Addiction Flashcards
Three areas of the brain involved in addiction?
NUCLEUS ACCUMBENS- pleasure center, this is down-regulated over time with repeated stimulation
VENTRAL TEGMENTAL AREA- area of compulsion is unregulated
PRE FRONTAL CORTEX also undergoes changes
What are the four Cs of addition?
CONTROL-loss of control, and some attempts to stop
COMPULSIONS-feeling like you have to use the drug
CONTINUOUS-continued despite consequences
CRAVINGS
To do you treat spice
low dose of neuroleptics (anti-psychotics)
what class is cannabis and how does it make people feel?
- Cannabis is current a class B drug in the UK
- It is addictive and can make people feel very giggly, relaxed and talkative
What are symptoms associated with cannabis withdrawal?
- anxious and paranoid
- irratable
- sweaty
- shakey
- nausea
- trouble sleeping
- increased appetite
Adverse affects of cannibis?
- affect cognition (memory and concentration)
- anxiety and paranoia
- psychotic episodes
- precipitate psychosis
What are amphetamines (class and pathway) How do they make people feel?
- Amphetamines are class B drugs
- MONOAMINE AGONIST (stimulants)
Effects
- talkative
- full of energy/excited
- reduced appetite
describe features of an amphetamine withdrawl?
- poor concentration
- irritibility
- tiredness
adverse effects of amphetamines
Psych health
- poor concentration
- insomnia
- psychosis
- aggression
- paranoia
physical health
- cardiac problems
- weight loss
- immune system suppression
- tremors/seizures
What is methamphetamine and what class?
- same as amphetamine, however reaches brain more easily (lasts longer and quicker)
- greater dopamine release
- otherwise known as Ice, crystal, christina, tina, glass, crank, meth
What is coccaine? (class and pathway) How does it make people feel?
COCAINE
- Class A stimulant
- Dopamine acting
- People feel confident, full of energy, on top of the world, reduces hunger and is short acting
symptoms of withdrawal for coccaine?
WITHDRAWL
-generally unwell and poor concentration (psychological dependence)
side effects of coccaine
SIDE EFFECTS psych symptoms -panic attacks -depression -anxiety
physical symptoms
- Tachycardia
- Hyperthermia
- instant MI
- heart failure
- hypertension
- seizure
- bowel gangrene
- ENT (nose bleeds, cartalidge damage)
What is heroin? What receptors does it act on?
- Heroin is just a naturally occurring molecule of DIAMORPHINE. It is a class A drug that acts on opioid mu receptors in our brains
Signs of heroin use?
- mild euphoria as well as sedation, drowsiness, analgesia and constricted pupils
signs of heroin withdrawal?
WITHDRAWAL
- sweating
- malaise
- anxiety
- depression
- akathisia
- excessive yawning or sneezing
- tears
- rhinorrhoea
- sleep difficulties
- cold sweats
- muscle and bone aches
- N&V&D
adverse side effects of heroin?
- dependency
- mental health illness
- constipation
- respiratory depression
- psychosis
What type of drug is ketemin (class and mechanism)
- Ketamine is a class B drug that is a NMDA ANTAGONIST
Effects of ketamine?
- Causes relaxation, altered body sensations, floating feelings, dissociations, altered perceptions, delusions
adverse effects of ketamine?
- ulcerative cystitis
- bladder pain
- memory problems
- dependency panic attacks
- confusion and agitation
What class is MDMA? (c
MDMA is a CLASS A drug
effect of MDMA
MDMA makes you feel chatty, energized, alert, happy, have dilated pupils, and have increased affection
withdrawal symptoms for MDMA?
- In MDMA WITHDRAWAL people will experience lethargy, memory problems and depression
Adverse effects of MDMA
MDMA
psych causes
- anxiety
- panic attacks
- paranoia
- psychosis
physical causes
- tachycardia
- hyperpyrexia
- electrolyte disturbances (dehydration and overhydration)
what are benzos? (class and mechanism)
- Benzodiazpines are class C substances that are often prescribed for anxiety and panic disorders
- GABA agonists (feel relaxed and ease anxiety)
symptoms of Benzodiazepines withdrawal?
psych symptoms of withdrawal
- relapse of anxiety
- concentration
- panic Attacks
- little insight
physical
- tremours
- nausea and vomitting
- headaches
*people often have very little insight when they are addicted to benzodiazepines and they are very difficult addicitions to treat
Adverse effects of benzos?
- respiritory depression
- falls
- feeling hungover
- memory loss
- death if injected
Whats the maximum amount of alcohol units?
maximum of 14 units of alcohol a day
How do you work out alcohol units ?
Units= %alcohol present in 1 liter
what questionnaire is used for alcohol addiction?
AUDIT questionnaire (score of 8+ for men and 7+ women is worrying)
name some metabolic side effects of alcohol addiction
- Hypoglycaemia
- Hyperlipidaemia (high fats)
- Hyperuricaemia
- Hypomagnesaemia, hypophosphataemia, hyponatraemia (low Mg, low phosphate, low Na)
- Alcohol-induced pseudo-Cushing’s syndrome
Name some haematological effects of alcohol addiction?
- Red cell macrocytosis
- Anaemia
- Neutropenia
- Thrombocytopenia
What is delerium tremens? How common is it?
DELIRIUM TREMENS
This is an acute confusional state that occurs during the withdrawal of alcohol (4% in people withdrawing from alcohol)
When does delerium tremens occur?
- It usually starts three days into the withdrawal process and will last about 2-3 days
what are the symptoms of delerium tremens?
○ Agitation
○ Profound confusion
○ Hallucinations
○ Fever
○ Hypertension
○ Sweating
○ HTN and tachycardiaBiological treatment of alcohol withdrawal? (3)
CHLORDIAEPOXIDE (diazepam)
- These help with comfort as well as reducing the seizure risk
- Titrate the initial dose, depending on how severe the symptoms are and then slowly dial it down to nothing over the next 7-10 days
LORAZEPAM is first line treatment for DELIRIUM TREMENS
THIAMINE should always be given to reduce risk of Wernicke’s Encephalopathy
What drugs help prevent RELAPSE of alcohol consumption and how do they work? (3)
RELAPSE PREVENTION DRUGS
- ACAMPROSATE and NALTREXONE
○ Acamprosate appears to be neuroprotective
○ Naltrexone appears to reduce cravings
-DISULFIRAM
○ Interferes with the metabolism of alcohol meaning that even if small amounts are consumed there is a large build up of ACETYL-ALDEHYDE giving very unpleasant symptoms
-throbbing headache
-facial flushing
- palpitations
-dyspnoea
-tachypnoea
-nausea.
Name some other features of alcohol withdrawal?
When will the symptoms occur?
Withdrawal symptoms occur 6-8 hours after the alcohol has stopped
○ Anxiety
○ Sweating
○ Tremor
○ Nausea and vomiting
○ Problem sleeping
○ Seizures (usually within first 24-48 hours)
- ***these symptoms usually peak after 10-30 hours and then begin to subside after 2-3 days
what drugs are in the misuse drugs act 1971?
Misuse of Drugs Act 1971
A : Heroin, ecstasy, PCP,LSD, MDMA, cocaine (incl. crack), methamphetamine, psilocybin mushrooms, any class B drug prepared for injections
7 years possession…..life for supply
B : Cannabis, synthetic cannabinoids, ketamine, mephedrone, amphetamine, codeine, methoxetamine, methylphenidate
5 years possession…..14 years supply
C : Khat, GHB/GBL, benzodiazepines, tramadol, anabolic steroids
2 years possession…..14 years supply
Psychoactive Substances Act 2016
Offence to supply/offer to supply any psychoactive substance…regardless of its potential for harm
POSSESSION IS NOT AN OFFENCE
EXEMPTIONS:
nicotine, alcohol, caffeine
what is used to assess opiate withdrawal?
COWS questionaire (clinical opiate withdrawal scale)
what drugs are used in opioid addiction
Buprenorphine Methadone Naltrexone (long acting) Lofexidine -alpha2-adrenergic receptor agonist -used to relieve withdrawal symptoms, particularly those cause by noradrenaline
what is wernikes encephalopathy
Wernicke’s encephalopathy is characterised by confusion, ataxia and ophthalmoplegia
PRE CURSER TO KORSACOFFS
what is korsakoffs syndrome?
anterograde amnesia
confabulation
lack of insight
caused by chronic alcoholism
Onset of alcohol withdrawal symptoms?
peak time of seizures?
peak time of delirium tremens?
symptoms: 6-12 hours
seizures: 36 hours
delirium tremens: 72 hours
