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Lecture week 4 > Drug dependency > Flashcards

Drug dependency Flashcards

1
Q

What’s dependence?

A

dependence - an adaptive state associated with withdrawal symptoms if exposure to the substance/stimulus is stopped

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2
Q

What effects do opioids produce?

A

Opioids

  • confident, warm, safe, pain-free, invincible /pl niepokonany/
  • constricted pupils, hallucinations, addiction, withdrawal, overdose
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3
Q

What effects do stimulants produce?

A

Stimulants

  • increased energy
  • increased HR, dilated pupils
  • paranoia, anxiety
  • sexual arousal but impotence
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4
Q

What effects do empathogens produce?

A

Empathogens

  • loved, connected, warmth, understanding, arousal, belonging
  • depression, mood swing
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5
Q

What effects do psychedelics produce?

A

Psychedelics

  • ‘trips’, spiritual connection
  • heightened senses, visual/auditory hallucinations
  • anxiety, panic, mental health issues
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6
Q

What effects do dissociatives produce?

A

Dissociatives

  • ‘out of the body’, floating
  • euphoric, disconnected, relaxed
  • scared, unable to move, ‘in a hole’
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7
Q

What effects do cannabinoids produce?

A

Cannabinoids

  • calm, chilled out, giggly, sensual
  • paranoid, dry mouth, lazy, sleepy, mental health issues
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8
Q

What effects do depressants produce?

A

Depressants

  • euphoric, confident, relaxed
  • risk-taking, vomiting, withdrawal
  • unconsciousness, coma, death
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9
Q

Drugs belonging to class A

  • examples
  • prison length
A

Class A

Examples: ecstasy, LSD, crack, cocaine, magic mushrooms, amphetamines (injections)

Prison:

  • possession - up to 7 years
  • dealing - up to life in prison
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10
Q

Drugs belonging to class B

  • examples
  • prison length
A

Class B drugs

Examples: Ketamine, Amphetamines (non-injection)

Prison:

  • possession - up to 5 years
  • dealing - up to 14 years
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11
Q

Drugs belonging to class C

  • examples
  • prison length
A

Class C drugs

Examples: cannabis, tranquilizers, gamma hydroxybutyrate

Prison:

  • possession - up tp 2 years in prison
  • dealing - up to 14 years in prison
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12
Q

What is the fastest method of drug delivery that affects drug concentration in the brain?

A

Inhalation, then injection

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13
Q

What are the effects of cocaine similar to?

A

Halfway between amphetamine and ecstasy

(euphoria, love, agitation, isomnia)

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14
Q

How do amphetamine, cocaine and Ecstasy (MDMA) work on a physiological level?

A

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

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15
Q

Physiological effects of cocaine

A

Cocaine

  • Na+ channel blocker (anaesthetic)
  • stimulant; appetite supressant
  • Triple re-uptake inhibitor (noradrenaline, dopamine, serotonin)
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16
Q

What is more dangerous: cocaine or amphetamine?

A
  • Cocaine is more dangerous
  • due to Na+ channel blockage (coronary and myocardial disease - sudden death)
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17
Q

What’s ‘crack’?

  • components
  • effects
A

‘Crack;

Mixture of: cocaine + sodium bicarbonate (baking soda) + water

Effects: immediate ‘high’ when inhaled

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18
Q

What’s ‘speedball’?

  • components
  • why it is dangerous?
A

‘Speedball’

Mixture of: heroin + cocaine (injection)

*it is particularly dangerous because it masks symptoms of OD

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19
Q

What are the physiological effects of Ecstasy (MDMA)?

A
  • block serotonin & dopamine re-uptake -> more in the synaptic cleft
20
Q

Ecstasy

What are the fatal adverse effects?

A

Ecstasy

  • hyperthermia
  • dehydration
  • overhydration* - as ADH is suppressed

*due to fatal hyponatraemia - occurs in those who consume excess water without replacing electrolytes (ADH suppression)

21
Q

Ketamine

  • class
A

Ketamine

  • complex, multiple sites action

Class: NMDA receptor antagonist - glutamate receptor antagonist

22
Q

Effects of Ketamine

A

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
23
Q

What happens to SNS with intake of Ketamine?

A

Ketamine

SNS stimulant -> ventilatory system is maintained

*used in paediatric sedation and in psychiatry

24
Q

LSD

*physiological effects

* what is the adverse effect?

A

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)

25
Q

gamma-hydroxybutyric acid (GHB)

  • physiology
A

gamma - hydroxybutyric acid

Physiology:

  • CNS agonist, an excitatory receptor agonist, GABA agonist (properties depend how much of the substance is taken)
26
Q

What do low concentrations of gamma-hydroxybutyric acids do?

What do high concentrations do?

A

Low - stimulate dopamine

High - inhibit dopamine via GABA

27
Q

What do the effects of OD with gamma-hydroxybutyric acid look like?

A

Similar to alcohol intoxication but less predictable

28
Q

Magic mushroom

  • physiological effects
A

Magic mushroom

Effects:

  • serotonin agonist
  • psychedelic
29
Q

What’s the danger of ‘magic mushrooms’?

A

It is easy to mistake with Psilocybin *-> cause acute renal and hepatic failure

*may be even picked in the forest

30
Q

What substances are included in Marijuana?

A

Over 60 cannabinoids in marijuana

*pharmacology of most cannabinoids is unknown

31
Q

What is the concern re long-term effects of Marijuana?

A

Possible link to psychosis

32
Q

what’s the timeframe of the detection of marijuana?

A

Marijuana has a half-life of a week -> can be detected weeks after ingestion

*it is lipid soluble

33
Q

Marijuana

  • physiological and psychological effects
A

Marijuana

Physiological: increase in dopamine, serotonin release

*also affects Mu and Delta opioid receptors

Effects: anxiolytic, sedative, analgesic, psychedelic

34
Q

Synthetic cannabinoids

  • example
  • risks
A

Synthetic cannabinoids

e.g. ‘Spice’

*synthesised - hundreds of times more potent than cannabis -> acute presentation

  • high risk of seizures
  • psychosis
  • hyponatraemia
35
Q

Heroin

  • physiological effect (what receptor)
  • effects
A

Heroin

Physiology: Mu opioid receptor agonist

(GABA release is inhibited & reduced inhibitory effect of GABA on dopaminergic neurones)

Effects: euphoria, analgesia, anxiolytic

36
Q

Antidote for opioids

A

Naloxone

37
Q

Desomorphine (Krokodil)

  • what is it synthesised from
  • what’s the danger
A

Desomorphine (Krokodil)

*morphine analogue

  • synthesised from codeine
  • 8 -10 times more potent and more addictive than heroin
  • limbs can be lost, death
38
Q

Serotonin syndrome

- what happens

  • clinical effects
A

Serotonin syndrome

Cause: too much serotonin

Clinical effects: altered mental status, hypertension, tachyarrhythmias, hyperthermia, rhabdomyolysis, muscular rigidity, clonus, hyperreflexia, seizures, death

39
Q

What drugs potentially increase risk of serotonin syndrome?

A

Serotonin syndrome

Risk increased when multiple drugs are taken:

SSRIs, MAOIs, TCAs, SNRIs, Amphetamines, Ecstasy, Cocaine etc

40
Q

Management of serotonin syndrome

A

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
41
Q

Physiological (receptors) effects of alcohol

A

Alcohol

  • GABA receptors are stimulated
  • NMDA (glutamate) receptors are inhibited
  • increased release of opiates
42
Q

What happens in dependency (on neurotransmitter level) and withdrawal

A

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

43
Q

Symptoms of withdrawal of alcohol

A
  • tremor
  • diaphoresis
  • tachycarida
  • anxiety
  • delirium
  • seizures
44
Q

Management of alcohol withdrawal

A

Alcohol withdrawal management

Benzodiazepines +/- dextrose infusion

*Chlordiazepoxide is a benzodiazepine of choice

45
Q

Management of Heroin withdrawal

A

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)
46
Q

Stimulants withdrawal management

A

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)

Lecture week 4 (18 decks)

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