CNS - Drug and alcohol abuse Flashcards
Class A
ecstasy, LSD, heroin, cocaine, crack, magic mushrooms, crystal meth
Class B
cannabis, ampohetamines, ketamine, barbiturates, codeine
Class C
tranquilisers, some painkillers, GHB, khat
stimulants
amphetamine
MDMA
cocaine
crack
depressants
benzodiazepines
opoids
alcohol
cannabis
hallucinogens
LSD
magic mushrooms
PCP
ketamine
edwards and gross criteria
narrowing pf behavioural repertoire
salience of drinking and drug use
^^ tolerance
relifer from or avoidance of withdrawal symptoms
post abstinence re-instatement
Assessment
- confirm patient is taking drugs
- assess degree of dependence
- identify physical and mental helath problems
- identify social problems
- assess risk behaviour
- determine patient’s expecttions of treatment and desire to change
- determine need fro substitute medication
- obtain info about dependent children
assessing drug user;
ask about
- type of drugs used
- pattern of use
- when l`st used
- other drugs used
- route of ad.
- history of use
- previous treatment
medical complications of drug misuse
Hazards of drug;
overdose
psychosis
withdrawal seizures
hazards of inj.
viral infections, hiv, hepa B and C
Drug testing
biol. samples used;
urine, oral fluid, hair
2 types of analysis
a) screening test
b) confirmation/ classification test
uses of drug testing;
initial assessment and confirmation of drug use
confirm treatment compliance
monitor illicit drug use
psychosocial interventions
drug related advice and info
advice and support for social problems
harm reduction
motivational interviewing
relapse prevention
Complementary and alt therapies
Harm minimisation strategies
education - condoms, sterile eauipment, dangers of overdose..
direct action; hep B immunisation
opiate analgesia addiction
chronic pain? at risk of developing addiction to opiate painkillers
pharmacological interventions
sub meds for heroin dependence;
methadone
buprenorphine
Espranor
Buvidal
interventions for opiate withdrawal
symptomatic relief of withdrawal symptoms
- paracetamol, aspirin, other NSAIDs
stomach cramps - mebeverine, buscopan
agitation/ anxiety - diazepam & zopiclone
N&V - metoclopramide
diarrhoea - loperamide
lofexidine
not controlled drug
alpha-2 adrenergic agionist inh. noradrenaline release
treatment course between 7-10 days
s.e - dry mouth, drowsiness, hypotension, bradycardia
`methadone
- not expensive
full agonist
well absorbed
85% bioavail. metabolised by liver
cumulative effect, must be titrated
buprenorphine
synthetic opoid
partial agonist
last dose illicit opoids used
Nalozone
opoids antagonist
reverses opoiid
safe, cost effective
Nattrexone foir relapse prevention
opoids antagonist
blocks former opiate user from effect of opiate
can be hepatotoxic
LFT conducted before and during naltrexone treatment
what type of drug is heroin methadone
full agonist
buprenorphine
partial agonist
naloxone naltrexone
antagonist
FASD
fetal alcohol sprectrum disorders
FAS
fetal alcohol symdrome
ARND
slcohol related nerudevelopmental disorders
ARBD
alcohol related birth defects
Excessive alcohol intake can lead to
physical morbidity
psychiatric morbidity
social morbidity
Summary of AWS course
Stage I AWS - appear 6-12 hrs after
Stage II AWS - untreated in stage 1
Stage III AWS - begin 48hrs - 14 days after last drink
Symptom triggered therapy
Patients are rated every 90 minutes using the CIWA-Ar. Scores of 11+ are treated with Diazepam 20mg to a maximum of 200mg daily. When patient scores <11 on two occasions, the treatment is discontinued. THIS SHOULD ONLY BE PRACTISED BY TRAINED TEAMS.
Acamprosate
Reduces glutamate activity by “monitoring” the amount of glutamate that can react at the NMDA receptors
Limits the amount of glutamate released by the neuron
Enhance inhibitory effect of GABAA receptor
Naltrexone
Blocks opioid receptors
Diminishes dopamine release at nucleus accumbens when alcohol is consumed so reducing the pleasurable effects
Reduces cravings during non-drinking periods
Baclofen
Derivative of GABA (agonist for GABAB receptor)
Used for spasticity
Newer use as anti-craving agent for alcohol
Can cause withdrawal symptoms
Addiction Pharmacology
Naltrexone
Chlordiazepoxide
Buprenorphine
Disulfiram
Oxazepam
Naloxone
Acamprosate
Oxycodone
Choose the drug that best fits descriptions below:
Aldehyde dehydrogenase inhibitor
Non-selective long-acting opiate antagonist
Mu opioid receptor partial agonist
Shorter acting mu opioid antagonist
