Drugs Flashcards
Give 3 clinical features of opiate, benzodiazepine, and stimulant use.
Opiates: Pinpoint pupils, low BP, venepuncture marks. Benzos: Disinhibited, appear drunk, low GCS. Psychostimulants: Rapid speech, large pupils, agitation, restlessness, high BP.
Give 5 features of opiate withdrawal. How is OD treated?
Dilated pupils, increased BP, sweating, flu-like symptoms, pain. Is not fatal! OD treated with naloxone
What type of drug is cannabis? How does it work and give 4 effects it has.
A hallucinogen (but only a few have true hallucinations). Is a cannabinoid receptor agonist. Causes sedation, anxiolytic, analgesic, psychedelic.
Can cannabis be toxic?
Theoretically yes in incredibly high doses, but no cases in humans reported
What does sporadic and regular use cause?
Regular use leads to anxiety and depression. Sporadic use increases chances of this. It probably causes schizophrenia with regular use. Exacerbates mental health problems!
Describe the effects of cannabis on the lungs.
Does damage the lungs but no links with COPD. Not as harmful as tobacco
Is cannabis addictive?
Yes, as it releases dopamine
What is spice?
Synthetic cannabinoid, increasing in popularity
Give 3 ways opiates are used.
Smoked (safest way), s/c injection (leads to ‘skin popping’) and IVI.
What causes most of the risks with opiates?
The risks of injection itself, not the drug at non-toxic levels
What type of drug is cocaine? How does it work?
Stimulant. Works by blocking DAT (DA reuptake transporters), leading to release of DA into the brain. Also thought to increase NAd and 5HT. Also a local anaesthetic and a vasoconstrictor
How quickly does cocaine take effect?
5-10 mins IV and 60 mins smoked. High lasts around an hour
What is a risk of regular cocaine use?
Cardiotoxicity
What is crack?
Cocaine variant that releases all DA instantly, more addictive.
What type of drug are amphetamines? What is crystal meth?
Stimulants. Very similar to cocaine, but high lasts 5-10 hours. Crystal meth is like the crack version of amphetamine (speed).
How do amphetamines work?
Inhibit MAO reuptake inhibitors, releases MAO into synapse, and blocking degradation of MAOs.
What type of drug is ecstasy?
Stimulant.
What does ecstasy cause and how does it do this?
Causes serotonin release happiness and social reward.
Is an indirect 5HT agonist and increases 5HT in synapse. Also has some effects on DA and NAd.
What happens on withdrawal of ecstasy?
Severe mood drops. NB it is a relatively safe drug, about 50 deaths/year in the UK, commonly cut with other substances
Give an overview of LSD and psilocybin.
Both are hallucinogens. LSD is man-made, highs last around 12 hours, not addictive. Psilocybin is natural, highs last less long, causes 5HT release euphoria
What does ketamine cause and what is this often used for recreationally? Is it addictive?
Causes dissociation (can be used for anaesthesia). Often used to dissociate from come down of another drug. Not addictive but can over-sedate.
Early and late on, what clinical pictures are there in paracetamol OD
Early: Normally none. Can get RUQ pain and vomiting. Later: Jaundice and encephalopathy from liver failure, can cause AKI too
Describe management if <4 hours since OD of paracetamol
activated charcoal
At 4 hours what Ix should be done for paracetamol?
LFTs, glucose, INR, ABG, FBC, HCO3-, paracetamol
Describe management at <10-12 hours and >8-24 for paracetamol
<10-12 hours: if plasma paracetamol above Rx level, and no vomiting N-acetylcysteine. >8-24: suspecting large OD? N-acetylcysteine.
What if the time is unknown, the dose of paracetamol is staggered or if it is <15 hours?
Then treatment may not help
What is the most commonly misused illegal substance in general, and class A specifically?
Cannabis. Ecstasy most common class A
What 3 factors are paramount in causing addiction?
Availability, vulnerable personality, peer pressure – not the drug itself!
What is dependence syndrome?
Where a substance takes much higher priority than other behaviours which once held a higher value.
Give the 6 things comprising it. How many are needed to have dependence syndrome?
3 or more needed of: 1) strong desire to take substance (craving). 2) difficulty controlling substance use. 3) physiological withdrawal/using another substance to avoid this. 4) Tolerance (increased doses needed for original effect). 5) progressive neglect of alternate pleasures. 6) persisting use despite clear evidence of harm.
Give 3 behaviours that would make you suspect drug addiction.
Odd, transient behaviours. Repeated requests for certain medicines. Injection stigmata (venepuncture, abscesses, hepatitis, HIV etc)
What is methadone meant to be used as? What is it more used for in reality?
Meant to be a transition to abstinence. More used as an alternative to opiates, as technically still addicted, but is free and not needing IVI.
Give 2 other medicines that can be used for opiate cravings.
Naltrexone, buprenorphine.
Give 5 social and 3 psychological methods of support for opiate (and generally) addicts.
Social: Needle exchange, safer routes of use (smoking not injecting), safe sex, housing, employment, lowering criminal activity.
Psychological: Counselling, CBT, group therapy, family therapy.
What community team is useful for drug addiction?
Community substance misuse team
