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Part 3 – PM3B > (PM3B) Substance Abuse & Society > Flashcards

(PM3B) Substance Abuse & Society Flashcards

1
Q

What is substance abuse?

A

Disorder

Characterised by the destructive pattern of using a substance

Leads to problems/ distress

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2
Q

What is the ventral tegmental area?

A

Receives stimuli from different parts of the brain

Information from neurones (tongue/ tastebuds)

(1) Connected to the nucleus accumbens via dopamine-releasing neurones
(2) Connected to the medial prefrontal cortex via dopamine-releasing neurones

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3
Q

What is the nucleus accumbens?

A

Connected to the ventral tegmental area via dopamine-releasing neurones

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4
Q

What is addiction?

A

Compulsive engagement in rewarding stimuli

Despite adverse consequences

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5
Q

What is a rewarding stimuli?

A

Stimuli that the brain interprets as intrinsically positive/ something to be approached

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6
Q

What is sensitisation?

A

Amplified response to a stimulus resulting from repeated exposure to it

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7
Q

What types of dependence are there?

A

(1) Somatic/ physical

(2) Psychological

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8
Q

What percentage of the UK population are dependent on alcohol?

A

5%

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9
Q

What percentage of the UK population are dependent on heroin and crack cocaine?

A

1%

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10
Q

What is abuse?

A

Sexual/ psychological/ emotional/ physical

Can influence drug use as a coping mechanism

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11
Q

What effect do underlying emotional disorders have on substance abuse?

A

Increased risk of substance abuse

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12
Q

What effect does family history have on substance abuse?

A

Increased risk of substance abuse

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13
Q

What are some categories of abused substances?

A

(1) Nicotine
(2) Alcohol

(3) Euphorics
- Cannabis
- Ketamine
- Nitrous oxide

(4) Opiates
(5) Benzodiazepines
(6) Stimulants

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14
Q

What is the meso-cortico-limbic system?

A

Dopamine pathway

Ventral tegmental area (VTA) to nucleus accumbens via dopamine-releasing neurones

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15
Q

What are the two overall treatment approaches for substance abuse?

A

(1) Pharmacological

(2) Behavioural

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16
Q

What is, generally, the most effective overall treatment?

A

Combination of pharmacological + behavioural

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17
Q

What is cognitive behavioural therapy?

A

Behaviours being learned responses

Through learning different responses, can be altered

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18
Q

What are contingency management interventions?

A

Rewarding compliance with abstinence

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19
Q

What is motivational enhancement therapy?

A

Focuses on identifying the need to change behaviours

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20
Q

What is family behaviour therapy?

A

Therapy undertaken with at least one other family member

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21
Q

What are the principles of pharmacological therapies for substance misuse?

A

(1) Abstinence
(2) Detoxification
(3) Replacement/ substitution therapy
(4) Formulation/ distribution – reduce misuse potential of replacement therapies

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22
Q

What is the role of the pharmacist in substance misuse?

A

(1) Provision of substance misuse services
- Needle exchange schemes
- Health promotions

(2) Identifying interactions

(3) Detection of misuse
- Unusual patterns of OTC purchases
- Altered prescriptions (strengths + quantity)

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23
Q

What is cannabis?

A

Plant

Cannabis sativa

One of the most widely used recreational/ medicinal drugs worldwide

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24
Q

Name some phytocannabinoids.

A

(1) delta9-tetrahydrocannabinol
(2) Cannabidiol
(3) Cannabigeroland

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25
Q

What is the psychoactive constituent of cannabis?

A

Phytocannabinoid

THC

delta9-tetrahydrocannabinol

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26
Q

What class drug is cannabis in the UK?

A

Class B

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27
Q

Is it a crime to possess anabolic steroids?

A

Personal use = No

Distribution = Yes

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28
Q

What is the endocannabinoid system?

A

THC exertion of function via CB1 receptor

CB1 receptor expressed almost everywhere in CNS

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29
Q

Why is it difficult to predict effects of THC?

A

CB1 receptors are almost everywhere in the body in the CNS

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30
Q

What is the effect of CB1 receptor binding?

A

Decreases release of dopamine + GABA

Release of glutamate activates postsynaptic mGluR5

Activates phospholipase C

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31
Q

What are some of the symptoms of cannabinoid receptor binding (CB1/ CB2)?

A

(1) Increased appetite
(2) Decreased pain sensitivity
(3) Nausea suppression
(4) Slow reaction time
(5) Sense of wellbeing
(6) Relaxation
(7) Euphoria
(8) Hallucinations
(9) Affected memory
(10) Affected judgement

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32
Q

Where are CB1 receptors?

A

In CNS (mostly)

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33
Q

Where are CB2 receptors?

A

In PNS (mostly)

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34
Q

What are some clinical uses for cannabinoids?

A

(1) Pain management
(2) Anti-emetic
(3) Appetite stimulant
(4) Anti-spastic – e.g. for multiple sclerosis

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35
Q

Why do people abuse substances?

A

Engaging in rewarding behaviours leads to pleasurable feelings

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36
Q

What are the most common forms of cannabis?

A

(1) Dried flowering tops of female plant buds

(2) Resins + oils

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37
Q

What are some different administration routes for illicit use of cannabis?

A

(1) Inhalation – smoking/ water pipes (bongs)

(2) Orally – food supplement, metabolised in GIT
- Produces more potent + less predictable effects

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38
Q

What are some different administration routes for medical use of cannabis?

A

(1) Sublingual aerosol

(2) THC capsules

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39
Q

What are the benefits of licensed medical cannabis over illicit use?

A

(1) Proven in clinical trials
(2) Pure compounds (standardised)
(3) Dose is controlled

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40
Q

What are some therapeutic applications of licensed medicinal cannabis?

A

(1) Appetite stimulant for AIDS patients
(2) Multiple sclerosis related spasticity
(3) Chemotherapy related nausea
(4) Neuropathic pain – from chronic disorders

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41
Q

What are some long-term effects of cannabis use?

A

(1) Addiction
(2) Altered brain development
(3) Poor educational outcome
(4) Cognitive impairment
(5) Diminished life satisfaction + achievement
(6) Symptoms of chronic bronchitis
(7) Increased risk of chronic psychosis disorders (including schizophrenia in those with a predisposition)

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42
Q

What are some of the potential withdrawal symptoms of cannabis use?

A

(1) Dysphoria – state of unease/ general dissatisfaction
(2) Disturbed sleep
(3) Decreased appetite

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43
Q

What are some behavioural treatment approaches for cannabis use?

A

(1) Motivational enhancement therapy (MET)
(2) Cognitive behavioural therapy (CBT)
(3) Contingency management (CM)
(4) Family-based treatments

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44
Q

What is Salvia divinorum?

A

Hallucinogenic

Leaves

Family same as mint, oregano, lavender, thyme

Family: Lamiaceae

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45
Q

What is salvinorin A?

A

Active component of Salvia divinorum

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46
Q

What is the mechanism of action of salvinorum A (the active component of Salvia divinorum)?

A

(1) Hydrolysed to salvinorin B
(2) Selective potent agonist for KOR (kappa-opioid receptor)
(3) Non-nitrogenous lipid-like GPCRs

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47
Q

What dose of salvinorin A produces hallucinogenic effects?

A

200-500mcg of dried leaves

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48
Q

What are some of the potential effects of salvinorin A?

A

(1) Modified state of awareness
(2) 1-30minute inebriant state (drunk)
(3) Bizarre feelings of depersonalisation
(4) Synaesthesia – sensory feeling in a component separate to where the sensation stimulant is
(5) Visual hallucination

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49
Q

What are some unproven therapeutic claims for salvinorin A?

A

(1) Anti-nociceptive effects
(2) Utility in depression
(3) Treatment of cocaine abusers

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50
Q

What is important, with regard to dosage of salvinorin A?

A

Low dose = pain and mood amelioration

High dose = exacerbation of symptoms

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51
Q

What effects does nitrous oxide have on the CNS?

A

(1) Analgesia
(2) Euphoria
(3) Anxiolytic effects

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52
Q

How does nitrous oxide exhibit an analgesic effect?

A

(1) Enhances release of endorphins
(2) Inhibits interneuronal inhibition of endorphin releasing neurons
(3) Endorphines induce analgesia through opioid receptor activation

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53
Q

How does nitrous oxide exhibit a euphoric effect?

A

(1) Induces dopamine release

(2) Stimulates mesolimbic reward pathway

54
Q

How does nitrous oxide exhibit anxiolytic (reducing anxiety) effects?

A

GABA-mediated

55
Q

Name some clinical uses of nitrous oxide.

A

(1) Dental surgery

(2) Childbirth

56
Q

What are some of the effects of gas inhalation?

A

(1) Dizziness
(2) Euphoria
(3) Bursts of laughing
(4) Dissociation
(5) Sexual performance enhancer

57
Q

What are some of the physical symptoms of nitrous oxide?

A

(1) Nerve damage
(2) Demyelination
(3) Neuropathy – peripheral nerve dysfunction
(4) Nausea+ vomiting

58
Q

What treatment is available for nitrous oxide toxicity?

A

Vitamin B12

59
Q

Where is cocaine sourced?

A

Erythorxylon coca leaves in the Andes

60
Q

What is cocaine?

A

An alkaloid

61
Q

When is cocaine used medicinally?

A

Ophthalmic procedures

Local anaesthetic

62
Q

What is the mechanism of action of cocaine?

A

In CNS

Blocks dopamine active transporter (DAT)

Blocks noradrenaline transporter (NAT)

Blocks serotonin transporter (SERT)

63
Q

What do dopamine active transporters (DAT) do?

A

Nucleus accumbens – reward + reinforcement

64
Q

What do noradrenaline transporters (NAT) do?

A

Activate sympathetic nervous system

(1) Increase arterial pressure
(2) Tachycardia
(3) Ventricular arrhythmias

65
Q

What do serotonin transporters (SERT) do?

A

Cortex – reward + reinforcement

66
Q

How is crack cocaine made?

A

Cocaine (hydrochloride) powder mixed with baking soda

67
Q

What salt form is cocaine powder?

A

Cocaine hydrochloride

68
Q

What are some routes of administration of cocaine?

A

(1) Transmucosal – intranasal absorption

(2) Injection – IV

69
Q

What are some short term psychological side effects of cocaine use?

A

(1) Increased sense of energy + alertness + restlessness
(2) Extremely elevated mood
(3) Feeling of supremacy
(4) Irritability
(5) Paranoia
(6) Anxiety
(7) Exuberant speech

70
Q

What are some short term pathological side effects of cocaine use?

A

(1) Increased temperature
(2) Pupil dilation
(3) Blood vessel constriction
(4) Increased blood pressure
(5) Increase HR
(6) Risk of cardiac arrest
(7) Risk of respiratory arrest
(8) Tremor/ twitches

71
Q

What are some long term side effects of cocaine use?

A

(1) Increased BP + HR
(2) Lethal arrhythmia
(3) Central vasoconstriction
(4) Increased risk of stroke
(5) Seizures
(6) Violent behaviour
(7) Damage nose + sinuses
(8) Ulceration/ perforation of gut
(9) Impaired sexual function

72
Q

What are some withdrawal symptoms of cocaine?

A

(1) Depression/ anxiety
(2) Fatigue
(3) Difficulty concentrating
(4) Inability to feel pressure
(5) Inability to feel pleasure
(6) Increased craving for cocaine
(7) Aches/ pains/ tremors/ chills
(8) Formication – feeling of insects under skin
(9) Suicidal thoughts

73
Q

How long do withdrawal symptoms of cocaine typically last?

A

1-2 weeks

Intense craving can return years after first use

74
Q

What is the pharmacological treatment for cocaine use?

A

None FDA/ EMA approved

Some used off-license to reduce withdrawal symptoms

75
Q

What is the psychological treatment for cocaine use?

A

Cognitive behavioural therapy

76
Q

Name some potential pharmacological drugs to treat cocaine usage (they are not licensed).

A

(1) Antidepressants/ tranquillisers
(2) Amantadine
(3) Bromocriptine
(4) Propanolol

77
Q

Give an example of a methylphenidate.

A

Ritalin

78
Q

What is ritalin used for?

A

First choice treatment for ADHD

79
Q

What is the mechanism of action of phenidates and methylphenidates?

A

Amphetamine-like drug

Major effect in basal ganglia – dopamine-releasing properties

80
Q

What happens following snorting of methylphenidate?

A

Rapid release of synaptic dopamine

Produces subjective effects of an instant high

81
Q

How is methylphenidate dependence treated?

A

Similarly to cocaine – via behavioural approaches

CBT – cognitive behavioural therapy

82
Q

What are amphetamines?

A

Stimulants

Include methamphetamines as well as amphetamines

Originally used primarily via nasal inhalation

83
Q

Which naturally occurring molecules do amphetamines resemble?

A

Adrenaline + noradrenaline

84
Q

What is amphetamine used for recreationally?

A

(1) Increase alertness
(2) Relieve fatigue
(3) Control weight
(4) Treatment of mild depression
(5) Intense euphoric effects

85
Q

What is the mechanism of action of amphetamines?

A

Enters presynaptic membrane

Causes leakage of dopamine into synaptic cleft

86
Q

What are some routes of administration of amphetamines?

A

(1) Intranasal
(2) Oral
(3) IV

87
Q

What is the duration of effects of amphetamines?

A

4-8 hours

Residual effects can last up to 12 hours

88
Q

How is methamphetamine metabolised in the body?

A

Methamphetamine is metabolised to amphetamine

89
Q

What are some of the side effects of amphetamine?

A

(1) Light sensitivity
(2) Irritability
(3) Insomnia
(4) Nervousness
(5) Headache
(6) Tremors
(7) Anxiety
(8) Paranoia
(9) Aggressiveness/ violence
(10) Hallucinations/ delusions

90
Q

What can happen following an amphetamine overdose?

A

(1) Hyperthermia
(2) Tachycardia
(3) Severe hypertension
(4) Convulsions
(5) Chest pains
(6) Stroke
(7) Cardiovascular collapse
(8) Death

91
Q

What effects can occur following abrupt discontinuation of amphetamine use?

A

(1) Extreme fatigue
(2) Mental depression
(3) Apathy
(4) Long periods of sleep
(5) Irritability
(6) Disorientation

92
Q

What is MDMA?

A

Ecstasy

Synthetic psychoactive drug

Produces feelings of:

  • Increased energy
  • Euphoria
  • Emotional warmth
  • Empathy towards others
93
Q

What are some dangers of MDMA in the illegal market?

A

(1) May contain different drugs
(2) May contain incorrect doses
(3) May contain other drugs

94
Q

What is LSD?

A

Lysergic acid diethylamide

Hallucinogen

95
Q

What molecule in the body does LSD resemble structurally?

A

Serotonin

96
Q

How does LSD exert its effect?

A

Primarily through serotonin receptors

97
Q

What are some psychological side effects of LSD use?

A

150-250µg:
(1) Illusions

(2) Stationary objects seem to move
(3) Colours seem brighter/ more intense
(4) Synaethesia
(5) Emotional changes
(6) Judgment is suspended
(7) Time + spatial orientation are affected
(8) Transcendental experiences

98
Q

What are some pathological side effects of LSD use?

A

(1) Changes in HR + BP
(2) Pupil dilation
(3) Sweating
(4) Hypersalivation
(5) Piloerection
(6) Nausea/ vomiting/ diarrhoea
(7) Tremors/ increased muscular tension
(8) Fatigue
(9) Headaches
(10) Analgesia

99
Q

What is the therapy for LSD and other hallucinogen ingestion?

A

(1) Talk therapy (until effects end)

(2) Antipsychotics + benzodiazepines when users may harm themselves and others

100
Q

What is opium?

A

A seedpod

Milky fluid seeps from cute in the unripe poppy seed pod

101
Q

How is opium transformed for illicit use?

A

(1) Raw opium
(2) Hot water + Ca2+ (alkali pH dissolves morphine)
(3) Ammonium chloride added after filtration to precipitate morphine
(4) Crude morphine powder
(5) Acetic anhydride/ boiling to acetylate
(6) Brown heroin precipitation
(7) HCl purification
(8) 6% yield

102
Q

What ligands act in the endogenous opioid system?

A

(1) Enkephalins
(2) Dynorphins
(3) Endorphins

103
Q

What are some opioid side effects?

A

(1) Respiratory depression
(2) Euphoria
(3) Cough suppression
(4) Nausea
(5) Constipation
(6) Dryness of the mouth
(7) Warm flushing of the skin
(8) Muscle weakness

104
Q

What are some short term side effects of opioid use?

A

(1) Analgesia
(2) Sedation
(3) Euphoria
(4) Respiratory depression
(5) Small pupils
(6) Nausea + vomiting
(7) Itching/ flushed skin
(8) Constipation
(9) Slurred speech
(10) Confusoin/ poor judgement

105
Q

What are some long term side effects of opioid use?

A

(1) Addiction

(2) Tolerance

106
Q

What are some withdrawal symptoms of opioid use?

A

(1) Anxiety
(2) Irritability
(3) Craving for opioid
(4) Rapid breathing
(5) Yawning
(6) Runny nose
(7) Salivation
(8) Goosebumps
(9) Nasal congestion
(10) Muscle aches
(11) Abdominal cramping
(12) Sweating
(13) Tremors
(14) Confusion
(15) Enlarged pupils
(16) Loss of appetite

107
Q

What is the treatment for opioid overdose?

A

(1) Assess patient to clear airway
(2) Provision of support ventilation
(3) Assess + support cardiac function
(4) Provision of IV fluids
(5) IV naloxone – opioid antagonist

108
Q

What is Evzio?

A

Naloxone

Autoinjector form for home

109
Q

What are some of the goals of treatment of opioid therapy?

A

(1) Detoxification
(2) Replacement/ substitute therapy
(3) Behavioural approaches

110
Q

What are most opioid drugs replaced with?

A

(1) Methadone maintenance
(2) Buprenorphine/ naloxone maintenance – 4:1 ratio

(3) Alpha2 adrenoceptor agonists
- clonidine/ lofexidine

(4) Diacetyl morphine
(5) CBT - cognitive behavioural therapy

111
Q

Where is opioid detoxification therapy undertaken?

A

(1) Prison
(2) Specialised addiction centre
(3) Community clinic
(4) Private sector hospital
(5) Psychiatric hospital
(6) Detoxification camp

112
Q

What is doping?

A

Artificially changing body physiology to enhance performance

Usually muscle mass or blood oxygenation

113
Q

What is WADA?

A

World Anti-Doping Agency

114
Q

What are PEDs?

A

Performance Enhancing Drugs

115
Q

What types of PEDs are there?

A

(1) Stimulants – e.g. amphetamines
(2) Anabolic steroids – e.g. nandrolone
(3) Diuretic – help lower body weight
(4) Blood doping agents – EPO

116
Q

What is EPO treatment?

A

Hormone produced by the kidney

Enhances oxygen during hypoxia

117
Q

What are some side effects/ risks of using PEDs?

A

(1) Heart disease
(2) Stroke
(3) Cerebral embolism
(4) Pulmonary embolism
(5) Autoimmune diseases

118
Q

What are IPEDs?

A

Image and performance enhancing drugs

e.g. melanotan – darkens skin tone + improves sexual function

119
Q

What is alcohol abuse?

A

Solvents

Mild anaesthetic

Disinfectant

120
Q

How many units are in a standard glass of wine?

A

2 units

121
Q

How many units are in a large glass of wine?

A

3 units

122
Q

How many units are in a bottle of wine?

A

9 units

123
Q

How many units are in a pint of strong lager?

A

3 units

124
Q

How many units are in pint of normal strength lager?

A

2 units

125
Q

How many units are in a standard can of lager?

A

2 units

126
Q

How many units are in a shot of spirit?

A

1 unit

127
Q

What are some health risks of chronic heavy drinking?

A

(1) Anaemia
(2) Cancer
(3) CVD
(4) Cirrhosis
(5) Dementia
(6) Depression
(7) Seizures
(8) Gout
(9) High BP
(10) Infectious diseases
(11) Nerve damage
(12) Pancreatitis

128
Q

What are some physical withdrawal symptoms of alcohol?

A

At their worst for 48 hours

(1) Sleep disturbance
(2) Dehydration
(3) Increased risk of seizures

129
Q

What drugs can be used in maintaining alcohol abstinence?

A

(1) Acamprosate
(2) Disulfiram
(3) Naltrexone

130
Q

What are some coping strategies?

A

(1) Social situation – avoid people/ situations that may impair abstinence
(2) Develop healthy habits – diet/ exercise/ sleep
(3) Avoid alcohol – find new activities/ hobbies

Part 3 – PM3B (32 decks)

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