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Psychiatry > Addictive Disorders > Flashcards

Addictive Disorders Flashcards

1
Q

what are the two main mechanisms underlying addiction?

A

tolerance

reward centres

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2
Q

which two ways can drug tolerance occur?

A

dispositional tolerance

pharmacodynamic tolerance

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3
Q

what is the mechanism of dispositional tolerance?

A

drug has a lesser effect because less of it reaches the target receptor due to changes in absorption, metabolism or excretion

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4
Q

what is the mechanism of pharmacodynamic tolerance?

A

drug has a lesser effect after it has reached the target receptor due to fewer/less sensitive receptors

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5
Q

explain the mechanism of withdrawal symptoms in addiction

A
  • drug causes change in neurotransmitter release
  • consistently altered amount of neurotransmitter causes compensatory change in available receptors
  • ceasing drug causes the neurotransmitter level to revert to normal, whilst there is still a compensatory number of receptors
    = normal neurotransmitter levels will cause either an exaggerated or reduced stimulus depending on the amount of receptors present
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6
Q

describe the course of the reward pathway

A
  • stimulus causes stimulation of the ventral tegmental area (VTA)
  • VTA releases dopamine
  • dopaminergic neurons from VTA signal to nucleus accumbens, prefrontal cortex, hippocampus and amygdala
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7
Q

what neurotransmitter is released by the ventral tegmental area?

A

dopamine

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8
Q

explain the craving aspect of drug addiction

A

certain drugs cause an increase in dopamine release, resulting in increased firing of the reward pathway

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9
Q

what is the relationship between a drug’s effect and its withdrawal symptoms

A

a drug’s withdrawal symptoms are normally the opposite of its acute effects (eg heroin causes constipation, withdrawal causes diarrhoea)

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10
Q

where is the ventral tegmental area found, and why is it important?

A

VTA is found in the midbrain. it’s important because it forms the start of the reward pathway

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11
Q

which illicit drug is generally considered to be the most addictive?

A

crack cocaine

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12
Q

how can cocaine be consumed?

A

snorted, injected or smoked (crack)

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13
Q

how can amphetamine be consumed?

A

snorted, eaten or injected

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14
Q

how can heroin be consumed?

A

smoked, injected or snorted

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15
Q

name a few psychological effects of cocaine

A 
euphoria
increased confidence
reduced sleep
reduced appetite
increased energy
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16
Q

why is cocaine classed as a stimulant drug? what are some of its physical effects as a result?

A

because it increases the body’s metabolism. it causes:

  • increased body temp
  • increased HR
  • increased BP
  • vasoconstriction
  • increased resp rate
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17
Q

why is cocaine a risk factor for MIs and strokes?

A

because it’s a potent vasoconstrictor, so it increases BP which is in itself a risk factor for MI and strokes

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18
Q

why do chronic cocaine users present with damaged nasal septa?

A

because it’s a vasoconstrictor, so it stops blood flow to the septal capillaries

19
Q

how long does a cocaine high normally last?

A

around 15 mins

20
Q

how long does an amphetamine high normally last?

A

around 3-4 hours

21
Q

how long does a metamphetamine high normally last?

A

around 24 hours

22
Q

why is metamphetamine more addictive than amphetamine?

A

because its structure allows it to cross the BBB barrier more easily

23
Q

what is the user population difference between crack cocaine and cocaine hydrochloride?

A

crack cocaine is associated with low income, crime and violence
cocaine hydrochloride is associated with success, wealth and ambition

24
Q

what is the basic mechanism of action of stimulants like cocaine and amphetamines?

A

reduce reuptake of serotonin, dopamine and noradrenaline

25
Q

what is another name for amphetamine?

A

speed

26
Q

what is the basic mechanism of action of opiates?

A

general inhibition of sympathetic system
analgesic effect through binding to opioid receptors
dopamine release through inhibition of GABA neurons

27
Q

what is the typical combination of signs in an opiate overdose?

A

respiratory arrest with a pulse and pinpoint pupils

28
Q

what is the main difference between cocaine and amphetamine?

A

amphetamine stays in circulation longer

29
Q

what is the reasoning behind converting heroin users to methadone?

A

harm control - methadone is taken in liquid form once a day, heroin requires several injections a day with risk of infection, overdose, contamination and needlestick complications

30
Q

what component of opium is heroin synthesized from?

A

morphine

31
Q

name a few short term side effects from heroin use

A

nausea
vomiting
headache
itching

32
Q

name a few long term side effects from heroin use

A 
constipation 
anorexia
bradycardia
hypotension
drowsiness
reduced respiratory rate
33
Q

name a few common withdrawal symptoms from heroin use

A 
muscle cramps
yawning
tearing
runny nose
anxiety
insomnia
headache
nausea/vomiting 
dilated pupils
34
Q

name a few side effects of MDMA

A 
dehydration
dry mouth
nausea
increased temperature
increased BP
35
Q

name a few side effects of using anabolic steroids

A 
acne
stretch marks
hair loss
feminisation (men)
masculinisation (women)
high cholesterol/CVA risk
liver damage
growth impairment
36
Q

name a few symptoms of anabolic steroid withdrawal

A

irritability
hypomania/mania
depression/suicidal thoughts

37
Q

what is harmful use of alcohol classed as?

A

harmful/toxic use of alcohol for >1 month or repeatedly over 12 months

38
Q

what signs can alcohol dependence present with?

A
  • cravings
  • withdrawal
  • tolerance
  • use despite negative consequences
  • primacy
  • difficulty controlling use
39
Q

how can alcohol withdrawal present?

A
  • tremor
  • anxiety
  • insomnia
  • confusion
  • sweats
  • seizures
  • nausea
  • headache
  • vomiting
40
Q

what is wernicke’s encelopathy?

A

triad of symptoms caused by thiamine (B1) deficiency, secondary to alcohol abuse. symptoms include confusion, ataxia, opthalmoplegia and nystagmus

41
Q

what is korsakoff’s psychosis?

A

loss of short term memory caused by thiamine (B1) deficiency secondary to alcohol abuse

42
Q

what do korsakoff’s psychosis and wernicke’s encephalopathy have in common?

A

both caused by thiamine (vitamine B1) deficiency secondary to alcohol abuse

43
Q

name some non-pharmacological management options for alcohol abusers

A
  • psychological help (CBT, group therapy)
  • community support (AA)
  • social services support (benefits, housing)
44
Q

name some medical treatment options for alcohol abusers and what they aim to treat specifically

A
  • thiamine (to prevent B1 deficiency)
  • benzodiazepines for alcohol withdrawal
  • disulfiram (antabuse) as aversion therapy
  • anti-craving medication (campral, naltrexone, nalmefene)

Psychiatry (7 decks)

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