(PM3B) Substance Abuse & Society Flashcards
What is substance abuse?
Disorder
Characterised by the destructive pattern of using a substance
Leads to problems/ distress
What is the ventral tegmental area?
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
What is the nucleus accumbens?
Connected to the ventral tegmental area via dopamine-releasing neurones
What is addiction?
Compulsive engagement in rewarding stimuli
Despite adverse consequences
What is a rewarding stimuli?
Stimuli that the brain interprets as intrinsically positive/ something to be approached
What is sensitisation?
Amplified response to a stimulus resulting from repeated exposure to it
What types of dependence are there?
(1) Somatic/ physical
(2) Psychological
What percentage of the UK population are dependent on alcohol?
5%
What percentage of the UK population are dependent on heroin and crack cocaine?
1%
What is abuse?
Sexual/ psychological/ emotional/ physical
Can influence drug use as a coping mechanism
What effect do underlying emotional disorders have on substance abuse?
Increased risk of substance abuse
What effect does family history have on substance abuse?
Increased risk of substance abuse
What are some categories of abused substances?
(1) Nicotine
(2) Alcohol
(3) Euphorics
- Cannabis
- Ketamine
- Nitrous oxide
(4) Opiates
(5) Benzodiazepines
(6) Stimulants
What is the meso-cortico-limbic system?
Dopamine pathway
Ventral tegmental area (VTA) to nucleus accumbens via dopamine-releasing neurones
What are the two overall treatment approaches for substance abuse?
(1) Pharmacological
(2) Behavioural
What is, generally, the most effective overall treatment?
Combination of pharmacological + behavioural
What is cognitive behavioural therapy?
Behaviours being learned responses
Through learning different responses, can be altered
What are contingency management interventions?
Rewarding compliance with abstinence
What is motivational enhancement therapy?
Focuses on identifying the need to change behaviours
What is family behaviour therapy?
Therapy undertaken with at least one other family member
What are the principles of pharmacological therapies for substance misuse?
(1) Abstinence
(2) Detoxification
(3) Replacement/ substitution therapy
(4) Formulation/ distribution – reduce misuse potential of replacement therapies
What is the role of the pharmacist in substance misuse?
(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)
What is cannabis?
Plant
Cannabis sativa
One of the most widely used recreational/ medicinal drugs worldwide
Name some phytocannabinoids.
(1) delta9-tetrahydrocannabinol
(2) Cannabidiol
(3) Cannabigeroland
What is the psychoactive constituent of cannabis?
Phytocannabinoid
THC
delta9-tetrahydrocannabinol
What class drug is cannabis in the UK?
Class B
Is it a crime to possess anabolic steroids?
Personal use = No
Distribution = Yes
What is the endocannabinoid system?
THC exertion of function via CB1 receptor
CB1 receptor expressed almost everywhere in CNS
Why is it difficult to predict effects of THC?
CB1 receptors are almost everywhere in the body in the CNS
What is the effect of CB1 receptor binding?
Decreases release of dopamine + GABA
Release of glutamate activates postsynaptic mGluR5
Activates phospholipase C
What are some of the symptoms of cannabinoid receptor binding (CB1/ CB2)?
(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
Where are CB1 receptors?
In CNS (mostly)
Where are CB2 receptors?
In PNS (mostly)
What are some clinical uses for cannabinoids?
(1) Pain management
(2) Anti-emetic
(3) Appetite stimulant
(4) Anti-spastic – e.g. for multiple sclerosis
Why do people abuse substances?
Engaging in rewarding behaviours leads to pleasurable feelings
What are the most common forms of cannabis?
(1) Dried flowering tops of female plant buds
(2) Resins + oils
What are some different administration routes for illicit use of cannabis?
(1) Inhalation – smoking/ water pipes (bongs)
(2) Orally – food supplement, metabolised in GIT
- Produces more potent + less predictable effects
What are some different administration routes for medical use of cannabis?
(1) Sublingual aerosol
(2) THC capsules
What are the benefits of licensed medical cannabis over illicit use?
(1) Proven in clinical trials
(2) Pure compounds (standardised)
(3) Dose is controlled
What are some therapeutic applications of licensed medicinal cannabis?
(1) Appetite stimulant for AIDS patients
(2) Multiple sclerosis related spasticity
(3) Chemotherapy related nausea
(4) Neuropathic pain – from chronic disorders
What are some long-term effects of cannabis use?
(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)
What are some of the potential withdrawal symptoms of cannabis use?
(1) Dysphoria – state of unease/ general dissatisfaction
(2) Disturbed sleep
(3) Decreased appetite
What are some behavioural treatment approaches for cannabis use?
(1) Motivational enhancement therapy (MET)
(2) Cognitive behavioural therapy (CBT)
(3) Contingency management (CM)
(4) Family-based treatments
What is Salvia divinorum?
Hallucinogenic
Leaves
Family same as mint, oregano, lavender, thyme
Family: Lamiaceae
What is salvinorin A?
Active component of Salvia divinorum
What is the mechanism of action of salvinorum A (the active component of Salvia divinorum)?
(1) Hydrolysed to salvinorin B
(2) Selective potent agonist for KOR (kappa-opioid receptor)
(3) Non-nitrogenous lipid-like GPCRs
What dose of salvinorin A produces hallucinogenic effects?
200-500mcg of dried leaves
What are some of the potential effects of salvinorin 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
What are some unproven therapeutic claims for salvinorin A?
(1) Anti-nociceptive effects
(2) Utility in depression
(3) Treatment of cocaine abusers
What is important, with regard to dosage of salvinorin A?
Low dose = pain and mood amelioration
High dose = exacerbation of symptoms
What effects does nitrous oxide have on the CNS?
(1) Analgesia
(2) Euphoria
(3) Anxiolytic effects
How does nitrous oxide exhibit an analgesic effect?
(1) Enhances release of endorphins
(2) Inhibits interneuronal inhibition of endorphin releasing neurons
(3) Endorphines induce analgesia through opioid receptor activation
How does nitrous oxide exhibit a euphoric effect?
(1) Induces dopamine release
(2) Stimulates mesolimbic reward pathway
How does nitrous oxide exhibit anxiolytic (reducing anxiety) effects?
GABA-mediated
Name some clinical uses of nitrous oxide.
(1) Dental surgery
(2) Childbirth
What are some of the effects of gas inhalation?
(1) Dizziness
(2) Euphoria
(3) Bursts of laughing
(4) Dissociation
(5) Sexual performance enhancer
What are some of the physical symptoms of nitrous oxide?
(1) Nerve damage
(2) Demyelination
(3) Neuropathy – peripheral nerve dysfunction
(4) Nausea+ vomiting
What treatment is available for nitrous oxide toxicity?
Vitamin B12
Where is cocaine sourced?
Erythorxylon coca leaves in the Andes
What is cocaine?
An alkaloid
When is cocaine used medicinally?
Ophthalmic procedures
Local anaesthetic
What is the mechanism of action of cocaine?
In CNS
Blocks dopamine active transporter (DAT)
Blocks noradrenaline transporter (NAT)
Blocks serotonin transporter (SERT)
What do dopamine active transporters (DAT) do?
Nucleus accumbens – reward + reinforcement
What do noradrenaline transporters (NAT) do?
Activate sympathetic nervous system
(1) Increase arterial pressure
(2) Tachycardia
(3) Ventricular arrhythmias
What do serotonin transporters (SERT) do?
Cortex – reward + reinforcement
How is crack cocaine made?
Cocaine (hydrochloride) powder mixed with baking soda
What salt form is cocaine powder?
Cocaine hydrochloride
What are some routes of administration of cocaine?
(1) Transmucosal – intranasal absorption
(2) Injection – IV
What are some short term psychological side effects of cocaine use?
(1) Increased sense of energy + alertness + restlessness
(2) Extremely elevated mood
(3) Feeling of supremacy
(4) Irritability
(5) Paranoia
(6) Anxiety
(7) Exuberant speech
What are some short term pathological side effects of cocaine use?
(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
What are some long term side effects of cocaine use?
(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
What are some withdrawal symptoms of cocaine?
(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
How long do withdrawal symptoms of cocaine typically last?
1-2 weeks
Intense craving can return years after first use
What is the pharmacological treatment for cocaine use?
None FDA/ EMA approved
Some used off-license to reduce withdrawal symptoms
What is the psychological treatment for cocaine use?
Cognitive behavioural therapy
Name some potential pharmacological drugs to treat cocaine usage (they are not licensed).
(1) Antidepressants/ tranquillisers
(2) Amantadine
(3) Bromocriptine
(4) Propanolol
Give an example of a methylphenidate.
Ritalin
What is ritalin used for?
First choice treatment for ADHD
What is the mechanism of action of phenidates and methylphenidates?
Amphetamine-like drug
Major effect in basal ganglia – dopamine-releasing properties
What happens following snorting of methylphenidate?
Rapid release of synaptic dopamine
Produces subjective effects of an instant high
How is methylphenidate dependence treated?
Similarly to cocaine – via behavioural approaches
CBT – cognitive behavioural therapy
What are amphetamines?
Stimulants
Include methamphetamines as well as amphetamines
Originally used primarily via nasal inhalation
Which naturally occurring molecules do amphetamines resemble?
Adrenaline + noradrenaline
What is amphetamine used for recreationally?
(1) Increase alertness
(2) Relieve fatigue
(3) Control weight
(4) Treatment of mild depression
(5) Intense euphoric effects
What is the mechanism of action of amphetamines?
Enters presynaptic membrane
Causes leakage of dopamine into synaptic cleft
What are some routes of administration of amphetamines?
(1) Intranasal
(2) Oral
(3) IV
What is the duration of effects of amphetamines?
4-8 hours
Residual effects can last up to 12 hours
How is methamphetamine metabolised in the body?
Methamphetamine is metabolised to amphetamine
What are some of the side effects of amphetamine?
(1) Light sensitivity
(2) Irritability
(3) Insomnia
(4) Nervousness
(5) Headache
(6) Tremors
(7) Anxiety
(8) Paranoia
(9) Aggressiveness/ violence
(10) Hallucinations/ delusions
What can happen following an amphetamine overdose?
(1) Hyperthermia
(2) Tachycardia
(3) Severe hypertension
(4) Convulsions
(5) Chest pains
(6) Stroke
(7) Cardiovascular collapse
(8) Death
What effects can occur following abrupt discontinuation of amphetamine use?
(1) Extreme fatigue
(2) Mental depression
(3) Apathy
(4) Long periods of sleep
(5) Irritability
(6) Disorientation
What is MDMA?
Ecstasy
Synthetic psychoactive drug
Produces feelings of:
- Increased energy
- Euphoria
- Emotional warmth
- Empathy towards others
What are some dangers of MDMA in the illegal market?
(1) May contain different drugs
(2) May contain incorrect doses
(3) May contain other drugs
What is LSD?
Lysergic acid diethylamide
Hallucinogen
What molecule in the body does LSD resemble structurally?
Serotonin
How does LSD exert its effect?
Primarily through serotonin receptors
What are some psychological side effects of LSD use?
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
What are some pathological side effects of LSD use?
(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
What is the therapy for LSD and other hallucinogen ingestion?
(1) Talk therapy (until effects end)
(2) Antipsychotics + benzodiazepines when users may harm themselves and others
What is opium?
A seedpod
Milky fluid seeps from cute in the unripe poppy seed pod
How is opium transformed for illicit use?
(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
What ligands act in the endogenous opioid system?
(1) Enkephalins
(2) Dynorphins
(3) Endorphins
What are some opioid side effects?
(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
What are some short term side effects of opioid use?
(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
What are some long term side effects of opioid use?
(1) Addiction
(2) Tolerance
What are some withdrawal symptoms of opioid use?
(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
What is the treatment for opioid overdose?
(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
What is Evzio?
Naloxone
Autoinjector form for home
What are some of the goals of treatment of opioid therapy?
(1) Detoxification
(2) Replacement/ substitute therapy
(3) Behavioural approaches
What are most opioid drugs replaced with?
(1) Methadone maintenance
(2) Buprenorphine/ naloxone maintenance – 4:1 ratio
(3) Alpha2 adrenoceptor agonists
- clonidine/ lofexidine
(4) Diacetyl morphine
(5) CBT - cognitive behavioural therapy
Where is opioid detoxification therapy undertaken?
(1) Prison
(2) Specialised addiction centre
(3) Community clinic
(4) Private sector hospital
(5) Psychiatric hospital
(6) Detoxification camp
What is doping?
Artificially changing body physiology to enhance performance
Usually muscle mass or blood oxygenation
What is WADA?
World Anti-Doping Agency
What are PEDs?
Performance Enhancing Drugs
What types of PEDs are there?
(1) Stimulants – e.g. amphetamines
(2) Anabolic steroids – e.g. nandrolone
(3) Diuretic – help lower body weight
(4) Blood doping agents – EPO
What is EPO treatment?
Hormone produced by the kidney
Enhances oxygen during hypoxia
What are some side effects/ risks of using PEDs?
(1) Heart disease
(2) Stroke
(3) Cerebral embolism
(4) Pulmonary embolism
(5) Autoimmune diseases
What are IPEDs?
Image and performance enhancing drugs
e.g. melanotan – darkens skin tone + improves sexual function
What is alcohol abuse?
Solvents
Mild anaesthetic
Disinfectant
How many units are in a standard glass of wine?
2 units
How many units are in a large glass of wine?
3 units
How many units are in a bottle of wine?
9 units
How many units are in a pint of strong lager?
3 units
How many units are in pint of normal strength lager?
2 units
How many units are in a standard can of lager?
2 units
How many units are in a shot of spirit?
1 unit
What are some health risks of chronic heavy drinking?
(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
What are some physical withdrawal symptoms of alcohol?
At their worst for 48 hours
(1) Sleep disturbance
(2) Dehydration
(3) Increased risk of seizures
What drugs can be used in maintaining alcohol abstinence?
(1) Acamprosate
(2) Disulfiram
(3) Naltrexone
What are some coping strategies?
(1) Social situation – avoid people/ situations that may impair abstinence
(2) Develop healthy habits – diet/ exercise/ sleep
(3) Avoid alcohol – find new activities/ hobbies
