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5. Addictions psychiatry > Pharmacological, physical and psychological effects of substances > Flashcards

Pharmacological, physical and psychological effects of substances Flashcards

1
Q

Effects of alcohol on neuroreceptors

A

Decreases NMDA sensitivity
Increases GABA sensitivity
Down regulates calcium channels
Up regulates nicotine receptor gated sodium channels

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2
Q

Factors which lead to higher oral availability of alcohol in females compared to males

A

Lower body water volume
Higher alcohol absorption rate
Less alcohol dehydrogenase in the gut mucosa

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3
Q

Hours from last drink of alcohol to onset of shakes

A

4-12 hours

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4
Q

Hours from last drink of alcohol to onset of perceptual disturbances

A

8-12 hours

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5
Q

Hours from last drink of alcohol to onset of seizures

A

12-24 hours

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6
Q

Hours from last drink of alcohol to peak of seizures

A

48 hours

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7
Q

Hours from last drink of alcohol to onset of delirium tremens

A

72 hours

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8
Q

Percentage of patients with alcohol withdrawal who develop delirium tremens

A

5%

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9
Q

Risk of seizures in untreated patients with alcohol dependence

A

8%

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10
Q

Risk of seizures in treated patients with alcohol dependence

A

3%

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11
Q

Percentage of patients with withdrawal seizures who develop delirium tremens

A

30%

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12
Q

Percentage of patients with DTs who die if untreated

A

10%

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13
Q

Difference between opiates and opioids

A

Opiates refer to natural opioids
Opioids are natural, semisynthetic, or synthetic

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14
Q

Receptor which mediates euphoric response to opioid use

A

Mu

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15
Q

Half life of morphine

A

2-3 hours

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16
Q

Oral bioavailability of morphine

A

30%

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17
Q

Half life of heroin

A

<3 minutes

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18
Q

Oral bioavailability of heroin

A

30%

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19
Q

Half life of methadone

A

15-60 hours

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20
Q

Oral bioavailability of methadone

A

80%

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21
Q

Half life of codeine

A

2-4 hours

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22
Q

Main psychoactive component of cannabis

A

9-tetrahydrocannabinol (THC)

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23
Q

Time to peak euphoric effects of cannabis after smoking

A

30 minutes

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24
Q

Percentage of patients using benzodiazepines for a year who become dependent

A

40%

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25
Q

Mechanisms of action of GHB

A

GABA like action
Inhibits dopamine release at low doses
Boosts dopamine availability with chronic use
Induces the release of noradrenaline in the hypothalamus

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26
Q

Percentage of patients taking GHB who develop bradycardia

A

33%

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27
Q

GHB derived compound used in the USA for cataplexy associated with narcolepsy

A

Sodium oxybate

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28
Q

Effects of a ‘bad trip’ from LSD

A

Dissociation
Frightening perceptions
Panic attack type symptoms

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29
Q

Drug most likely to cause nasal septum perforation

A

Cocaine

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30
Q

Side effects of opioids which does not develop tolerance

A

Constipation
Miosis

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31
Q

Most common side effects of benzodiazepines

A

Drowsiness
Ataxia
Dizziness

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32
Q

Benzodiazepine antagonist used to reverse the effects of benzodiazepines in an emergency situation

A

Flumazenil

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33
Q

Benzodiazepine particularly implicated in cases of date rape

A

Flunitrazepam

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34
Q

Drug withdrawal which the term ‘cold turkey’ is used for

A

Opioid withdrawal

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35
Q

Symptom which the term ‘cold turkey’ refers to

A

Piloerection

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36
Q

Most common cause of death in benzodiazepine overdose

A

Respiratory depression

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37
Q

Time in hours for untreated heroin withdrawal symptoms to peak

A

32-72 hours

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38
Q

Time from last dose for untreated heroin withdrawal to start

A

6 hours

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39
Q

Time in hours for untreated methadone withdrawal to peak

A

80-96 hours

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40
Q

Time in hours for untreated fentanyl withdrawal to peak

A

8-12 hours

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41
Q

Longest lasting symptoms of heroin withdrawal

A

Insomnia
Bradycardia
Temperature dysregulation
Cravings

42
Q

Drug where withdrawal is associated with kinaesthetic hallucinations

A

Benzodiazepines

43
Q

Drug associated with lung carcinoma

A

Cannabis

44
Q

Drug class associated with rashes around the mouth and nose and unusual breath odour

A

Inhalants

45
Q

Injection practice associated with candida endophthalmitis

A

Using lemon juice to reconstitute

46
Q

Features of PCP intoxication

A

Nystagmus
Numbness or lowered response to pain
Ataxia
Dysarthria
Lack of communication
Muscle rigidity
Vomiting
Violent behaviour
Tachycardia
HTN

47
Q

Effect after quitting smoking that women, heavy smokers, and smokers of low SES are most at risk for

A

Weight gain

48
Q

Length of time alcohol withdrawal symptoms usually last

A

3-7 days

49
Q

Symptoms of stimulant withdrawal

A

Mood ‘crash’
Insomnia
Hypersomnia
Agitation
Vivid dreams
Suicidal ideation
Psychomotor agitation or retardation
Hunger

50
Q

Blood tests which are markers for excess alcohol consumption

A

GGT
MCV
Carbohydrate deficient transferrin
Anaemia
Thrombocytopaenia
Deranged LFTs

51
Q

Drug most likely to cause frequent urination and blood in the urine

A

Ketamine

52
Q

Types of deaths most commonly associated with stimulant use

A

Cardiovascular deaths
Suicide
Accidental injuries
Homicides

53
Q

Drug least likely to cause dependence or withdrawals

A

LSD

54
Q

Drug least likely to cause overdose

A

LSD

55
Q

Signs of an advance opioid withdrawal state

A

Muscle spasms
Twitching

56
Q

Most common features of cannabis intoxication

A

Tachycardia
Red eyes
Poor coordination
Postural hypotension

57
Q

Most common features of benzodiazepine intoxication

A

Sedation
Dizziness
Respiratory depression

58
Q

Most common features of amphetamine intoxication

A

Tachycardia
Hypertension
Anorexia
Tremor
Restlessness

59
Q

Most common features of cocaine intoxication

A

Tachycardia
Tachypnoea
Hypertension
Headache
Chest pain
Respiratory depression

60
Q

Most common features of heroin intoxication

A

Pinpoint pupils
Respiratory depression
Clammy skin

61
Q

Symptoms of heroin withdrawal

A

Nausea
Aches and pains
Piloerection
Runny eyes/nose
Yawning
Fever
Diarrhoea
Insomnia
Bradycardia

62
Q

Symptoms of alcohol withdrawal

A

Tremor
Sweating
Insomnia
GI disturbance
Anxiety
Craving
Seizures
Delirium tremens - disturbed pulse, temperature etc, clouded consciousness, hallucinations

63
Q

Cannabis withdrawal symptoms

A

Irritability
Insomnia
Restlessness
Anxiety

64
Q

Benzodiazepine withdrawal symptoms

A

Anxiety
Tremor
Insomnia
Nausea/vomiting
Hallucinations
Psychomotor agitation
Seizures
Paraesthesia

65
Q

Amphetamine withdrawal symptoms

A

Extreme fatigue
Hunger
Depression
Hypersomnia
Vivid, unpleasant dreams
Psychomotor retardation
Small pupils

66
Q

Symptoms of ecstasy withdrawal

A

Fatigue
Anorexia
Depression
Anxiety
Difficulty concentrating

67
Q

Symptoms of cocaine withdrawal

A

Strong craving for cocaine with limited physical symptoms
Profound lethargy and hypersomnia
Decreased consciousness
‘Crash’ in mood
Agitation

68
Q

Symptoms of nicotine withdrawal

A

Low mood
Insomnia
Irritability
Frustration
Anxiety
Restlessness
Increased appetite

69
Q

Drug intoxication which causes synaesthesia

A

LSD

70
Q

Drug intoxication which causes nasal congestion

A

Cocaine

71
Q

Drug intoxication which causes conjunctival injection

A

Cannabis

72
Q

Drug intoxication which causes rapid onset of psychotic symptoms

A

Amphetamine

73
Q

Blood test which is a sensitive marker of alcohol abuse and where levels return to normal after 2-4 weeks of abstinence

A

GGT

74
Q

Blood test which is felt to be the most sensitive and specific marker of recent alcohol abuse and can be useful in detecting relapses

A

Carbohydrate deficient transferrin

75
Q

Blood test which is specific but not sensitive, and so not useful in detecting recent alcohol abuse

A

MCV

76
Q

Drug class associated with the opioid receptor system

A

Opiates

77
Q

Drug associated with the GABA receptor system

A

Alcohol

78
Q

Drug associated with the acetylcholine receptor system

A

Nicotine

79
Q

Drug associated with the glutamate receptor system

A

PCP

80
Q

Drug associated with the adenosine receptor system

A

Caffeine

81
Q

Interaction between chlormethiazole and alcohol

A

Respiratory depression

82
Q

Features of mercury poisoning

A

Bloody stools
Diarrhoea
Vomiting
Restlessness
Anxiety
Difficulty concentrating
Agitation

83
Q

Features of lead poisoning in children

A

Encephalopathy
Permanent intellectual impairment

84
Q

Features of lead poisoning in adults

A

Anorexia
Colicky pain
Cognitive impairment

85
Q

Features of manganese poisoning

A

Headache
Irritability
Joint pains
Sleepiness
Parkinsonian features

86
Q

Features of thallium poisoning

A

Pain in the legs
Diarrhoea
Vomiting
Alopecia
Delirium
Convulsions
Blindness
Eventually coma

87
Q

Features of arsenic poisoning

A

Impairment of new learning
Memory impairment
Usually occurs in industrial workers

88
Q

Features of strychnine poisoning

A

Muscle spasms and convulsions
Lactic acidosis
Rhabdomyolysis
Postictal depression
Asphyxiation from paralysis of neural pathways that control breathing

89
Q

Time in days for untreated methadone withdrawal to peak

A

4-6

90
Q

Time in days for untreated methadone withdrawal to resolve

A

10

91
Q

Time in days for untreated heroin withdrawal to resolve

A

3-5

92
Q

Time in days for untreated buprenorphine withdrawal to resolve

A

10

93
Q

Area of the brain with high density of mu receptors which is involved in the stimulation of wakefulness

A

Locus coeruleus

94
Q

Time in hours for untreated alcohol withdrawal to peak

A

24-48

95
Q

Most common symptom of benzodiazepine withdrawal

A

Insomnia

96
Q

Recreational drug most likely to cause haematuria

A

Ketamine

97
Q

Recreational drug associated with B12 deficiency

A

Nitrous oxide (laughing gas)

98
Q

Early signs of opiate withdrawal

A

Anxiety
Cravings
THEN
Agitation
Insomnia
Headache
Lacrimation
Rinorrhoea
Yawning
Shivering
Perspiration

99
Q

Late signs of opiate withdrawal

A

Dilated pupils
Piloerection
Tachycardia
Raised respiratory rate
Abdominal cramps

100
Q

Advanced sign of opiate withdrawal

A

Muscle cramps

101
Q

Substance associated with a fishy smell in the sweat and a runny nose in intoxication

A

Mephedrone

102
Q

Substances associated with renal membrane nephropathy

A

Ketamine
Opiates

5. Addictions psychiatry (10 decks)

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