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Psychiatry > Drug Abuse > Flashcards

Drug Abuse Flashcards

1
Q 
What class of drugs are the following:
morphine, methadone, meperidine, codeine, opium, heroin?
A

opiates

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2
Q 
What class of drugs are the following:
alcohol, benzodiazepines, barbituates?
A

CNS depressants

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3
Q 
What class of drugs are the following:
amphetamines, cocaine, caffeine, nicotine?
A

CNS stimulants

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4
Q 
What class of drugs are the following:
MDMA, LSD, PCP, THC
A

hallucinogens

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5
Q 
What class of drugs are the following:
toulene [glue], nitrous oxide, gasoline
A

inhalants

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6
Q

What is “the pattern of compulsive drug use characterized by overwhelming involvement with getting and using drugs with high likelihood of relapse”?

A

Substance dependence

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7
Q

What term describes the strong desire to achieve pleasure, avoid dysphoria and continue drug use?
What drugs does it occur with?

A

Psychological dependence- occurs with all drugs of abuse even in the ABSENCE of physical dependence

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8
Q

What term describes the reduction in response to a drug after repeated use?

A

Tolerance

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9
Q

What is cross-tolerance?

A

When 2 drugs affect the same receptor or metabolic pathway and tolerance to one automatically causes tolerance to the second:
ex. alcohol and benzos

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10
Q

What is behavioral tolerance?

A

Learning to act normally despite impairment

ex. alcoholics learning to act sober

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11
Q

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?

A

kinetic [pharmacokinetic] tolerance

ex. phenobarbitol induces liver enzymes

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12
Q

What is the adaption to a drug by the downregulation of receptors?

A

Cellular tolerance- adaptation to a drug at the cellular level

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13
Q

What is the state that develops from re-setting homeostatic mechanisms in response to repeated drug use?

A

Physical dependence - it can be a normal response to clinical therapy of many drugs

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14
Q

What is cross-dependence?

A

One drug class substitutes for another to prevent abstinence syndrome/withdrawal.

Ex. benzodiazepines for alcohol withdrawal, methadone for heroin

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15
Q

What are the medical uses of opioids?

What are they abused for?

A
  1. pain, cough, diarrhea
  2. methadone is used for detox and maintenance of functional but dependent state

Abused for euphoria initially, and then relief later

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16
Q

For opioids, tolerance develops quickly to ______ however ____ and ____ are likely to persist.

A

Tolerance is quick to most things, including euphoria and respiratory depression.
Miosis and constipation are likely to persist

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17
Q

What kinds of dependence develop for opioids?

which type of dependence is most likely to cause recidivism?

A

psychological and physical
cross-tolerance and cross dependence [methadone]

Recidivism is most often caused by psychological dependence

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18
Q

What are the early characterisitics of abstinence syndrome from morphine or heroin?
When does it occur?

A

8-12 hours they get:

  1. rhinorrhea
  2. salivation
  3. lacrimation
  4. yawning and stretching
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19
Q

What are the later characteristics of abstinence syndrome of heroin/morphine [but not yet peak]?

A 
restless sleep
piloerection
mydriasis 
anorexia
tremor
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20
Q

What are the peak symptoms of abstinence syndrome from heroin/morphine?
When does it occur?

A

48-72 hr after the drug the patient will have:

  1. constant movement
  2. chills, sweating
  3. insomnia
  4. gut pain with retching and vomiting
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21
Q

When the patient is recovering from abstinence syndrome, what are they experiencing ?

A
  1. psychological dependence/craving
  2. insomnia
  3. muscle aches, weakness
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22
Q

What differentiates abstinence syndrome associated with heroin/morphine vs. CNS depressants like alcohol/benzos/barbituates?

A

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

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23
Q

What are the signs of an acute overdose of heroin?

What is treatment?

A

Respiratory depression, pulmonary edema, cardiovascular collapse

Treatment is naloxone and support

24
Q

What is treatment for overdose of opioid in a chronic user?

A

Support only because naloxone can precipitate withdrawal

25
Q

What is Ts and blues?

A

psychosis, seizures, subcutaneous abscesses and muscle necrosis from opioids

26
Q

What is the recidivism rate for heroin/morphine?

A

85%- mostly due to “triggers” and psychological dependence

27
Q

What are the approaches to detox for heroin/morphine?

A
  1. methadone taper - 20days
  2. methadone + clonidine = 10-14 days
  3. methadone, clonidine, naltrexone = 4-5 days*
  4. buprenorphrine+ clonidine+naltrexone = 1 days*
28
Q

What is the MOA of naltrexone?

A

It is used as chronic treatment to prevent reinforcement by subsequent exposure to acheive drug seeking behavior

29
Q

What are the medical uses of CNS depressants?

A
  1. sedation
  2. anticonvulsion
  3. anesthesia
  4. insomnia relief
  5. methanol intoxication
30
Q

What tolerances develop for CNS depressants?

What is there minimal tolerance for?

A

Tolerance to euphoria and sedative action
Minimal tolerance to respiratory depression [which can make it lethal]
There is some kinetic tolerance

31
Q

What CNS depressants will have more intense abstinence syndrome?

A

Short acting agents like phenobarbital

32
Q

What occurs in the first 12-16 hours of abstinence syndrome for CNS depressants?
24?
2-3 days?
4 days?

A

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

33
Q

With alcohol withdrawal, how long until hallucinations and seizures?
How long to develop delerium tremons [confusion, disorientation, delusions] ?

A

Hallucinations and seizures in a day, delerium tremons in about 2

34
Q

What can treat overdoses of CNS depressants?

A

For most, you just need to treat symptoms because there isn’t good pharmacological or physiological antagonists.

Exception : flumenazil for benzodiazepines

35
Q

How is withdrawal from a CNS depressant treated?

A

Put them on a stabilized CNS depressant [with a long half life–> benzo] and withdraw slowly

36
Q

What are CNS stimulants used for medically?

A
  1. ADHD
  2. narcolepsy
  3. obesity
  4. local anesthesia
37
Q

A patient is excited, restless, insomniac, anorexic, speaks rapidly and has mydriasis. What type of drug are they probably on?

A

CNS stimulant

38
Q

What symptoms characterize withdrawal of CNS stimulants?

A

fatigue, sleep, psychological depression, craving, hunger

39
Q

What is the MOA of cocaine? How does the length and intensity of its action compare to amphetamines?

A

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

40
Q

What acute problems are associated with CNS stimulants?

A
  1. cardiovascular- HTN, arrhythmia, angiospasm, infarction
  2. hyperthermia
  3. convulsions
41
Q

What are the major hallucinogens?

A

PCP, LSD, mescaline, MDMA [ecstasy], THC

42
Q

What is the ONLY medical use for hallucinogens?

A

weed is used as an anti-emetic in cancer chemo and for glaucoma

43
Q

What dependence develops to hallucinogens?

A

use is intermittent so there is no appreciable physical dependence

44
Q

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?

A

LSD- high potency [25micrograms] can cause hallucinations

Negative effects:
panic reactions [bad trip], depersonalization, paranoia, flashbacks, depression, suicide

45
Q

What are the physiological effects of THC at low and high doses?

A

low:
tachycardia, HTN, reddening of conjunctiva, sedation, impaired memory/motor skills

High:
visual hallucinations, anxiety, paranoia, psychotic rxns

46
Q

What is the mechanism of action of PCP?

A

blocks NMDA receptors like ketamine

Individual responses vary to the drug

47
Q

What is PCP abused for?

A

euphoria, sense of power, strength, invulnerability

48
Q

What drug at small doses causes numbness, slurred speech, nystagmus, sweating, gait disturbance, bizarre behavior and at larger doses analgesia, hallucinations, psychtic state?

A

PCP

49
Q

When does PCP psychosis occur after taking the drug?
What can precipitate it?
What does it mimic?
What is treatment?

A

It can be temporally distant from administration, but often is precipitated by re-exposure to the drug.
It mimics schizophrenia.

Treatment:

  1. prevent injury to patient
  2. reduce external stimuli
  3. ameliorate psychosis with neuroleptic
50
Q

What does a PCP overdose look like for low levels, moderate levels and severe?

A

Low: conscious, violent, self-destructive
Moderate: unconscious, no airway probs
Severe: comatose, airway compromise, seizures

51
Q

Which drug causes dehydration, bruxism and hyperthermia?

A

Ecstasy [MDMA]

52
Q

What are the negative effects of inhalants [toulene, gas, NO]?

A
  1. liver, kidney, brain damage [except NO]
  2. asphyxiation –> anoxia
  3. ventricular standstill
53
Q

What behavioral manifestations are associated with steroid abuse?

A
  1. aggression
  2. increased or decreased libido
  3. irritability
  4. impaired cognitive functions
  5. psychotic symptoms
54
Q

What are the cardio and hepatic toxicities of steroids?

A

cardio- MIs

hepatic- increases in AST/ALT, edema, jaundice

55
Q

What does abstinence syndrome of anabolic steroids present with?

A

depression, fatigue, craving for steroids with drug seeking behavior

56
Q

What are the lab findings for steroid abuse?

A
  1. decreased LH
  2. increased LDL, decreased HDL
  3. increased Hb, Hct
  4. increased liver enzymes
57
Q

What are the ABCs of general treatment of drug overdose?

A
  1. Airway
  2. Breathing
  3. cardio - IV fluid to maintain BP
  4. drugs- identify the cause and initiate drug screen
  5. environment

Psychiatry (18 decks)

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