Drugs

Question 1

Give 3 clinical features of opiate, benzodiazepine, and stimulant use.

Answer 1

Opiates: Pinpoint pupils, low BP, venepuncture marks. Benzos: Disinhibited, appear drunk, low GCS. Psychostimulants: Rapid speech, large pupils, agitation, restlessness, high BP.

Question 2

Give 5 features of opiate withdrawal. How is OD treated?

Answer 2

Dilated pupils, increased BP, sweating, flu-like symptoms, pain. Is not fatal! OD treated with naloxone

Question 3

What type of drug is cannabis? How does it work and give 4 effects it has.

Answer 3

A hallucinogen (but only a few have true hallucinations). Is a cannabinoid receptor agonist. Causes sedation, anxiolytic, analgesic, psychedelic.

Question 4

Can cannabis be toxic?

Answer 4

Theoretically yes in incredibly high doses, but no cases in humans reported

Question 5

What does sporadic and regular use cause?

Answer 5

Regular use leads to anxiety and depression. Sporadic use increases chances of this. It probably causes schizophrenia with regular use. Exacerbates mental health problems!

Question 6

Describe the effects of cannabis on the lungs.

Answer 6

Does damage the lungs but no links with COPD. Not as harmful as tobacco

Question 7

Is cannabis addictive?

Answer 7

Yes, as it releases dopamine

Question 8

What is spice?

Answer 8

Synthetic cannabinoid, increasing in popularity

Question 9

Give 3 ways opiates are used.

Answer 9

Smoked (safest way), s/c injection (leads to ‘skin popping’) and IVI.

Question 10

What causes most of the risks with opiates?

Answer 10

The risks of injection itself, not the drug at non-toxic levels

Question 11

What type of drug is cocaine? How does it work?

Answer 11

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

Question 12

How quickly does cocaine take effect?

Answer 12

5-10 mins IV and 60 mins smoked. High lasts around an hour

Question 13

What is a risk of regular cocaine use?

Answer 13

Cardiotoxicity

Question 14

What is crack?

Answer 14

Cocaine variant that releases all DA instantly, more addictive.

Question 15

What type of drug are amphetamines? What is crystal meth?

Answer 15

Stimulants. Very similar to cocaine, but high lasts 5-10 hours. Crystal meth is like the crack version of amphetamine (speed).

Question 16

How do amphetamines work?

Answer 16

Inhibit MAO reuptake inhibitors, releases MAO into synapse, and blocking degradation of MAOs.

Question 17

What type of drug is ecstasy?

Answer 17

Stimulant.

Question 18

What does ecstasy cause and how does it do this?

Answer 18

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.

Question 19

What happens on withdrawal of ecstasy?

Answer 19

Severe mood drops. NB it is a relatively safe drug, about 50 deaths/year in the UK, commonly cut with other substances

Question 20

Give an overview of LSD and psilocybin.

Answer 20

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

Question 21

What does ketamine cause and what is this often used for recreationally? Is it addictive?

Answer 21

Causes dissociation (can be used for anaesthesia). Often used to dissociate from come down of another drug. Not addictive but can over-sedate.

Question 22

Early and late on, what clinical pictures are there in paracetamol OD

Answer 22

Early: Normally none. Can get RUQ pain and vomiting. Later: Jaundice and encephalopathy from liver failure, can cause AKI too

Question 23

Describe management if <4 hours since OD of paracetamol

Answer 23

activated charcoal

Question 24

At 4 hours what Ix should be done for paracetamol?

Answer 24

LFTs, glucose, INR, ABG, FBC, HCO3-, paracetamol

Question 25

Describe management at <10-12 hours and >8-24 for paracetamol

Answer 25

<10-12 hours: if plasma paracetamol above Rx level, and no vomiting N-acetylcysteine. >8-24: suspecting large OD?  N-acetylcysteine.

Question 26

What if the time is unknown, the dose of paracetamol is staggered or if it is <15 hours?

Answer 26

Then treatment may not help

Question 27

What is the most commonly misused illegal substance in general, and class A specifically?

Answer 27

Cannabis. Ecstasy most common class A

Question 28

What 3 factors are paramount in causing addiction?

Answer 28

Availability, vulnerable personality, peer pressure – not the drug itself!

Question 29

What is dependence syndrome?

Answer 29

Where a substance takes much higher priority than other behaviours which once held a higher value.

Question 30

Give the 6 things comprising it. How many are needed to have dependence syndrome?

Answer 30

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.

Question 31

Give 3 behaviours that would make you suspect drug addiction.

Answer 31

Odd, transient behaviours. Repeated requests for certain medicines. Injection stigmata (venepuncture, abscesses, hepatitis, HIV etc)

Question 32

What is methadone meant to be used as? What is it more used for in reality?

Answer 32

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.

Question 33

Give 2 other medicines that can be used for opiate cravings.

Answer 33

Naltrexone, buprenorphine.

Question 34

Give 5 social and 3 psychological methods of support for opiate (and generally) addicts.

Answer 34

Social: Needle exchange, safer routes of use (smoking not injecting), safe sex, housing, employment, lowering criminal activity. Psychological: Counselling, CBT, group therapy, family therapy.

Question 35

What community team is useful for drug addiction?

Answer 35

Community substance misuse team