the effects of the drug (withdrawal symptoms)

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7
Q

Give examples of the normal effect and withdrawal effect of:
Opioids
Barbiturates
Cocaine

A

Opioids - constipation normally, WE = diarrhoea
Barbiturates - anticonvulsants, WE = consulsions
Cocaine - elevated mood, WE = depressed mood

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8
Q

Describe the anatomy of the reward centre

A

VTA neurons project to the nucleus accumbens and release dopamine there
Nucleus accumbens linked to prefrontal cortex and release of dopamine –> sense of pleasure/reward

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9
Q

What normally activates the reward centre?

A

Sex, food, drinking

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10
Q 
How do the following drugs interact with the reward centre:
Heroine 
Amphetamine 
Cocaine
Alcohol?
A

Heroine - increased dopaminergic neuron firing
Amphetamine - increases dopamine release
Cocaine - inhibits uptake of dopamine
Alcohol - works via inhibitory neurons

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11
Q

What is the prison sentence for possession/dealing of class A drugs?

A

10 years

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12
Q

What is the prison sentence for possession/dealing of class B drugs?

A

5 years

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13
Q

What is the prison sentence for possession/dealing of class C drugs?

A

3 years

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14
Q

What is a huge factor making heroine so dangerous?

A

Associated with criminality, poor mental health and family life

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15
Q

What is a huge factor making cocaine so dangerous?

A

It is so expensive –> financial problems and social fall out

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16
Q

What are two stimulants?

A

Cocaine

Amphetamine

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17
Q

What is crack cocaine?

A

Purified cocaine

You can smoke this

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18
Q

What ways can you take cocaine?

A

Snorting, smoking, injecting

19
Q

How fast acting is cocaine? How long does its effects last?

A

Fast acting, short acting

20
Q

What are the effects of cocaine?

A 
Euphoria
Increased alertness
Impaired judgement Increased energy 
Increased confidence
Lessens appetite and need for sleep
21
Q

What are the negative effects of cocaine?

A 
Damages nose and airway (vasoconstrictor) 
Cardiac arrhythmias and MI
Convulsions and respiratory failure 
HTN and CVA 
Toxic confusion 
Paranoid psychosis
22
Q

What are the withdrawal effects of cocaine?

A 
Opposites of effects
Hypersomnia
Hyperphagia 
Depressed mood
Irritability and agitation 
Craving
23
Q

How is amphetamine generally taken?

A

Amphetamine sulphate

Sniffed, snorted or injected

24
Q

What are the effects of amphetamine?

A

Similar to cocaine but longer lasting

25
Q

Give examples of opiates

A 
Opium 
Morphine 
Diamorphine (heroine) 
Methadone 
Codeine and dihydrocodeine
26
Q

How do opiates work?

A

Act on opiate receptor to reduce pain and stimulate reward centre

27
Q

What are the different ways of taking heroine?

A

Sniffing, smoking, injecting

People tend to resort to injecting when their tolerance increases

28
Q

What are the effects of heroine?

A 
Analgesia 
Drowsiness, sleep
Euphoria 
Respiratory depression 
Cough reflex suppression 
Sensitisation of labyrinth (--> N/V)
Bradycardia/hypotension 
Lowering body temp 
Pupillary constriction 
Constipation
29
Q

What is respiratory arrest with pulse almost pathognmonic of?

A

Opiate OD

30
Q

What tends to happen on first use of opiates?

A

NV and headache

31
Q

What are short term consequences of opiate use?

A

Phlebitis
Anorexia
Constipation

32
Q

What are long term consequences of opiate use?

A

Tolerance
Withdrawal
Social and health problems

33
Q

What are the symptoms of opiate withdrawal?

A 
Craving 
Insomnia
Muscle pain and cramps
Increased salivation, nasal and lacrimal secretions
Dilated pupils 
Yawning 
Piloerection
34
Q

Why is methadone good to use in heroine addicts?

A

Decriminalises drug use
Stops IV use and reduces problems assoc. with that
Normalises life

35
Q

What is the biggest problem with ecstasy/MDMA?

A

Over half of ecstasy tablets don’t contain any MDMA

36
Q

What are the effects of MDMA?

A

Euphoria
Increased sociability
Inability to distinguish between real and fake

37
Q

What are the side effects of ecstasy use?

A

Nausea
Dry mouth
Increased BP and temp
Dehydration in clubs

38
Q

What can larger doses of MDMA cause?

A

Anxiety, panic, psychosis

39
Q

What can long term use of MDMA cause?

A

Chronic anxiety and depression and insomnia

40
Q

What are the two active compounds in cannabis and what do they do?

A

THC - psychoactive substance

CBD - antipsychotic and anti-anxiety

41
Q

What are the effects of cannabis?

A 
Relaxing or stimulating 
Increased sociability 
increased hilarity Synaesthesia 
Changes in time perception 
Increased appetite
42
Q

In higher doses what can cannabis cause?

A

Anxiety and panic, persecutory ideation, hallucinations

43
Q

What are anabolic steroids illegally used for?

A

Building muscle and reducing fat

Especially builds pectorialis, trapezius, biceps and deltoids

44
Q

What are the side effects of steroid use?

A 
Acne, hair thinning, stretch marks 
Feminisation/virulization 
HTN, hypercholesterolaemia
Growth deficits (as premature fusion of epiphyseal plates 
Liver tumours, cholestatic jaundice
Irritability/anger (roid rage) 
Mania/hypomania
Suicidal ideation/depression on withdrawal

Psychiatry (26 decks)

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