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Psychiatry > Basic Science of Substance Misuse > Flashcards

Basic Science of Substance Misuse Flashcards

1
Q

What are the 2 distinct mechanisms of substance misuse?

A

Tolerance- the basis of physical dependence

Reward centre-the basis of psychological craving

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2
Q

What does tolerance mean?

A

Reduced responsiveness to a drug caused by previous administration

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3
Q

What are a few examples of drugs that people commonly develop tolerance to?

A

Opioids
Ethanol
Barbiturates

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4
Q

What are the 2 mechanisms of tolerance?

A

Dispositional tolerance

Pharmacodynamic tolerance

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5
Q

What does dispositional tolerance mean?

A

Less drug reaches the active site

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6
Q

What are the mechanisms of dispositional tolerance?

A
  • 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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7
Q

What is Pharmacodynamic tolerance?

A

Site of action is less affected by the drug

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8
Q

What are the mechanisms of pharmacodynamic tolerance?

A
  • down-regulation (reduced number) or internalisation of drug receptors
  • reduced signalling down stream of drug receptors
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9
Q

How can the development of tolerance lead to withdrawal symptoms?

A

Drug effect: Reduced transmitter release

Adaptive response: Increased sensitivity to transmitter

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10
Q

What is the withdrawal phenomenon?

A

The withdrawal effect is usually the reverse of the acute effect

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11
Q

What is the acute effect of opioids?

A

Constipation

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12
Q

What is the withdrawal effect of opioids?

A

Diarrhoea

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13
Q

What is the acute effect of barbiturates?

A

Anticonvulsant

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14
Q

What is the withdrawal effect of barbiturates?

A

Convulsions

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15
Q

What is the acute effect of cocaine?

A

Elevated mood

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16
Q

What is the withdrawal effect of cocaine?

A

Depressed mood

17
Q

How are tolerance and dependence linked?

A

Development of tolerance may lead to physical dependence in order to avoid the (unwelcome) withdrawal effects

18
Q

How does heroin increase dopamine in the reward centre?

A

Heroin increases firing rate of dopaminergic neurones

19
Q

How do amphetamines increase dopamine in the reward centre?

A

Increase dopamine release

20
Q

How does cocaine increase dopamine in the reward centre?

A

Inhibits dopamine uptake

21
Q

What do drugs tapping into the reward pathway and increasing dopamine cause?

A

It produces the psychological component of addiction - “craving

Psychiatry (28 decks)

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