Drug dependency Flashcards
What’s dependence?
dependence - an adaptive state associated with withdrawal symptoms if exposure to the substance/stimulus is stopped
What effects do opioids produce?
Opioids
- confident, warm, safe, pain-free, invincible /pl niepokonany/
- constricted pupils, hallucinations, addiction, withdrawal, overdose
What effects do stimulants produce?
Stimulants
- increased energy
- increased HR, dilated pupils
- paranoia, anxiety
- sexual arousal but impotence
What effects do empathogens produce?
Empathogens
- loved, connected, warmth, understanding, arousal, belonging
- depression, mood swing
What effects do psychedelics produce?
Psychedelics
- ‘trips’, spiritual connection
- heightened senses, visual/auditory hallucinations
- anxiety, panic, mental health issues
What effects do dissociatives produce?
Dissociatives
- ‘out of the body’, floating
- euphoric, disconnected, relaxed
- scared, unable to move, ‘in a hole’
What effects do cannabinoids produce?
Cannabinoids
- calm, chilled out, giggly, sensual
- paranoid, dry mouth, lazy, sleepy, mental health issues
What effects do depressants produce?
Depressants
- euphoric, confident, relaxed
- risk-taking, vomiting, withdrawal
- unconsciousness, coma, death
Drugs belonging to class A
- examples
- prison length
Class A
Examples: ecstasy, LSD, crack, cocaine, magic mushrooms, amphetamines (injections)
Prison:
- possession - up to 7 years
- dealing - up to life in prison
Drugs belonging to class B
- examples
- prison length
Class B drugs
Examples: Ketamine, Amphetamines (non-injection)
Prison:
- possession - up to 5 years
- dealing - up to 14 years
Drugs belonging to class C
- examples
- prison length
Class C drugs
Examples: cannabis, tranquilizers, gamma hydroxybutyrate
Prison:
- possession - up tp 2 years in prison
- dealing - up to 14 years in prison
What is the fastest method of drug delivery that affects drug concentration in the brain?
Inhalation, then injection
What are the effects of cocaine similar to?
Halfway between amphetamine and ecstasy
(euphoria, love, agitation, isomnia)
How do amphetamine, cocaine and Ecstasy (MDMA) work on a physiological level?
Amphetamine, cocaine and ecstasy:
- all increase levels of monoamines (dopamine, serotonin, noradrenaline)
*different balance of monoamines - different behaviors:
A. amphetamine - mostly dopamine
B. Ecstasy - mostly serotonin
Physiological effects of cocaine
Cocaine
- Na+ channel blocker (anaesthetic)
- stimulant; appetite supressant
- Triple re-uptake inhibitor (noradrenaline, dopamine, serotonin)
What is more dangerous: cocaine or amphetamine?
- Cocaine is more dangerous
- due to Na+ channel blockage (coronary and myocardial disease - sudden death)
What’s ‘crack’?
- components
- effects
‘Crack;
Mixture of: cocaine + sodium bicarbonate (baking soda) + water
Effects: immediate ‘high’ when inhaled
What’s ‘speedball’?
- components
- why it is dangerous?
‘Speedball’
Mixture of: heroin + cocaine (injection)
*it is particularly dangerous because it masks symptoms of OD
What are the physiological effects of Ecstasy (MDMA)?
- block serotonin & dopamine re-uptake -> more in the synaptic cleft
Ecstasy
What are the fatal adverse effects?
Ecstasy
- hyperthermia
- dehydration
- overhydration* - as ADH is suppressed
*due to fatal hyponatraemia - occurs in those who consume excess water without replacing electrolytes (ADH suppression)
Ketamine
- class
Ketamine
- complex, multiple sites action
Class: NMDA receptor antagonist - glutamate receptor antagonist
Effects of Ketamine
Ketamine effects
Overall: NMDA receptor antagonist (glutamate receptor antagonist)
Effects: disconnection of thalamocortical and limbic systems -> dissociation of CNS from outside stimuli (e.g. pain, sound, sight)
‘sensory isolation’ is produced
- anaesthesia -> slurred speech, immobilisation
- euphoria
- amnesia
What happens to SNS with intake of Ketamine?
Ketamine
SNS stimulant -> ventilatory system is maintained
*used in paediatric sedation and in psychiatry
LSD
*physiological effects
* what is the adverse effect?
LSD
Physiological effect: serotonin agonist
- very potent - even if people leak small amount - will have a powerful effect lasting even a week
Adverse effect: causes flashbacks - chronic psychiatric problems (10-20 years later)
gamma-hydroxybutyric acid (GHB)
- physiology
gamma - hydroxybutyric acid
Physiology:
- CNS agonist, an excitatory receptor agonist, GABA agonist (properties depend how much of the substance is taken)
What do low concentrations of gamma-hydroxybutyric acids do?
What do high concentrations do?
Low - stimulate dopamine
High - inhibit dopamine via GABA
What do the effects of OD with gamma-hydroxybutyric acid look like?
Similar to alcohol intoxication but less predictable
Magic mushroom
- physiological effects
Magic mushroom
Effects:
- serotonin agonist
- psychedelic
What’s the danger of ‘magic mushrooms’?
It is easy to mistake with Psilocybin *-> cause acute renal and hepatic failure
*may be even picked in the forest
What substances are included in Marijuana?
Over 60 cannabinoids in marijuana
*pharmacology of most cannabinoids is unknown
What is the concern re long-term effects of Marijuana?
Possible link to psychosis
what’s the timeframe of the detection of marijuana?
Marijuana has a half-life of a week -> can be detected weeks after ingestion
*it is lipid soluble
Marijuana
- physiological and psychological effects
Marijuana
Physiological: increase in dopamine, serotonin release
*also affects Mu and Delta opioid receptors
Effects: anxiolytic, sedative, analgesic, psychedelic
Synthetic cannabinoids
- example
- risks
Synthetic cannabinoids
e.g. ‘Spice’
*synthesised - hundreds of times more potent than cannabis -> acute presentation
- high risk of seizures
- psychosis
- hyponatraemia
Heroin
- physiological effect (what receptor)
- effects
Heroin
Physiology: Mu opioid receptor agonist
(GABA release is inhibited & reduced inhibitory effect of GABA on dopaminergic neurones)
Effects: euphoria, analgesia, anxiolytic
Antidote for opioids
Naloxone
Desomorphine (Krokodil)
- what is it synthesised from
- what’s the danger
Desomorphine (Krokodil)
*morphine analogue
- synthesised from codeine
- 8 -10 times more potent and more addictive than heroin
- limbs can be lost, death
Serotonin syndrome
- what happens
- clinical effects
Serotonin syndrome
Cause: too much serotonin
Clinical effects: altered mental status, hypertension, tachyarrhythmias, hyperthermia, rhabdomyolysis, muscular rigidity, clonus, hyperreflexia, seizures, death
What drugs potentially increase risk of serotonin syndrome?
Serotonin syndrome
Risk increased when multiple drugs are taken:
SSRIs, MAOIs, TCAs, SNRIs, Amphetamines, Ecstasy, Cocaine etc
Management of serotonin syndrome
Mx of Serotonin syndrome
Treatment is supportive
- cardiac monitoring (telemetry)
- cooling with IV fluid, ice bath
- benzodiazepines
- BP control
- Cyproheptadine -> anti-histamine with anti-serotoninergic properties
Physiological (receptors) effects of alcohol
Alcohol
- GABA receptors are stimulated
- NMDA (glutamate) receptors are inhibited
- increased release of opiates
What happens in dependency (on neurotransmitter level) and withdrawal
Body get used to a certain level of neurotransmitter (at the synaptic cleft) -> if that level of neurotransmitter is changed (e.g. reduced) -> withdrawal symptoms
Symptoms of withdrawal of alcohol
- tremor
- diaphoresis
- tachycarida
- anxiety
- delirium
- seizures
Management of alcohol withdrawal
Alcohol withdrawal management
Benzodiazepines +/- dextrose infusion
*Chlordiazepoxide is a benzodiazepine of choice
Management of Heroin withdrawal
Mx of heroin withdrawal
- Methadone (opioid analgesic)
- anti-emetics
- Buprenorphine (opioid antagonist-agonist used for the purpose of Rx of opioid withdrawal * less commonly used due to its antagonist-agonist effects on opioids receptors -> may increase withdrawal - mostly used in chronic pain)
Stimulants withdrawal management
Mx of stimulants withdrawal
- mainly supportive
- benzodiazepines
Monitor:
- ECG
- HR - make sure it goes down
- CK - due to risk of rhabdomyolysis (potential arrhythmogenic and renal failure)
