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MRCPsych Part B > Addiction Psychiatry > Flashcards

Addiction Psychiatry Flashcards

1
Q

Percentage of general population who drank alcohol in last week in UK

A

67% men

53% women

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2
Q

Percentage of adults who drank above recommended limits

A

55% men

53% women

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3
Q

Percentage of children 11-15 who had drunk alcohol at least once

A

43%

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4
Q

Percentage of patients who present to primary care that consume alcohol at a harmful level

A

20%

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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
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6
Q

Peak age of hazardous drinking?

A

16-19 (women)

20-24 (men)

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7
Q

Definition of hazardous drinking

A

8 or more on AUDIT

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8
Q

Number of all hospital admissions that all alcohol related

A

1 in 16 hospital admissions

1 in 6 ED attencees

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9
Q

Age at first alcoholic drink

A

13-15

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10
Q

Age at first alcohol intoxication

A

15-17

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11
Q

Age at first problem related to alcohol

A

16-22

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12
Q

Age of death of people who are alcohol dependent

A

60

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13
Q

Alcohol use during pregnancy

A

1 in 10

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14
Q

% of adults in the UK 16-59 who took an illicit drug in the last year

A

8.3%

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15
Q

Popular recreational drugs in the UK

A

Cannabis 6.4%
Cocaine 1.9%
Ecstacy 1.3%

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16
Q

Percentage of adults 16-24 taking any drug in last year in the UK

A

16.3%

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17
Q

Percentage of adults 16-59 who had taken a Class A drug in last year

A

2.6%

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18
Q

Percentage of school pupils who took an illicit drug in last year in UK

A

12%

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19
Q

Percentage of drug users in last year who use multiple substances

A

61% if EtOH included

7% if not included

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20
Q

Most commonly reported age of first taking drugs

A

Cannabis - 16

Cocaine and Ecstacy - 18

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21
Q

Average duration of drug use

A

Cannabis - 6 years
Cocaine - 4.4 years
Ecstacy - 3.9 years

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22
Q

Which law classifies recreational drugs?

A

1971 Misuse of Drugs Act UK

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23
Q

Name the Class A drugs

A 
Ecstasy
LSD
Heroin
Cocaine
Crack
Magic mushrooms
Methamphetamine
Other amphetamines if prepared for injection
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24
Q

Name the Class B drugs

A

Amphetamines
Methylphenidate
Pholcodine

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25
Q

Name the Class C drugs

A 
Cannabis
Tranquilisers
Some painkillers
GHB
Ketamine
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26
Q

Who coined the term alcoholism?

A

Magnus Huss in 1865

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27
Q

What does harmful use mean in the ICD 10

A

Actual damage caused to drinker physically or mentally but no dependence pattern

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28
Q

ICD-10 alcohol dependence criteria

A

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

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29
Q

What is salience?

A

Neglecting alternate forms of leisure or pleasure in life

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30
Q

What is definition of abuse in DSM IV?

A

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

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31
Q

Criteria for DSM IV alcohol dependence

A

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

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32
Q

Changes in alcohol & substance dependence criteria in DSM V

A

Combines DSM IV categories of substance abuse and dependence into Substance Use Disorder that is measured from mild (abuse) to severe (dependence).

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33
Q

Criteria for mild substance abuse disorder in DSM V

A

2-3 sx from list of 11

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34
Q

What has been added and removed to list of diagnostic features for substance abuse in DSM V?

A

Drug craving added

Legal problems removed

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35
Q

How has the topic of Addictive Disorders changed in dSM V?

A

Broader, encompassing non-substance addictions.
Gambling disorder added to behavioural addictions.
Internet Gambling and caffeine use disorder added to Section III

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36
Q

What is Section III of DSM V?

A

Disorders requiring further research before formal diagnostic description

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37
Q

Importance of the concept of dependence

A

Indicates intensity and predicts outcome

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38
Q

Who created the criteria for alcohol dependence

A

Edwards & Gross in 1976

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39
Q

What are the criteria for alcohol dependence?

A 
Narrowed repertoire
Salience of alcohol-seeking behaviour
Increased tolerance
Repeated withdrawals
Drinking to prevent or relieve withdrawals
Subjective awareness of compulsion
Reinstatement after abstinence
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40
Q

What is neuroadaptation?

A

Term used to differentiate a certain state of dependence

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41
Q

Biological cause of tolerance

A

Increased excitability of neurons when using depressants

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42
Q

Is tolerance seen in benzos?

A

Not as much

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43
Q

Is tolerance seen in barbituates?

A

Yes

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44
Q

What is diminished tolerance due to in alcohol misuse?

A

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

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45
Q

What is withdrawal?

A

Physical and psychological sx due to non-availability of alcohol in a dependent user

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46
Q

Significance of withdrawal

A

Opportunity towards permanent behaviour change

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47
Q

What is compulsion?

A

Repetitive intense drug seeking with an urge

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48
Q

What is craving?

A

Motivational state occurring in withdrawal

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49
Q

Who identified the components of craving?

A

Tiffany

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50
Q

What are the components of craving?

A 
Urge/compulsion
Intention/plan
Expectation of satisfying outcome
Anticipation of decrease in pain/relief from negative effects
Loss of control
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51
Q

Explanations of reinstatement on relapse

A

Abstinence violation effect
Propensity to experience withdrawal sx may be carried through abstinence phase
Cues may trigger memory after priming dose

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52
Q

What is abstinence violation effect?

A

That cognition that ‘I had a drink, so I am a drinker’ may force patients to reinstate full pattern of drinking

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53
Q

How is impaired control explained?

A

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

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54
Q

What does Cloninger divide alcohol misuse into?

A

Type 1

Type 2

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55
Q

What is Type 1 alcohol misuse

A 
Milieu limited
Males and females
Loss of control
No FHx
No criminality
Starts >25 years
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56
Q

What is Type 2 alcohol misuse?

A 
Males usually
Inability to abstain
Strong heritability
Antisocial traits
Starts <25 years
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57
Q

What is Jellineks classification of alcohol misuse?

A 
Alpha
Beta
Gamma
Delta
Epsiln
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58
Q

What is Alpha alcohol misuse?

A

Psychological dependence
Undisciplined, not progressive
No Withdrawal
Major problems are inrerpersonal only

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59
Q

What is beta alcohol misuse?

A

Physical damage but no dependence

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60
Q

What is gamma alcohol misuse?

A

Loss of control plus physical dependence.
Withdrawal seen
Earlier stages similar to alpha

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61
Q

Who is gamma alcohol misuse commonly seen in?

A

AngloSaxons

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62
Q

What is Delta alcohol misuse?

A

No loss of control but unable to abstain

No disapproval or interpersonal problems

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63
Q

What is epsilon alcohol misuse?

A

Dipsomania - binges and bouts

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64
Q

Pharmacology of alcohol

A 
Intercalates into fluid cell membrane
Decreases NMDA sensitivity
Increases GABA sensitivity
Down-regulates Ca channels
Up-regulates nicotine receptor gated Na channels
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65
Q

Males vs Females re pharmacology of alcohol

A

Females have lower body water, higher alcohol absorption rate and lesser alcohol dehydrogenase in gut mucosa
Thus, higher oral availability in females

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66
Q

When do features of alcohol withdrawal start?

A

Within 12 hours of last drink

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67
Q

Onset of shakes in alcohol withdrawal?

A

4-12 hours

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68
Q

Onset of perceptual disturbances in alcohol withdrawal?

A

8-12 hours

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69
Q

Seizure onset in alcohol withdrawal

A

12-24 hours

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70
Q

Peak of seizure onset in alcohol withdrawal

A

48 hours

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71
Q

Delirium onset in alcohol withdrawal

A

72 hours

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72
Q

Prominent sx of alcohol withdrawal

A 
Tremor
Diaphoresis
Sleeplessness
Anxiety
GI distress
Increased urge and craving for alcohol
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73
Q

What is severity of sx of alcohol withdrawal related to?

A

Degree of pre-existent drinking

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74
Q

When do alcohol withdrawal sx peak if unattended?

A

48 hours

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75
Q

What types of seizures occur in alcohol withdrawal?

A

Grand mal

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76
Q

In which group of people are alcohol withdrawal seizures more likely?

A

Previous withdrawal seizures
Epilepsy
HI
Electrolyte imbalance

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77
Q

How many patients with alcohol withdrawal will get delirium tremens?

A

5%

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78
Q

What happens in delirium tremens?

A

Disturbed autonomic functions
Clouded consciousness with hallucinations
Agitation

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79
Q

What type of hallucinations tend to occur in delirium tremens?

A

Lilliputian

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80
Q

Incidence of seizures in untreated alcohol-dependent patients

A

8%

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81
Q

Risk of seizures in alcohol withdrawal if treated

A

3%

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82
Q

How does alcohol withdrawal lead to seizures?

A

Kindling process - episodic alcohol withdrawal sensitises brain leading to increased likelihood of seizure with each future episode

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83
Q

How many patients with withdrawal seizures go on to develop delirium tremens?

A

30%

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84
Q

Risk factors for delirium tremens and seizures

A

Severe dependence
Hx of delirium tremens
Older patient
Acute physical illness

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85
Q

How many patients in delirium tremens die if untreated>

A

10%

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86
Q

What does the term opiate refer to?

A

Natural opium alkaloids and semi-synthetics derived from the alkaloids

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87
Q

Most commonly used opioid

A

Heroin

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88
Q

How is heroin most commonly taken?

A

Smoking/chasing

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89
Q

Prevalence of heroin use in the UK

A

1%

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90
Q

M:F ratio of heroin use

A

2:1

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91
Q

Age of most treatment seekers of heroin misuse?

A

20s

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92
Q

Which receptors are relevant in opioid physiology

A

Mu
Kappa
Delta
All G-protein coupled

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93
Q

What is the most abused opioid in terms of receptors?

A

Mu agonist (morphine-like)

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94
Q

What do kappa agonists lead to?

A

Dysphoria

Decrease dopamine release in VTA

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95
Q

Oral bioavailability or morphine

A

30%

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96
Q

Half life of morphine

A

2-3 hours

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97
Q

How strong is parenteral morphine compared to PO?

A

3x stronger

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98
Q

Bioavailability of PO diamorphine

A

30%

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99
Q

Half life of diamorphine

A

<3 minutes

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100
Q

How much stronger is diamorphine compared to morphine?

A

4-5x stronger

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101
Q

PO bioavailability of methadone

A

80%

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102
Q

Half life of methadone

A

15-60 hours

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103
Q

How much stronger is methadone compared to morphine?

A

3-4x stronger

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104
Q

How can Buprenorphine be taken

A

S/L
Transdermal
Injected

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105
Q

Half-life of PO Buprenorphine

A

1-7 hours

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106
Q

Half-life of S/L buprenorphine

A

30 hours

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107
Q

Potency of Buprenorphine

A

40x more potent at receptor level

Partial agonist

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108
Q

Half life of Oxycodone

A

3-7 hours

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109
Q

Potency of oxycodone

A

5-7x more potent that morphine

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110
Q

How can pethidine be taken?

A

IV

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111
Q

Half life of codeine and pethidine

A

2-4

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112
Q

Potency of codeine

A

0.1-0.1x potent compared to morphine

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113
Q

Intoxication effects of opioids

A 
Initial euphoria
Apathy &amp; dysphoria follow
Psychomotor agitation/retardation
Pupillary constriction
Drowsiness/coma
Slurred speech
Impairment in attention and memory
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114
Q

When do opioid withdrawal sx start?

A

6-8 hours after last dose

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115
Q

When do opioid withdrawal sx peak?

A

2 days

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116
Q

What do opioid withdrawal sx start to reduce?

A

In a week

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117
Q

Withdrawal sx of opioids

A 
Dysphoric mood
Nausea/vomiting
Muscle aches
Lacrimation/rhinorrhoea
Pupillary dilatation, piloerection, sweating
Diarrhoea
Yawning
Fever
Insomnia
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118
Q

Which withdrawal sx of opioids persist for months?

A

Insomnia
Bradycardia
Temperature dysregulation
Craving

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119
Q

What is cannabis obtained from?

A

The plan cannabis sativa

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120
Q

What is the principal component of cannabis?

A

9-THC

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121
Q

Describe the cannabinoid receptor

A

Gi linked receptor

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122
Q

What are endogenous cannabinoids called?

A

Anandamides

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123
Q

Where are cannabinoid receptors foind?

A

Basal ganglia
Hippocampus
Cerebellum
Sparsely in the cerebral cortex

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124
Q

Physiological effects of cannabis

A

Euphoric effects within minutes

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125
Q

When do euphoric effects of cannabis peak?

A

30 minutes

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126
Q

How long do euphoric effects of cannabis last?

A

2-4 hours

127
Q

Dependence of cannabis?

A

Psychological, not physiological

Tolerance can occur

128
Q

Withdrawal sx of cannabis

A

Irritability
Insomnia
Anorexia
Nausea

129
Q

Cannabis intoxication sx?

A 
Impaired motor coordination
Euphoria
Sensation of slowed time
Conjunctival injection
Increased appetite
Dry mouth
Tachycardia
Depersonalisation/rerealization
130
Q

Categories of people who abuse benzos

A

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
Q

How many patients on benzos for 1-5 months will develop dependence?

A

15%

132
Q

How many patients on benzos for a year will develop dependence?

A

40%

133
Q

Sx of benzo intoxication

A 
Slurred speech
Incoordinatino
Unsteady gait
Nystagmus
Impairment in attention and memory
Stupor/coma
Inappropriate sexual/aggressive behaviour
Mood lability
Impaired judgement
134
Q

Sx of benzo withdrawal

A 
Anxiety
Autonomic hyperactivity
Tremor
Insomnia
Nausea/vomiting
Transient hallucinations/illusions
Psychomotor agitation -> grand mal seizures
135
Q

Ratio of lethal dose to effective dose of benzo

A

200 to 1

136
Q

Management of benzo dependence if early/mild

A

Advisory letters

Short courses of relaxation

137
Q

Management of established benzo dependence

A

Graded discontinuation of px benzo

138
Q

How many patients on graded discontinuation of benzos stop misusing them short-term?

A

66%

139
Q

What other drugs can be used to control withdrawal sx in those on high dose benzos?

A

Carbamazepine

140
Q

What is GHB?

A

A naturally occurring substance in the brain

141
Q

What was GHB initially synthesised for?

A

Anaesthetic

142
Q

Why was GHB banned?

A

Abuse by body builders as it was thought to boost growth hormone

143
Q

Which recreational drug is used as a date rape drug?

A

GHB - colourless

144
Q

Street names of GHB

A

Georgia Home Boy

Liquid ecstacy

145
Q

Pharmacology of GHB

A

GABA-like action
Inhibits dopamine release at low dose
Boosts dopamine availability on chronic use
Induces release of NA in hypothalamus

146
Q

Risk of GHB mixed with EtOH

A

Respiratory depression

Coma

147
Q

How many patients on GHB develop b

A

33%

148
Q

What compound of GHB is used in the USA for cataplexy?

A

Sodium oxybate

149
Q

What is GHB abuse classified as in both ICD and DSM?

A

Sedative-hypnotic

150
Q

Withdrawal syndrome of GHB?

A

Similar to alcohol and benzo withdrawal

151
Q

Withdrawal sx in mild GHB use

A

Insomnia
Anxiety
Tremors

152
Q

Withdrawal sx in chronic GHB use

A

Paranoia
Hallucinations
Extreme agitation

153
Q

When do withdrawal effects of GHB start?

A

Within 12 hours

154
Q

How long can withdrawal sx of GB last for?

A

Up to 12 days

155
Q

Common cause of death among GHB users?

A

Aspiration pneumonia

156
Q

What drugs are sometimes used to support GHB withdrawal?

A

Lorazepam
Diazepam
Haloperidol

157
Q

How many 16-29 year olds in the UK have used amphetamines at least once?

A

22%

158
Q

How many patients who present to addiction services have a primary amphetamine-related problem?

A

10%

159
Q

Pharmacology of amphetamine

A

Block catecholamine - mainly DA and NE - reuptake and stimulate their release from vesicles

160
Q

Typical uses of amphetamine?

A

Stimulate performance and induce euphoric feeling

161
Q

Routes of amphetamine use

A

PO
IV
Snorting

162
Q

Street names of amphetamine

A

Whiz

Speed

163
Q

What type of amphetamine can cause HTN, psychosis and intestinal infarction?

A

Phenylpropranolamine

164
Q

How can methamphetamine be taken?

A

Inhaled
Smoked
IV injection

165
Q

What is Ice?

A

Strong, purer form of amphetamine

166
Q

How can Ice be taken?

A

Smoked

Injected

167
Q

Intoxication effects of amphetamine?

A 
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
Q

Withdrawal effects of amphetamines

A 
Dysphoric mood (crash) sometimes with suicidal ideation
Fatigue
Vivid, unpleasant dreams
Hypersomnia
Increased appetite
Psychomotor retardation
Small puils
169
Q

What diminishes as amphetamine is used long term?

A

Tachycardia
Euphoria
Anorexic effects
Increased alertness

170
Q

Full name of MDMA

A

3,4-methylene-dioxymethamphetamine

171
Q

What is MDMA?

A

Substituted amphetamine that produces subjective effects resembling those of amphetamine and LSD

172
Q

Full name of LSD

A

Lysergic acid Diethylamide

173
Q

Pharmacology of MDMA

A

Two optical isomers:
R isomer produces LSD-like effects
S isomer produces amphetamine-like effects

174
Q

What causes the LSD-like effects of MDMA?

A

Releases serotonin from terminals

175
Q

Long-term use of MDMA on serotonin?

A

Damage to serotonin nerves irreversibly causing depression

176
Q

What dose of MDMA causes stimulant effect?

A

Lose

177
Q

What dose of MDMA causes hallucinogenic effect?

A

High

178
Q

Routes of taking MDMA?

A

PO
Injected
Snorted

179
Q

MDMA withdrawal sx

A

Fatigue
Loss of appetite
Depression/anxiety
Trouble concentrating

180
Q

When do withdrawal sx of MDMA occuring

A

Same day or 2 days after

181
Q

What harm reduction advice should be given re MDMA use?

A

Maintaining hydration

Avoid overheating

182
Q

What is khat derived from?

A

Fresh leaves of catha edulis from East Africa and Yemen - used as stimulant

183
Q

What is the main ingredient of khat?

A

Cathinone

184
Q

Effect of Cathinone/khat?

A

CNS and peripheral actions similar to amphetamine.

185
Q

How is khat taken?

A

Buccally absorbed after chewing leaf

186
Q

Why does khat have low toxicity?

A

Alkaloid and therefore absorbed rapidly

187
Q

What is a synthetic form of khat?

A

Methcatinone

188
Q

What is cocaine?

A

Alkaloid derived from the shrub erythroxylon coca

Powerful reinforcer and strong dependence producer

189
Q

Neurotransmitter function of cocaine

A

Dopamine reuptake blockade

190
Q

How can cocaine be taken?

A

Injected
Smoked
Snorted

191
Q

Risks of snorting cocaine

A

Nasal septal perforation due to local anaesthetic effect with repeated trauma
Vasoconstriction
Ischaemic necrosis

192
Q

What is freebased cocaine?

A

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
Q

Duration of cocaines euphoric effects?

A

Depends on route of administration; faster absorption leads to more intense euphoria but shorter duration

194
Q

How long does euphoria from snorting cocaine last?

A

15-30 minutes

195
Q

How long does euphoria from smoking cocaine last?

A

5-10 minutes

196
Q

How many cocaine users have MH problems?

A

60%

197
Q

How many cocaine users have psychotic experiences?

A

18%

198
Q

Intoxication effects of cocaine

A

Increased energy and confidence
Euphoria
Diminished need for sleep

199
Q

Sx of high doses of cocaine

A 
Agitation
Impaired judgement
Impulsive aggression
Tachycardia
HTN
Mydriasis
Formication
200
Q

Duration of withdrawal effects of cocaine?

A

Short-lived due to rapid metabolism

201
Q

Features of withdrawal from cocaine

A 
Intense craving with lack of physical withdrawal sx
Dysphoria
Anhedonia
Irritability
Hypersomnolence
202
Q

How long do effects of cocaine withdrawal last?

A

18 hours

203
Q

How long can effects of cocaine last in heavy users?

A

One week

204
Q

When do withdrawal of cocaine sx peak in heavy use?

A

3 days

205
Q

Physical adverse effects of cocaine

A 
Nasal perforation
Nonhemorrhagic cerebral infarctions
SAH, IVH and intraparenchymal haemorrhages
TIAs
Seizures
MI &amp; arrhythmias
206
Q

Pharmacology of caffeine

A

Methylxanthine (like theophylline)

207
Q

Half life of caffeine

A

3-10 hours

208
Q

Peak concentration of caffeine

A

30-60 minutes

209
Q

How does caffeine work?

A

Crosses blood-brain barrier and acts as antagonist of adenosine receptors and so increases intraneuronal cAMP.

210
Q

What receptors can caffeine effect at high doses?

A

Dopamine and NA neurons

211
Q

Receptor effects in caffeine use in nontolerant individuals?

A

May reduce GABAergic activity in cerebral cortex and striatum

212
Q

Dose of caffeine in single cup

A

20-200mg

213
Q

At what dose of caffeine does anxiety and nervousness start

A

300-800mg

214
Q

Effect of caffeine on the brain

A

Global cerebral vasocontriction

215
Q

What happens to cerebral blood flow when caffeine use stops?

A

Rebound increase

216
Q

At what dose of caffeine can intoxication start

A

Excess of 250mg (more than 2-3 cups at once)

217
Q

Intoxication sx of caffeine

A 
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
Q

Withdrawal sx of caffeine

A 
Headache
Fatigue
Drowsiness
Anxiety/depression
Nausea/vomiting
219
Q

At what doses can withdrawal sx of caffeine be seen

A

100mg/day

220
Q

When do withdrawal sx of caffeine start?

A

Within 12 hours

221
Q

When do withdrawal sx of caffeine peak?

A

24-48 hours

222
Q

How long can withdrawal sx of caffeine last?

A

Up to 1 week

223
Q

Name some naturally occurring hallucinogens

A

Psilocybin

Mescaline

224
Q

Where does Psilocybin come from?

A

Mushrooms

225
Q

What type of magic mushroom is popular in the UK?

A

Liberty cap - psilocybe semilanceata

226
Q

What can large doses of magic mushrooms (>25) cause?

A

LSD-like effects

227
Q

Dependence and withdrawal with magic mushrooms?

A

None

228
Q

What is LSD

A

Classic synthetic hallucinogen

229
Q

Who created LSD?

A

ALbert Hoffman in 1938

230
Q

What is LSD derived from?

A

Synthetic base derived from ergot alkaloids

231
Q

What is the most commonly used hallucinogen in the UK?

A

LSD

232
Q

How does LSD act?

A

Via sigma opioid and aspartate receptors as well as serotonergic effects

233
Q

Sx of LSD use

A

Acute confusion
Visual sensory distortions
Aggression
Psychosis

234
Q

When is tolerance to LSD’s sensory and psychological effects seen?

A

2nd-3rd day of successive use

235
Q

How long does one need to be free of LSD use to lose tolerance?

A

4-6 days

236
Q

Dependence of LSD?

A

No physical or psychological dependence seen

237
Q

What does PCP stand for>

A

Phencyclidine

238
Q

Street name of PCP?

A

Angel dust

239
Q

What is PCP?

A

Synthetic agent

240
Q

How is PCP taken?

A

Smoked

Snorted

241
Q

What is ketamine?

A

Structurally similar to phencyclidine

242
Q

How does Ketamine work?

A

Reduces cortical awareness of painful stimuli

243
Q

How is ketamine taken?

A

Sniffed

244
Q

Street name of ketamine?

A

K

245
Q

Sx of hallucinogen intoxication?

A 
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
Q

Sequence of sx on hallucinogen intoxication

A

Somatic sx first
Then mood and perceptual changes
Finally psychological changes

247
Q

Sx of PCP intoxication

A

Vertical or horizontal nystagmus
Diminshed response to pain
Ataxia and dysarthria with muscle rigidity

248
Q

What drugs are named as club drugs?

A 
MDMA
Ecstacy
Rohypnol
GHB
Ketamine
LHD
249
Q

Who created the term club drug?

A

National Institute on Drug Abuse

250
Q

What drugs are known as date rape drugs?

A

GHB
Flunitrazepam
Rohypnol
Ketamine

251
Q

How many smokers are nicotine dependent?

A

80%

252
Q

Pharmacology of nicotine

A

Stimulates central nicotinic ach receptors and improves alertness
Polycyclic hydrocarbons stimulate CYP1A2

253
Q

Drugs most affected by smoking?

A 
Clozapine
Olanzapine
Chlorpromazine
Fluphenazine
Haloperidol
TCAs
Mirtazapine
Fluvoxamine
Propranolol
254
Q

Withdrawal sx of nicotine

A 
Dysphoric mood
Insomnia
Frustration
Anger/anxiety
Difficulty concentrating
Restlessness
Bradycardia
Increased appetite
255
Q

When do withdrawal sx of nictoine start?

A

Within a few hours

256
Q

When do withdrawal sx of nicotine peak?

A

2-3 days

257
Q

When do withdrawal sx of nicotine become less intense?

A

1-3 weeks

258
Q

Mean weight gain after smoking cessation

A

10 lb

259
Q

Who is at greatest risk of weight gain after stopping smoking?

A

Women

Heavy smokers

260
Q

How many substance related deaths are due to inhalants?

A

1%

261
Q

Common substances inhaled

A 
Glues
Adhesives
Propellants for aerosol paint sprays
Hair sprays
Thinners (paint products, typing correction products)
Fuels
262
Q

Pharmacology of inhalants

A

Act as CNS depressants

Concentration in blood increased with EtOH

263
Q

When do effects of inhalants appear?

A

Within 5 minutes

264
Q

How long do effects of inhalants last?

A

30 minutes to several hours

265
Q

Intoxication sx of inhalants

A 
Dizziness
Nystagmus
Incoordination
Slurred speech
Unsteady gait
Depressed reflexes
Psychomotor retardation
Generalised muscle weakness
Blurred vision/diplopia
Stupor/coma
Euphoria
266
Q

Evidence of recent inhalant use

A

Rash around nose or mouth
Unusual breath odours
Residue of inhalant substance on body or clothes
Signs of ocular and oropharyngeal irritation

267
Q

Dependence and withdrawal of inhalants?

A

None recognised at present

268
Q

What does the Misuse of Drug Regulations 2001 state?

A

It defines the authorised persons who can supply and possess controlled drugs in their professional capacities.

269
Q

How many schedules in the Misuse of Drug Regulations 2001?

A

Five

270
Q

Examples of drugs in Schedule 1

A

Coca leaf
Cannabis
LSD
Mescaline

271
Q

Regulations of Schedule 1 drugs

A

No medicinal use.
Supply limited to research or special purposes judged to be in public interest.
Requires Home Office license to possess.

272
Q

Examples of drugs in Schedule 2

A 
Diamorphine
Dipipanone
Morphine
Remifentanil
Pethidine
Secobarbital
Glutethimide
Amphetamine
Cocaine
273
Q

Regulations of Schedule 2 drugs

A

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
Q

Schedule 3 drugs?

A 
Barbituates except secobarbital
Buprenorphine
Diethylpropion
Mazindol
Meprobamate
Pentazocine
Phentermine
Temazepam
275
Q

Regulations of Schedule 3 drugs

A

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
Q

Schedule 4 Part 1 drugs

A

Benzos except temazepam

Zolpidem

277
Q

Schedule 4 Part 2 drugs

A 
Androgenic and anabolic steroids
Clenbuterol
HCG
Non-human chorionic gonadotrophin
Somatotropin
Somatrem
Somatropin
278
Q

Regulations of Schedule 4 drugs

A

Not subject to special px or safe custody requirements.
No need for register.
Requirement for retention of invoices for 2 years.

279
Q

Schedule 5 drugs

A

Weak preparations of drugs in other schedules e.g. codeine

280
Q

Regulations of Schedule 5 drugs

A

Exempt from all CD regulations except need to keep invoices for at least 2 years

281
Q

What should all CD px have?

A

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
Q

How long are px of Schedule 1-4 drugs valid?

A

28 days

283
Q

Which drugs cannot be px on repeat prescriptions?

A

Schedule 2 & 3 drugs

284
Q

How must patients collect CD on first occassion?

A

In person after showing ID

Sign back of px form

285
Q

How must substitute opioids be px?

A

In daily instalments

286
Q

What must px of instalment of substitute opioid include?

A

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
Q

At what dose does buprenorphine act as a mild agonist?

A

Low doses

288
Q

At what does does buprenorphine act as antagonist?

A

High doses

289
Q

Which cannabinoid receptor is central?

A

CB1

290
Q

What activates CB1 receptor?

A

11OH tetra hydro cannabinoid

291
Q

What does CB1 receptor do?

A

Inhibits GABA tone in substantia nigra and other areas

292
Q

Where is CB2 receptor found?

A

Spleen

Thymus

293
Q

Give examples of presynaptic alpha 2 agonists

A

Clonidine

Lofexidine

294
Q

What do presynaptic alpha 2 agonists do?

A

Reduce central sympathetic tone

295
Q

What to opioid receptors on locus coeruleus do on longterm use?

A

Reduce NA tone

296
Q

What does long-term use of Opioid lead to?

A

Opioid receptors on locus coeruleus projections reduce NA tone
Cellular machinery compensates via up-regulation of adenylate cyclase and maintains sympathetic tone

297
Q

What does sudden withdrawal of opioids lead to?

A

Increased adrenergic firing rate leading to withdrawal sx

298
Q

How does clonidine/lofexidine help in withdrawal of opioid?

A

Reduces central sympathetic tone

299
Q

How do Dexfenfluramine and Fenfluramine work?

A

Massive serotonin release from nerve endings

300
Q

What was Fen-Phen?

A

Combination of Fenfluramine and Phentermine

301
Q

What was Fen-Phen used for?

A

Weight loss

302
Q

Why was fenfluramine and dexfenfluramine withdrawn?

A

Irreversible serotonergic damage
Valvular regurgitation
Pulmonary fibrosis

303
Q

How does Disulfiram work?

A

Inhibits aldehyde dehydrogenase

304
Q

What happens if EtOH is consumed while on Disulfiram?

A

Accumulation of acetaldehyde producing unpleasant reactions

305
Q

What is Levomethadyl acetate?

A

Long-acting opioid agonist

Pure mu agonist

306
Q

Why was levomethadyl acetate withdrawn?

A

Prolonged QT

Torsades de pointes

307
Q

How does LSd produce its hallucinogenic effect?

A

5HT2A partial agonism

308
Q

What type of agonist is methadone?

A

Pure mu

309
Q

What is naloxone?

A

Short acting opioid mu antagonist

310
Q

What is naltrexone?

A

Longer acting opioid mu antagonist

311
Q

What is phencyclidine?

A

Noncompetitive NMDA antagonist

Also binds to sigma receptors

312
Q

What is Varenicline?

A

Partial agonist at alpha4beta2 subunit of nicotinic acetylcholine receptor

313
Q

What is Varenicline used for?

A

Relieving nicotine withdrawal sx and reducing rewarding properties of nicotine

MRCPsych Part B (64 decks)

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