Drugs Flashcards
Define drug addiction
Chronic relapsing disorder
Characterised by compulsive drug seeking and use despite adverse consequences
Brain disorder - functional changes to brain circuits involved in reward, stress and self control
- can last a long time after person has stopped taking drugs
Define drug misuse
Taking a drug which harms or threatens to harm the physical or mental health or social well-being of an individual or other individuals or society of large or which is illegal
Misuse of drugs act
Provides legal framework for control of drugs according to potential for misuses
Classifies drugs and penalties based on harm/addictiveness
Drug classifications
Class A - major opiates - cocaine, crack -LSD - injected amphetamines - magic mushrooms - MDA - Dealing -> up to life - Possession -> up to 7 years Class B - cannabis - oral amphetamines - Ritalin - pholcodine - mephedrone - synth cannabinoids - Dealing -> up to 14 years - Possession -> up to 5 years Class C - tranquilisers (benzodiazepines) - some painkillers (buprenorphine, dextropropoxyphene) - GHB - ketamine - Dealing up to 14 years - Possession up to 2 years
Features of addictive process
An initial pleasurable effect
Rebound unpleasant effect on stopping
Drug dependence
Psychological dependence Neuroadaptation Tolerance Physical dependence Withdrawal syndromes
Drug related deaths in Scotland
Heroin commonest single drug - poly use most common Big rise in over 35 age group Mostly white males from deprived areas 75% unemployed 75% single 50% living alone 33% have children
Features of drug related deaths
75% occur at home 66% someone in vicinity Ambulance attends in 80% Resus attempted in 50% Heroin in 59% Methadone in 32% Diazepam in 28% Alcohol in 30% Polydrug use is normal
Features of canabis
Active compound - tetrahydrocannabinol (THC)
Herbal cannabis comes from dried leaves, flowers
Cannabis resin (hash)
Cannabis oil - solvent extraction from resin
Smoked as joint or spliff, in pipe or bone, brewed as tea, eaten as cookies
Acute psychological effects of cannabis
Talkative, hilarity, well-being, confidence Appreciation of sound and colour Time slows Nausea Hunger Poor concentration Impaired driving Anxiety, agitation, paranoia Cannabis psychosis
Acute physical effects of cannabis
Dry mouth Dilated pupils Red eyes Tachycardia Hypertension Postural hypotension
Chronic effects of cannabis
Psychosis - schizophrenia Amotivational syndrome Reduced sperm count in men Reduced fertility in women Bronchitis and emphysema Query lung caner
Features of cannabis withdrawal
Irritability Mood change Restlessness Loss of appetite Weight loss Insomnia
Acute effects of benzodiazepines
Relief of anxiety and relaxation Impaired memory Paradoxical aggression Uncharacteristic criminal behaviour Uncontrollable emotions Effects potential by alcohol Hangover Dizziness Sedation Incoordination Sexual dysfucntion Weight gain Hypotension and coma with high dose
Chronic effects of benzodiazpeines
Chronic intoxication
Tolerance
Psychosocial and physical dependence
Benzodiazepine withdrawal
2-3 days on Anxiety, insomnia Sweating and headache Tremors Nausea Disordered perceptions Hypersensitive to stimuli Psychosis Convulsions
Chronic adverse effects of amphetamines
Aggression, fatigue and insomnia Anorexia, malnutrition and weight loss Diarrhoea and vomiting Heart muscle damage Chronic paranoid psychosis Depression Schizophrenia
Features of cocaine
Naturally occurring stimulant
Coca leaf from south America
Illegal manufacture - leaf, paste, powder
Snorted, smoked, rubbed on, injected
Powder heated with baking soda to make crack - smoked
Strong craving but less dependence and withdrawal syndrome
Acute pscyhoclical effects of cocaine
Euphira, well-being
Formication - feels like insects under skin
Irritability and confusion
Hallucinations, paranoia and depression
Acute phsycial effects of cocaine
Tachycardia, hypertension, tachypnoea
Dilated pupils
Increased mental excitement
Hyperpyrexia
Chronic effects of cocaine
Chest pains, muscles spasm Weight loss Perforated nasal septum Crack keratitis of eyes Erosion of tooth enamel Crack callus of fingers Male impotence, female orgasm problems
Features of cocaine withdrawal
Crash rather than true withdrawal Intense psychological craving Irritability and depression Muscle pains, tremor Hunger Exhaustion and prolonged sleep
Detection of cocaine and metabolites
Blood Urine Nasal swabs Hair Saliva
Commonly misused drugs
Opiates - morphine, heroin, methadone Depressants - alcohol, barbiturates Benzodiazepines - diazepam, temazepam Stimulants - amphetamines, cocaine Hallucinogens - LSD, mushrooms Others - cannabis - nicotine - VSA
Define drug abuse
An excessive or improper use of drugs
- especially through self-administration for nonmedical purposes
Define drug dependence
Physical or psychologic state in which a person displays withdrawal symptoms if drug use is halted suddenly
- can lead to addiction
Define dependence syndrome
Cluster of behavioural, cognitive and physiological phenomena that may develop after repeated substance use
- strong desire to take the drug
- impaired control over its use
- persistent use despite harmful consequences
- higher priority given to drug use than other activities and obligations
- increased tolerance and a physical withdrawal reaction when drug use is discontinues
Types of benzodiazepines
Diazepam - valium, vallies Temazepam - jellies, eggs, temazzies Lorazepam Nitrazepam Chlordiazepoxide
Types of amphetamines
Amphetamine - uppers, A, speed, whizz, sulph, cranks, wake-up, hearts
Dextroamphetamine - dex, dexy, dexies
Methamphetamine - ICE, crystal, meth
Methylenedioxymethamphetamine - MDMA, ADAM, Ecstasy, E, doves
Features of amphetamines
Synthetic stimulants
Medical use in narcolepsy and psychiatry
Illicit manufacture of tablets/powder
Associated with rave culture
Taken orally - snorted, smoked or injected
Tolerance and psychological dependence occurs
Acute psychological effects of amphetamines
Euphoria, calm, peace and friendliness Heightened awareness and concentration Increased energy Irritability, restlessness Irrational behaviours, confusion Hallucinations, delusions, paranoia Psychosis
Acute physical effects of amphetamines
Tachycardia, hypertension, tachypnoea Loss of appetite Dilated pupils, brisk reflexes Dry mouth, blurred vision, dizziness Sweating, flushing or pallor Teeth grinding, repetitive actions Pyrexia, dehydration
Acute adverse effects of amphetamines
Arrhythmias Stroke Hyperpyrexia DIC Acute paranoid psychosis
Effects of cocaine on the heart
Premature Atherosclerosis Heart muscle damage - acute catecholamine stress - chronic scarring - cardiomyopathy Fatal arrhythmia
Effects of cocaine on the brain
Brain haemorrhage - intracerebral - subarachnoid Cerebral infarction - arterial spasm
Features of LSD
LySergic acid Diethylamide
Semi-synthetic hallucinogen
Derived from lysergic acid - found in ergot fungus which grows on rye grains
Synthesised in 1938 - former psychiatric use
Taken orally
Effects within 1 hour, peak at 4 hours, lasts 12 hours
Tolerance develops but not dependence
Acute psychological effects of LSD
Effect vary widely - good and bad trips Depends on mood and environment Hallucinations - visual and auditory Distorted perception of time, distance and speed Mood swings, paranoia and violence
Acute physical effects of LSD
Hypertension, tachycardia Dilated pupils Tremor and incoordination Flushing and nausea Pyrexia
Chronic effects of LSD
Tolerance develops but not dependence
Abortion in pregnant women
Anxiety and psychosis
Later flashbacks
Types of opiates
Morphine Heroin Methadone Dipipanone Pethidine Pentazocine Buprenorphine Dextropropoxyphene Codeine DHC
Features of opiates
Derived from opium poppy - grows in SE and SW Asia Unripe seed capsule scored Milky extract emerges Dries to brown gummy residue Used medically from 13th centaury
Medical uses of opiates
Pain relief - analgesia
Cough suppressants
Antidiarrheal drugs
Types of heroin
White or brown powder
Injected
Smoked - chasing the dragon
Sniffed
Acute psychological effects of opiate abuse
Rush of euphoria
Contentment
Relief of anxiety
Inability to concentrate
Acute physical effects of opiates
Constricted pupils N+V Suppression of cough reflex Decreased heart rate and breathing Unconsciousness, respiratory arrest and death - naloxone may be necessary Fatal reaction to impurities
Chronic effects of opiate abuse
Tolerance Physical and psychological dependence Constipation Loss of libido Complications of IV injection
Features of opiate withdrawal
Clinical effects opposite of intoxication
Commences after 8-15 hours, peaks at 36-48 hours, subsides over 5-10 days
Symptoms of opiate withdrawal
Craving Anxiety, restlessness, irritability Alternate sweating and shivering Generalised aches and weakness Cramps in back, legs and abdo Insomnia Dilated pupils Watering eyes, yawning Tachycardia, hypertension Cold clammy skin with goose flesh Loudly audible bowel sounds N+V and diarrhoea
Metabolism of heroin
Heroin (Diacetylmorphine or diamorphine) -> 6-Mono-Acetyl Morphine (6-MAN) -> Morphine -> Morphine-3-Glucurondie (inactive) and Morphine-6-Glucuronide (active)
Features of IV abuse of oral pharmaceuticals
Tablet crushed, dissolved and infected Gelatinous capsule content Methadone liquid Tablet filler - starch - cellulose - talc - cotton Lung and liver granulomas
Infections associated with IV injections
Septicaemia Acute endocarditis Anthrax Skin abscesses Necrotising fasciitis Hep B,C HIV Opportunistic infections
IVDA systemic complications
Heart - enlargement - endocarditis Lung - scarring - FB granulomas Liver - granulomas Brain - blood vessels - neurones
Adverse effects of a drug
Dose dependent toxic effects Dose independent collateral side effects Idiosyncratic reaction Allergic reaction to impurities Hazards related to route of administration - inhalation - smoking - IV injection Chronic effects - heart, lungs, liver, brains
Determining lethal drug levels
Inter-individual variation Tolerance Cocktail effect Active metabolites Sampling site Older databases are unreliable - sampling site often unknown Therapeutic levels overlap with lethal levels PM redistribution
Features of PM drug redistribution
PM artefactual elevation of measured drug concentration
Passive diffusion of drug from a site of high concentration into neighbouring blood vessels
- unabsorbed drug or alcohol in stomach
- drug/metabolites accumulated in the liver, lung tissue
Central blood vessels most vulnerable
- heart blood and aorta
- pulmonary arteries and veins
- inferior vena cava
Depends on anatomical site and time since death
Blood from peripheral veins preferred