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Year 3 - Psychiatry > Addictions symposium > Flashcards

Addictions symposium Flashcards

1
Q
  • Recognise the universality of substance use and abuse.
  • Discuss the distinctions between use, problem use, dependence and addiction.
  • Discuss the ways in which substance misuse may impact on the individual, his social nexus and wider society.
  • Differentiate between the physical and psychological aspects of addiction.
  • Explain the concept of physical drug tolerance and drug dependence. - DONE
  • Describe the location and function of the reward centre and recognise that activation of the reward centre by addictive drugs causes the psychological symptom of craving. - DONE
  • Recognise that there may be a genetic basis for variation in the strength of the reward centre between individuals.
A

.

Tolerance (the basis of physical dependence)
Reward centre (the basis of psychological craving)
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2
Q

Define tolerance

A

Reduced responsiveness to a drug caused by previous administration

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3
Q

Mechanisms underlying tolerance

  • DISPOSITIONAL TOLERANCE
  • PHARMACODYNAMIC TOLERANCE
A

Less drug reaching active site (DISPOSITIONAL TOLERANCE)

  • less drug absorbed
  • drug metabolised faster
  • more drug excreted

Drug has less action at active site (PHARMACODYNAMIC TOLERANCE)

  • fewer drug receptors
  • reduced signalling downstream of drug receptors
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4
Q

Withdrawing a drug has what effect

A

The reverse of the acute effect, e.g. opioids have acute effect on constipation but when withdrawn will cause diarrhoea

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5
Q

Acute v withdrawal effect of barbiturates

A

Anticonvulsant

Convulsions

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6
Q

Acute v withdrawal effect of cocaine

A

Elevated mood

Depressed mood

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7
Q

Development of tolerance can lead to …

A

Dependence in order to avoid the withdrawal effects (because while being on the drug, body produces adaptive response to drug so drug no longer works)

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8
Q

Location and function of the reward centre

A

Location - nucleus accumbent + ventral tegemental area (neurones project from the ventral tegmental area to the nucleus accumbens & prefrontal cortex)

Function - when VTA neurones are stimulated, they release dopamine which causes a sensation of pleasure/reward

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9
Q

Reward pathway (VTA neurones projecting to nucleus accumbens & prefrontal cortex) is activated by what things

A

Eating
Drinking
Sex

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10
Q

Activation of the reward centre by addictive drugs causes the psychological symptom of craving

They do this by increasing dopamine levels - how do different drugs do this?

  • heroin
  • amphetamine
  • cocaine
A

Heroin increases firing rate of dopaminergic neurones

Amphetamine increases dopamine release

Cocaine inhibits dopamine reuptake

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11
Q

Psychological craving is a result of stimulation of what pathways in the brain

A

Reward pathways in the brain

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12
Q

Name 2 stimulant drugs

A

Cocaine

Amphetamine

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13
Q

Different forms of cocaine and how they’re taken

A

Coca leaves - chewed or brewed

Cocaine hydrochloride (powder) - snorted or injected

Crack cocaine - smoked

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14
Q

How quickly does it take for the effects of cocaine to kick in

  • smoking
  • injecting
  • snorting
A

Smoking - almost immediate (very intense but wear out after 15 mins)
Injecting - 15-30 secs
Snorting - 3-5 mins

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15
Q

Symptoms (5)/ signs (6) of cocaine

A 
Elevated mood
Increased alertness/energy
Increased confidence but impaired judgement
Reduced appetite 
Reduced desire to sleep
Damage to nose + airways
Convulsions (seizures)
Arrhythmias, MI
Hypertension
Toxic confusion (delirium)
Psychosis
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16
Q

Withdrawal symptoms of cocaine (6)

A 
Depression 
Irritability
Agitation
Craving
Hyperphagia (huge desire to eat)
Hypersomnia (excessive sleepiness)
17
Q

Is cocaine or amphetamine longer lasting

A

Amphetamine

18
Q

Name some examples of opiates (6)

A 
Opium
Morphine
Heroin (diamorphine)
Methadone
Codeine
Dihydrocodeine
19
Q

Symptoms (5)/ signs (4) of heroin

A 
Analgesic (i.e. pain relief)
Drowsy
Elevated mood (euphoria)
Nausea/vomiting 
Constipation

Resp depression
Cough reflex depression
Bradycardia + hypotension (due to decreased sympathetic outflow)
Pupils CONSTRICT

20
Q

Pathognomic sign of opiate overdose

A

Resp arrest with a pulse

21
Q

Side effects of opiates

  • first time
  • medium term
  • long term
A

N/V
Headache

Phlebitis (inflamed vein)
Anorexia (reduced appetite)
Constipation

Tolerance
Withdrawal effects
Social + health problems

22
Q

Withdrawal effects of opiates*(opiate withdrawal syndrome)

*worse withdrawal problems out of all stimulant drugs

A 
Craving
Insomnia
Yawning
Muscle pain and cramps
Increased salivary, nasal and Lacrimal secretions
Dilated pupils
Piloerection
23
Q

Clinical effects of ecstasy (MDMA - 3,4-methylenedioxymethamphetamine) (3)

A

Euphoria followed by feeling of calm
Increased sociability
Inability to distinguish between what is and isn’t desirable

24
Q

Side effects of ecstasy

A

Nausea and dry mouth
Increased blood pressure and temperature
Large doses can cause anxiety and panic
Drug induced psychosis

25
Q

Most commonly used illicit drug is cannabis

What is the psychoactive agent in cannabis?

A

Tetrahydrocannabinol (THC)

26
Q

Symptoms/psychological effects (5) of cannabis

A

Relaxing or stimulating
Increases sociability and hilarity,
Increases appetite,
Changes in time perception, Synaesthesia (neurological trait/condition that results in a merging of senses that aren’t normally connected, e.g. hearing colour)

In higher dose - anxiety, panic, hallucinations

27
Q

Ill effects of cannabis

A

Resp depression
Toxic confusion (delirium)
Exacerbation of existing major mental illness

28
Q

Novel psychoactive substances also known as

A

legal highs

29
Q

Anabolic steroids are a family of drugs comprising analogues of what hormone usually

A

Testosterone

30
Q

Anabolic steroids are often abused by athletes (to increase muscle mass + reduce fat) but they can be clinically prescribed for what conditions

A

Hypogonadism
Muscular dystrophy
Various anaemias

31
Q

Side effects of steroids

  • skin
  • males
  • females
  • cardio
  • bone
  • liver
A

Skin - stretch marks, acne, baldness

Feminisation in males with hypogonadism and gynaecomastia

Virilisation (masculinisation) in women, e.g. hirsutism, deep voice, clitoral enlargement

Cardio - increased cholesterol, hypertension

Bone - growth deficits due to premature closure of epiphyses

Liver - cholestatic jaundice, liver tumours

32
Q

Psychological side effects of anabolic steroids

A

Irritability and anger

Hypomania or mania

Depression and suicidality on withdrawal

Year 3 - Psychiatry (7 decks)

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