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ADH - Care Of Patients > Drug Abuse And Dental Patients > Flashcards

Drug Abuse And Dental Patients Flashcards

1
Q

Define drug abuse

A

Defined as a pattern of pathological behaviour associated with the continual use of a drug or drugs, despite persistent social, psychological or physical problems caused by such use

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2
Q

What issue can drug abuse cause

A

Drug abuse can produce pathological changes eg cardiac and liver damage

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3
Q

Dependence divided in

A

Dependence divided in psychological and physical.

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4
Q

Dependence divided in psychological and physical.

psychological=

A

Psychological; Feeling of satisfaction or psychic drive requiring periodic or continuous
administration of the drug to produce pleasure, or avoid discomfort.

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5
Q

Dependence divided in psychological and physical

physical=

A

Physical; or neuroadaptation , is characterised by physical disturbances when the drug is suspended, or when its actions are antagonized

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6
Q

… DEPENDANCE OFTEN OUTLASTS … DEPENDANCE AND IS THE MAJOR CAUSE OF … IN TREATED ADDICTS.

A

Psychological

Physical

Relapse

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7
Q

Drug tolerance?

A

Tolerance is the reduction in the effect of the drug due to prior exposure, and is dependant on the dose and frequency of the exposure.

The physiological basis for tolerance can be due to the decrease in the number of drug receptors, depletion of essential mediators, or a decrease in the plasma concentration with prolonged usage.

Tolerance may be overcome by increasing the dose of the drug.

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8
Q

ALCOHOL: THE SOCIALLY ACCEPTED ADDICTIVE BEVERAGE

A

ONE OF THE FEW DRUGS THAT DOES NOT ACT ON A SPECIFIC RECEPTOR SITE OF ITS OWN IN THE BODY
PERHAPS AS MANY AFFECTS OUTSIDE THE BRAIN, AS WITHIN, YET ITS USE IS PRIMARILY FOR ITS EFFECTS ON THE CNS

IT IS TOXIC TO ALMOST EVERYTHING, INCLUDING THE LIVER, HEART, BRAIN, GUT, PANCREAS AND FOETUS

PREDOMINENTLY ETHANOL, LESS SO METHANOL
PREDOMINENTLY ORALLY ADMINISTERED, LESS SO SNORTED OR VIA ENEMAS!!

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9
Q

How does alcohol affect the body?

A

10% ABSORBED VIA STOMACH WALL, 90% VIA SMALL INTESTINE (UNDERNORMAL CONDITIONS)

ALCOHOL PASSES CELL MEMBRANE VERY READILY

  1. ALCOHOL DEHYDROGENASE BREAKS ALCOHOL INTO ACETALDEHYDE
  2. ALDEHYDE DEHYDROGENASE TO ACETYL CO-ENZYME A
    - THEN INTO KREBS CYCLE
    - FINALLY PRODUCING CARBON DIOXIDE AND WATER
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10
Q

What causes hangovers from alcohol and how is this formed?

A

ACETALDEHYDE IS THE CAUSE OF THE MAJORITY OF THE UNPLEASENT AFFECTS OF ALCOHOL HANGOVER

EG FLUSHING, SWEATING, NAUSEA

METRONIDAZOLE INHIBITS ALDEHYDE DEHYDROGENASE LEADING TO ACETALDEHYDE ACCUMULATION IN TISSUE

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11
Q

What is a competitive inhibitor of methanol

A

Ethanol

It competes for the enzyme site on alcohol dehydrogenase

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12
Q

How should alcoholism be treated

A

ALCOHOLISM IS A PSYCHIATRIC CONDITION WHICH ORAL HEALTH CARE PROVIDERS MUST TREAT AS A SPECIFIC DISEASE WITHOUT MORAL IMPLICATIONS

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13
Q

Affects of long term alcoholism

A

MALNUTRITION
VIT DEFICIENCES ESPECIALLY VIT B COMPLEX JAUNDICE
NEUROLOGICAL DISORDERS EG TREMOR LIVER DYSFUNCTION
AGGRIVATED CARDIOVASCULAR DISEASE DRUG INTERACTIONS
IMPAIRED COORDINATION
PERSONALITY CHANGES
IMMUNOSUPRESSION
MEMORY LOSS

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14
Q

Affects of alcohol on the oral cavity

A

POOR ORAL HYGIENE
UVULITIS
INCREASED DECAYED, MISSING OR FILLED TEETH PERIODONTAL DISEASE
ORAL MUCOSAL CHANGES
CHANGES IN APPEARANCE OF TONGUE ENLARGED PAROTID GLANDS
XEROSTOMIA
PREDISPOSITION TO ORAL CANCER

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15
Q

Metamphetamine

What is it

A

Potent CNS stimulant
Can be smoked, swallowed, snorted or injected during drug use, with varying rapidity of onset.
Highly addictive, cheap and readily available when compared to some other illicit drugs
Methamphetamine is a powerful, highly addictive stimulant that affects the central nervous system. Also known as meth, chalk, ice, and crystal, among many other terms, it takes the form of a white, odourless, bitter- tasting crystalline powder that easily dissolves in water or alcohol

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16
Q

What is met-amphetamine used for clinically

A

Clinically its used to treat conditions such as ADHD

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17
Q

How is metamphetamine used recreationally

A

Smoking or injecting methamphetamine puts the drug very quickly into the bloodstream and brain, causing an immediate, intense “rush” and amplifying the drug’s addiction potential and adverse health consequences. The rush, or “flash,” lasts only a few minutes and is described as extremely pleasurable. Snorting or oral ingestion produces euphoria—a high, but not an intense rush. Snorting produces effects within 3 to 5 minutes, and oral ingestion produces effects within 15 to 20 minutes.

Because the pleasurable effects of methamphetamine disappear even before the drug concentration in the blood falls significantly, users try to maintain the high by taking more of the drug. In some cases, abusers indulge in a form of binging known as a “run,” foregoing food and sleep while continuing to take the drug for up to several days.

18
Q

Metamphetamine long term effects

A

Addiction
Psychosis, including:
 paranoia
 hallucinations
 repetitive motor activity
 Changes in brain structure and function  Deficits in thinking and motor skills
 Increased distractibility
 Memory loss
 Aggressive or violent behaviour  Mood disturbances
 Severe dental problems
 Due to clenching, dry mouth, poor oh, poor nutrition and gross neglect  Weight loss

19
Q

Cocaine - what is it

A
  • Central Stimulant, amphetamine like drug, blocks the reuptake of Dopamine into nerve terminals
  • Usually snorted
  • Cocaine hydrochloride is water soluble, so can inject it
  • Can also rub onto gums for absorption, as well as dissolve it and inject it
  • Often mixed with all sorts of things to increase profits, eg cornstarch, talc, flour
  • But can be mixed with other substances such as Methamphetamine, fentanyl or Heroin eg “a speedball”
20
Q

What effects does cocaine cause regarding dopamine

A
  • Normally, dopamine recycles back into the cell that released it, shutting off the signal between nerve cells.
  • However, cocaine prevents dopamine from being recycled, causing large amounts to build up in the space between two nerve cells, stopping their normal communication.
  • This flood of dopamine in the brain’s reward circuit strongly reinforces drug-taking behaviours, because the reward circuit eventually adapts to the excess of dopamine caused by cocaine, and becomes less sensitive to it.
  • As a result, people take stronger and more frequent doses in an attempt to feel the same high, and to obtain relief from withdrawal.
21
Q

Other affects of cocaine in the body

A

Cocaine inhibits the reuptake from nor-adrenaline (norepinephrine) by nerve terminals

Causes extreme happiness, mental alertness, hypersensitivity to sight, sound and touch, irritability, paranoia

Also constricted blood vessels, pupil dilation, nausea, irregular heart rate, increased body temperature, increased blood pressure, tremors and muscle twitches, (especially of the face), restlessness AND XEROSTOMIA

Long term increased risk of Parkinson’s, malnourishment due to appetite suppression

Cocaine freely passes through the placenta, leading to fetal hypoxia….. Retardation, congenital malformations, premature birth and in some cases death

22
Q

How does cocaine overdose occur

A

An overdose occurs when a person uses enough of a drug to produce serious adverse effects, life-threatening symptoms, or death.

An overdose can be intentional or unintentional.
Some of the most frequent and severe health consequences of overdose are irregular heart rhythm, heart attacks, seizures, and strokes.

Other symptoms of cocaine overdose include difficulty breathing, high blood pressure, high body temperature, hallucinations, and extreme agitation or anxiety.

23
Q

Marijuana
What is it

A

The plant contains the Tetrahydrocannabinol (THC) a mind-altering chemical

24
Q

How does Marijuana cause effects

A

When a person smokes marijuana, THC quickly passes from the lungs into the bloodstream. The blood carries the chemical to the brain and other organs throughout the body.

25
Q

Possiblephysicalpresentationanddirecteffects

A

 Reddened eyes
 Stained fingers
 Frequent vomiting episode
 Relaxed inhibitions
 Risky unprotected sexual practices  Increased appetite
 Lack of motor coordination
 Distorted perception of time
 Difficulty concentration
 Flattened emotions
 Errors in judgement
 Lack of motivation
 Impaired memory and attention

26
Q

Marijuana pro-facia manifestations

A

Acid erosion of enamel
Dental caries
Inflammation
Stomatitis with Leukedaemia (buccal mucosa)
Hyperkeratosis
Gingival Hyperplasia- risk factor for perio disease
Uvulitis
 Leukoplakia
 Oropharyngeal cancer risk
 Lowered anti-tumour immunity
 Poor Oral Hygiene
 Alveolar bone loss
 Xerostomia

27
Q

Why are opioids

A

OPIATES ARE DRUGS DERIVED FROM OPIUM, AND INCLUDE MORPHINE AND CODEINE, (AND HEROIN)
OPIUM POPPY, BLOOMS ANNUALLY, VARIOUS COLOURS
OPIOIDS ARE A BROADER GROUP OF DRUGS, INCLUDING AGONISTS AND ANTAGONISTS WITH MORPHINE LIKE ACTIVITY
SOMETIMES OPIOIDS ARE REFFERED TO AS NARCOTICS, BECAUSE THEY PRODUCE SLEEPINESS

28
Q

What’s heroin

A

ADD 2 ACETYL GROUPS TO MORPHINE, CREATES DIAMORPHINE AKA HEROIN
HEROIN PASSES BLOOD-BRAIN BARRIER MUCH MORE READILY, AS MORE LIPID SOLUBLE
IDENTICAL EFFECTS AS MORPHINE, BUT 3 TIMES AS POTENT AND MORE RAPID ONSET
ONCE IN THE BRAIN, HEROIN GOES THROUGH A BIOTRANSFORMATION AND IS CONVERTED BACK TO MORPHINE

29
Q

What are opioid antagonist

A

OPIOID ANTAGONISTS ARE DRUGS THAT DISPLACE OPIATES AND RELATED COMPOUNDS FROM RECEPTOR SITES
WHEN OPOID ANTAGONISTS ARE TAKEN PROPHYLACTICALLY, OPIATES ARE UNABLE TO PRODUCE INTOXICATION

THEY ARE ALSO USED IN THE EMERGENCY SITUATION, EG DRUGS OVERDOSE
NALOXONE (NARCAN) AND NALTREXONE (REVIVA), WITHIN SECONDS OF ADMINISTRATION REVERSE COMATOSED PATIENTS
NEED TO REMEMBER HALF LIFE OF ANTAGONISTS CAN BE SHORTER THAN HALF LIFE OF DRUG THEY ARE TREATING

30
Q

BIOBEHAVIOURAL EFFECTS OF OPIOIDS

A

CONSTRICTED PUPILS (MIOSIS)
DECREASED PULSE
DECREASED TEMPERATURE
DECREASED RESPIRATION
SLOWED REFLEXES
SLOW, LOW, RASPY. SLURRED SPEECH
SKIN COOL TO TOUCH
IMPAIRED MEMORY AND ATTENTION
STUPOR AND COMA (OVERDOSE)

31
Q

Opioids Oreo-facial manifestations

A

XEROSTOMIA
POOR ORAL HYGIENE
INCREASED DMF TEETH
CHRONIC MALNUTRITION
INCREASED SUSCEPTIBILITY TO PERIODONTAL DISEASE

32
Q

What affect do opioids have on the brain

A

OPIOIDS DECREASE THE ACTIVITY OF THOSE BRAINSTEM REGIONS THAT MONITOR BLOOD CO2 LEVELS

33
Q

What happens in opioid overdose

A

DEATH BY RESPIRATORY DEPRESSION IS THE USUAL CONSEQUENCE OF AN OPIOID OVERDOSE

34
Q

Chronic opiate abuse does not cause however..

A

UNLIKE MOST OTHER PSYCOACTIVE AND ABUSED DRUGS, CHRONIC OPIATE ABUSE IS NOT GENERALLY ASSOCIATED WITH LIVER, HEART, BRAIN OR OTHER ORGAN DAMAGE

35
Q

CHALLENGES IN THE DENTAL MANAGEMENT OF SUBSTANCE ABUSERS

PAIN CONTROL AND MANAGEMENT

A

Should use local without a vasoconstrictor

Not treat patients that appear high

Not treat patients that are high on Meth Amphetamnine

Dental professionals should be knowledgeable about substance abuse

Longer acting drugs such as Bupivicaine could be used for procedures requiring longer anaesthesia, therefore cutting down on the quantity of drug used

Drug abusers may claim an allergy to codeine in order to receive a stronger drug such as morphine or hydrocodone (not really applicable to general practice in the UK)

36
Q

CHALLENGES IN THE DENTAL MANAGEMENT OF SUBSTANCE ABUSERS

XEROSTOMIA

A

UKNOWN MECHANISM, BUT:
- QUANTITY AND QUALITY OF SALIVA AFFECTED
- ELEVATION OF METABOLISM, LEADING TO DEHYDRATION
- LACK OF GENERAL SELF REGULATION OF HYDRATION LEVELS, (ABUSERS DON’T EAT OR DRINK REGULARLY)
- THE RISK OF DENTAL CARIES, TOOTH SUBSTANCE LOSS/WEAR AND PERIODONTAL DISEASE IS CONSIDERABLY INCREASED BY XEROSTOMIA

37
Q

CHALLENGES IN THE DENTAL MANAGEMENT OF SUBSTANCE ABUSERS.

SOFT TISSUE/MUCOSAL/CUTANEOUS DAMAGE

A

VERY COMMOM IN COCAINE USERS

SOME USERS SNORT COKE, LEADS TO DAMAGE OF NASAL TISSUE AND CAN PERFORATE

SOME RUB ON TO GINGIVAL TISSUES, LEADS TO RECESSION AND POSSIBLE BUCCAL CARIES, IF MIXED WITH ICING SUGAR/CORN FLOUR

COCAINE HAS A VASOCONSTRICTIVE AFFECT LEADING TO ULCERATION AND ATROPHY OF THE TISSUES

MORPHINE EXERTS AN INHIBITORY EFFECT ON THE PHAGOCYTOSIS OF CANDIDA BY MACROPHAGES, SO TOGETHER WITH REDUCES SALIVA FORMATION/FUNCTION CAN LEAD TO ORAL CANDIDOSIS

SMOKING CANNABIS, COCAINE, SPICE CAN LEAD TO TISSUE DYSPLASIA

38
Q

CHALLENGES IN THE DENTAL MANAGEMENT OF SUBSTANCE ABUSERS

TEMPEROMANDIBULAR JOINT DISORDERS, INCLUDING BRUXISM, CLENCHING AND GRINDING

A

VERY COMMON IN CHRONIC SUBSTANCE ABUSERS

ONE RESEARCH PAPER SHOWED 75% OF PEOPLE “FELT LIKE CHEWING SOMETHING” AFTER TAKING SUCH DRUGS

CAN LEAD TO EARLY TOOTH LOSS\AGGREVIATES THE EFFECTS OF PERIODONTAL DISEASE

39
Q

CHALLENGES IN THE DENTAL MANAGEMENT OF SUBSTANCE ABUSERS

Diet

A

SUBSTANCE ABUSERS USUALLY HAVE UNHEALTHY DIETS AS A CONSEQUENCE OF THEIR CHAOTIC LIFESTYLE

OFTEN HAVE POOR OR SUPRESSED APPETITES, ALTERED TASTE AND SMELL SENSATIONS

OFTEN CRAVE FOR SUGAR, OF WHICH THEY CONSUME HUGE AMOUNTS

PRIORITY IS NOT TO MAINTAIN GOOD DIETARY HABITS, BUT TO SECURE NEXT HIT

40
Q

THE TREATMENT OF DENTAL CARIES AND PERIODONTAL DISEASE IN SUBSTANCE ABUSERS IS OFTER VERY DIFFICULT DUE TO THE …..

A

MULTIFACTORIAL NATURE OF THEIR DISEASE

41
Q

TIPS ON TALKING WITH PATIENTS ABOUT SUBSTANCE ABUSE

A

COMMUNICATE YOUR CONCERN
OFFER SUPPORT
AVOID SHAMING
ASK NON-JUDEMENTAL QUESTIONS
DEVELOP TRUST AND OFFER HOPE

ADH - Care Of Patients (6 decks)

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