Lecture 15: Drugs of abuse Flashcards

1
Q

What is tolerance?

A

The reduction in response to a drug after a repeated administrisation. May be innate or aquired. Very common.

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2
Q

Where does addiction, drug abuse and drug dependence manifest?

A

In the mesolimbic dopamine system

  • The nucleus accumbens (pleasure centre) linked to the ventral tegmental area by this system.
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3
Q

Physical dependence is?

A

A state that develops as a result of tolerance produced by resetting of homeostatic mechanisms in response to repeated drug abuse.

Characterised by a withdrawal syndrome

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4
Q

Withdrawal syndromes are?

A

Evidence of physical dependence

Caused by removal of the drug or CNS hyperarousal

opposite to drug effect

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5
Q

Opoid withdrawal syndrome symptoms?

A

Symptoms:

Craving, restlessness, irritability, Inc. sensitivity to pain, nausea, muscle aches, dysphoria

autonomic dysfunction: sweating, tachycardia, hypertension, vomiting, diarrhoea, fever

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6
Q

3 Origins of drug abuse?

A
  1. The Drug itself
    - Reinforcement is the property that makes you want it again
    - what is does to you and how fast it does this
    - Convenience of administration
  2. The user
    - Their personality (genetic, development, upbringing)
    - Pharmacokinetic, pharmacodynamic
    - other psychiatric conditions
  3. The environment
    - Employment, peer pressure, education levels
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7
Q

Drug of abuse classifications?

A

Stimulants

Mixed

Depressants

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8
Q

Alcohol as a drug of abuse?

Delerium Tremens symptoms?

A
  • Is a CNS depressant that also impairs recent memory
  • Increased does leads to sedation, coma then death
  • As tolerance develops sedation is reduced but lethal dose remains unchanged

DT: severe agitation, confusion, visual hallucinations, fever, profuse sweating, nausea, dilated pupils

  • Happens in about 5% of people who suddenly stop but 50% will get withdrawal that is not as bad.
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9
Q

Chronic alcohol abuse?

A

Liver cirrhosis - fulminant hepatic failure GI bleed

Cardiac failure - dilated cardiomyopathy, heart failure

Cushing’s, malnutrition, GI cancers, pancreatitis, FAS

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10
Q

Opoid benefits and AE?

A

Analgesia

Sedation

Cough supression

Respiratory depression (kills you)

Constipation, nausea, vomiting

Hypotension, Bradycardia

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11
Q

Heroin - diamorphine

A

Euphoric rush + period of sedation and tranquility

widely used in the UK for analgesia

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12
Q

Order of Opioids?

A

diamorphine >> fentanyl > Pethidine > Morphine > codeine

  • Chronic pain + opioids = potential for abuse
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13
Q

Methamphetamine (speed)?

A

Increases release and reduces the re-uptake of CNS catecholamines - dopamine, noradrenaline and seratonin

Ritalin acts differently but does essentially the same thing.

inc = libido, energy, self-esteem, agression, hallucinations, BP, arythmias, renal failure, death

Physical dependence is less than other drugs but psychological dependence is significant.

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14
Q

Cocain beginnings and use?

A

Dervied from coca leaves

local anaesthetic and vasoconstrictors

potent inhibitor of catecholamines re-uptake

Mixed with baking soda + water = crack cocaine and has a pKa closer to that of the body so absorbed much faster.

Lipid soluble = potent psychostimulant

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15
Q

AE of cocaine?

A

Seizure and Cardiotoxicity causing death

Highly addictive and shows some tolerance but with a constant lethal dose much like alcohol.

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16
Q

Removal of drugs from the blood in overdose cases?

A

Intralipid = fat emulsion that binds to many drugs over albumin

17
Q

Synthetic Cannabinoids?

A

Addictive with bad withdrawal

Psychosis, Seizures, Renal Failure, Heart Failure, Arrythmia

Much more potent than Marijuana

18
Q

Propofol?

A

Most widely used anaesthetic induction agent

Safe, reliable, effective, rapid onset/offest, minimal SE

Narrow therapeutic index