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Psychiatry > Addiction psychiatry > Flashcards

Addiction psychiatry Flashcards

1
Q

What are the 2 distinct mechanism which drive substance misuse?

A

Tolerance

Reward centre

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2
Q

What is tolerance?

A

Reduced responsiveness to a drug caused by previous administration

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3
Q

What causes dispositional tolerance?

A

Less drug reaches the active site
Less drug absorbed
Drug metabolised faster
More drug excreted

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4
Q

What causes pharmacodynamic tolerance?

A

Drug has less action at the active site
Fewer drug receptors
Less efficient drug receptors

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5
Q

Why does tolerance sometimes lead to dependence?

A

Development of tolerance may lead to withdrawal symptoms

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6
Q

What are the acute and withdrawal effects of opioids?

A

Constipation

Diarrhoea

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7
Q

What is the reward pathway?

A

Neurones project from the ventral tegmental area to the nucleus accumbens & prefrontal cortex

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8
Q

What is released when VTA neurones are stimulated?

A

Dopamine

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9
Q

How does drug abuse relate to reward centres?

A

Some drugs of abuse tap into the reward pathway and increase dopamine levels
This produces the psychological component of addiction

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10
Q

How does heroin affect reward centres?

A

Increase firing rate of dopaminergic neurones

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11
Q

How does amphetamine affect reward centres?

A

Increased dopamine release

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12
Q

How does cocaine affect reward centres?

A

Inhibits dopamine uptake

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13
Q

Which is the most potent natural stimulant?

A

Cocaine

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14
Q

How quickly does cocaine take effect?

A

Smoking - almost immediate
Injecting - 15 to 30 secs
Snorting - 3 to 5 mins

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15
Q

What are the effects of cocaine?

A 
Stimulant/euphoriant
Alertness
Energy
Confidence
Impaired judgement
Lessens appetite and desire for sleep
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16
Q

What are some adverse effects of cocaine?

A 
Damage to nose and airways
Convulsions with respiratory failure
Cardiac arrhythmia's and MI
Hypertension and CVA
Toxic confusion
Paranoid psychosis
17
Q

What are some withdrawal effects of cocaine?

A 
Depression 
Irritability
Agitation
Craving
Hyperphagia
Hypersomnia
18
Q

Does amphetamine last longer or shorter than cocaine?

A

Longer

19
Q

What are some commonly abused opiates?

A 
Opium
Morphine
Heroin
Methadone
Codeine
Dihydrocodeine
20
Q

What does the phrase “chasing the dragon refer to?”?

A

Smoking heroin

21
Q

What are some adverse effects of heroin use?

A 
Respiratory arrest with a pulse
Pinpoint pupils Unreactive to light
Snoring giving way to shallow respiration
Bradycardia
Hypotension
Reduced consciousness/coma
22
Q

What are some adverse effect of opiates?

A 
Nausea
Vomiting
Headache
Phlebitis
Anorexia
Constipation
Tolerance
Withdrawal
Social
23
Q

What are some characteristics of opiate withdrawal syndrome?

A 
Craving
Insomnia
Yawning
Muscle pain and cramps
Increased salivary and nasal secretions
Dilated pupils
Piloerection
24
Q

Almost half of all eccies contain no MDMA. What else do they contain?

A

Nil active
LSD
Amphetamine
Ketamine

25
Q

What are some common effects of MDMA?

A

Euphoria followed by feeling of calm
Increased sociability
Inability to distinguish between what is and isn’t desirable

26
Q

What are some adverse side effects of MDMA?

A 
Nausea
Dry mouth/dehydration
Increased BP and temp
Anxiety
Panic
Psychosis
27
Q

What is another name for Novel Psychoactive Substances (NPS)?

A

Legal highs

28
Q

When might anabolic (androgenic) steroids be legitimately prescribed?

A

Hypogonadism
Muscular dystrophy
Various anaemias
Wasting in AIDS

29
Q

Muscle hypertrophy from steroid use is particularly marked in which areas?

A

Pectoralis
Deltoid
Trapezius
Biceps

30
Q

What are some skin effects of steroid use?

A

Acne
Stretch marks
Baldness

31
Q

How might steroid use adversely affect males?

A

Feminisation
Hypogonadism
Gynaecomastia

32
Q

How might steroid use adversely affect women?

A 
Virilisation
Hirsutism
Deep voice
Clitoral enlargement
Menstrual irregularities
Hair thinning
33
Q

How does steroid use affect the CVS?

A

Increased cholesterol

Hypertension

34
Q

How does steroid use affect growth?

A

Growth deficits due to premature closure of epiphyses

35
Q

How does steroid use affect the liver?

A

Cholestatic jaundice

Liver tumours

36
Q

What are some psych side effects of steroid use?

A

Irritability
Hypomania/mania
Depression on withdrawal

37
Q

How is naloxone used?

A

Opiate antagonist

Reverses effect of opiates

Psychiatry (18 decks)

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