Clinical aspects of substance misuse Flashcards
Name 5 Class A drugs
- Heroin
- Cocaine
- Ectasy
- Street Methadone
- LSD
Name 2 Class B drugs
- Barbiturates
- Amphetamine
Name 3 Class C drugs
- Benzodiazepines
- Ketamine
- Cannabis
Which unclassified substances pose more of a risk than some Class A and B drugs? (3)
- Alcohol
- Tobacco
- Solvents
What are the most commonly abused substances in the UK which tend to have the biggest impact on local health services/communities?
Alcohol!
Heroin / opiates
Benzodiazepines
Cocaine (powder) / crack cocaine (smoked)
Cannabis
Give 4 examples of stimulant drugs
- Cocaine
- Amphetamine (speed) - not as widely used nowadays
- Methamphetamine (meth) - never been a big problem in the UK
- Methylphenidate
How does Cocaine work?
It is a monoamine reuptake inhibitor
- Monoamines such as dopamine, serotonin and noradrenaline are increased after taking cocaine
- Reuptake inhibitors inhibit the reuptake of dopamine etc therefore meaning their levels in the synaptic cleft increase
- Because of this increase in dopamine/serotonin/noradrenaline you get a sensation/rush of euphoria / less need for sleep etc
How quickly do the different forms of Cocaine effect you?
The effects of cocaine depend on the dose and rate of entry to the brain
Smoking - almost immediate
Injecting - 15 to 30 secs
Snorting - 3 to 5 mins
The effects of crack smoking are very intense but quickly over ( 15 mins)
What are the effects of cocaine? i.e what does it do to the body and how do you feel after taking it?
- Euphoric
- It is a stimulant
- It has an anaesthetic effect
- Hypersensitive
- Increased alertness and energy
- Increased confidence (arrogant, loud) and impaired judgement
- Lessens appetite and lessens desire for sleep
- If mixed with alcohol - produces cocaethylene (sort of like cocaine but with a longer half life)
- Damage to nose and airways - septal erosion
- Convulsions with respiratory failure
- Cardiac arrhythmias and MI
- Hypertension and CVA
- Toxic confusion
What are the withdrawal effects from cocaine?
- Depression
- Irritability
- Agitation
- Craving
- Hyperphagia - abnormally strong sensation of hunger or desire to eat
- Hypersomnia - excessive sleepiness
PRETTY MUCH THE OPPOSITE OF DRUG EFFECT
What are amphetamines?
A CNS stimulant that can be sniffed, swallowed or injected
- Its effects are similar to cocaine (dopamine enhancer) but longer lasting
- Toxic confusion occasionally with convulsions and death
- Can get Amphetamine psychosis in heavy chronic use
What is the difference between opioids and opiates?
Opioids are a class of drugs that are commonly prescribed to treat pain.
Opioids include both opiates, natural drugs derived from the opium poppy and synthetic opioids.
Give some examples of opiates (5)
- Opium - comes from poppies
- Morphine - natural
- Heroin (diamorphine) - man made drug - synthesised from morphine
- Methadone - synthetic (opioid)
- Oxycodone (opioid)
- Codeine and dihydrocodeine
How do Opiates work generally / why do people generally take them?
They can depress the nervous system to reduce physical and psychological pain.
Heroin
- How does Heroin effect you?
- Method of action?
- Half life time?
- Sense of analgesia and euphoria + mood effects
- It is an opioid agonist - it acts on Mu, delta and kappa opioid receptors
- Half life = 30 mins - if you are dependent on it you will need multiple administrations i.e because of the short half life you need to top it up to not go into withdrawal (approx every 4 hours). Tend to go into acute withdrawals in the middle of the night,
Effects of heroin
- Analgesia - very potent analgesic - you have a sensation of feeling the pain but you don’t care as much about it
- Emotional analgesia - the same ^ applies for this - you know your life is unmanageable / you have problems etc but you don’t care as long as you have heroin in your system
- Nausea initially - usually given morphine with an anti-emetic - remember you were sick from your morphine after surgery
- Euphoria
- Pin point pupils
- Itching/sweating
- Constipation
- Decreased libido/menstrual irregularities
- Reduced cough reflex - increases risk of respiratory infections etc (loss of defence)
What happens when you overdose on heroin?
- Respiratory depression
- Snoring - can often just seem like they’re sleeping but if they start snoring then that indicates risk
- Bradycardia
- Hypotension
- Death
Risk of overdose and death is increased if mixed with other respiratory depressants – alcohol, benzodiazepines etc
What is given to people who have either come to A&E with suspected heroin overdose or been given too much analgesia on a medical ward?
Give them naloxone - an opiate antagonist which will immediately reverse that effect
Side effects of opiates
First time use - nausea/vomiting and headache
Medium term:
- Phlebitis - inflammation of the vein
- Endocarditis
- Injection site injuries / consequences - blood borne viruses i.e hep B and C
- Anorexia
- Constipation
Longer term:
- Tolerance / Withdrawal cycle
- Social and health problems - drug becomes your whole life
Opiate withdrawal syndrome / symptoms?
- Very marked craving
- Insomnia - very severe - can last for days
- Yawning
- Muscle pain and cramps
- Increased salivary, nasal and lacrimal secretions
- Dilated pupils
- Piloerection - erection or bristling of hairs
INTENSE
Why is methadone given out to reduce opiate use?
- It reduces risk
- Once a day preparation - long half life
- Allows a degree of normalisation of lifestyle
- Reducing amount of times they will inject
Give some examples of benzodiazepines (6)
- Diazepam (valium)
- Nitrazepam
- Temazepam
- Alprazolam (Xanax)
- Lorazepam
- Etizolam
What are benzodiazepines?
- They are anxiolytics and sedatives - GABA agonists
- Used mainly for acute withdrawal /sedation
- However, these drugs can be found easily on the internet - can buy lethal amounts easily online
How does Ecstasy i.e MDMA / Mandy make you feel?
- Relaxed euphoric state without hallucinations 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
Side effects of Ecstasy
- 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
What is the most commonly used illicit drug?
Cannabis
- What are the main 2 active components of cannabis?
- What are the effects of these 2 active components?
- What is important about the ratio between the two?
- THC and CBD
- THC – psychedelic effects – bright colours, jokes are funnier, euphoriant, increases appetite – affects mental state. CBD – anxiolytic / anti-psychotic affect (more of a healthy drug).
- The higher the THC the higher the risk! You can buy different cannabis with different levels of THC/CBD
What issues are associated with cannabis use?
- It can cause respiratory problems
- If you are a younger person and smoke high THC potency cannabis you are at increased risk of Schizophrenia
- Exacerbation of major mental illness
- If person has a predisposition to psychotic illness then cannabis use will make this worse
Performance or image enhancing drug examples
- Anabolic steroids - comprise of testosterone etc - legitimately prescribed in hypogonadism, muscular dystrophy, various anaemias, wasting in AIDS
- Growth hormone
- Injectable tanning agents e.g melotan
Steroid side effects
- Skin – acne, stretch marks, baldness
- Feminisation in males with hypogonadism and gynaecomastia (occasioning use of anti-oestrogens)
- Virilisation in women including hirsutism, deep voice, clitoral enlargement, menstrual irregularities, hair thinning
- Cardiovascular – increased cholesterol and hypertension
- Growth deficits due to premature closure of epiphyses
- Liver Disease – cholestatic jaundice, liver tumours
- Irritability and anger – ‘roid rage’
- Hypomania and mania
- Depression and suicidality on withdrawal
How did legal highs come about?
Found a loophole in the law where by you could slightly alter the chemical make up of class A/B/C drugs and then you could sell it online etc as a legal high whilst avoiding the drug laws
