Drugs Flashcards
What is the ICD 10 definition of dependence syndrome?
a cluster of physiological, behavioural and cognitive phenomena in which the use of a substance or a class of substances takes on a much higher priority for a given individual than other behaviours that once had greater value
What is a central descriptive characteristic of dependence syndrome (ICD10)?
the desire (often strong, or overpowering) to take the psychoactive drugs (may/not have been prescribed), alcohol or tobacco.
What is the misuse of drugs act?
An act providing the legal framework for control of drugs according to potential for misuse.
Details requirements for prescription, safe custody and record-keeping.
Classifies drugs and penalties for supply & possession offences, allowing premises to be used for drug production.
List the class A drugs.
Major opiates cocaine, crack LSD injectable amphetamines magic mushrooms
List the class B drugs.
cannabis oral amphetamines ritalin pholocodeine mephedrone (bubbles) synthetic cannabinoids
List the class C drugs.
Tranquilisers (including benzodiazepines)
some painkillers (buprenorphine, dextropropoxyphene)
gamma hydroxybutyrate (GHB)
Ketamine
Jail time for dealing and possession of class A drugs?
dealing: up to life
possession: up to 7 years
Jail time for dealing and possession of class B drugs?
dealing: up to 14y
possession: up to 5y
Jail time for dealing and possession of class C drugs?
dealing: up to 14y
possession: up to 2y
According to the misuse of drugs regulations, which drugs are prohibited without a H.O. licence?
Schedule 1: prohibited without H.O licence
LSD, cannabis, opium, ecstasy
According to the misuse of drugs regulations, which drugs have controlled prescribing, custody and registers?
Schedule 2: controlled prescribing, custody and registers.
Heroin, methadone, cocaine, amphetamine
According to the misuse of drugs regulations, which drugs are schedule 3?
barbiturates, pentazocine
According to the misuse of drugs regulations, which drugs are schedule 4?
benzodiazepines
According to the misuse of drugs regulations, which drugs are schedule 5 (contain small amounts of CD)?
Schedule 5: contain small amounts of controlled drugs
co-proxamol, co-codamol
Drug use in Scotland per head is amongst the highest in the world - which drug is used most?
4% of Scots use Cocaine (highest)
- 5% use ecstasy
- 5% smoke or inject heroin
how many more times likely are drug users likely to die than general population?
users 12x more likely to due than gen population
Which drug is the commonest single use drug in Scotland?
heroin is commonest single drug
but poly use is normal
the majority of drug deaths are in people from which ethnic and socioeconomic background?
mostly white males from deprived areas
common to have had alcohol, or psychiatric problems within 6m prior to death
1/3 in contact with drug treatment service at time of death
in terms of value for money (VFM), which is cheaper, drugs or alcohol?
drugs are cheaper in terms of VFM/hr of effect
what is the active compound in cannabis?
THC = tetra-hydro-cannabinol
what is hash?
cannabis resin (blocks in clingfilm)
Acute physical effects of cannabis
Dry mouth Dilated pupils red eyes tachycardia, HTN postural HTN
Chronic effects of cannabis
psychosis - schizophrenia A-motivational syndrome Reduced sperm count Reduced fertility (F) Bronchitis + emphysema Lung cancer?
Withdrawal symptoms for cannabis
irritability mood change restlessness loss of appetite weight loss insomnia
what class of drug is valium?
valium = diazepam = benzo = class C
acute effects of benzodiazepines
anxiolytic, relaxation impaired memory paradoxical aggression uncharacteristic criminal behaviour uncontrollable emotions 'hangover' dizziness sedation, incoordination sexual dysfunction weight gain hypotension + coma w/ high dose
chronic effects of benzodiazepines
chronic intoxication
tolerance
psychological and physical dependence
withdrawal effects of benzodiazepines
anxiety, insomnia sweating, headache tremor, nausea disordered perceptions hypersensitivity to stimuli psychosis convulsions
full names for MDA and MDMA
MDA = methylene-dioxy-amphetamine MDMA = 3,4, methylene-dioxy-methamphetamine
acute psychological effects of amphetamines
Euphoria, friendly Heightened awareness and concentration Increased energy Irritability, restlessness Irrational behaviour, confusion Hallucinations, delusions, paranoia Psychosis
acute physical effects of amphetamines
Tachycardia, HTN, 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 reactions from amphetamines
arrhythmia stroke (intra-cerebral or sub-arachnoid haemorrhage) hyper-pyrexia DIC Acute paranoid psychosis
chronic effects of amphetamines
Aggression, fatigue, insomnia Anorexia, malnutrition, weight loss Diarrhoea and vomiting Cardiomyopathy Chronic paranoid psychosis Depression, schizophrenia
Alternative names for mephedrone and class type
aka. bubbles, plant food
4-methylo-meth-cathinone (MMCAT)
similar to XTC and cocaine Made class B in 2010
acute effects of mephedrone
tachycardia, HTN insomnia, anorexia Bruxism Nystagmus Blue/cold extremities (vasoconstriction) Pain in chest, throat, nose Nosebleeds if snorted
Withdrawal effects of mephderone
unpleasant come down with sleep disturbance
paranoia
depression
SUICIDE
cocaine is detectable in which samples?
blood, urine, nasal, hair and saliva (everywhere)
acute effects of cocaine
Euphoria Formication (insects under skin) Irritability, confusion Hallucinations, paranoia, depression Tachycardia, HTN, tachypnoea Dilated pupils Increased mental excitement Hyper-pyrexia
Chronic effects of cocaine (general)
chest pains, muscle spasm weight loss perforated nasal septum "crack keratitis" of eyes erosion of tooth enamel "crack callus" of fingers male impotence, female orgasm problems
Chronic effects of cocaine on the heart
premature atherosclerosis, CAT, MI
Acute contraction band necrosis (catecholamine stress)
Chronic scarring (cardiomyopathy)
Fatal arrhythmia
Chronic effects of cocaine on the brain
Haemorrhage (intra-cerebral or SA)
Infarction - arterial spasm
Withdrawal effects of cocaine
Intense psychological craving irritability, depression muscle pains, tremor hunger exhaustion, prolonged sleep
Full name of LSD and time until peak effects
Lysergic acid Diethytlamide
a semi-synthetic hallucinogen
effects within 1hr, peak at 4hr
eliminated at 12hrs
you cannot become dependent on LSD - true or false
tolerance develops but not dependence
hallucinations with LSD are visual - true or false
trick Q - hallucinations are visual and auditory
distorted perception of time, distance and speed
what are some chronic effects of LSD
tolerance
abortion in pregnant women
anxiety, psychosis
flashbacks
constricted pupils, relief of anxiety, N&V, inability to concentrate and suppressed cough reflex = which drug class?
opiates
also decreased HR and RR
chronic effects of opiates
tolerance dependence constipation loss of libido complications of IV injection
withdrawal signs from opiates
OPPOSITE SIGNS OF OPIATE INTOXICATION dilated pupils, raised HR and BP lacrimation, yawning cold clammy skin, gooseflesh loud bowel sounds N/V/D
Timing of opiate withdrawal
Commences after 8-15hrs
Peaks at 36-48hrs
Subsides over 5-10 days
metabolism of heroin
diacetylmorphine aka. diamorphine > 6-MAM > morphine > M3G (inactive) or M6G (active)
new heroin addicts are more likely to die from over dose than older addicts - true or false
false
older addicts most at risk
morphine levels at death are no different to those in living addicts i.e. not a huge dose required to kill
presence of 6-MAM in toxicology samples from a drugs death tells you what?
6-MAM indicates rapid death from heroin overdose
6-MAM hasn’t yet turned to morphine
M3G and M6G in toxicology tells you that the death was how long ago?
M3G and M6G is seen if death is some hours after injection
IV abuse of oral drugs -> ?
lung and liver granulomas due to e.g. gelatinous capsule content, tablet filler etc.
Person with pulmonary scarring and granulomas, which microscopy investigation might indicate IVDU?
birefringement in polarised light of foreign body granulomas suggests IVDU
what substances are being referred to when “cocktail effect” is mentioned re. heroin death?
diazepam, methadone, alcohol and heroin
why is it difficult to quantify the ‘lethal level’ form PM toxicology?
inter-individual variation tolerance cocktail effect active metabolites sampling site PM redistribution
Which drugs cause sexual dysfunction of some form?
benzodiazepines - sexual dysfunction
chronic effects of cocaine - male impotence and female orgasm problems
chronic use of opiates - loss of libido
Which drugs cause reproductive issues?
cannabis - reduced sperm count and female fertility
LSD causes abortion in pregnant females
which drugs cause paradoxical aggression and uncharacteristic criminal behaviour?
benzodiazepines
Which drugs can cause brain haemorrhage as an adverse effect?
cocaine and amphetamines can cause intra-cerebral or subarachnoid haemorrhages
alcohol potentiates the effects of benzodiazepines - true or false
true
how long until withdrawal symptoms for benzos set in?
2-3 days
