Addiction Medicine Part 4 Flashcards
What are Classic Hallucinogens
Cannabis
Dissociative Anesthetics
- LSD
- Mescaline
- Psilocybin (mushrooms)
- Marijuana
- Hashish
- PCP (Phencyclidine)
- Ketamine
What are the 3 commonalities associated with these drugs and what alteration specifically do each of them cause
- These drugs are known for their perceptual altering abilities.
- These drugs are known for their mind calming effects, despite having sympathomimetic effects.
•sometimes these drugs are associated with agitation/paranoia - Concerns (largely unproven) exist that these drugs cause a persisting psychosis (e.g., marijuana causing schizophrenia)
Classic-Hallucinations
Cannabis-Distortions
Dissociative Hallucinogens-Depersonalization
What is LSD
Symptoms?
Withdrawal?
LSD is one of the most potent hallucinogens and is long lasting (8-12 hrs).
▪visual, poorly formed hallucinations (unlike those in schizophrenia)
▪mydriasis
►Associated with “flashback” perceptual experiences long after LSD is metabolized:
• Known as “Hallucination Persisting Perception Disorder”
• Example symptoms
■ false perceptions of movement
■ intensifications of color
• No withdrawal syndrome is recognized.
What is Cannabis known as:
Is it commonly used
Does it cause hallucinations
How fast does it act
What is it associated with
What are the psychological and physical intoxication symptoms
What are the withdrawal symptoms-psychological and physical
What is the legal status
- “Gateway” drug (alongside Rx opioids
- Most commonly used illegal substance
- Rarely unless it is ingested
- Shorter acting than LSD (2-4 hrs vs. 8-12 hrs) unless ingested
- Associated with “amotivational syndrome”
Intoxication
PSYCHOLOGICAL
• perceptual distortions
(e.g., intensification of senses, perception of slowed time)
PHYSICAL
• conjunctival injection • increased appetite
• dry mouth
Withdrawal PSYCHOLOGICAL • irritability and nervousness • dysphoric mood • sleep disturbance (insomnia, vivid dreams) • decreased appetite PHYSICAL • headaches, night sweats, stomach cramping, shakiness
Legal Status
•Many U.S. states have removed state-level criminal penalties associated with medicinal marijuana (e.g., for pain relief, appetite stimulation).
•A few states have removed criminal penalties for recreational marijuana use.
•Marijuana is a Schedule I substance; Growing/ possession/use of this drug violates federal law.
Dissociative Anesthetics
Example:
Intoxication symptoms
What is intoxication considered?
Are there withdrawal symptoms recognized?
Treatment of Acute Intoxication?
(Phencyclidine [PCP])
Intoxication • depersonalization • agitation, belligerence and confusion • impulsivity and unpredictability • nystagmus, hyperacusis • decreased responsiveness to pain • ataxia, muscle rigidity, seizures, coma
psychiatric emergency because of violent and unpredictable behaviors.
- benzodiazepines/antipsychotics
- reduced environmental stimulation • restraints may be needed
No
What are examples of Opioids and what is its main medical use
Additional notable effects
What does Heroin do?
2 things
morphine, fentanyl, hydrocodone, oxycodone
Analgesia
•Euphoria in varying intensities
•Produces intense euphoria (highly addictive)
•Can be smoked/snorted, so users don’t always
have needle track marks.
What are the intoxication effects?
• initial intense rush followed by: ■ euphoria and drowsiness ■ dysphoria (as the high dissipates) • miosis • unconscious • respiratory depression
What is the treatments for Acute Overdose?
Can you use it for addiction treatment?
• Naloxone (Narcan): A short-acting opioid receptor antagonist
No
What are withdrawal symptoms?
Is withdrawal life threatening?
Can overdose be deadly?
- dysphoria
- nausea, vomiting, diarrhea
- muscle aches, lacrimation and rhinorrhea
- piloerection, sweating, fever
- yawning
- pupillary dilation
No
Yes
What are the two types of treatment for Opioids?
- Abstinence-Based Therapy:
2. Replacement Therapy (RT):
What is Abstinence Based Therapy, what drug does it often use, and is it successful?
- Requires patient to be completely abstinent from opioid drugs.
- Often involves use of naltrexone (a long- acting opioid receptor blocker) to block opioid effects if relapse occurs.
- Tends to be unsuccessful.
What is Replacement Therapy?
Is it more successful?
What are the symptoms associated with heavy opioid usage that make abstinence difficult?
- Involves giving patient a safer opioid drug
- Tends to be more successful than abstinence-based therapies
▪anhedonia (due to reduced dopamine availability)
▪physical discomfort (due to reduced availability of endogenous opioids)
What are the two drugs used for replacement therapy?
What schedule of drugs are they
What is the duration and benefits of RT?
a. Methadone (a Schedule II opioid drug) can use freely for pain patients
►When used for addiction treatment,
methadone:
•is only available at an official federally- regulated Opioid Treatment Program (OTP).
•cannot be “prescribed”. It can only be “administered” or “dispensed” at a OTP.
Buprenorphine (a Schedule III opioid drug)
►When used for addiction treatment, buprenorphine:
•is available from a doctor’s office after approval by the DEA.
•can be “prescribed”, “administered” or “dispensed” from a doctor’s office.
Duration and Benefits of RT
•RT usually continues for at least 1-2 yrs.
•Benefits of RT:
▪oral administration
▪stable drug levels
▪less euphoria and less drowsiness
•RT (plus other interventions) results in healthier, productive and less crime-causing heroin addicts.
What is Suboxone
buprenorphine + naloxone (released only if medication is abused)
What is Gambling Disorder
How many symptoms must you have in what length of time and what are some examples of symptoms
When are you diagnosed with Gambling Disorder?
➢ Persistent and recurrent problematic gambling behavior indicated by ≥4 symptoms in 12-mos:
• Gambling with increasing amounts of money to
achieve excitement
• Restless/irritable when trying to cut down or stop
• Unsuccessful efforts to control or stop gambling
• Preoccupied with gambling (e.g., reliving past
gambling experiences)
• Gambles when feeling distressed
• Continues to gamble, even after losing money
• Lies to conceal the extent of gambling
• Jeopardized relationship, job, or educational or career opportunity because of gambling.
• Relies on others for bail-out money caused by gambling.
➢The gambling behavior is not better explained by a manic episode
