Drug Abuse Flashcards
What class of drugs are the following: morphine, methadone, meperidine, codeine, opium, heroin?
opiates
What class of drugs are the following: alcohol, benzodiazepines, barbituates?
CNS depressants
What class of drugs are the following: amphetamines, cocaine, caffeine, nicotine?
CNS stimulants
What class of drugs are the following: MDMA, LSD, PCP, THC
hallucinogens
What class of drugs are the following: toulene [glue], nitrous oxide, gasoline
inhalants
What is “the pattern of compulsive drug use characterized by overwhelming involvement with getting and using drugs with high likelihood of relapse”?
Substance dependence
What term describes the strong desire to achieve pleasure, avoid dysphoria and continue drug use?
What drugs does it occur with?
Psychological dependence- occurs with all drugs of abuse even in the ABSENCE of physical dependence
What term describes the reduction in response to a drug after repeated use?
Tolerance
What is cross-tolerance?
When 2 drugs affect the same receptor or metabolic pathway and tolerance to one automatically causes tolerance to the second:
ex. alcohol and benzos
What is behavioral tolerance?
Learning to act normally despite impairment
ex. alcoholics learning to act sober
What term describes the change in distribution OR metabolism of a drug with repeated use so that the plasma and tissue levels are reduced relative to the first dose?
kinetic [pharmacokinetic] tolerance
ex. phenobarbitol induces liver enzymes
What is the adaption to a drug by the downregulation of receptors?
Cellular tolerance- adaptation to a drug at the cellular level
What is the state that develops from re-setting homeostatic mechanisms in response to repeated drug use?
Physical dependence - it can be a normal response to clinical therapy of many drugs
What is cross-dependence?
One drug class substitutes for another to prevent abstinence syndrome/withdrawal.
Ex. benzodiazepines for alcohol withdrawal, methadone for heroin
What are the medical uses of opioids?
What are they abused for?
- pain, cough, diarrhea
- methadone is used for detox and maintenance of functional but dependent state
Abused for euphoria initially, and then relief later
For opioids, tolerance develops quickly to ______ however ____ and ____ are likely to persist.
Tolerance is quick to most things, including euphoria and respiratory depression.
Miosis and constipation are likely to persist
What kinds of dependence develop for opioids?
which type of dependence is most likely to cause recidivism?
psychological and physical
cross-tolerance and cross dependence [methadone]
Recidivism is most often caused by psychological dependence
What are the early characterisitics of abstinence syndrome from morphine or heroin?
When does it occur?
8-12 hours they get:
- rhinorrhea
- salivation
- lacrimation
- yawning and stretching
What are the later characteristics of abstinence syndrome of heroin/morphine [but not yet peak]?
restless sleep piloerection mydriasis anorexia tremor
What are the peak symptoms of abstinence syndrome from heroin/morphine?
When does it occur?
48-72 hr after the drug the patient will have:
- constant movement
- chills, sweating
- insomnia
- gut pain with retching and vomiting
When the patient is recovering from abstinence syndrome, what are they experiencing ?
- psychological dependence/craving
- insomnia
- muscle aches, weakness
What differentiates abstinence syndrome associated with heroin/morphine vs. CNS depressants like alcohol/benzos/barbituates?
Opioid abstinence is uncomfortable but NOT life threatening.
CNS depressant abstinence is life threatening because it leads to excitation w/ convulsions, exhaustion and cardio collapse
What are the signs of an acute overdose of heroin?
What is treatment?
Respiratory depression, pulmonary edema, cardiovascular collapse
Treatment is naloxone and support
What is treatment for overdose of opioid in a chronic user?
Support only because naloxone can precipitate withdrawal
What is Ts and blues?
psychosis, seizures, subcutaneous abscesses and muscle necrosis from opioids
What is the recidivism rate for heroin/morphine?
85%- mostly due to “triggers” and psychological dependence
What are the approaches to detox for heroin/morphine?
- methadone taper - 20days
- methadone + clonidine = 10-14 days
- methadone, clonidine, naltrexone = 4-5 days*
- buprenorphrine+ clonidine+naltrexone = 1 days*
What is the MOA of naltrexone?
It is used as chronic treatment to prevent reinforcement by subsequent exposure to acheive drug seeking behavior
What are the medical uses of CNS depressants?
- sedation
- anticonvulsion
- anesthesia
- insomnia relief
- methanol intoxication
What tolerances develop for CNS depressants?
What is there minimal tolerance for?
Tolerance to euphoria and sedative action
Minimal tolerance to respiratory depression [which can make it lethal]
There is some kinetic tolerance
What CNS depressants will have more intense abstinence syndrome?
Short acting agents like phenobarbital
What occurs in the first 12-16 hours of abstinence syndrome for CNS depressants?
24?
2-3 days?
4 days?
12-16: restlessness, anxiety, tremor, nausea, vomiting, cramps
24: cant get up, hyperreflexic, purposive behavior
2-3 days: convulsions [peak for short acting]
4: delerium, hallucinations, agitation, hyperthermia, exhaustion, cardio collapse
With alcohol withdrawal, how long until hallucinations and seizures?
How long to develop delerium tremons [confusion, disorientation, delusions] ?
Hallucinations and seizures in a day, delerium tremons in about 2
What can treat overdoses of CNS depressants?
For most, you just need to treat symptoms because there isn’t good pharmacological or physiological antagonists.
Exception : flumenazil for benzodiazepines
How is withdrawal from a CNS depressant treated?
Put them on a stabilized CNS depressant [with a long half life–> benzo] and withdraw slowly
What are CNS stimulants used for medically?
- ADHD
- narcolepsy
- obesity
- local anesthesia
A patient is excited, restless, insomniac, anorexic, speaks rapidly and has mydriasis. What type of drug are they probably on?
CNS stimulant
What symptoms characterize withdrawal of CNS stimulants?
fatigue, sleep, psychological depression, craving, hunger
What is the MOA of cocaine? How does the length and intensity of its action compare to amphetamines?
It is shorter and more intense.
Cocaine inhibits the reuptake of NE and DA leading to increased synaptic concentration and psychomotor stimulation
Amphetamines release NE and DA and competitively inhibit MAO
What acute problems are associated with CNS stimulants?
- cardiovascular- HTN, arrhythmia, angiospasm, infarction
- hyperthermia
- convulsions
What are the major hallucinogens?
PCP, LSD, mescaline, MDMA [ecstasy], THC
What is the ONLY medical use for hallucinogens?
weed is used as an anti-emetic in cancer chemo and for glaucoma
What dependence develops to hallucinogens?
use is intermittent so there is no appreciable physical dependence
A patient presents with visual hallucinations, moods changes, perceptual disturbances, distorted body image.
On PE, the patient has mydriasis, tachycardia, HTN, piloerection and hyperthermia.
What drug are they probably on? What is the potency?
What are negative side effects?
LSD- high potency [25micrograms] can cause hallucinations
Negative effects:
panic reactions [bad trip], depersonalization, paranoia, flashbacks, depression, suicide
What are the physiological effects of THC at low and high doses?
low:
tachycardia, HTN, reddening of conjunctiva, sedation, impaired memory/motor skills
High:
visual hallucinations, anxiety, paranoia, psychotic rxns
What is the mechanism of action of PCP?
blocks NMDA receptors like ketamine
Individual responses vary to the drug
What is PCP abused for?
euphoria, sense of power, strength, invulnerability
What drug at small doses causes numbness, slurred speech, nystagmus, sweating, gait disturbance, bizarre behavior and at larger doses analgesia, hallucinations, psychtic state?
PCP
When does PCP psychosis occur after taking the drug?
What can precipitate it?
What does it mimic?
What is treatment?
It can be temporally distant from administration, but often is precipitated by re-exposure to the drug.
It mimics schizophrenia.
Treatment:
- prevent injury to patient
- reduce external stimuli
- ameliorate psychosis with neuroleptic
What does a PCP overdose look like for low levels, moderate levels and severe?
Low: conscious, violent, self-destructive
Moderate: unconscious, no airway probs
Severe: comatose, airway compromise, seizures
Which drug causes dehydration, bruxism and hyperthermia?
Ecstasy [MDMA]
What are the negative effects of inhalants [toulene, gas, NO]?
- liver, kidney, brain damage [except NO]
- asphyxiation –> anoxia
- ventricular standstill
What behavioral manifestations are associated with steroid abuse?
- aggression
- increased or decreased libido
- irritability
- impaired cognitive functions
- psychotic symptoms
What are the cardio and hepatic toxicities of steroids?
cardio- MIs
hepatic- increases in AST/ALT, edema, jaundice
What does abstinence syndrome of anabolic steroids present with?
depression, fatigue, craving for steroids with drug seeking behavior
What are the lab findings for steroid abuse?
- decreased LH
- increased LDL, decreased HDL
- increased Hb, Hct
- increased liver enzymes
What are the ABCs of general treatment of drug overdose?
- Airway
- Breathing
- cardio - IV fluid to maintain BP
- drugs- identify the cause and initiate drug screen
- environment
