Drugs Of Abuse Flashcards
How to get addicted?
Operant conditioning
- positive reinforcement
- removal of noxious experience
Huger/withdrawal
Deficit state
Want to rellieve
Craving =
Incentive salience
NTs related in reward
Dopamine + opioids
Hedonic regulation
Regulation of reward
Uppers go to
Nucleus Accumbens
Downers go to
Ventral tegmental area
Anticipation effect on NT
Dopamine increases with anticipation
What makes drug addictive?
- genetics, temperament, psychopathology
- route/bioavailability
- onset time
- elimination t1/2 = shorter=more addictive
- administration schedule
- mechanism of action
What sets up vulnerable phenotype?
Genetic
Early chaotic experiences
3 categories of addiction treatment
Use disorder
Intoxication
Withdrawal
Screening tools
CAGE
2+ = investigate addiction
Substance abuse S/s
Loss of control (4)
- taken in larger amounts
- Persistent desire/unsuccessful efforts to cut down
- Lot of time spent
- Important activities given up
Substance abuse S/s
Adverse consequences (4)
- peristent psyc/physical problems caused by drug
- Peristent social /interpersonal problems
- failure to fulfill major roles
- physically hazardous situations
Subtance abuse s/s
Psyc dpendence (3)
- tolerance
- Withdrawal
- cravings
Most commonly abused drugs
- weed
* Rx
Who starts later but progresses faster
Females
Highest risk for addiction
Multi-ethnic
Native american
Pacific islanders
More common where?
Urban
Exceeds daily limits
2-3 symptoms
Mild
Exceeds daily limits
4-5 symptoms
Moderate
Exceeds limits daily or near
Exceeds limits daily or near daily
*6+ sys
Dependence + chornic relapsing/co-morbidity
Chronic dependence
Nicotine
Mech
Nic agonist,
UP vasopressin, b-endorphin, ACTH, cortisol
Nicotine
Intoxication
Relaxation, increased concentration, anorexia, increased BP
Nicotine
Withdrawal
Begins one hour after last cigarette, peaks in 24 hours irritability
Nicotine cessation
COMBO: Nic replace + pharmacotherapy
- buproprion = down cravings
- varenicline = down cravings + pleasurable activity
Alcohol withdrawal
Tx
thiamine (give before glucose or induce Wernicke’s)
folic acid
Benzos - diazepam
Chlordiazopoxide
Hallucinaiton + anti-psyc
(Most use longer acting)
diazepam = shorter acting not damaging liver as much
Long term = still cognitive disfunction
Alcohol use disorder
Tx
- Acamprosate (best)
- Naltrexone (no pleasure)
- disulfam (sick)
Caffeine
Mech
Dopamine
Caffeine
Withdrawal
Headache, lethargy, irritability, depressed mood
Opiates
Mech
Mu
Kappa
Delta
Opiates
Withdrawals
Dysphoria Myalgias Rhinorrhea Diarrhea Lacrimation Dilated pupils
Opiates
Adverse
HIV Hepatitis Endocarditis OD Self neglect
Opiate overdose
Tx
*Naxalone
Opiate Addiction
Tx
Methadone (mu, w pregger)
- Buprenorphine - partial ag (no pleasure - narcan, ceiling)
- clonidine (watch hypoTN)
- Naltrexone
Stimulants
Mec
Coke = inhibit dopa reuptake
Amphetamines = up dopa release
Stimulants
Withdrawal
Like Major depressive disorder
Stimulants
Adverse effects
Necrosis soft tissues
Cyanosis
Cardio
Stroke
Stimulants
Tx
Symptomatic + behavioral
PCP
Mech
Nmda agonist
Marijuana
Most used?
After cigs + alcohol
PCP
Intoxication
Stored in fat cells, big people will last longer
RED DANES
Rage, erythema, dilated pupils, delusions, amnesia, nystagmus, excitation, skin dryness
PCP
Withdrawal
Lack of energy + depression
PCP
Treatment
Wait Coctail (halodol, ..., adivan)
Marijuana danger
Can set off latent psyc issue
PCP
Adverse effects
Memory loss
Liver function
Depression
Psychosis
Ecstacy
Mech
Monoamine release
Dilated pupils?
PCP
Cocaine
Hallucinogens
Mech
Serotonin ag
Hallucinogens
Effect
Pupil dilation
Synthesesia
Not addictive
Ecstacy
Effects
confused Depressed Paranoid Chills Dizzy Nausea
Cyanosis?
Amphetamine use
Alcohol withdrawal
Which comes first?
Wernickes vs. Korsakoff
Wernickes
Confusion
Ataxia
Nystagmus
Wernicke’s Encephalopathy triad
Amnesia
Confabulation
Hallucinations
Korsakoff Syndrome/psychosis
Withdrawal for inhalants?
NOPE
