Module 2 Flashcards
1
Q
substance use disorders (SUD)
A
defined and clinically diagnosed by a number of criteria
if an individual meets two of the criteria they have mild SUD, more = more severe
2
Q
substance use disorder (SUD) criteria
A
- social impairment
- risky use
- impaired control
- withdrawal
- tolerance
3
Q
social impairment
A
individual fails to fulfill major roles (work, school, home) and/or has persistent social or interpersonal problems
social, occupational, recreational actives may be given up
4
Q
risky use
A
individuals may use substances in physically hazardous situations or use the substance despite physiological/psychological problems caused by use
5
Q
impaired control
A
individual have persistent craving for substance
addiction
6
Q
withdrawal
A
after stopping use individual experience withdrawal syndrome
7
Q
tolerance
A
individual develops tolerance to the substance
8
Q
addiction
A
impaired control associated with SUD manifested as emotional and mental preoccupation with drugs effects and a persistent craving for the drug regardless of consequences
can be other stimuli
9
Q
dopamine hypothesis
A
commonly misused drugs increase dopamine in reward system
neurotransmitter systems involved in misuse by dopamine is key component
drugs associated with addiction cause an exaggerated increase in dopamine altering communication in brain
10
Q
characteristics of addiction drugs
A
- increase dopamine
- produce novelty
- reduce anxiety
11
Q
drugs increasing dopamine
A
CNS stimulates
- cocaine
- amphetamines
- nicotine
- caffeine
opioids
- morphine
- heroin
- oxycodone
alcohol and cannabis
12
Q
drugs produce novelty
A
novel feeling produced in person (new emotion of sensation)
lysergic acid diethylamide (LSD) and ecstasy (MSMA)
13
Q
drugs reduce anxiety
A
CNS depressants
- benzodiazepines
- barbiturates
14
Q
drug withdrawal
A
abnormal physiological state
severity of withdrawal syndrome increases with the speed of drug withdrawal (biological processes that accommodated the presence of drug do not have time to reverse themselves)
fear of withdrawal adds to continuing drug taking behaviour
15
Q
stimulates withdrawal symptoms
A
- sleepiness
- muscle pain
- anxiety
- tremors
- low mood
- suicidal ideations (some)
- cardiovascular problems (some)
16
Q
opioid withdrawal symptoms
A
- sweating
- muscle aches
- agitation
- diarrhea
- abdominal cramping
- vomiting
17
Q
drug tolerance
A
state in which repeated administration of a given dose of a drug has progressively less pharmacological effect
or
a state in which the dose of a drug must be increased to obtain the same magnitude of pharmacological effects produced by the original dose
is reversible upon drug discontinuation
18
Q
cross tolerance
A
the resistance or tolerance of a drug because of the resistance of tolerance to a pharmacologically similar drug
19
Q
factors influencing substance use disorders (SUD)
A
- genetic factors
- pre existing disorders
- environmental factors
- developmental factors
20
Q
genetic factors, SUD
A
can predispose an individual to SUD
mutations in dopaminergic pathways to brain increase risk
21
Q
pre existing disorders, SUD
A
major affective disorder (depression, bipolar), anxiety disorder or schizophrenia at higher risk of SUD
22
Q
environmental factors, SUD
A
exposure to environments that promote drug use, family dynamic, trauma, social/work groups alter risks
23
Q
developmental factors, SUD
A
more vulnerable during certain developmental timeframes
adolescence and early adulthood association with initiation of SUD
23
Q
stigma of SUD
A
people with SUD are judged by others without knowing anything about the individual
can lead to isolation and low self esteem
individuals don’t receive medical or social help needed
23
harm reduction
approach that seeks to reduce/prevent negative consequences of substance use and improve health without stigma and without necessarily requiring the person to stop using the substance
24
health harms
goal is to decrease morbidity (disease, infection) and mortality (overdose)
25
societal harms
goal is to decrease lost productivity, apprehension of children and criminal activity
26
prescription use vs misuse
SUD can occur with medications used as prescribed or misuse of substances
27
misuse definition
using drugs in ways or amounts other than what was prescribed or against social norms
28
potential misuse of a drug
- nature of the drug
- route of administration
- amount/frequency of use
- availability
- inherent harmfulness
29
nature of drug, misuse
drugs are natural reinforcers
pleasurable effects produced increase probability of use
30
route of administration, misuse
drugs administered by routed with rapid absorption hence rapid effects have greater potential of misuse
31
amount/frequency of use, misuse
greater dose and frequency, greater the potential for tolerance, withdrawal and addiction, thus misuse
32
availability, misuse
availability of drug in society determines potential misuse
more widespread, higher likelihood of misuse
33
inherent harmfulness, misuse
potential of the drug to cause harm
if perceived to be a serious risk to life and health, likeliness of use is lessened
34
amphetamines and cocaine drug type
classes of CNS stimulant drugs
35
amphetamines
widely misused and is a controlled substance in Canada
drug class that includes:
- amphetamine
- dextroamphetamine
- methamphetamine
36
amphetamine related compounds
methlypenidate (ritalin) - used to treatt ADHD
MDMA (ecstasy) - derivative of methamphetamine
37
MDMA (ecstasy) effects
creates a feeling of intimacy and empathy while improving intellectual capacities
neurotoxic, causes neuronal damage and death
long lasting, if not permanent effect
38
chemistry of amphetamines
synthetic organic compound
structure is similar to endogenous neurotransmitters norepinephrine and dopamine
synthesized readily resulting in illicit manufacturing
purity of illicit substances is variable, can contain side products of the chemical reaction, unreacted chemicals and cutting/filler agents (starch, baking soda) which can be dangerous
39
pharmacology of amphetamines
increase amount of dopamine or norepinephrine in the synaptic cleft
they are substrates for dopamine transporters which clears dopamine out of the synaptic cleft
compete with dopamine and end up in the presynaptic nerve
in the nerve they block vesicular monoamine transporters which bring dopamine into vesicles to be packaged and released when nerve impulses arrive
leads to a build up in free dopamine in the neuron which forces it to travel through the dopamine transporters in the reverse direction (into synaptic cleft)
increases CNS excitation
same actions for norepinephrine but with norepinephrine transporters
40
pharmacology of ecstacy
similar to amphetamines but has preferential effect on serotonin containing neurons and causes release of serotonin
41
amphetamines CNS effect
decreased threshold for transmitting sensory input to the cerebral cortex, thus CNS excitation
euphoria and reward feeling
temperature regulation and feeding centre modifications leading to appetite suppression
increased aggressive behaviour and mood swings
42
excitation symptoms
- overstimulation
- restlessness
- dizziness
- mild confusion
- tremor
rare cases
- panic and psychosis
43
effects associated with increased CNS excitation
- increased alertness
- feeling of power
- reduced fatigue
- increased responsiveness
- increased heart rate and blood pressure
44
short term effects of amphetamines
non CNS tissue effects
- chest pain or heart attack
- cardiovascular collapse (high doses)
- increased respiratory rate
overdose can result in
- seizure
- high fever
- stroke
45
cardiovascular collapse
severely low blood pressure resulting in heart failing to pump blood around the body
46
long term effects of amphetamines
- chronic sleeping problems
- poor appetite
- anxiety, repetitive behaviour, psychoses, aggressive behaviour
- elevated blood pressure and abnormal cardiac rhythm
47
amphetamine concurrent drug use
other drugs used to antagonize various toxic effects of amphetamines (CNS depressants/stimulants)
can lead to drug to drug interactions, misuse of additional drugs and potential SUDs
48
therapeutic use of amphetamines
narcolepsy - chronic sleep disorder
ADHD - hyperactivity, impulsivity and/or difficulty controlling or refocusing attention
49
amphetamines potential for misuse
high since they produce powerful euphoria
water soluble salts forms of the drug allow for large doses that are readily injectable, resulting in rapid and intense response
50
amphetamines potential for SUD
tolerance develops to effects (does not develop to therapeutic effects or drug induced psychosis)
cessation results in withdrawal
addiction occurs
51
cocaine
local anesthetic and CNS stimulate
classified as a narcotic
52
pharmacology of cocaine
similar to amphetamines in its acute effects and toxicity patterns
has a shorter duration of action (less than an hour, amphetamines 12 hours)
commonly sniffed or smoked (amphetamines intravenously)
53
mechanisms of cocaine
causes generalized CNS stimulation in dose dependent manner (more = more stimulation)
inhibits the active re uptake of primarily dopamine and serotonin into the presynaptic neuron
increase concentration of neurotransmitters in synaptic cleft thus increasing activation of post synaptic neuron receptors
54
therapeutic use of cocaine
used as a local anesthetic for the mouth and throat
rarely used tho since other options are better
55
effects of long term use of cocaine
- toxic psychosis (paranoia)
- hallucinations or sensations of insects crawling under the skin
- impaired sexual function
- permanent brain damage and impairment of neuronal function may occur
- high blood pressure and an irregular heart rhythm
- changes to the nasal mucosa as the drug is sniffed
56
cocaine potential for misuse
has the highest misuse liabilities amongst all drugs (powerful euphoria)
57
pharmacokinetics of nicotine
absorption, particles inhaled > rapidly absorbed (GI tract, oral mucosa, across skin)
distribution, throughout body > rapid access to brain
metabolism, rapidly metabolized in liver
excretion, urine (half life is about 2 hours)
58
mechanism of action of nicotine
stimulates nicotinic receptors at synapses > increases psychomotor activity, cognitive function, attention and memory
effect in CNS mediated by nicotinic receptors mediated release of CNS neurotransmitters dopamine and serotonin
58
effect of large doses of nicotine
causes agitation, tremors, seizures
59
therapeutic use of nicotine
smoking cessation program
administered as chewing gum, transdermal patches or buccal spray (maintain blood nicotine levels)
59
short term effect in regular smoker
mild euphoria, enhances arousal, increased ability to concentrate, sense of relaxation
may cause small increase in heart rate, blood pressure, suppress appetite
60
short term effect in non regular smoker
dizziness, headache, nausea, vomiting, abdominal cramps
smoke can cause coughing or gagging
61
long term effects of smoking - cardiovascular
cardiovascular disease linked to nicotine
respiratory and carcinogenic effects related to products of combustion (not nicotine)
nicotine and carbon monoxide reduce capacity of red blood cells to carry oxygen, increase incidence of atherosclerosis and formation of thrombi
62
tobacco smoke chemicals
nicotine, carbon monoxide, carcinogenic aromatic hydrocarbons, tars, other products of combustion
63
what is atheroscleorisis
narrowing and hardening of arteries due to plaque buildup
64
what are thrombi
blood clots
65
long term effects of smoking - lungs
linked to lung disease (smokers syndrome)
increase risk of emphysema and other forms of chronic obstructive lung disease
66
smoker syndrome
characterize by difficulty in breathing, wheezing, chest pain, congested lung and increased lung infection
67
long term effects of smoking - cancer
cancer risk is associated with smoking (cigarette smoke)
cancer of lung, oral cavity, throat, bladder and uterus
68
passive smoke
second hand smoke associated with increased risk of cardiovascular disease and cancer
69
passive smoke in children
increase risk of bronchitis, pneumonia, asthma and sudden infant death syndrome
70
smoking during pregnancy
has adverse effects on developing fetus
risk of fetus being to small or being born preterm
effects reverse if stop smoking early in pregnancy
passive smoke increase chance of low birth weight neonate (decreased oxygen to fetus)
71
nicotine potential misuse and SUD
tolerance - smokers will smoke to keep nicotine blood levels at certain range (30-40mL)
withdrawal - number of symptoms
addiction - extreme urge to smoke
72
smoking cessation programs
involve counselling and pharmacological support (nicotine replacement programs)
73
caffeine
found in drinks and in over the counter stimulants analgesics and diuretics
increase mental performance and motor activity while decreasing drowsiness and fatigue
74
what are diuretics
substances that increase urine production and excretion of water from body through kidneys
75
lethal dose of caffeine
10g for average adult (50 cups of medium strength coffee)
76
absorption of caffeine
orally, rapidly and completely absorbed
blood levels of caffeine are significant 30 minutes after and peak 2 hours after ingestion
77
distribution of caffeine
distributes to all parts of the body and freely crosses into the brain and placenta
78
metabolism of caffeine
genetics determine rate of metabolize and excretion (slow or fast)
79
elimination of caffeine
half life various amount individuals (2.5-10 hours)
80
mechanism of action without caffeine
in the brain activation of receptors (adenosine receptors) stimulate GABAergic neurons that inhibit dopamine release
81
mechanism of action of caffeine
competitively blocks adenosine receptors in brain
when blocked, neurons released from adenosine inhibition decreasing GABA activation, thus increasing dopamine
effect is stimulation of CNS
81
short term effects of caffeine - CNS
produce mild mood elevations and reduce fatigue
small increase in performance may exist
flow of thought may be clearer and more rapid
when taken by abstainers produced nervousness and can interfere with sleep
82
high doses of caffeine short term effects
cause irritability, nervousness, rambling flow of thoughts and speech and psychomotor agitation
cause rapid and irregular heartbeat
83
short term effects of caffeine - cardiovascular
produce constriction or cerebral blood vessels, increase peripheral blood flow and stimulates cardiac muscle
84
short term effects of caffeine - respiration
mild stimulation of respiratory rate and relaxation of bronchial smooth muscles occurs
85
clinical use of caffeine
stimulate breathing in preterm newborns
helps immature brains and lungs remember to breathe
86
long term effect of caffeine
- restlessness
- nervousness
- insomnia
- increased urinary output
- gastic upset
- rambling speech and though
87
special circumstances of caffeine
- smoking
- pregnancy
88
caffeine and smoking
smoke increase metabolism of caffeine
duration of action of caffeine shortened (returns when smoker quits)
89
caffeine and pregnancy
large doses of caffeine increase risk of stillbirth and miscarriage, decrease fetal growth cate
metabolism is slower in pregnant people, duration of action longer
90
caffeine potential for misuse
misuse potential is low
doesnt act as mild reinforcer, though euphoria experienced (mild)
only larger dose are harmful
91
caffeine potential for SUD
tolerance - only in some individual
withdrawal - mild, headache, fatigue, drowsiness
addiction - mild can occur
92
drugs in sport
some athletes use performance enhancing substances
93
effects of amphetamines
euphoria and reward
increased respiration
insomnia and psychoses
94
benefits of amphetamines in sport
produce increase alertness, feeling of power, reduce fatigue, increase aggression, increase responsiveness
increase heat rate and blood pressure
cause appetite suppression, helpful in sports that benefit from weight loss
95
amphetamine impact on endurance and speed
masks pain and fatigue felt by athletes
96
toxicity of amphetamines
large doses lead to fatal increase in blood pressure
after drugs wear off person crashes
97
anabolic steroids
used to increase muscle mass and strength
testosterone is an anabolic steroid but synthetic ( ones are used in sports performers
98
synthetic anabolic steriods effects
has androgenic effects
- effects on secondary male sex characteristics
has anabolic effects
- building of mass
99
difference between testosterone and synthetic anabolic steroids
testosterone has androgenic and anabolic properties while synthetic has androgenic and anabolic effects
100
mechanisms of action of anabolic steroids
- anti catabolic
- anabolic
- motivation
101
mechanisms of action of anabolic steroids - anti catabolic
produce anti catabolic effect
- process that reduce breakdown of proteins and muscle tissue
helps athletes maintain muscle mass
102
mechanisms of action of anabolic steroids - anabolic
anabolic effects result in protein production
greater effects at high does
protein supplementation also important
103
mechanisms of action of anabolic steroids - motivation
motivational response
create aggressive behaviour (roid rage)
beneficial in sports (football)
104
effect of anabolic steroids + doses
have greater effect in ppl with lower basal circulating levels of testosterone
low moderate dose
- modest effects
large dose w diet high in proteins
- increases in lean body mass body weight and strength
- aggressive behaviour
105
toxicities of anabolic steroids
- mood swings
- severe acne
- cardiovascular disease
- altered liver function
- reduced testosterone levels
106
mood swings - anabolic steroids
chronic use associated with aggressive behaviour and mood swings
107
severe acne - anabolic steroids
development of severe acne on face and body common adverse effect of chronic use
108
cardiovascular disease - anabolic steroids
increase plasma levels of low density lipoproteins (bad cholesterol)
decrease the levels of high density lipoproteins (good cholesterol)
higher risk of cardiovascular disease
109
altered liver function - anabolic steroids
associated with altered liver functions
- hepatitis
- liver failure
- liver cancer
110
reduced testosterone levels - anabolic steroids
block the release of gonadotropin releasing hormone
- reduce testosterone levels and sperm production
can lead to infertility, reduced libido and impotence
111
anabolic steroid toxicities in women - testosterone levels
produce some androgenic effects
- increase facial and body hair
- lowered voice
- enlarged clitoris
- increase libido
- amenorrhea (absence of menstruation)
may or may not be reversible upon cessation
112
benzodiazepines
lorazepam (ativan) and diazepam (valium)
used to combat insomnia and anxiety in athletes
help them sleep and recover from training
113
benzodiazepines side effects
can impair psychomotor coordination and focus at higher doses
cause benzodiazepine use disorder
114
blood doping
effort to raise the number of blood cells by taking blood out storing it and then re infusing
when returned there is a sudden boost to the red blood cells which carry higher than normal amounts of oxygen to muscles
enhances performance
115
erythropoietin (EPO)
boosts the bodies natural production of red blood cells
injection stimulates bone marrow to make more blood cells, thus boosting levels of oxygen
116
blood doping and EPO use
used in sports (illegal)
used in people on dialysis (EPO), and removing blood and putting back is common during surgery
117
toxicity of EPO
inappropriate use of EPO or its derivatives can result in thrombotic events (stoke, heart attack)
118
detection of blood doping
measure the age of red blood cells
119
detection of EPO
testing urine for the presence of recombinant EPO
120
diuretics
drugs that enhance excretion of salt and water through kidneys
used before competitions to reduce body water, allowing lower weight class
sometimes used to hasten excretion to avoid detection of banned drugs
121
toxicities of diuretics
excess electrolyte and water depletion (blood pressure drop and kidney failure)
122
