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Psychiatry > Addictions Psychiatry > Flashcards

Addictions Psychiatry Flashcards

1
Q

The two distinct mechanisms of substance misuse

A

Tolerance and reward centre

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2
Q

Define Tolerance

A

Reduced responsiveness to a drug caused by previous administration

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3
Q

Tolerance develops in response to which drugs

A

Opioids, ethanol, barbiturates, benzodiazepines

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4
Q

Dispositional Tolerance

A

less drug reaches the active site, eg
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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5
Q

Pharmacodynamic Tolerance

A

site of action is less affected by the drug, eg
down-regulation or internalisation of drug receptors
reduced signalling down stream of drug receptors
some other compensatory mechanism

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6
Q

Withdrawal Phenomena

A

The reverse of the acute effect, it is closely linked to tolerance. Development of tolerance may lead to physical dependence in order to avoid the withdrawal effects

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7
Q

Opioid withdrawal

A

Acute effect is constipation and the withdrawal effect is diarrhoea

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8
Q

Barbiturate withdrawal

A

Acute effects are anticonvulsants and the withdrawal effect is convulsions

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9
Q

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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10
Q

Why has the reward pathway evolved

A

The reward pathway is normally activated by eating, drinking and sex
It therefore encourages those “healthy” behaviours that lead to propagation of your genes

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11
Q

How do drugs affect the reward centres

A

They tap into the reward pathways and increase dopamine levels.

heroin increases firing rate of dopaminergic neurones

amphetamine increases dopamine release

cocaine inhibits dopamine uptake

alcohol

THIS PRODUCES THE PSYCHOLOGICAL COMPONENT OF ADDICTION - CRAVING

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12
Q

Stimulant Drugs

A

Cocaine and Amphetamine

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13
Q

How is cocaine used

A

The leaves are chewed or brewed. Cocaine hydrochloride is snorted or injected. Cocaine freebase or crack cocaine is smoked.

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14
Q

The effects of Cocaine (good)

A

Stimulant and Euphoriant
Increased alertness and energy
Increased confidence and impaired judgement
Lessens appetite and desire for sleep

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15
Q

Dangerous 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

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16
Q

Cocaine Withdrawal Effects

A 
Depression 
Irritability
Agitation
Craving
Hyperphagia
Hypersomnia
17
Q

Amphetamine is usually

A

Amphetamine Sulphate

18
Q

How is Amphetamine used

A

Sniffed, swallowed or injected

19
Q

Effects of amphetamine

A

similar to cocaine but longer lasting

20
Q

Dangers of amphetamine use

A

Toxic confusion occasionally with convulsions and death

Amphetamine psychosis in heavy chronic use

21
Q

Opiates

A 
Opium
Morphine
Heroin (diamorphine)
Methadone
Codeine and dihydrocodeine
22
Q

Heroine

A

Diamorphine or as diamorphine hydrochloride

23
Q

Heroine is also known as

A

H, gear, smack or brown

24
Q

How can heroine be taken

A

Snorting
Smoking
Injection

25
Q

Effects of Heroine

A 
Analgesia,
Drowsiness and sleep,
Mood change
Respiratory depression 
Cough reflex depression 
Sensitisation of the labyrinth with nausea and vomiting
Decreased sympathetic outflow 
Lowering of body temperature
Pupillary Constriction 
Constipation
26
Q

Dangers of Heroine

A 
Respiratory arrest wtih a pulse
Pinpoint pupils unreactive to light 
Snoring giving way to shallow respiration 
Bradycardia and hypotension 
Reduced consciousness
27
Q

First time side effects of Opiates

A

Nausea, vomiting and headache

28
Q

Medium term side effects of opiates

A

Phlebitis, anorexia, constipation

29
Q

Longer term side effects of opiates

A

tolerance, withdrawal and social and health problems

30
Q

Opiate Withdrawal Syndrome

A 
craving
insomnia
yawning
muscle pain and cramps
increased salivary, nasal and lacrimal secretions
dilated pupils
piloerection (hence ‘cold turkey’)
31
Q

Methadone Maintenance

A

This is given to patients with opiate dependency. It decriminalises heroine use and allows normalisation of the lifestyle. It helps by reduces IV misuse and therefore reduces the consequences of doing so.

32
Q

Ecstasy

A

3,4-methylenedioxymethamphetamine

33
Q

Effects of ecstasy

A

relaxed euphoric state without hallucinations

euphoria followed by feeling of calm
increased sociability
inability to distinguish between what is and isn’t desirable
effects after 20 mins lasting 2-4 hours

34
Q

Side effects of Ecstasy

A 
Nausea and dry mouth
increased blood pressure and temperature
in clubs users risk dehydration
large doses can cause anxiety and panic 
drug induced psychosis
? liver and brain cell damage
35
Q

Psychoactive agent in cannabis

A

tetrahydrocannabinol

36
Q

Psychological Effects of Cannabis

A

relaxing or stimulating, euphoriant , increases sociability and hilarity, increases appetite, changes in time perception, synaesthesia

anxiety , panic , persecutory ideation, hallucinatory activity

37
Q

Ill effects of cannabis

A

respiratory problems as with tobacco
toxic confusion
exacerbation of major mental illness
cannabis psychosis

Psychiatry (20 decks)

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