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Psychiatry > Addictions > Flashcards

Addictions Flashcards

1
Q

There are two sides to addiction:

A

Tolerance –> Physical Dependence

Reward Centres –> Psychological Craving

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2
Q

Define tolerance?

A

Reduced responsiveness to a drug due to past administration

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3
Q

What are the 2 main mechanisms of tolerance?

A
  • Dispositional

- Pharmacodynamic

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4
Q

What’s dispositional tolerance?

A

LEss drug reaching the active site due to changes in absorption, metabolism, excretion etc

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5
Q

What’s Pharmacodynamic tolerance?

A

Less effect of drug at the active site due to e.g. internalisation of receptors or less efficient receptors

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6
Q

How does tolerance cause dependence?

A

Physiological changes in response to the drug use causes you to depend on the drug to maintain your normal homeostasis
When the drug’s taken away you swing too hard the other way and get withdrawal

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7
Q

What do withdrawal symptoms look like?

A

Pretty much the opposite of whatever the drug’s effect is e.g. diarrhoea when you stop opiates

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8
Q

Describe how the brains “reward centres” work?

A

The Ventral Tegmental Area projects VTA neurons to the nucleus accumbens & prefrontal cortex releasing dopamine

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9
Q

How do drugs cause craving?

A

Basically they trigger some part of our reward pathways, usually increasing dopamine, triggering it’s release or decreasing it’s reuptake

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10
Q

What types of cocaine are there?

A

Cocaine hydrochloride is what you snort and inject

Cocaine freebase aka crack is what you smoke

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11
Q

What are the desired and undesired effects of cocaine?

A

Most potent natural stimulant - monoamine reuptake inhibitor

  • Euphoria
  • Confidence
  • Energy
  • Decreased appetite/sleep
  • If mixed with alcohol, cocaethylene

Dangers include:

  • Airway damage
  • Convulsions
  • Resp failure
  • Arrhythmia
  • MI
  • HTN
  • Toxic confusion & paranoid psychosis
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12
Q

What happens when you withdraw from cocaine

A

Think the opposite of the effects:

  • Low mood & irritability
  • Agitation
  • Craving
  • Hypersomnia
  • Hyperphagia
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13
Q

How do you take amphetamine?

A
  • Snort, swallow or inject

- Generally amphetamine sulphate

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14
Q

Effects of amphetamine?

A

Similar to cocaine but longer.

Risks:

  • toxic confusions
  • convulsions
  • amphetamine psychosis
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15
Q

What are the forms of heroin?

A

Diamorphine or Diamorphine Chlorine

Comes in powder or tar and can be snorted, smoked or injected

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16
Q

Heroin gives an intense but transient pleasure rush, what are the side effects though?

A 
Analgesia
Emotional analgesia
Nausea initially
Euphoria
Pin point pupils
Itching/sweating
Constipation
Decreased libido/menstrual irregularities
Reduced cough reflex
17
Q

What do you get when you withdraw from heroin?

A 
Craving
Insomnia & yawning
Muscle pain & cramps
Increased secretion from nose, lacrima and saliva
Dilated pupils
Piloerection (hence cold turkey)
18
Q

Why do we give people methadone?

A

Best case scenario is they remain opiate dependant but they are able to get their life together because its normalized, regulated, reduces IV misuse and so eliminates most of the social problems

19
Q

What’s the big problem with buying mandy?

A

only 1/2 are mdma, the others are either nothing active, lsd, amphetamine or ket etc

20
Q

What are the effects of MDMA?

A

Euphoria, increased sociability etc

Negative effects:
Nausea
Dry mouth
HTN & high temp
Dehydration
Anxiety, panic & Psychosis
21
Q

What are anabolic steroids prescribed for?

A

Hypogonadism
Muscular dystrophy
Anaemias
Wasting in aids

22
Q

What are the side effects of steroid use?

A
  • Acne, stretch marks and baldness
  • Feminisation in males with hypogonadism and gynaecomastia (occasioning use of anti-oestrogens)
  • Virilisation in women – Hirsutism, deep voice, clitoral enlargement, menstrual irregularities & hair thinning
  • Cholesterol & HTN
  • Growth deficits (closes epiphysis)
  • Cholestatic jaundice & liver tumours
23
Q

What are the best known opiates?

A 
Opium
Morphine
Heroin (diamorphine)
Methadone
Codeine and dihydrocodeine
24
Q

What is heroin?

A

Opioid agonist

  • Acts via mu (principally)
  • Acts principally via Mu, Delta and Kappa receptors
  • Kappa and Delta – analgesia
  • Mu – mood effects, analgesia and euphoria
25
Q

Describe a heroin overdose?

A 
Respiratory depression
Snoring indicates risk 
Bradycardia
Hypotension
Death
26
Q

What are the medium-term side-effects of opiates?

A 
Phlebitis
Endocarditis
Injection injuries/consequences (BBVs)
Anorexia
Constipation
27
Q

What are the long-term side-effects of opiates?

A

Tolerance
Withdrawal
Social and health problems

28
Q

What are the best-known benzodiazepines?

A 
Diazepam (Valium)
Nitrazepam
Temazepam
Alprazolam (Xanax)
Lorazepam
Etizolam
29
Q

What are benzodiazepines?

A

GABA agonists

Anxiolytics, sedatives

Previously misused medical prescriptions
Now easily accessable online (as are all medicines!) – main route for drug misusers
Can be abused in huge doses

30
Q

What is the psychoactive agent in cannabis?

A

Tetrahydrocannabinol (THC) - psychedelic , hallucinatory effect

CBD ( cannabidiol) – anxiolytic and antipsychotic effect

31
Q

What are the negative side effects of cannabis?

A

Respiratory problems as with tobacco
Toxic confusion
Exacerbation of major mental illness
Cannabis psychosis

32
Q

What are the psychological side-effects of steroids?

A

Irritability and anger – ‘roid rage’

Hypomania and mania

Depression and suicidality on withdrawal

Psychiatry (33 decks)

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