Addictions (BJ)

Question 1

There are two sides to addiction:

Answer 1

Tolerance –> Physical Dependence

Reward Centres –> Psychological Craving

Question 2

Define tolerance?

Answer 2

Reduced responsiveness to a drug due to past administration

Question 3

What are the 2 main mechanisms of tolerance?

Answer 3

• Dispositional

- Pharmacodynamic

Question 4

What’s dispositional tolerance?

Answer 4

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

Question 5

What’s Pharmacodynamic tolerance?

Answer 5

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

Question 6

How does tolerance cause dependence?

Answer 6

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

Question 7

What do withdrawal symptoms look like?

Answer 7

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

Question 8

Describe how the brains “reward centres” work?

Answer 8

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

Question 9

How do drugs cause craving?

Answer 9

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

Question 10

What types of cocaine are there?

Answer 10

Cocaine hydrochloride is what you snort and inject

Cocaine freebase aka crack is what you smoke

Question 11

What are the effects of cocaine?

Answer 11

Euphoria, confidence, energy and decreased appetite/sleep

Dangers include airway damage, convulsions, resp failure, arrhythmia, MI, HTN, toxic confusion & paranoid psychosis

Question 12

What happens when you withdraw from cocaine

Answer 12

Think the opposite of the effects:

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

Question 13

How do you take amphetamine?

Answer 13

Snort, swallow or inject

Question 14

Effects of amphetamine?

Answer 14

Similar to cocaine but longer.

Risks toxic confusions, convulsions & amphetamine psychosis

Question 15

What are the forms of heroin?

Answer 15

Diamorphine or Diamorphine Chlorine

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

Question 16

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

Answer 16

N&V + headache
Resp depression + hypotension (big cause of deaths)

Longer term patients develop:

• Phlebitis
• anorexia
• Constipation (big reason for hospilisation)
• Social problems

Question 17

What do you get when you withdraw from heroin?

Answer 17

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

Question 18

Why do we give people methadone?

Answer 18

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

Question 19

What’s the big problem with buying mandy?

Answer 19

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

Question 20

What are the effects of MDMA?

Answer 20

Euphoria, increased sociability etc

Nausea
Dry mouth
HTN & high temp
Dehydration
Anxiety, panic & Psychosis

Question 21

What are anabolic steroids prescribed for?

Answer 21

Hypogonadism
Muscular dystrophy
Anaemias
Wasting in aids

Question 22

What are the side effects of hypogonadism?

Answer 22

acne, stretch marks and baldness
Cholesterol & HTN
Growth deficits (closes epiphysis)
Cholestatic jaundice & liver tumours

Virilisation in women – Hirsutism, deep voice, clitoral enlargement, menstrual irregularities & hair thinning