Addiction Psychiatry Flashcards
1
Q
Percentage of general population who drank alcohol in last week in UK
A
67% men
53% women
2
Q
Percentage of adults who drank above recommended limits
A
55% men
53% women
3
Q
Percentage of children 11-15 who had drunk alcohol at least once
A
43%
4
Q
Percentage of patients who present to primary care that consume alcohol at a harmful level
A
20%
5
Q
Annual prevalence of hazardous drinking in UK households
A
38% men
15% women
27% white adults
18% black adults
8% south asian asults
6
Q
Peak age of hazardous drinking?
A
16-19 (women)
20-24 (men)
7
Q
Definition of hazardous drinking
A
8 or more on AUDIT
8
Q
Number of all hospital admissions that all alcohol related
A
1 in 16 hospital admissions
1 in 6 ED attencees
9
Q
Age at first alcoholic drink
A
13-15
10
Q
Age at first alcohol intoxication
A
15-17
11
Q
Age at first problem related to alcohol
A
16-22
12
Q
Age of death of people who are alcohol dependent
A
60
13
Q
Alcohol use during pregnancy
A
1 in 10
14
Q
% of adults in the UK 16-59 who took an illicit drug in the last year
A
8.3%
15
Q
Popular recreational drugs in the UK
A
Cannabis 6.4%
Cocaine 1.9%
Ecstacy 1.3%
16
Q
Percentage of adults 16-24 taking any drug in last year in the UK
A
16.3%
17
Q
Percentage of adults 16-59 who had taken a Class A drug in last year
A
2.6%
18
Q
Percentage of school pupils who took an illicit drug in last year in UK
A
12%
19
Q
Percentage of drug users in last year who use multiple substances
A
61% if EtOH included
7% if not included
20
Q
Most commonly reported age of first taking drugs
A
Cannabis - 16
Cocaine and Ecstacy - 18
21
Q
Average duration of drug use
A
Cannabis - 6 years
Cocaine - 4.4 years
Ecstacy - 3.9 years
22
Q
Which law classifies recreational drugs?
A
1971 Misuse of Drugs Act UK
23
Q
Name the Class A drugs
A
Ecstasy
LSD
Heroin
Cocaine
Crack
Magic mushrooms
Methamphetamine
Other amphetamines if prepared for injection
24
Q
Name the Class B drugs
A
Amphetamines
Methylphenidate
Pholcodine
25
Name the Class C drugs
Cannabis
Tranquilisers
Some painkillers
GHB
Ketamine
26
Who coined the term alcoholism?
Magnus Huss in 1865
27
What does harmful use mean in the ICD 10
Actual damage caused to drinker physically or mentally but no dependence pattern
28
ICD-10 alcohol dependence criteria
At least 3 of the following in last 12 months:
Intense desire to drink alcohol
Difficulty in controlling onset, termination and level of drinking
Withdrawal sx if alcohol not taken
Use of alcohol to relieve withdrawal sx
Tolerance as evidenced by need to escalate dose over time to achieve same effect
Salience
Narrowing personal repertoire of alcohol use
29
What is salience?
Neglecting alternate forms of leisure or pleasure in life
30
What is definition of abuse in DSM IV?
Maladaptive use defined as:
despite problems in social, occupational, physical or psychological domains
In hazardous situations
At least one moth, recurring over longer period usually
But not dependent on alcohol
31
Criteria for DSM IV alcohol dependence
At least 3 of the following lasting for a month
Consuming alcohol for longer period and in larger amounts than intended
Unsuccessful attempts to cut down
Experiencing withdrawal sx if alcohol not taken
Use of alcohol to relieve withdrawal sx
Tolerance - 50% increase from start
Salience
Failure in role obligations and physical health
Giving up alternate pleasures
Continued use despite knowing harm caused
32
Changes in alcohol & substance dependence criteria in DSM V
Combines DSM IV categories of substance abuse and dependence into Substance Use Disorder that is measured from mild (abuse) to severe (dependence).
33
Criteria for mild substance abuse disorder in DSM V
2-3 sx from list of 11
34
What has been added and removed to list of diagnostic features for substance abuse in DSM V?
Drug craving added
Legal problems removed
35
How has the topic of Addictive Disorders changed in dSM V?
Broader, encompassing non-substance addictions.
Gambling disorder added to behavioural addictions.
Internet Gambling and caffeine use disorder added to Section III
36
What is Section III of DSM V?
Disorders requiring further research before formal diagnostic description
37
Importance of the concept of dependence
Indicates intensity and predicts outcome
38
Who created the criteria for alcohol dependence
Edwards & Gross in 1976
39
What are the criteria for alcohol dependence?
Narrowed repertoire
Salience of alcohol-seeking behaviour
Increased tolerance
Repeated withdrawals
Drinking to prevent or relieve withdrawals
Subjective awareness of compulsion
Reinstatement after abstinence
40
What is neuroadaptation?
Term used to differentiate a certain state of dependence
41
Biological cause of tolerance
Increased excitability of neurons when using depressants
42
Is tolerance seen in benzos?
Not as much
43
Is tolerance seen in barbituates?
Yes
44
What is diminished tolerance due to in alcohol misuse?
When drinking alcohol after abstinence, tolerance may revert to normal and lead to quick intoxication
Older patients with brain damage may have reversed tolerance
Metabolic problems like liver disease may look like diminished tolerance
45
What is withdrawal?
Physical and psychological sx due to non-availability of alcohol in a dependent user
46
Significance of withdrawal
Opportunity towards permanent behaviour change
47
What is compulsion?
Repetitive intense drug seeking with an urge
48
What is craving?
Motivational state occurring in withdrawal
49
Who identified the components of craving?
Tiffany
50
What are the components of craving?
Urge/compulsion
Intention/plan
Expectation of satisfying outcome
Anticipation of decrease in pain/relief from negative effects
Loss of control
51
Explanations of reinstatement on relapse
Abstinence violation effect
Propensity to experience withdrawal sx may be carried through abstinence phase
Cues may trigger memory after priming dose
52
What is abstinence violation effect?
That cognition that 'I had a drink, so I am a drinker' may force patients to reinstate full pattern of drinking
53
How is impaired control explained?
Within a single episode of drinking, one loses his control on the intended amount of alcohol and ends up being intoxicated
Considering ones overall alcohol career it is evident that one tries to cut down repeatedly but fails
54
What does Cloninger divide alcohol misuse into?
Type 1
Type 2
55
What is Type 1 alcohol misuse
Milieu limited
Males and females
Loss of control
No FHx
No criminality
Starts >25 years
56
What is Type 2 alcohol misuse?
Males usually
Inability to abstain
Strong heritability
Antisocial traits
Starts <25 years
57
What is Jellineks classification of alcohol misuse?
Alpha
Beta
Gamma
Delta
Epsiln
58
What is Alpha alcohol misuse?
Psychological dependence
Undisciplined, not progressive
No Withdrawal
Major problems are inrerpersonal only
59
What is beta alcohol misuse?
Physical damage but no dependence
60
What is gamma alcohol misuse?
Loss of control plus physical dependence.
Withdrawal seen
Earlier stages similar to alpha
61
Who is gamma alcohol misuse commonly seen in?
AngloSaxons
62
What is Delta alcohol misuse?
No loss of control but unable to abstain
No disapproval or interpersonal problems
63
What is epsilon alcohol misuse?
Dipsomania - binges and bouts
64
Pharmacology of alcohol
Intercalates into fluid cell membrane
Decreases NMDA sensitivity
Increases GABA sensitivity
Down-regulates Ca channels
Up-regulates nicotine receptor gated Na channels
65
Males vs Females re pharmacology of alcohol
Females have lower body water, higher alcohol absorption rate and lesser alcohol dehydrogenase in gut mucosa
Thus, higher oral availability in females
66
When do features of alcohol withdrawal start?
Within 12 hours of last drink
67
Onset of shakes in alcohol withdrawal?
4-12 hours
68
Onset of perceptual disturbances in alcohol withdrawal?
8-12 hours
69
Seizure onset in alcohol withdrawal
12-24 hours
70
Peak of seizure onset in alcohol withdrawal
48 hours
71
Delirium onset in alcohol withdrawal
72 hours
72
Prominent sx of alcohol withdrawal
Tremor
Diaphoresis
Sleeplessness
Anxiety
GI distress
Increased urge and craving for alcohol
73
What is severity of sx of alcohol withdrawal related to?
Degree of pre-existent drinking
74
When do alcohol withdrawal sx peak if unattended?
48 hours
75
What types of seizures occur in alcohol withdrawal?
Grand mal
76
In which group of people are alcohol withdrawal seizures more likely?
Previous withdrawal seizures
Epilepsy
HI
Electrolyte imbalance
77
How many patients with alcohol withdrawal will get delirium tremens?
5%
78
What happens in delirium tremens?
Disturbed autonomic functions
Clouded consciousness with hallucinations
Agitation
79
What type of hallucinations tend to occur in delirium tremens?
Lilliputian
80
Incidence of seizures in untreated alcohol-dependent patients
8%
81
Risk of seizures in alcohol withdrawal if treated
3%
82
How does alcohol withdrawal lead to seizures?
Kindling process - episodic alcohol withdrawal sensitises brain leading to increased likelihood of seizure with each future episode
83
How many patients with withdrawal seizures go on to develop delirium tremens?
30%
84
Risk factors for delirium tremens and seizures
Severe dependence
Hx of delirium tremens
Older patient
Acute physical illness
85
How many patients in delirium tremens die if untreated>
10%
86
What does the term opiate refer to?
Natural opium alkaloids and semi-synthetics derived from the alkaloids
87
Most commonly used opioid
Heroin
88
How is heroin most commonly taken?
Smoking/chasing
89
Prevalence of heroin use in the UK
1%
90
M:F ratio of heroin use
2:1
91
Age of most treatment seekers of heroin misuse?
20s
92
Which receptors are relevant in opioid physiology
Mu
Kappa
Delta
All G-protein coupled
93
What is the most abused opioid in terms of receptors?
Mu agonist (morphine-like)
94
What do kappa agonists lead to?
Dysphoria
Decrease dopamine release in VTA
95
Oral bioavailability or morphine
30%
96
Half life of morphine
2-3 hours
97
How strong is parenteral morphine compared to PO?
3x stronger
98
Bioavailability of PO diamorphine
30%
99
Half life of diamorphine
<3 minutes
100
How much stronger is diamorphine compared to morphine?
4-5x stronger
101
PO bioavailability of methadone
80%
102
Half life of methadone
15-60 hours
103
How much stronger is methadone compared to morphine?
3-4x stronger
104
How can Buprenorphine be taken
S/L
Transdermal
Injected
105
Half-life of PO Buprenorphine
1-7 hours
106
Half-life of S/L buprenorphine
30 hours
107
Potency of Buprenorphine
40x more potent at receptor level
Partial agonist
108
Half life of Oxycodone
3-7 hours
109
Potency of oxycodone
5-7x more potent that morphine
110
How can pethidine be taken?
IV
111
Half life of codeine and pethidine
2-4
112
Potency of codeine
0.1-0.1x potent compared to morphine
113
Intoxication effects of opioids
Initial euphoria
Apathy & dysphoria follow
Psychomotor agitation/retardation
Pupillary constriction
Drowsiness/coma
Slurred speech
Impairment in attention and memory
114
When do opioid withdrawal sx start?
6-8 hours after last dose
115
When do opioid withdrawal sx peak?
2 days
116
What do opioid withdrawal sx start to reduce?
In a week
117
Withdrawal sx of opioids
Dysphoric mood
Nausea/vomiting
Muscle aches
Lacrimation/rhinorrhoea
Pupillary dilatation, piloerection, sweating
Diarrhoea
Yawning
Fever
Insomnia
118
Which withdrawal sx of opioids persist for months?
Insomnia
Bradycardia
Temperature dysregulation
Craving
119
What is cannabis obtained from?
The plan cannabis sativa
120
What is the principal component of cannabis?
9-THC
121
Describe the cannabinoid receptor
Gi linked receptor
122
What are endogenous cannabinoids called?
Anandamides
123
Where are cannabinoid receptors foind?
Basal ganglia
Hippocampus
Cerebellum
Sparsely in the cerebral cortex
124
Physiological effects of cannabis
Euphoric effects within minutes
125
When do euphoric effects of cannabis peak?
30 minutes
126
How long do euphoric effects of cannabis last?
2-4 hours
127
Dependence of cannabis?
Psychological, not physiological
Tolerance can occur
128
Withdrawal sx of cannabis
Irritability
Insomnia
Anorexia
Nausea
129
Cannabis intoxication sx?
Impaired motor coordination
Euphoria
Sensation of slowed time
Conjunctival injection
Increased appetite
Dry mouth
Tachycardia
Depersonalisation/rerealization
130
Categories of people who abuse benzos
Those who were px them at some point but became dependent
Those who use benzos in combination with other drugs e.g. to come off stimulants/boost methadone effect
Those dependent on prescriptions (non-abusers)
131
How many patients on benzos for 1-5 months will develop dependence?
15%
132
How many patients on benzos for a year will develop dependence?
40%
133
Sx of benzo intoxication
Slurred speech
Incoordinatino
Unsteady gait
Nystagmus
Impairment in attention and memory
Stupor/coma
Inappropriate sexual/aggressive behaviour
Mood lability
Impaired judgement
134
Sx of benzo withdrawal
Anxiety
Autonomic hyperactivity
Tremor
Insomnia
Nausea/vomiting
Transient hallucinations/illusions
Psychomotor agitation -> grand mal seizures
135
Ratio of lethal dose to effective dose of benzo
200 to 1
136
Management of benzo dependence if early/mild
Advisory letters
Short courses of relaxation
137
Management of established benzo dependence
Graded discontinuation of px benzo
138
How many patients on graded discontinuation of benzos stop misusing them short-term?
66%
139
What other drugs can be used to control withdrawal sx in those on high dose benzos?
Carbamazepine
140
What is GHB?
A naturally occurring substance in the brain
141
What was GHB initially synthesised for?
Anaesthetic
142
Why was GHB banned?
Abuse by body builders as it was thought to boost growth hormone
143
Which recreational drug is used as a date rape drug?
GHB - colourless
144
Street names of GHB
Georgia Home Boy
Liquid ecstacy
145
Pharmacology of GHB
GABA-like action
Inhibits dopamine release at low dose
Boosts dopamine availability on chronic use
Induces release of NA in hypothalamus
146
Risk of GHB mixed with EtOH
Respiratory depression
Coma
147
How many patients on GHB develop b
33%
148
What compound of GHB is used in the USA for cataplexy?
Sodium oxybate
149
What is GHB abuse classified as in both ICD and DSM?
Sedative-hypnotic
150
Withdrawal syndrome of GHB?
Similar to alcohol and benzo withdrawal
151
Withdrawal sx in mild GHB use
Insomnia
Anxiety
Tremors
152
Withdrawal sx in chronic GHB use
Paranoia
Hallucinations
Extreme agitation
153
When do withdrawal effects of GHB start?
Within 12 hours
154
How long can withdrawal sx of GB last for?
Up to 12 days
155
Common cause of death among GHB users?
Aspiration pneumonia
156
What drugs are sometimes used to support GHB withdrawal?
Lorazepam
Diazepam
Haloperidol
157
How many 16-29 year olds in the UK have used amphetamines at least once?
22%
158
How many patients who present to addiction services have a primary amphetamine-related problem?
10%
159
Pharmacology of amphetamine
Block catecholamine - mainly DA and NE - reuptake and stimulate their release from vesicles
160
Typical uses of amphetamine?
Stimulate performance and induce euphoric feeling
161
Routes of amphetamine use
PO
IV
Snorting
162
Street names of amphetamine
Whiz
Speed
163
What type of amphetamine can cause HTN, psychosis and intestinal infarction?
Phenylpropranolamine
164
How can methamphetamine be taken?
Inhaled
Smoked
IV injection
165
What is Ice?
Strong, purer form of amphetamine
166
How can Ice be taken?
Smoked
Injected
167
Intoxication effects of amphetamine?
Tachy/bradycardia/arrhythmia
Pupillary dilatation
High or low BP
Perspiration or chills
Nausea/vomiting
Weight loss
Psychomotor agitation/retardation
Muscle weakness
Respiratory depression
CP
Confusion
Seizures
Dyskinesias
Dystonias
168
Withdrawal effects of amphetamines
Dysphoric mood (crash) sometimes with suicidal ideation
Fatigue
Vivid, unpleasant dreams
Hypersomnia
Increased appetite
Psychomotor retardation
Small puils
169
What diminishes as amphetamine is used long term?
Tachycardia
Euphoria
Anorexic effects
Increased alertness
170
Full name of MDMA
3,4-methylene-dioxymethamphetamine
171
What is MDMA?
Substituted amphetamine that produces subjective effects resembling those of amphetamine and LSD
172
Full name of LSD
Lysergic acid Diethylamide
173
Pharmacology of MDMA
Two optical isomers:
R isomer produces LSD-like effects
S isomer produces amphetamine-like effects
174
What causes the LSD-like effects of MDMA?
Releases serotonin from terminals
175
Long-term use of MDMA on serotonin?
Damage to serotonin nerves irreversibly causing depression
176
What dose of MDMA causes stimulant effect?
Lose
177
What dose of MDMA causes hallucinogenic effect?
High
178
Routes of taking MDMA?
PO
Injected
Snorted
179
MDMA withdrawal sx
Fatigue
Loss of appetite
Depression/anxiety
Trouble concentrating
180
When do withdrawal sx of MDMA occuring
Same day or 2 days after
181
What harm reduction advice should be given re MDMA use?
Maintaining hydration
Avoid overheating
182
What is khat derived from?
Fresh leaves of catha edulis from East Africa and Yemen - used as stimulant
183
What is the main ingredient of khat?
Cathinone
184
Effect of Cathinone/khat?
CNS and peripheral actions similar to amphetamine.
185
How is khat taken?
Buccally absorbed after chewing leaf
186
Why does khat have low toxicity?
Alkaloid and therefore absorbed rapidly
187
What is a synthetic form of khat?
Methcatinone
188
What is cocaine?
Alkaloid derived from the shrub erythroxylon coca
Powerful reinforcer and strong dependence producer
189
Neurotransmitter function of cocaine
Dopamine reuptake blockade
190
How can cocaine be taken?
Injected
Smoked
Snorted
191
Risks of snorting cocaine
Nasal septal perforation due to local anaesthetic effect with repeated trauma
Vasoconstriction
Ischaemic necrosis
192
What is freebased cocaine?
Released free from the base e.g. sodium bicarbonate to produce a purer form called crack which when inhaled acts as rapidly as IV use
193
Duration of cocaines euphoric effects?
Depends on route of administration; faster absorption leads to more intense euphoria but shorter duration
194
How long does euphoria from snorting cocaine last?
15-30 minutes
195
How long does euphoria from smoking cocaine last?
5-10 minutes
196
How many cocaine users have MH problems?
60%
197
How many cocaine users have psychotic experiences?
18%
198
Intoxication effects of cocaine
Increased energy and confidence
Euphoria
Diminished need for sleep
199
Sx of high doses of cocaine
Agitation
Impaired judgement
Impulsive aggression
Tachycardia
HTN
Mydriasis
Formication
200
Duration of withdrawal effects of cocaine?
Short-lived due to rapid metabolism
201
Features of withdrawal from cocaine
Intense craving with lack of physical withdrawal sx
Dysphoria
Anhedonia
Irritability
Hypersomnolence
202
How long do effects of cocaine withdrawal last?
18 hours
203
How long can effects of cocaine last in heavy users?
One week
204
When do withdrawal of cocaine sx peak in heavy use?
3 days
205
Physical adverse effects of cocaine
Nasal perforation
Nonhemorrhagic cerebral infarctions
SAH, IVH and intraparenchymal haemorrhages
TIAs
Seizures
MI & arrhythmias
206
Pharmacology of caffeine
Methylxanthine (like theophylline)
207
Half life of caffeine
3-10 hours
208
Peak concentration of caffeine
30-60 minutes
209
How does caffeine work?
Crosses blood-brain barrier and acts as antagonist of adenosine receptors and so increases intraneuronal cAMP.
210
What receptors can caffeine effect at high doses?
Dopamine and NA neurons
211
Receptor effects in caffeine use in nontolerant individuals?
May reduce GABAergic activity in cerebral cortex and striatum
212
Dose of caffeine in single cup
20-200mg
213
At what dose of caffeine does anxiety and nervousness start
300-800mg
214
Effect of caffeine on the brain
Global cerebral vasocontriction
215
What happens to cerebral blood flow when caffeine use stops?
Rebound increase
216
At what dose of caffeine can intoxication start
Excess of 250mg (more than 2-3 cups at once)
217
Intoxication sx of caffeine
Restlessness
Nervousness
Excitement
Insomnia
Flushed face
Diuresis
GI disturbance
Muscle twitching
Rambling flow of thought and speech
Tachycardia/arrhythmia
Periods of inexhaustability and psychomotor agitation
218
Withdrawal sx of caffeine
Headache
Fatigue
Drowsiness
Anxiety/depression
Nausea/vomiting
219
At what doses can withdrawal sx of caffeine be seen
100mg/day
220
When do withdrawal sx of caffeine start?
Within 12 hours
221
When do withdrawal sx of caffeine peak?
24-48 hours
222
How long can withdrawal sx of caffeine last?
Up to 1 week
223
Name some naturally occurring hallucinogens
Psilocybin
Mescaline
224
Where does Psilocybin come from?
Mushrooms
225
What type of magic mushroom is popular in the UK?
Liberty cap - psilocybe semilanceata
226
What can large doses of magic mushrooms (>25) cause?
LSD-like effects
227
Dependence and withdrawal with magic mushrooms?
None
228
What is LSD
Classic synthetic hallucinogen
229
Who created LSD?
ALbert Hoffman in 1938
230
What is LSD derived from?
Synthetic base derived from ergot alkaloids
231
What is the most commonly used hallucinogen in the UK?
LSD
232
How does LSD act?
Via sigma opioid and aspartate receptors as well as serotonergic effects
233
Sx of LSD use
Acute confusion
Visual sensory distortions
Aggression
Psychosis
234
When is tolerance to LSD's sensory and psychological effects seen?
2nd-3rd day of successive use
235
How long does one need to be free of LSD use to lose tolerance?
4-6 days
236
Dependence of LSD?
No physical or psychological dependence seen
237
What does PCP stand for>
Phencyclidine
238
Street name of PCP?
Angel dust
239
What is PCP?
Synthetic agent
240
How is PCP taken?
Smoked
Snorted
241
What is ketamine?
Structurally similar to phencyclidine
242
How does Ketamine work?
Reduces cortical awareness of painful stimuli
243
How is ketamine taken?
Sniffed
244
Street name of ketamine?
K
245
Sx of hallucinogen intoxication?
Anxiety/depression
Ideas of reference
Paranoid ideation
Perceptual changes
Fear of losing ones mind
Depresonalisation/derealization
Hallucinatinos
Synesthesias
Pupillary dilatation
Tachycardia
Sweating/palpitations
Blurring of vision
Incoordination/tremors
246
Sequence of sx on hallucinogen intoxication
Somatic sx first
Then mood and perceptual changes
Finally psychological changes
247
Sx of PCP intoxication
Vertical or horizontal nystagmus
Diminshed response to pain
Ataxia and dysarthria with muscle rigidity
248
What drugs are named as club drugs?
MDMA
Ecstacy
Rohypnol
GHB
Ketamine
LHD
249
Who created the term club drug?
National Institute on Drug Abuse
250
What drugs are known as date rape drugs?
GHB
Flunitrazepam
Rohypnol
Ketamine
251
How many smokers are nicotine dependent?
80%
252
Pharmacology of nicotine
Stimulates central nicotinic ach receptors and improves alertness
Polycyclic hydrocarbons stimulate CYP1A2
253
Drugs most affected by smoking?
Clozapine
Olanzapine
Chlorpromazine
Fluphenazine
Haloperidol
TCAs
Mirtazapine
Fluvoxamine
Propranolol
254
Withdrawal sx of nicotine
Dysphoric mood
Insomnia
Frustration
Anger/anxiety
Difficulty concentrating
Restlessness
Bradycardia
Increased appetite
255
When do withdrawal sx of nictoine start?
Within a few hours
256
When do withdrawal sx of nicotine peak?
2-3 days
257
When do withdrawal sx of nicotine become less intense?
1-3 weeks
258
Mean weight gain after smoking cessation
10 lb
259
Who is at greatest risk of weight gain after stopping smoking?
Women
Heavy smokers
260
How many substance related deaths are due to inhalants?
1%
261
Common substances inhaled
Glues
Adhesives
Propellants for aerosol paint sprays
Hair sprays
Thinners (paint products, typing correction products)
Fuels
262
Pharmacology of inhalants
Act as CNS depressants
Concentration in blood increased with EtOH
263
When do effects of inhalants appear?
Within 5 minutes
264
How long do effects of inhalants last?
30 minutes to several hours
265
Intoxication sx of inhalants
Dizziness
Nystagmus
Incoordination
Slurred speech
Unsteady gait
Depressed reflexes
Psychomotor retardation
Generalised muscle weakness
Blurred vision/diplopia
Stupor/coma
Euphoria
266
Evidence of recent inhalant use
Rash around nose or mouth
Unusual breath odours
Residue of inhalant substance on body or clothes
Signs of ocular and oropharyngeal irritation
267
Dependence and withdrawal of inhalants?
None recognised at present
268
What does the Misuse of Drug Regulations 2001 state?
It defines the authorised persons who can supply and possess controlled drugs in their professional capacities.
269
How many schedules in the Misuse of Drug Regulations 2001?
Five
270
Examples of drugs in Schedule 1
Coca leaf
Cannabis
LSD
Mescaline
271
Regulations of Schedule 1 drugs
No medicinal use.
Supply limited to research or special purposes judged to be in public interest.
Requires Home Office license to possess.
272
Examples of drugs in Schedule 2
Diamorphine
Dipipanone
Morphine
Remifentanil
Pethidine
Secobarbital
Glutethimide
Amphetamine
Cocaine
273
Regulations of Schedule 2 drugs
Special px requirements and safe custody requirements - except for secobarbital.
Stock drugs must be recorded in a register that meets regulations of the 2001 Regulations
Drug stock must only be destroyed in presence of an appropriately authorized person
274
Schedule 3 drugs?
Barbituates except secobarbital
Buprenorphine
Diethylpropion
Mazindol
Meprobamate
Pentazocine
Phentermine
Temazepam
275
Regulations of Schedule 3 drugs
Subject to special px requirements except for temazepam.
Not subject to safe custody requirements except for buprenorphine, diethylpropion, flunitrazepam and temazepam.
No need to keep register.
Requirement for retention of invoices for 2 years.
276
Schedule 4 Part 1 drugs
Benzos except temazepam
Zolpidem
277
Schedule 4 Part 2 drugs
Androgenic and anabolic steroids
Clenbuterol
HCG
Non-human chorionic gonadotrophin
Somatotropin
Somatrem
Somatropin
278
Regulations of Schedule 4 drugs
Not subject to special px or safe custody requirements.
No need for register.
Requirement for retention of invoices for 2 years.
279
Schedule 5 drugs
Weak preparations of drugs in other schedules e.g. codeine
280
Regulations of Schedule 5 drugs
Exempt from all CD regulations except need to keep invoices for at least 2 years
281
What should all CD px have?
Patients full name, address and age
Name and form of drug written
Dose written
Total quantity of preparation or number of dose units to be supplied in both words and figures
Patient identifier number (NHS)
Signed by prescriber along with GMC number - must be handwritten
282
How long are px of Schedule 1-4 drugs valid?
28 days
283
Which drugs cannot be px on repeat prescriptions?
Schedule 2 & 3 drugs
284
How must patients collect CD on first occassion?
In person after showing ID
Sign back of px form
285
How must substitute opioids be px?
In daily instalments
286
What must px of instalment of substitute opioid include?
Number of instalments
Interval between instalments
Instructions for supplies on weekends or BH
Total quantity to provide treatment for a period (not exceeding 14 days)
Quantity to be supplied on each instalment along with duration of instalments to be set out on px
287
At what dose does buprenorphine act as a mild agonist?
Low doses
288
At what does does buprenorphine act as antagonist?
High doses
289
Which cannabinoid receptor is central?
CB1
290
What activates CB1 receptor?
11OH tetra hydro cannabinoid
291
What does CB1 receptor do?
Inhibits GABA tone in substantia nigra and other areas
292
Where is CB2 receptor found?
Spleen
Thymus
293
Give examples of presynaptic alpha 2 agonists
Clonidine
Lofexidine
294
What do presynaptic alpha 2 agonists do?
Reduce central sympathetic tone
295
What to opioid receptors on locus coeruleus do on longterm use?
Reduce NA tone
296
What does long-term use of Opioid lead to?
Opioid receptors on locus coeruleus projections reduce NA tone
Cellular machinery compensates via up-regulation of adenylate cyclase and maintains sympathetic tone
297
What does sudden withdrawal of opioids lead to?
Increased adrenergic firing rate leading to withdrawal sx
298
How does clonidine/lofexidine help in withdrawal of opioid?
Reduces central sympathetic tone
299
How do Dexfenfluramine and Fenfluramine work?
Massive serotonin release from nerve endings
300
What was Fen-Phen?
Combination of Fenfluramine and Phentermine
301
What was Fen-Phen used for?
Weight loss
302
Why was fenfluramine and dexfenfluramine withdrawn?
Irreversible serotonergic damage
Valvular regurgitation
Pulmonary fibrosis
303
How does Disulfiram work?
Inhibits aldehyde dehydrogenase
304
What happens if EtOH is consumed while on Disulfiram?
Accumulation of acetaldehyde producing unpleasant reactions
305
What is Levomethadyl acetate?
Long-acting opioid agonist
Pure mu agonist
306
Why was levomethadyl acetate withdrawn?
Prolonged QT
Torsades de pointes
307
How does LSd produce its hallucinogenic effect?
5HT2A partial agonism
308
What type of agonist is methadone?
Pure mu
309
What is naloxone?
Short acting opioid mu antagonist
310
What is naltrexone?
Longer acting opioid mu antagonist
311
What is phencyclidine?
Noncompetitive NMDA antagonist
Also binds to sigma receptors
312
What is Varenicline?
Partial agonist at alpha4beta2 subunit of nicotinic acetylcholine receptor
313
What is Varenicline used for?
Relieving nicotine withdrawal sx and reducing rewarding properties of nicotine
