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Psychiatry > Addictions > Flashcards

Addictions Flashcards

1
Q

What class of drugs are amphetamines?

A

Class B

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2
Q

How do amphetamines work?

A

They are a CNS stimulant, they increase the levels of noradrenaline and dopamine. (monoamine agonist/antagonist)

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3
Q

How do amphetamines make you feel?

A

Wide awake, excited, talkative, reduced hunger/appetite, more energy.

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4
Q

What are the withdrawal symptoms of amphetamines?

A

Lethargy, drowsiness and poor concentration.

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5
Q

What are the risks and negative effects associated with amphetamines?

A

Dependency, insomnia, poor concentration, anxiety, depression, irritability, aggression and paranoia, psychosis, cardiac problems. Up HR, RR, temp, dilate pupils

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6
Q

Which amphetamines are abused as study aids?

A

Methylphenidate (Ritalin)

Modafinil

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7
Q

What are the negative effects of amphetamines?

A

Panic attacks, depression, aggressiveness, paranoia, hallucinations, psychosis
Dependency, chronic sleep deprivation, weight loss, tremors, seizures, immune system suppression

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8
Q

What are the comparisons of dopamine release from the baseline?

A
  • Sex: x2
  • Cocaine: x3.5
  • Meth: x12.5
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9
Q

What are the negative effects of methamphetamine?

A

Addictive, ↑MI risk, damages cognition

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10
Q

What are the 7 groups of drugs?

A

Depressants, Opioids, Stimulants, Empathogens, Psychodelics, Dissociatives, Cannabinioids

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11
Q

What type of drug is ketamine?

A

Dissociative

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12
Q

What type of drug is diazepam, GHB, GBL, Pregabalin, Gabapentin, Zopiclone, Chlordiazepoxide?

A

Depressants

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13
Q

What type of drugs are heroin, morphine, tramadol, methadone and fentanyl?

A

Opiods

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14
Q

What type of drugs are amphetamine and cocaine?

A

Stimulants

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15
Q

What type of drug is MDMA?

A

Empathogen

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16
Q

What does glutamate do?

A

Excitatory, turns the brain on, builds memory, regulates alertness, sensation, movement and mood.

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17
Q

What does GABA do?

A

This turns the brain off, it is involved in sleep, sedation, relaxation, reducing anxiety, decreasing muscle tension.

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18
Q

What type of neurotransmitter is endocannabinoids and what do they do?

A

They are lipids which regulate pain, appetite, coordination and learning.

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19
Q

What does serotonin do?

A

It regulates mood and anxiety, appetite, sleep/wake cycle, body temperature.

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20
Q

What does noradrenaline do?

A

It creates feelings of alertness, attention, concentration, it raises blood pressure, can life mood and increase anxiety.

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21
Q

What does dopamine do?

A

It creates feelings of motivation and drive, liking, attention, pleasure, enjoyment of food.

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22
Q

What does acetylcholine do?

A

it regulates sleep/wake cycle and alertness, builds memory.

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23
Q

What does adenosine do?

A

It makes us feel tired and hungry.

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24
Q

What does endorphins do?

A

Creates feeling of pleasure and reward, reduce pain

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25
Q

What does substance P do?

A

Regulates pain, stress response

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26
Q

What does cholecystokinin do?

A

It tells us when to eat, possibly involved in managing anxiety.

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27
Q

Name the monoamines?

A 
Histamine[6]
Catecholamines:
Adrenaline (Ad; Epinephrine, Epi)
Dopamine (DA)
Noradrenaline (NAd; Norepinephrine, NE)
Classical Tryptamines:
Serotonin (5-HT)
Melatonin
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28
Q

Which receptors does cocaine target?

A

DOPAMINE and Noradrenaline to a smaller extent

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29
Q

What receptors does amphetamine/methamphetamine target?

A

DOPAMINE and noradrenaline to a smaller extent

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30
Q

What receptors does mephedrone target?

A

Noradrenaline, serotonin, dopamine

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31
Q

What receptors does khat target?

A

Noradrenaline

32
Q

What receptors does caffeine target?

A

Adenosine

33
Q

What receptors does tobacco target?

A

Acetylcholine, dopamine

34
Q

What are the primary targets of alcohol and what are the brain effects?

A

It is a GABA agonist and antagonist at the glutamate receptors. It increases GABA, it blocks NMDA glutamate receptors. So blocks glutamate ie, blocking alertness sensation. movement.

35
Q

What are the primary targets of benzodiazipines and what are their brain effects?

A

Agonist on GABA-A receptor, increasing GABA.

36
Q

What are the primary targets of GHB?

A

GABA receptor agonist, it mimics GABA and inhibits dopamine release.

37
Q

What are the primary targets of ketamine?

A

It is a NMDA glutamate receptor antagonist and it blocks glutamate.

38
Q

What is the primary target of cannabis?

A

It works on the cannabis CB1 receptor. It stimulates the echo-cannabinoid signalling leading to a change in cortical and memory functions.

39
Q

How does cocaine work?

A

It blocks dopamine re-uptake site and greatly increases dopamine.

40
Q

How does amphetamines work?

A

They release dopamine and block re-uptake. They greatly increase dopamine and noradrenaline.

41
Q

How does nicotine work?

A

It is an agonist against acetly-choline/nicotinic receptors thereby slightly increasing dopamine.

42
Q

How does MDMA work?

A

It blocks serotonin and dopamine re-uptake and it increases serotonin and dopamine function.

43
Q

How does mephedrone work?

A

It releases dopamine and blocks the re-uptake and it increases dopamine and serotonin in the brain.

44
Q

How do hallucinogens work?

A

They are 5HT3 agonists (serotonin), and they change across-cortex signalling in the brain.

45
Q

How does heroin and other opiods work?

A

They are agonists at the endorphin receptors and they produce euphoria in the brain and reduce pain.

46
Q

Name all the Class A drugs?

A

Heroin, ecstasy, PCP,LSD, MDMA, cocaine (incl. crack), methamphetamine, psilocybin mushrooms, any class B drug prepared for injections

47
Q

Name class B drugs?

A

Cannabis, synthetic cannabinoids, ketamine, mephedrone, amphetamine, codeine, methoxetamine, methylphenidate

48
Q

Name class C drugs?

A

Khat, GHB/GBL, benzodiazepines, tramadol, anabolic steroids

49
Q

What is the penalty for possession of each of the classes?

A

A- 7years
B- 5years
C- 2years

50
Q

What is the penalty for supply in each of the classes?

A

A-Life
B- 14years
C- 14years

51
Q

What are novel psychoactive substances?

A

Drugs that mimic / claim to mimic effects of traditional recreational drugs. Synthesised by manufacturers to evade detection & legal prohibition.
Cheap – young people can afford (~8%in EU, ~6%in UK*) -student, clubber, LGBT ‘subcultures’, homeless - “More bang for your buck”
Not detected in drug tests – prisons, hostels etc. (>80% in one hostel; med student, personal experience)
Un-researched - effects (psychotropic & side) unknown/limited knowledge: over 100 new identified 2014 (European Monitoring Centre for Drugs and Drug Addiction)

52
Q

What is a psychoactive substance?

A 
Psychoactive: any substance which
a) is capable of producing a psychoactive effect in a person who consumes it
b) is not an exempted substance
EXEMPTIONS:
nicotine, alcohol, caffeine
53
Q

Is possession of a psychoactive substance an offence?

A

No

54
Q

What are the symptoms or opiate withdrawal?

A

You can do a COWS score (clinical opiate withdrawal state), assessing resting pulse rate, sweating, restlessness, pupil size, bone or joint aches, runny nose or tearing, GI upset, tremor, yawning, anxiety and irritability and gooseflesh skin.

55
Q

What are the criteria for tolerance? (YOU MUST HAVE 3 OR MORE IN LAST 12 MONTHS)

A

Tolerance
Withdrawal
Using more or for longer than was intended
Unsuccessful attempts to reduce use
Large amount of time spent seeking, using and recovering from use
Drug use taking priority over social, work and recreational activities
Persistent use despite harm

56
Q

What is methadone?

A

It is a synthetic opioid, comes in liquid, tablets and injection, it has a long half life (24 hours/may reduce to 8 hours in pregnancy)

57
Q

What is Buprenorphine?

A

It is a semi-synthetic compound. It is an agonist/antagonist opioid receptor modulator. It usually comes as a sub-lingual tablet

58
Q

What is lofexidone?

A

alpha2-adrenergic receptor agonist
• Used to relieve withdrawal symptoms, particularly those cause by noradrenaline
• Can be used in conjunction with naltrexone for detox

59
Q

What is Naltrexone?

A

Long acting opiate antagonist
• Oral, depot, implant
• Blocks euphoric effects, little effect on cravings
• Also used in Alcohol dependency (better evidence base)

60
Q

When do you get symptoms, seizures and delirium tremors with alcohol withdrawal?

A

symptoms: 6-12 hours
seizures: 36 hours
delirium tremens: 72 hours

61
Q

What is the treatment of delirium tremors?

A

Chlordiaxipoxide

62
Q

Name the 7 key features of alcohol dependance?

A

Compulsion, primacy of drinking over other activities, pattern, tolerance, withdrawal, reinstatement, relief drinking to avoid withdrawals. (other narrowing of repertoire?)

63
Q

What are delirium tremens?

A

Medical emergency occurs in 3% of alcohol dependent people at 1-3 days after stopping. Clouding of consciousness, disorientation in TIME and PLACE, recent memory impaired, fear, agitation and restlessness, vivid hallucinations and delusions, insomnia, autonomic disturbances (tachycardia, hypertension, hyperthermia, sweating, dilated pupils), coarse tremor, N&V, electrolyte disturbances, seizures.

64
Q

What is wernickes encephalopathy?

A

MEDICAL EMERGENCY. Disorder of acute onset characterised by impaired consciousness and confusion, episodic memory impairment, ataxia, nystagmus, abducens and conjugate gaze palsies, pupillary abnormalities and peripheral neuropathy. Results from thiamine deficiency, most commonly secondary to alcohol dependence. So give thiamine. 20% recover, 10% die.

65
Q

What is Korsakovs syndrome?

A

Irreversible syndrome of prominent impairment of recent memory. Confabulation may be a marked feature.

66
Q

Which blood tests are useful in alcohol misuse and which has the highest specificity?

A

Gamma glutamyltransferase (GGT) is raised in 80%, ALP raised in 60% and MCV is increased in 50%. MCV has the highest specificity for alcohol misuse.

67
Q

How do you achieve detoxification in alcohol misuse if they are dependent?

A

Reducing course of benzos in lieu of alcohol e.g. chlordiazepoxide 20mg QDS reducing daily over 7 days and supplementation with thiamine.

68
Q

What is disulfam?

A

Disulfiram is a drug discovered in the 1920s used to support the treatment of chronic alcoholism by producing an acute sensitivity to ethanol (drinking alcohol).

69
Q

What is acamprostate?

A

Acamprosate, sold under the brand name Campral, is a medication used along with counselling in the treatment of alcohol dependence

70
Q

How do you treat cravings of alcohol and opioids

A

Naltrexone

71
Q

What do you take to detox from alcohol?

A

Chlordiazepoxide

72
Q

What do you treat opioid withdrawal with?

A

Lofexidine

73
Q

How do you treat benzo overdose?

A

Flumazenil

74
Q

What is the best screening tool for detecting if someone has an alcohol addiction problem?

A

AUDIT
10 item questionnaire,
has been shown to be superior to CAGE and biochemical markers for predicting alcohol problems
minimum score = 0, maximum score = 40
a score of 8 or more in men, and 7 or more in women, indicates a strong likelihood of hazardous or harmful alcohol consumption
a score of 15 or more in men, and 13 or more in women, is likely to indicate alcohol dependence
AUDIT-C is an abbreviated form consisting of 3 questions

75
Q

What does ICD-10 say about alcohol dependence?

A

ICD-10 definition - 3 or more needed
compulsion to drink
difficulties controlling alcohol consumption
physiological withdrawal
tolerance to alcohol
neglect of alternative activities to drinking
persistent use of alcohol despite evidence of harm

Psychiatry (24 decks)

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