Drugs of Abuse Flashcards
What is the purpose of the misuse of drugs act 1971?
graded to harmfulness attributable to a drug when it is misused
What class of drugs are deemed as the most dangerous?
class A drugs
Give examples of class A drugs
Heroin
LSD
Ecstasy
Cocaine
Give examples of class B drugs
cannabis
barbiturates
ketamine
What class of drugs are supposedly the least harmful class of drugs ?
class C
Give examples of class C drugs
benzodiazepines
buprenorphine
What is the MOA of benzodiazepines?
the potentiate the inhibitory action of GABAa receptors
they are often used as sedatives
they do not have an effect on GABAb receptors
____% of drug related deaths occur in men
74%
____% of drug related deaths occur in women
26%
The 2001 amendment to the misuse of drugs regulations allows for …
lawful possession and supply of controlled (illegal) drugs for legitimate purposes. They cover
-prescribing
-administering
-safe custody
-dispensing
-record keeping
-disposal to prevent diversion for misuse
What is the maximum penalty for possession of a class A drug?
7 years plus a fine
What is the maximum penalty for possession of a class B drug?
5 years plus a fine
What is the maximum penalty for possession of a class C drug?
2 years plus a fine
What is the maximum penalty for supply of a class A drug?
Life + fine
What is the maximum penalty for supply of a class B drug?
14 years + fine
What is the maximum penalty for supply of a class C drug?
14 years + fine
What is the British Pharmacopoeia?
it is the only comprehensive collection of authoritative official standards for pharmaceutical substances and medicinal products
Illicit drugs are not pure, therefore they can contain…
contaminants
diluents
adulterants
What is a contaminant?
these are bi-products of the manufacturing process
What is an adulterant?
it is a pharmacologically active ingredient added to either give synergistic or antagonistic effects
What are diluents?
they are inert substances added to bulk up the drug, decreasing the amount of active ingredient in the drug
Give examples of adulterants used in the 80s
sugar alcohols
mannitol
sorbitol
Give examples of adulterants used in the 2000s
Local anaesthetics
Benzocaine
Lidocaine
They have a numbing effect on the gums
What is dependence?
this is a state in which withdrawal of the drug can cause adverse physiological effects
Physical dependence often leads to …
withdrawal syndrome
Psychological dependence often leads to…
cravings
What class of drug causes the most dependence?
class A drugs which can lead to physical harm
class B drugs have intermediate effect on dependence
class C drugs have the lowest effect on dependence
What are the effects of psychomotor stimulants?
marked effect on mental function and behaviour
produce excitement, euphoria
produces reduced sensation of fatigue
increases motor activity
some can enhance cognitive function
What are the effects of psychomimetic drugs?
they mainly affect thought pattern and perception
they distort cognition in a complex way
Give examples of psychomotor stimulants
Amphetamine (A)- ?? MDMA-is an analogue of amphetamines therefore it is a powerful pscyhomotor stimulant
Cocaine (A)
Cannabis is a psychomimetic and a __________.
psychomotor depressant
Give examples of psyhomimetic drugs
Ecstasy (A)
Ketamine (B)
LSD (A)
Cannabis originates from the plant…
cannabis sativa
Give slang terms for cannabis
weed
herb
pot
grass
bud
ganja
What is a spliff/joint of cannabis?
a rolled cannabis cigaretted; smoked with tobacco
What is hashish/hash?
a black/brown lump made from the plant resin
What is skunk?
they are more potent forms of cannabis, contain more THC
What are synthetic cannaboids?
they are so-called “legal highs”; they act like THC but are often more potent
they have not been banned undet the psychoactive substances act in 2016
What is the main psychoactive component in cannabis?
THC
TetraHydrocannabinol
What are cannabinoids?
There are related compounds that bind to cannabinoid receptors and have similar effect to those produced by cannabis sativa plant
they are a group of compounds that are found in the cannabis plant
What is the first cannabis-based medicine to be licensed in the UK?
Sativex
Nabiximols (US approved name)
In Wales (from 2014), Sativex is NHS funded. True or false
True
Sativex is NHS funded in England. True or false
False
postcode lottery; depends on whee you reside?
What are cannabis extracts?
there are wide range of products generally containing higher levels of cannabinoids than are found in the cannabis plant
Sativex exists in the form of a …
oromucosal spray
cannabis extract
What is the composition of Sativex (oromucosal spray)?
approximate 1:1 ratio of two active cannabinoids
cannabidiol 2.5mg per 1 dose
Dronabinol 2.7mg per 1 dose
What is a pure isomer of THC (tetrahydrocannabinol) ?
Dronabinol
In the BNF, Sativex is listed for specialist use only. What can Sativex be used for?
used as an adjunct in moderate to severe spasticity in multiple sclerosis (MS)
How is Sativex adminisetered?
buccal administration
(oromucosal spray)
What is spasticity?
a symptom of MS
muscles feel stiff, heavy and difficult to move
What are the potential applications of cannbinoid agonists?
Glaucoma to release pressure in eye
Nausea/vomiting associated with cancer chemotherapy
cancer and aids in relation to weight loss
neuopathic pain
head injurt
tourettes syndrome to reduce tics
paskinsons disease to reduce levo-dopa induced involuntary movement
What are the potential applications of cannabinoid antagonists?
obesityy
tobacco dependence
drug addition
alcoholism
Cannabinoids act via which receptor?
cannabinoid receptors
GPCRs
CB1 (cannbinoid 1) receptors are expressed in … and have ______ effects
the CNS ( in the plasma membrane of nerve terminals)
Psychoactive effects
Where are CB2 cannaninoid receptors expressed ?
they are expressed mainly in the periphery- lymphoid, microglia of CNS
expressed in immune system and haematopoietic cells
What is the MOA of cannabinois?
they inhibit adenylate cyclase and calcium channels
they activate potassium channels
they therefore inhibit synaptic transmission
Endogenous ligands of CB receptors (endocannbinoids) include: (name the two)
anandamide
2-arachidonoyl glycerol
they have distinct receptor selectivities (selective to either CB1/CB2 receptors)
What is the function of endocannabinoids?
they have neuromodulatory actions in a wide range of physiological activities
What is the problem with synthetic cannbinoids such as “spice” as opposed to THC (tetrahydrocannabinol) from cannabis ?
synthetic cannabinoids are full agonists of the CB1 receptor
THC from cannabis is a partial agonist
Thus the adverse effects from synthetic cannabinoids are more as they have a greater effect
What are side effects of synthetic cannabinoids?
hypertension
tachycardia
MI
vomiting
hallucinations
psychosis
convulsions
Psychosis induced by synthetic cannabinoids can remain after cessation of use. True or false
True
(from weeks to months)
Withdrawal symptoms from synthetic cannabinoids are not possible. True or false
They are possible
Give an example of a synthetic cannabinoid
CBH
CannaBicycloHexanol
THC action mainly on the CNS is a mixture of…
psychomimetic and depressant effects
centrally mediated autonomic effects
What are the two major sensory effects of THC (stoned/high)?
sensation of relaxation and wellbeing; it is like alcohol without associated aggression and recklessness
sharpened sensory awareness (sounds and sight becomes more intense)
THC is similar to but _____ pronounced than psychomimetic drugs (LSD, ecstacy, ketamine). Give examples of this
less pronounced
Time passes more slowly
hallucinations are less pronounced
paranoid delusions and alarming sensations are unlikely
What are the central effects of THC (tetrahydrocannabinol) ?
impairment of short-term memory and simple learning tasks
impairment of motor coordination (e.g. driving affected)
catalepsy- trance like state marked by loss of voluntary motion
hypothermia
analgesia
anti-emetic action (vomiting)
increased appetite
What are the peripheral effects of THC
Eyes: reddening, decrease in intraocular pressure (vasodilation)
Mouth (dryness)
Skin (sensation of heat or cold)
Heart (increased heart rate)
Muscles (relaxation)
Bloodvessels (vasodilation; hence reddening of eye)
Lung (bronchodilation)
Low dose THC and synthetic derivatives can produce…
euphoria and drowsiness
sometimes causes sensory distortion and hallucinations
Although THC is relatively safe in overdose, what are the effects of a THC overdose?
drowsiness and confusion
non life threatening respiratory or cardiovascular depression
Tolerance can occur heavy users of cannabis. What is tolerance?
this is when the user is having to take more and more to get the same effect
Heavy users can suffer from mild withdrawal syndrome. What symptoms may they experience?
nausea
agitation
irritability
confusion
tachycardia
sweating
Studies have revealed a link between long-term previous cannabis use and mental illness. What mental health disorders are associated with cannabis use?
depression
psychosis
There is evidence that cannabis use from teenage years can increase the risk of developing a psychotic illness. Give examples of psychotic illnesses that can be developed
Schizophrenia
bipolar disorder
LSD is a potent psychomimetic drug, what does it stand for?
LySergic acid Diethylamide
How is LSD manufactured?
LSD is manufactured from lysergic acid which occurs naturally on the ergot fungus which grows on wheat and rye
What is the mechanism of action of LSD?
5-HT(2A) receptor agonist of inhibitory autoreceptors
inhibits firing of 5-HT (serotonin) containing neurones in raphe nuclei
What are the pharmacological effects of LSD?
altered perception: sights and sounds appear distorted and fantastic
illogical and disconnected though
retain insight that changes are drug-induced (outside observer)
frightening hallucinations and delusions
bad trip- disturbing hallucination; menacing if user is already anxious, flashback after long intervals (weeks or months)
The tolerance to the effects develop quickly in LSD. True or false
True
having to take more and more for the same effect
Is there a physical dependence on LSD?
No
No withdrawal syndrome
What is physical dependence?
this is a condition in which a person takes a drug over time and unpleasant physical symptoms occur if the drug is suddenly stopped or taken in smaller doses
LSD has few physiological effects. True or false
True
so things like respiratory depression, vasodilation etc
Ecstacy, also known as MDMA stands for …
3,4-MethyleneDioxyMethAmphetamine
MDMA is an _____________ analogue
amphetamine
What are the characteristic of Ecstasy?
powerful psychostimulant
mild psychomimetic
What is a psychomimetic drug?
these are drugs that produce symptoms like those of psychosis; hallucinatory
Schizophrenia, bipolar disorder
MDMA is widely used as a party drug due to the following effects
Euphoria
loss of inhibitoons
induces energy surge
mildly hallucinogenic effects (mild psychomimetic)
feelings of empathy and emotional closeness
What is the mechanism of action of Ecstasy?
They inhibit monoamine transporters and depletes vesicles in pressynaptic bulb ?
Therefore there is an increase in monoamines (5HT, DA, NE) in the synaptic cleft
Ecstasy has a greater effect on which monoamine?
5-HT
5-HT>DA=NE
What are the pharmacological effect of ecstasy?
Euphoria
feel special
empathy
mild hallucinations
enhanced sensations
suppressed fatigue
Tachycardia
tremor
dilated pupils
hyperthermia
suppressed appetite
User of MDMA are subject to ________.
After effects
persists for a few days
What are the after effects of MDMA ?
Lack of energy
panic
depression
anxiety
lack of concentration
increased aggression- the mid week blues
At a party, use of ecstasy can cause hyperthermia which is exarcebated by … which leads to _________.
energetic dancing
(loss of sweat)
leads to dehydration
Ecstasy induced dehydration can cause…
excess water intake (hyponatraemia- more Na+)
water retention (increased ADH) for reabsorption of water from collecting ducts
brain swelling seizures
hypertension/ stroke due to increased blood volume
What are the oral health implications of ecstasy use?
-dry mouth (experienced by 93-99% of users and can persist for up to 48 hours after consumption)
-tooth decay (to relieve dehydration, excessive consumption of sugar containing acidic drinks) - tooth erosion
-bruxism (reported jaw clenching and grinding of teeth during MDMA use 50-89% which can persist for 48hours, leads to wearing down of teeth
-mouth ulcers (in 8% of users within 24-48 hours)
A rare oral health complication of ecstasy use includes…
necrotising gingivitis related to use of ecstasy
Ketamine replaced its analogue ___________. What was the reason for this?
PCP- Phencyclindine
This is because it was a better tolerated anaesthetic
Ketamine is also referred to as …
Special K
Phencyclidine (PCP) is also referred to as …
Angel dust
Ketamine and PCP are both…
Intravenous anaesthetics
Both Ketamine and PCP act as …
NMDA receptor antagonists
inhibit excitatory mechanism induced by glutamate
Ketamine and PCP can be used as dissociative anaesthetia. What is the meaning of this?
dissociative anaesthesia is a form of general anaesthesia
they provide analgesia but not necessarily complete unconsciousness
catalepsy (a trance like state)
catatonia- they are unresponsive to external stimuli
Amnesia- causes memory loss during the procedure
PCP was a popular hallucinogen in the 70s. What are the effects of PCP?
produces a feeling of euphoria
At high doses:
-hallucinations
-feeling of detachment
-disorientation
-delirium
-numbness
-psychotoc episodes (long term use can cause schizophrenia)
What are the effects of ketamine?
produces a feeling of euphoria
At high doses:
-hallucinations
-feeling of detachment
-disorientation
-delirium
-numbness
-psychotoc episodes (long term use can cause schizophrenia)
Ketamine is a useful anaesthetic in the the developing world. Why is this?
It is injectable thus it can be used in rural areas where anaesthetic gases are unavailable
What are the adverse effects of ketamine?
Tolerance develops quickly (more and more of the drug is required to produce the same effect)
Repeated use is associated with serious toxic effects
-abdominal pain
-liver damage
-cognitive impairment
-ulcerative cystitis (damage to bladder and associated bladder pain)
Ketamine has a dangerous overdose if combined with other drugs of abuse. True or false
True
Drugs of abuse include:
psychotomimetic drugs
Psychomotor stimulants (amphetamine - MDMA derived from amphetamines)
MDMA is a mild psychotomimetic but a psychomotor stimulant
psychomotor stimulants - amphetamine, cocaine
increased motor activity, euphoria, reduced sensation of fatigue
Amphetamine is what kind of drug of abuse?
Pschomotor stimulant
DL-amphetamine also referred to as speed, billy whizz belongs to what class of drugs?
class B
Methamphetamine is also known as …
crystal meth
Crystal meth belongs to what class of drugs ?
class A
Methylphenidate also known as Ritalin is a class _____ drug
class B
What is the clinical use of methylphenidate(ritalin)?
ADHD (attention deficit hyperactivity disorder)
nacrolepsy (rare sleep disorder)
What is the MOA of amphetamines?
amphetamines act by releasing monoamines from nerve terminals of the brain
They increase monoamines in the synaptic cleft
They also act as substrates for neuronal monoamine uptake transporters (DAT and NET, not SERT); this competitive inhibition reduces DA and NE vesicle uptake
they inhibit the monoamine pump VMAT-2
they displace endogenous monoamine into cytoplasma
at higher concentrations the inhibit MAO, further increasing cytoplasmic monoamines
What neurotransmitter is most affected by the action of amphetamines ?
Dopamine
DA>NE>5-HT in the synamptoc cleft
What NT is affected by a lesser extent by amphetamines?
serotonin
5-HT
What is the function of VMAT?
mediates the packaging of monoamines from neuronal cytoplasmic into presynaptic vesicles
it is a vesicular monoamine pump
What are the main central effects of amphetamines?
increased motor activity
euphoria or excitement
insomnia
anorexia
increased libido (unsafe sex, lower inhibitions)
fatigue is reduced (mental and physical)
What are the adverse effects of long term/large doses of amphetamines
psychotic symptoms
anxiety and depression
cognitive impairment
irritability and restlessness
panic and paranoia
muscle breakdown
When amphetamine is taken repeatedly over a few days what is developed ?
amphetamine psychosis
-acute schizophrenia attack
-hallucinations, paranoia and aggressive behaviour
When amphetamines are sopped after stopping taking them repeatedly what occurs?
deep sleep
lethargic
depressed
anxious (even suicidal)
hungry
Tolerance to ________ and _________ develop quickly with amphetamine abuse
tolerance to euphoric and anorexic effects develop quickly (more needed to see these effects)
There is a peripheral sympathomimetic action in amphetamines, briefly state what theres effects are
rise in blood pressure
inhibition of GI motility
What kind of dependence is developed when taking amphetamines?
strong psychological dependence to memory of euphoria
Meth mouth describes…
teeth that are blackened, rotting and falling apart
Tooth decay in crystal meth abusers are caused by a combination of drug induced effects. Name them.
Psychological- poor oral hygiene
Physiological- dry mouth
Biochemical- crystal meth is acidic
The high from methamphetamines can last up to 12 hours, what is the implication of this on dental health?
long periods of poor oral hygiene
consumption of many carbonated, sugar drinks to combat dehydration
grinding teeth (bruxism) and jaw clenching which can lead to tooth wear
these are all also observed with MDMA (Ecstasy users)
MDMA is an analogue of amphetamines
What is cocaine?
naturally occurring local anaesthetic (coca leaves)
William Halsted (1884) first injected cocaine to perform a ___________
peripheral nerve block
Cocaine has a _______ therapeutic agent. What is the implication of this
low therapeutic index
only a small difference between the minimum effective concentrations and minimum toxic concentration in the blood
“Crack” cocaine free-base form vaporises at ______ degree celsius
90
therefore it can be smoke
Crack cocaine has a strong ____________ dependence
psychological
occasional use>escalating doses>compulsive binges
crave drugs euphoric and stimulatory effects (psychostimulant)
What is the most addictive and most harmful drug of abuse?
heroin
What is the second most addictive and harmful drug of abuse?
cocaine
What is the mechanism of action and thus the effect of cocaine?
binds to and inhibits monoamine uptake transport
DAT, NET, SERT
This increases the monoamines in the synaptic cleft
Produces a marked psychomotor effect
enhanced peripheral effects of sympathetic nerve activity
Cocaine affects which monoamine uptake transporter the most ?
DA
DA>NE>5-HT
What is the effect of a cocaine overdose of respiratory system?
respiratory depression
respitatory failure
cyanosis
gross pulmonary oedema
What is the effect of cocaine on body temperature?
hyperthermia
What is the effect of cocaine overdose on CNS?
generalised convulsions
cerebral infarction and haemorrhage
pupils fixed and dialated
flaccid paralysis
coma
CNS depression
What is the effect of a cocaine overdose on CVS?
aortic dissection
MI
cardiac arrest
What are the short term effects of cocaine on the CNS?
mydriasis (dilated pupils)
headache
nausea
muscle tremors
twitching
pseudohallucinations (cocaine bugs)
What are the short term effects of cocaine on the CVS?
vasoconstriction
hypertension
tachycardia
pallor
What are the short term effects of cocaine on the respiratory system?
increased breathing rate and depth
What are the short term effects of cocaine on behaviour?
euphoria
elation
excitation
garrulousness (excessive talking)
alert
energetic
strong
paranoia
What are the long term effects of cocaine on CNS?
generalised seizures
gross muscle tremors
hallucinations
increased deep tendon reflexes
incontinence
What are the long term effect of cocaine on CVS?
hypertension
tachycardia
cardiac dysrhythmias
peripheral cyanosois
What are the long term effects of cocaine on respiratory system?
abnormal breathing (tachypnoea- increase breathing rate)
shortness of breath/gasping(dyspnea)
irregular breathing pattern
What are the long term effect of cocaine on behaviour?
social maladjustment
paranoia
depression
agitation
difficulties in emotion regulation and impulse control
violent or suicidal tendencies
What is the effect of cocaine overdose on behaviour ?
death
Briefly discuss dental implications of cocaine
rub cocaine on gums - lead to ulceration and exposure of underlying bone
mixed with saliva creates acidic solution- erodes enamel, exposes dentine , can cause decay
dry mouth, increased risk of tooth decay
tooth wear- bruxism
Briefly discuss dental implications of cannabis
dry mouth, increased risk of gum problems
cannabis smoke can cause oral cancer
Briefly discuss dental implications of ecstasy (MDMA)
tooth grinding
jaw clenching
dry mouth
Briefly discuss dental implications of heroin
crave sweet foods, increase risk of tooth decay if dental hygiene is neglected
causes dry mouth and tooth grinding
Briefly discuss dental implications of crystal meth
methamphetamine (similar to MDMA) BUT WORSE
severe tooth decay in a very short time, meth mouth by dental professionals
highly acidic and attacks tooth enamel
dry mouth, teeth grinding and jaw clenching
