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psychiatry > Addiction Symposium > Flashcards

Addiction Symposium Flashcards

1
Q

What are the 2 distinct mechanisms implicated in why we use drugs?

A
  • Tolerance (the basis of physical dependence)

- Reward centre (the basis of psychological craving)

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2
Q

Tolerance

A

reduced responsiveness to a drug caused by previous administration

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3
Q

What is tolerance an example of?

A

homeostasis

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4
Q

What does tolerance develop in response to?

A

many types of drug

- opioids, ethanol, barbiturates, benzodiazepines

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5
Q

What are the 2 mechanisms of tolerance?

A

dispositional tolerance: less drug reaches the active site

pharmacodynamic tolerance: drug has less action at the active site

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6
Q

What is the result of dispositional tolerance?

A
  • decreased rate of absorption
  • increased rate of metabolism to inactive metabolites
  • decreased rate of metabolism to active metabolites
  • increased rate of excretion
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7
Q

What is the result of pharmacodynamics tolerance?

A
  • fewer drug receptors

- less efficient drug receptors

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8
Q

What may the development of tolerance lead to?

A

Withdrawal symptoms

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9
Q

-

A

-

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10
Q

What is the withdrawal phenomena?

A

the reverse of the acute effect of the drug

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11
Q

What are the acute and withdrawal effect of opioids?

A

Acute
-Constipation

Withdrawal effect
-Diarrhoea

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12
Q

What are the acute and withdrawal effect of barbiturates?

A

Acute
-Anticonvulsant

Withdrawal effect
-Convulsions

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13
Q

What are the acute and withdrawal effect of cocaine?

A

Acute
-Elevated mood

Withdrawal effect
-Depressed mood

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14
Q

Describe the reward pathway.

A
  • neurones project from the ventral tegmental area to the nucleus accumbens & prefrontal cortex
  • when VTA neurones are stimulated they release dopamine is released
  • this causes a sensation of pleasure/reward
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15
Q

Why has the reward pathway evolved?

A
  • reward pathway activated by eating, drinking and sex

- encourages ‘healthy’ behaviours that lead to propagation of your genes

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16
Q

Give examples of some drugs of abuse that tap into the reward pathway and increase dopamine levels

A
  • heroin (increases firing rate of dopaminergic neurones)
  • amphetamine (increases dopamine release)
  • cocaine (inhibits dopamine uptake)
  • alcohol
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17
Q

Give 2 examples of stimulants.

A
  • Cocaine

- Amphetamine

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18
Q

What has cocaine be used for in the past?

A

ENT surgery

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19
Q

What is the most potent natural stimulant?

A

Cocaine

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20
Q

How can cocaine be taken?

A

cocaine (powder)

crack cocaine is smoked (cocaine + base + purified)

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21
Q

How does the means of consumption affect the effects of cocaine?

A

depends on dose and rate of entry to the brain

  • smoking: almost immediate
  • injecting 15 to 30 secs
  • snorting: 3 to 5 mins
  • the effects of crack smoking are very intense but quickly over ( 15 mins)
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22
Q

What are the effects of cocaine?

A
  • Stimulant and euphoriant
  • Increased alertness and energy
  • Increased confidence and impaired judgement
  • Lessens appetite and desire for sleep
  • Damage to nose and airways
  • Convulsions with resp failure
  • Cardiac arrhythmias and MI
  • Hypertension and CVA
  • Toxic confusion
  • Paranoid psychosis
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23
Q

What are the withdrawal effects of cocaine?

A
  • Depression
  • Irritability
  • Agitation
  • Craving
  • Hyperphagia
  • Hypersomnia
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24
Q

What is the general amphetamine used?

A

Amphetamine sulphate

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25
Q

How is amphetamine consumed?

A
  • sniffed
  • swallowed
  • injected
26
Q

What are the effects of amphetamine?

A

effects similar to cocaine but longer lasting

toxic confusion occasionally with convulsions and death

27
Q

Give examples of opiates.

A
  • Opium
  • Morphine
  • Heroin (diamorphine)
  • Methadone
  • Codeine and dihydrocodeine
28
Q

What is heroin available as?

A
  • Diamorphine

- Diamorphine hydrochloride

29
Q

How does purity of heroin vary?

A

Purity varies from 1%- 98% with average of 35% in US

30
Q

What are other names for heroin?

A
  • H
  • Gear
  • Smack
  • Brown
31
Q

How is heroin consumed?

A
  • snorted
  • smoked (chasing the dragon) (safest method)
  • injected (most dangerous method)
32
Q

What are the effects of heroin?

A
  • analgesia
  • euphoria
  • pin point pupils
  • itching/sweating
  • constipation
  • decreased libido/menstrual irregularities
  • reduced cough reflex
33
Q

What are the effects of heroin overdose?

A
  • respiratory depression
  • snoring
  • bradycardia
  • hypotension
  • death
34
Q

-

A

-

35
Q

What are the side effects of opiates?

A

first term: nausea/vomiting, headache

medium term: phlebitis, anorexia, constipation

longer term: tolerance, withdrawal, social/health problems

36
Q

-

A

-

37
Q

-

A

-

38
Q

What are the signs and symptoms of opiate withdrawal syndrome?

A
  • craving
  • insomnia
  • yawning
  • muscle pain and cramps
  • increased salivary, nasal and lacrimal secretions
  • dilated pupils
  • piloerection
39
Q

What are the consequences of methadone maintenance?

A
  • decriminalises drug use
  • allows normalisation of lifestyle
  • reduces iv misuse
  • leakage on to the illicit market
40
Q

What is ecstasy?

A
  • 3,4-methylenedioxymethamphetamine
  • Half of all ecstasy contain no MDMA
  • Causes a relaxed euphoric state without hallucinations
41
Q

What are the effects of ecstasy?

A
  • euphoria
  • calmness
  • increased sociability
  • inability to distinguish between what is and isn’t desirable
42
Q

What are the side effects of ecstasy?

A
  • nausea and dry mouth
  • increased blood pressure and temperature
  • drug induced psychosis
  • liver and brain cell damage
43
Q

What is the most commonly used illicit drug?

A

Cannabis

44
Q

What is the psychoactive agent in cannabis?

A

Tetrahydrocannabinol

45
Q

What form of cannabis has a high THC content?

A

Skunk (sensimilla)

46
Q

How can cannabis be presented?

A
  • Marijuana
  • Hashish (cannabis resin)
  • Hash oil (produced by extracting cannabinoids from plant material with a solvent)
47
Q

How is cannabis consumed?

A
  • Eaten

- Usually smoked

48
Q

-

A

-

49
Q

What are the psychological effects of cannabis in low doses?

A
  • relaxing or stimulating
  • euphoriant
  • increases sociability and hilarity
  • increases appetite
  • changes in time perception
  • synaesthesia
50
Q

What are the psychological effects of cannabis in higher doses?

A
  • anxiety
  • panic
  • persecutory ideation
  • hallucinatory activity
51
Q

What are the ill effects of cannabis?

A
  • respiratory problems
  • toxic confusion
  • exacerbation of major mental illness
  • cannabis psychosis
52
Q

Give examples of novel psychoactive substances.

A
  • NPS

- Legal highs

53
Q

What are anabolic steroids?

A

family of drugs comprising testosterone and many synthetic analogues

54
Q

What are anabolic steroids legitamely prescribed for?

A
  • Hypogonadism
  • Muscular dystrophy
  • Various anaemias
  • Wasting in AIDs
55
Q

Why are anabolic steroids used cosmetically?

A
  • increase muscle mass

- reduce body fat

56
Q

Muscle hypertrophy from steroid use is particularly marked…

A

In the upper body in the pectoralis, deltoid, trapezius and bicpes

57
Q

What are the side effects of anabolic steroids?

A
  • skin: acne, stretch marks, baldness
  • feminisation in males with hypogonadism and gynaecomastia (occasioning use of anti-oestrogens)
  • virilisation in women including hirsutism, deep voice, clitoral enlargement, menstrual irregularities , hair thinning
  • cardiovascular: increased cholesterol and hypertension
  • growth deficits due to premature closure of epiphyses
  • liver disease: cholestatic jaundice and liver tumours
58
Q

What are the psychological side effects of anabolic steroids?

A
  • irritability and anger (‘roid rage’)
  • hypomania and mania
  • depression and suicidality on withdrawal
59
Q

How is the psychological component of addiction (craving) produced?

A

Drugs can tap into the reward centre to increase dopamine levels

60
Q

How can heroin be presented?

A
  • Powder

- Tar like substance

psychiatry (23 decks)

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