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Dundee - Forensic Medicine > Drugs > Flashcards

Drugs Flashcards

1
Q

Define drug addiction

A

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

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2
Q

Define drug misuse

A

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

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3
Q

Misuse of drugs act

A

Provides legal framework for control of drugs according to potential for misuses
Classifies drugs and penalties based on harm/addictiveness

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4
Q

Drug classifications

A 
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
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5
Q

Features of addictive process

A

An initial pleasurable effect

Rebound unpleasant effect on stopping

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6
Q

Drug dependence

A 
Psychological dependence
Neuroadaptation
Tolerance
Physical dependence
Withdrawal syndromes
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7
Q

Drug related deaths in Scotland

A 
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
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8
Q

Features of drug related deaths

A 
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
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9
Q

Features of canabis

A

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

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10
Q

Acute psychological effects of cannabis

A 
Talkative, hilarity, well-being, confidence
Appreciation of sound and colour
Time slows
Nausea
Hunger
Poor concentration
Impaired driving
Anxiety, agitation, paranoia
Cannabis psychosis
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11
Q

Acute physical effects of cannabis

A 
Dry mouth
Dilated pupils
Red eyes
Tachycardia
Hypertension
Postural hypotension
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12
Q

Chronic effects of cannabis

A 
Psychosis - schizophrenia
Amotivational syndrome
Reduced sperm count in men
Reduced fertility in women
Bronchitis and emphysema
Query lung caner
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13
Q

Features of cannabis withdrawal

A 
Irritability
Mood change
Restlessness
Loss of appetite
Weight loss
Insomnia
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14
Q

Acute effects of benzodiazepines

A 
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
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15
Q

Chronic effects of benzodiazpeines

A

Chronic intoxication
Tolerance
Psychosocial and physical dependence

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16
Q

Benzodiazepine withdrawal

A 
2-3 days on 
Anxiety, insomnia
Sweating and headache
Tremors
Nausea
Disordered perceptions
Hypersensitive to stimuli
Psychosis
Convulsions
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17
Q

Chronic adverse effects of amphetamines

A 
Aggression, fatigue and insomnia
Anorexia, malnutrition and weight loss
Diarrhoea and vomiting
Heart muscle damage
Chronic paranoid psychosis
Depression
Schizophrenia
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18
Q

Features of cocaine

A

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

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19
Q

Acute pscyhoclical effects of cocaine

A

Euphira, well-being
Formication - feels like insects under skin
Irritability and confusion
Hallucinations, paranoia and depression

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20
Q

Acute phsycial effects of cocaine

A

Tachycardia, hypertension, tachypnoea
Dilated pupils
Increased mental excitement
Hyperpyrexia

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21
Q

Chronic effects of cocaine

A 
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
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22
Q

Features of cocaine withdrawal

A 
Crash rather than true withdrawal
Intense psychological craving
Irritability and depression
Muscle pains, tremor
Hunger
Exhaustion and prolonged sleep
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23
Q

Detection of cocaine and metabolites

A 
Blood
Urine
Nasal swabs
Hair
Saliva
24
Q

Commonly misused drugs

A 
Opiates 
- morphine, heroin, methadone
Depressants 
- alcohol, barbiturates
Benzodiazepines
- diazepam, temazepam
Stimulants
- amphetamines, cocaine
Hallucinogens
- LSD, mushrooms
Others
- cannabis
- nicotine
- VSA
25
Q

Define drug abuse

A

An excessive or improper use of drugs

- especially through self-administration for nonmedical purposes

26
Q

Define drug dependence

A

Physical or psychologic state in which a person displays withdrawal symptoms if drug use is halted suddenly
- can lead to addiction

27
Q

Define dependence syndrome

A

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
28
Q

Types of benzodiazepines

A 
Diazepam - valium, vallies
Temazepam - jellies, eggs, temazzies
Lorazepam
Nitrazepam
Chlordiazepoxide
29
Q

Types of amphetamines

A

Amphetamine - uppers, A, speed, whizz, sulph, cranks, wake-up, hearts
Dextroamphetamine - dex, dexy, dexies
Methamphetamine - ICE, crystal, meth
Methylenedioxymethamphetamine - MDMA, ADAM, Ecstasy, E, doves

30
Q

Features of amphetamines

A

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

31
Q

Acute psychological effects of amphetamines

A 
Euphoria, calm, peace and friendliness
Heightened awareness and concentration
Increased energy
Irritability, restlessness
Irrational behaviours, confusion
Hallucinations, delusions, paranoia
Psychosis
32
Q

Acute physical effects of amphetamines

A 
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
33
Q

Acute adverse effects of amphetamines

A 
Arrhythmias
Stroke
Hyperpyrexia
DIC
Acute paranoid psychosis
34
Q

Effects of cocaine on the heart

A 
Premature Atherosclerosis
Heart muscle damage
- acute catecholamine stress
- chronic scarring - cardiomyopathy
Fatal arrhythmia
35
Q

Effects of cocaine on the brain

A 
Brain haemorrhage 
- intracerebral
- subarachnoid
Cerebral infarction
- arterial spasm
36
Q

Features of LSD

A

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

37
Q

Acute psychological effects of LSD

A 
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
38
Q

Acute physical effects of LSD

A 
Hypertension, tachycardia
Dilated pupils
Tremor and incoordination
Flushing and nausea
Pyrexia
39
Q

Chronic effects of LSD

A

Tolerance develops but not dependence
Abortion in pregnant women
Anxiety and psychosis
Later flashbacks

40
Q

Types of opiates

A 
Morphine
Heroin
Methadone
Dipipanone
Pethidine
Pentazocine
Buprenorphine
Dextropropoxyphene
Codeine
DHC
41
Q

Features of opiates

A 
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
42
Q

Medical uses of opiates

A

Pain relief - analgesia
Cough suppressants
Antidiarrheal drugs

43
Q

Types of heroin

A

White or brown powder
Injected
Smoked - chasing the dragon
Sniffed

44
Q

Acute psychological effects of opiate abuse

A

Rush of euphoria
Contentment
Relief of anxiety
Inability to concentrate

45
Q

Acute physical effects of opiates

A 
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
46
Q

Chronic effects of opiate abuse

A 
Tolerance
Physical and psychological dependence
Constipation
Loss of libido
Complications of IV injection
47
Q

Features of opiate withdrawal

A

Clinical effects opposite of intoxication

Commences after 8-15 hours, peaks at 36-48 hours, subsides over 5-10 days

48
Q

Symptoms of opiate withdrawal

A 
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
49
Q

Metabolism of heroin

A 
Heroin (Diacetylmorphine or diamorphine)
->
6-Mono-Acetyl Morphine (6-MAN)
-> 
Morphine
->
Morphine-3-Glucurondie (inactive) and Morphine-6-Glucuronide (active)
50
Q

Features of IV abuse of oral pharmaceuticals

A 
Tablet crushed, dissolved and infected
Gelatinous capsule content
Methadone liquid
Tablet filler
- starch
- cellulose
- talc
- cotton
Lung and liver granulomas
51
Q

Infections associated with IV injections

A 
Septicaemia
Acute endocarditis
Anthrax
Skin abscesses
Necrotising fasciitis
Hep B,C
HIV
Opportunistic infections
52
Q

IVDA systemic complications

A 
Heart
- enlargement
- endocarditis
Lung
- scarring
- FB granulomas
Liver
- granulomas
Brain
- blood vessels
- neurones
53
Q

Adverse effects of a drug

A 
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
54
Q

Determining lethal drug levels

A 
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
55
Q

Features of PM drug redistribution

A

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

Dundee - Forensic Medicine (15 decks)

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