Addictive Psychiatry Flashcards
Stimulant drugs
Cocaine
Amphetamine
Which drug is the most potent natural stimulant?
Cocaine
How is cocaine taken?
Coca leaves = chewed or brewed
Cocaine hydrochloride = snorted or injected
Cocaine freebase or crack cocaine = smoked
What does cocaine hydrochloride have an association with?
Wealth
What does crack cocaine have an association with?
Violence and bad backgrounds
Effects of cocaine depend on what?
Dose
Rate of entry
How long does smoking cocaine take to have its effects?
Almost immediately
Effects of crack smoking very intense but over really quickly (15 mins)
How long does injecting cocaine take to have its effect?
15 to 30 secs
How long does snorting cocaine take to have its effect?
3 to 5 mins
Effects of cocaine
Stimulant Euphoriant increased alertness and energy increased confidence and impaired judgement lessens appetite lessens desire for sleep
Side effect of cocaine
Financial impact damage to nose and airways convulsions with respiratory failure cardiac arrthymias and MI hypertension and CVA Toxic confusion paranoid psychosis
Withdrawal effects of cocaine
depression irritability agitation craving hyperphagia (excessive eating) hypersomnia
What is the chemical compound of amphetamine?
Amphetamine sulphate
How is amphetamine taken?
Sniffed
Swallowed
Injected
How long does amphetamine effects last for?
2-3 hours (longer than cocaine)
side effects of amphetamines
amphetamine psychosis in heavy chronic use
toxic confusion
convulsions
death
types of opiates
opium morphine Heroin (diamorphine) methadone codeine and dihydrocodeine
Effects of opiates
Intense but transient feeling of pleasure
- a rush
- almost orgasmic
- physical and emotional anaesthetic
Side effects of opiates
first time = nausea/vomiting and headache second time - phlebitis - anorexia - constipation Longer term - tolerance - withdrawal - social and health problems
Symptoms of opiate withdrawal syndrome
craving insomnia yawning muscle pain and cramps increased salivary, nasal and lacrimal secretions dilated pupils piloerection
What is heroin available as chemically?
Diamorphine
Diamorphine hydrocodiene
How Is heroin presented?
Powder
tar like substance
How is heroin taken?
Snorting
Smoking (chasing the dragon)
Injection (dangerous)
Street names for heroin
H
Gear
Smack
Brown
What is used for heroin withdrawal?
Methadone
What does methadone in the treatment of heroin addiction allow for?
Decriminalises drug use
allowes normalisation of lifestyle
reduces IV misuse
effects of heroin
analgesia
drowsiness and sleep
mood change (euphoria, intense pleasure)
Side effects of heroin
Respiratory depression - if taking too much
- can lead to respiratory arrest with a pulse
cough reflex depression
sensitisation of the labyrinth with nausea and vomiting
decreased sympathetic outflow (bradycardia and hypotension)
lowering of body temperature
pupillary constriction
constipation
pinpoint pupils unreactive to light
snoring giving way to shallow respiration (<8 breaths per min)
varying degree of consciousness/coma
How is ecstasy used?
Orally
How long does ecstasy take to work and how long does it last for?
after 20 mins
lasting 2-4 hours
Effects of ecstasy
relaxed euphoric state without hallucinations
followed by a feeling of calm
increased sociability
inability to distinguish between what is desireable and what isn’t
What is another name for ecstasy?
MDMA
Side effects of ecstasy
nausea dry mouth increased BP increased temp in clubs users risk dehydration large doses can cause anxiety and panic drug induced psychosis liver and brain cell damage
What is the most commonly used illicit drug?
Cannabis
What is the psychoactive agent in cannabis?
Tetrahydrocannabinol
What can cannabis be presented as?
Loads of different forms including
- marijuana
- hashish (cannabis resin)
- hash oil
How is cannabis taken?
Eaten
Smoked (spliffs or blunts)
What has a high THC content in cannabis and therefore has higher risk?
Skunk (sensimilla)
Effects of cannabis
relaxing or stimulating euphoriant increased sociability and hilarity increases appetite changes in time perception synaesthesia
Effects of cannabis in higher doses
severe anxiety
panic
persecutory ideation
hallucinatory activity
Ill effects of cannabis
respiratory problems as with tobacco
toxic confusion
exacerbation of mental illness
cannabis psychosis
What are some novel psychoactive substances?
NPS
Legal highs
What do anabolic (androgenic) steroids contain?
Testosterone and many synthetic analogues
When are anabolic steroids used illegally?
In sports requiring muscle mass and strength
To enhance appearance - increase muscle mass and reduce body fat
Anabolic steroids are legitimately prescribed in….
hypogonadism
muscular dystrophy
various anaemias
wasting in AIDs
What do anabolic steroids cause?
Muscle hypertrophy
- especially in upper body such as pectoralis, deltoid, trapezius and biceps
Side effects of anabolic steriods
Acne
Stretch marks
baldness
irritability and anger - ‘roid rage’
hypomania and mania
in males
- feminisation
= hypogonadism and gynaecomastia (occasioning use of anti-oestrogens)
in women
- virilisation
= hirsutism, deep voice, clitoral enlargement, menstrual irregularities, hair thinning
- CVS = increased cholesterol and HTN
- growth deficits = due to premature closure of epiphysis
- liver disease = cholestatic jaundice, liver tumours
depression and suicidality on withdrawal
What are the 3 most common drugs abused?
Cocaine
Heroin
Diazepam
Substitutes for coming off heroin
Methadone
Suboxone
When is suboxone used?
Once have come off methadone
What form is methadone?
Liquid
What form is suboxone?
Tablet
Comorbidities often involved with drug abuse
Viral hepatitis
BBVs
Infection
