Lecture 15: Drugs of abuse Flashcards
Do you use the term addict or drug abuse?
Best term is “Substance dependence syndrome”
What diagnoses substance dependence syndrome?
Factors: A cluster of symptoms including;
- Continued use despite substance related problems
- Tolerance
- Withdrawal syndromes
1 or 2 factors = abuse
3 or more = dependence
What can repeated doses of the same drug lead to?
- Sensitization (rare)
- Tolerance (i.e because metabolism enhanced or decreased receptor expression)
What systems do drugs work on?
Increased activity of the mesolimbic system in response to pleasure/rewarding drugs
What are some factors that indicate withdrawal and why?
- Evidence of physical dependence
- Autonomic syndrome due to removal of drug i.e GI reflux, sweating, GI disturbance, etc
- Specific to drug class
- Body works overtime to tell you that you need more of the drug
Describe the symptoms of opioid withdrawal syndrome?
Extra
Craving Restlessness irritability increased sensitivity to pain nausea muscle aches dysphoria insomnia anxiety hallucinations
What are the autonomic dysfunction in opoid withdrawal syndrome:
Sweating tachycardia hypertension vomiting diarrhoea fever
What potentially makes a drug more dangerous?
- Associated with increased central neurotransmitters
- Rapidity of onset
- Presence of withdrawal syndrome
- Convenient and effective method of administration
What can make the user more likely to have dependence?
Personality: Genetics, development, upbringing
Anxiety, depression or psychiatric disorders
Stress, Insomnia
Environment - Peer pressure, societal norms, socioeconomic factors, education
What is the most physically dangerous and dependent drug?
NB upload pic
Fentanyl
What drugs are stimulants?
Amphetamines Cocaine LSD Caffiene Ritalin
What drugs have mixed effects?
Ketamine
Synthetics
What drugs are depressants?
Alcohol Benzodiazepines Barbiturates GHB Cannabis Opoids
What does alcoholism potentially lead to?
Increased risk of depression, suicide, cognitive deficits and dementia
Describe the elimination of alcohol
Michaelis-menten kinetics at low concentrations and apparent zero order kinetics once concentrations rise above moderate
Write some notes on the effects of alcohol on the body
Mild intoxication: Motor inco-cordination sleepiness stimulation disinhibition
Increasing dose = sedation /anesthesia -> Coma and death
What happens with alcohol tolerance and dose?
Tolerance leads to decreased sedation but lethal dose remains unchanged
What happens to withdrawal symptoms and alcoholism?
50% experience withdrawal symptoms following cessation
Only 5% will progress to delirium tremens
Write some notes on chronic alcohol abuse
-Liver cirrhosis
Dilated Cardiomyopathy
Pancreatitis
If you come across a drug overdose what are the first steps?
- Safety first for yourself
- Airway
- Breathing
- Circulation
- Disability
- Exposure
For alcohol, gastric lavage or charcoal is controversial
What do opiods do?
Analgesia
Respiratory depression
Another name for heroin?
Dimorphine
What does opioid abuse lead to?
Abuse potentially related to lipid solubility and euphoric high
List the order of opioids in severity:
Fentanyl > Diamoprhine > Oxycodone > Morphine
What is methadone used for?
Methadone = Long action, slower onset for treatment in weaning programs
What is the analgesic ladder?
An approach to prescribing pain relief such that you avoid opioids and reduce the risk of substance dependence syndrome
Describe the analgesic ladder:
1) Non-opioid +/- adjuvant i.e NSAID
2) Opioid for mild to moderate pain +/- nonopioid +/- adjuvant
3) Opioid for moderate to severe pain +/- Nonopioid +/- adjuvant
Write some notes on cocaine:
Potent inhibitor of catecholamines re-uptake, massive rush of adrenalin
Local anesthetic and vasoconstrictor
What is crack?
Cocaine and baking soda + water
Describe the psychological effects of cocaine:
Euphoria, increased libido, energy, self esteem
Highly addictive
What are the risks of cocaine?
Seizures
Cardiotoxicity (arrhythmogenic)
How does meth/amphetamine, benzadrine, dexedrine act?
Increased CNS catecholamines - dopamine, noradrenaline and serotonin
What do amphetamines do?
Anorexia
Restlessness
Euphoria
Wakefulness
Why are new psychoactive substances dangerous?
Cheap Available Synthetic Potent Easily made Trendy Profitable Smokable
Very very dangerous, not regulated
