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PSYCH - PHARMACOLOGY Flashcards

1
Q

ANTI-PSYCHOTICS
What are the two types of anti-psychotics?

A
  • Typical/1st generation
  • Atypical/2nd generation
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2
Q

ANTI-PSYCHOTICS
what is the general mechanism of action for anti-psychotics?

A

psychosis is thought to be caused be an excess of dopamine
therefore anti-psychotics aim to reduce dopamine by blocking receptors

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3
Q

ANTI-PSYCHOTICS
Give an example of a typical (1st generation) anti-psychotic.

A

haloperidol,
flupentixol
zuclopenthixol (decanoate = depot)
chlorpromazine

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4
Q

ANTI-PSYCHOTICS
Give examples of atypical (2nd generation) psychotics.

A

olanzapine,
risperidone (depot),
clozapine,
aripiprazole (depot),
quetiapine

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5
Q

ANTI-PSYCHOTICS
What is the mechanism of action of typical (1st generation) anti-psychotics?

A
  • D2 receptor antagonist
  • Reduced release of dopamine from dopaminergic neurones + so reduced electrical activity in dopaminergic pathways
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6
Q

ANTI-PSYCHOTICS
What pathway do typical (1st generation) anti-psychotics work on to have anti-psychotic effect?

A

Mesolimbic pathway (reduces +ve Sx)

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7
Q

ANTI-PSYCHOTICS
What is the mechanism of action of atypical (2nd generation) anti-psychotics?

A
  • Antagonists at dopamine D2 receptors but more selective in dopamine blockade + so block serotonin 5-HT2a
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8
Q

ANTI-PSYCHOTICS
What is the most crucial adverse effect of clozapine?

A
  • Severe life-threatening agranulocytosis
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9
Q

ANTI-PSYCHOTICS
What are the 5 broad categories of SEs caused by anti-psychotics?

A
  • Extra-pyramidal side effects (EPSEs)
  • Hyperprolactinaemia
  • Metabolic
  • Anticholinergic
  • Neurological
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10
Q

ANTI-PSYCHOTICS
What are the extra-pyramidal side effects (EPSEs) of anti-psychotics?

A
  • Acute dystonic reaction
  • Parkinsonism
  • Akathisia
  • Tardive dyskinesia
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11
Q

ANTI-PSYCHOTICS
How does Parkinsonism present?

A
  • Bradykinesia, rigid, resting pill-rolling tremor + postural instability
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12
Q

ANTI-PSYCHOTICS
How does akathisia present?

A
  • Motor restlessness, typically lower legs (can’t sit still)
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13
Q

ANTI-PSYCHOTICS
How does tardive dyskinesia present?

A
  • Purposeless involuntary movements (chewing, lip smacking, blinking, tongue protrusion)
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14
Q

ANTI-PSYCHOTICS
What are the SEs from hyperprolactinaemia?

A
  • Sexual dysfunction (+ anti-adrenergic)
  • Osteoporosis risk
  • Amenorrhoea
  • Galactorrhoea, gynaecomastia + hypogonadism in men
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15
Q

ANTI-PSYCHOTICS
What are the metabolic SEs?

A
  • Weight gain (esp. olanzapine)
  • Hyperlipidaemia, risk of stroke + VTE in elderly
  • T2DM risk + metabolic syndrome
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16
Q

ANTI-PSYCHOTICS
What are the anticholinergic SEs?

A

Can’t see, pee, spit, shit –
- Blurred vision
- Urinary retention
- Dry mouth
- Constipation
+ tachycardia

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17
Q

ANTI-PSYCHOTICS
What are the neurological SEs?

A
  • Seizures
  • Postural hypotension (anti-adrenergic)
  • Sedation
  • Headaches
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18
Q

ANTI-PSYCHOTICS
What baseline investigations are done for people starting on anti-psychotics?

A
  • FBC, U+Es, LFTs, lipids, BMI, fasting glucose, prolactin, BP, ECG (QTc prolongation) + smoking status (can reduce effects by enhancing metabolism so issues if suddenly stop)
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19
Q

ANTI-PSYCHOTICS
What regular investigations are done for people on anti-psychotics?

A
  • Lipids + BMI at 3m
  • Fasting glucose + prolactin at 6m
  • Frequent BP during dose titration
  • FBC, U+Es, LFTs, lipids, BMI, fasting glucose, prolactin + CV risk yearly
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20
Q

ANTI-PSYCHOTICS
What specific monitoring is required for clozapine?

A
  • FBC at baseline + weekly for 18w, fortnightly until 1y + monthly after
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21
Q

ANTI-PSYCHOTICS
What happens if a patient does not take their clozapine for 48 hours?

A

If not taken for 48hr needs retitrating

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22
Q

ANTI-DEPRESSANTS
What monitoring is needed when starting someone on an anti-depressant?

A
  • 2 weekly to ensure dose working + patient stable, may take up to 6w to start working,
  • weekly if <30y as increased suicide risk
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23
Q

ANTI-DEPRESSANTS
How should anti-depressants be stopped?
Why?

A
  • Gradual dose reduction over 4w
  • Sudden cessation can cause severe withdrawal effects (mostly GI) – pain, diarrhoea, vomiting, restlessness, sweating + mood change
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24
Q

ANTI-DEPRESSANTS
What is the mechanism of action of SSRIs?
Give some examples

A
  • Prevents reuptake + subsequent degradation of serotonin from synaptic cleft by inhibiting its reuptake transporter on the post-synaptic membrane
  • Prolonged serotonin in synaptic cleft = prolonged neuronal activity
  • Citalopram, sertraline, fluoxetine
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25
ANTI-DEPRESSANTS What are the side effects of SSRIs?
- GI Sx most common (N+V, hyponatraemia, abdo pain, bowel issues, increased bleed risk) - Sedation + sexual impotence - Citalopram + QTc prolongation (dose-dependent)
26
ANTI-DEPRESSANTS What are some cautions for SSRIs?
- Suicidal thoughts may increase initially, esp. younger patients - May precipitate manic phase in bipolar - 1st trimester risk of CHD, 3rd trimester risk of persistent pulmonary HTN
27
ANTI-DEPRESSANTS What are some interactions for SSRIs?
- NSAIDs + aspirin = increased risk of bleeding, co-prescribe PPI - Can lower seizure threshold - Do not start until 2w after stopping MAOI + vice-versa as increased risk of serotonin syndrome
28
ANTI-DEPRESSANTS What is the mechanism of action of SNRIs?
- Prevents reuptake + subsequent degradation of serotonin AND noradrenaline from synaptic cleft by inhibiting reuptake transporters on post-synaptic membrane
29
ANTI-DEPRESSANTS Give some examples of SNRIs?
Venlafaxine, duloxetine
30
ANTI-DEPRESSANTS What are some side effects of SNRIs?
- GI (N+V, constipation), central/peripheral effects (SIADH, rhabdomyolysis)
31
ANTI-DEPRESSANTS What is the mechanism of action of monoamine oxidase inhibitors (MAOI)?
- Inhibits monoamine oxidase enzyme which reduces breakdown of adrenaline, noradrenaline + serotonin so increases level
32
ANTI-DEPRESSANTS Give some examples of monoamine oxidase inhibitors (MAOI)? Give some examples.
- Selegiline is selective MAO-B inhibitor which also increases dopamine - Isocarboxazid, phenelzine
33
ANTI-DEPRESSANTS What are some side effects from MAOIs?
- Sexual dysfunction, weight gain + postural hypotension
34
ANTI-DEPRESSANTS What are some cautions with MAOIs?
- Increased risk of serotonin syndrome if used with other serotonergic drugs - Hypertensive crisis with ingestion of foods containing tyramine (aged cheeses, smoked/cured meats, pickled herring, Bovril, Marmite)
35
ANTI-DEPRESSANTS What is the mechanism of action of tricyclic antidepressants (TCAs)?
- Prevents reuptake + subsequent degradation of serotonin + noradrenaline from synaptic cleft by inhibiting reuptake transporters on post-synaptic neuronal membrane
36
ANTI-DEPRESSANTS Give some examples of tricyclic antidepressants (TCAs)?
Amitriptyline, dosulepin, imipramine
37
ANTI-DEPRESSANTS What are the side effects of TCAs?
- Anticholinergic (can't see, pee, spit, shit)
38
ANTI-DEPRESSANTS What cautions are there for TCAs?
- Caution in CVD, avoid following MI - Cardiotoxic in overdose so caution in suicidal patients (QTc prolongation)
39
ANTI-DEPRESSANTS In terms of TCA overdose... i) mild-moderate Sx? ii) severe Sx?
i) Dilated pupils, dry mouth, urinary retention, increased tendon reflexes + extensor plantars ii) Fits, coma, cardiac arrhythmias > arrest
40
ANTI-DEPRESSANTS In terms of TCA overdose what are the ECG signs?
Sinus tachy, wide QRS, prolonged QT interval
41
ANTI-DEPRESSANTS What is the management of a TCA overdose?
Sodium bicarbonate
42
ANTI-DEPRESSANTS What is the mechanism of action of mirtazapine?
- Blocks alpha-2 adrenergic receptors > increased release of neurotransmitters
43
ANTI-DEPRESSANTS What are some side effects of mirtazapine?
Increased appetite + weight gain + sedation are big ones, also increased triglyceride levels
44
MOOD STABILISERS What are some examples of mood stabilisers?
Lithium (first line) AEDs such as valproate, carbamazepine, lamotrigine
45
MOOD STABILISERS What is the mechanism of action of mood stabilisers?
Lithium inhibits cAMP production which inhibits monoamines
46
MOOD STABILISERS What is important to note about mood stabilisers?
Narrow therapeutic range 0.4–1.0mmol/L
47
MOOD STABILISERS What are the side effects of lithium?
LITHIUM – - Leukocytosis - Insipidus (diabetes, nephrogenic) - Tremors (fine if SE, coarse if toxicity) - Hydration (easily dehydrates, renally cleared) - Increased GI motility (N+V, diarrhoea) - Underactive thyroid - Mums beware (Ebstein's anomaly) Can cause weight gain + derm (acne, psoriasis) long-term too
48
MOOD STABILISERS What drugs does lithium interact with?
- NSAIDs, ACEi, ARBs + diuretics may increase lithium levels - Diuretics = dehydration, NSAIDs = renal damage
49
MOOD STABILISERS What baseline measurements are taken for lithium?
- FBC, U+Es, eGFR, TFTs, BMI + ECG
50
MOOD STABILISERS What regular monitoring is done for lithium?
- Weekly serum lithium after initiation + dose changes until stable then every 3m for a year, then every 6m (sample taken 12h after dose) - 6m = TFTs, U+Es, eGFR - Annual = BMI
51
MOOD STABILISERS What might carbamazepine and lamotrigine interfere with?
- Contraceptive pill
52
HYPNOTICS What is the mechanism of action of hypnotics?
- GABA agonists on alpha2-subunit of GABA(A)-BDZ receptor/Cl- channel complex
53
HYPNOTICS Give some examples
Zopiclone, zolpidem, BDZs used for hypnotic effect (lorazepam, temazepam)
54
HYPNOTICS What are the adverse effects?
Same as BDZs - Amnesia, ataxia (esp elderly = falls risk), confusion, drowsiness, dizziness next day (hangover effect), tolerance - Monitor for resp depression (caution in resp disease)
55
ANTI-PSYCHOTICS What are the issues for typical anti-psychotics?
Not selective so can bind to other dopaminergic pathways causing generalised dopamine receptor blockade
56
ANTI-PSYCHOTICS What pathway do typical anti-psychotics work on to cause side effects?
Nigrostriatal (Parkinsonism), tuberoinfundibular (prolactin)
57
ANTI-PSYCHOTICS What is the benefit of atypical anti-psychotics?
More useful in treating -ve Sx of schizophrenia + less likely to cause EPSEs
58
ANTI-PSYCHOTICS What anti-psychotic has a reduced SE profile and why?
Aripiprazole as it is a partial dopamine agonist
59
ANTI-PSYCHOTICS What is the most crucial adverse effect of clozapine?
- Severe life-threatening agranulocytosis
60
ANTI-PSYCHOTICS What is the most common adverse effect of clozapine? What other adverse effects may it have?
- Constipation (big issue in elderly) - Reduced seizure threshold, hypersalivation (Rx hyoscine hydrobromide)
61
ANTIPSYCHOTICS what is the effect of smoking on clozapine?
- when smoking a higher level of clozapine may be required to get therapeutic dose - if stopping smoking a lower dose of clozapine may be required
62
ANTI-PSYCHOTICS How is parkinsonism managed?
Reduce dose or switch to atypical anti-psychotic
63
ANTI-PSYCHOTICS Why is akathisia dangerous?
It is a massive risk factor for suicide in young men with schizophrenia
64
ANTI-PSYCHOTICS How is akathisia managed?
Reduce dose, introduce beta-blocker (propranolol)
65
ANTI-PSYCHOTICS When does tardive dyskinesia present?
After months-years of Tx
66
ANTI-PSYCHOTICS How is tardive dyskinesia managed?
Prevention crucial, switch to atypical anti-psychotic, tetrabenazine used if mod–severe but unlikely to completely resolve
67
ANTI-DEPRESSANTS When can an anti-depressant be stopped?
- Carried on 6m after Sx resolved even if patient feels better
68
ANTI-DEPRESSANTS What are some interactions of SNRIs?
- NSAIDs warfarin (increased risk of bleeding), lower seizure threshold
69
BDZs What is the mechanism of action of anxiolytics/benzodiazepines (BDZs)?
- Enhance effect of inhibitory GABA by increasing frequency of Cl- channels + flow of Cl- ions causing hyperpolarisation of membrane + so prevention of further excitation
70
BDZs Give some examples of BDZs?
- Diazepam (longer duration), lorazepam + temazepam (shorter duration), clonazepam, chlordiazepoxide
71
BDZs What are they suitable for?
Short-term Tx (<4w), sedation + anxiolytic
72
BDZs What are some adverse effects of BDZs?
- Amnesia, ataxia (esp elderly = falls risk), confusion, drowsiness, dizziness next day (hangover effect), tolerance - Monitor for resp depression (caution in resp disease)
73
BDZs What drugs can BDZs interact with?
- Anti-hypertensives as enhanced hypotensive effect
74
BDZs How would you manage an overdose? What is the risk of using this?
IV flumazenil (danger of inducing status epilepticus or death though)
75
SUBSTANCE ABUSE What is an addiction?
- Compulsive substance taking behaviour with physiological withdrawal state
76
SUBSTANCE ABUSE What is an addictive behaviour?
Behaviour which is both rewarding + reinforcing
77
SUBSTANCE ABUSE Why is something addictive?
Related to dopamine + mesolimbic reward system a motivational circuit
78
SUBSTANCE ABUSE What are the physical effects of dependent drug use?
- Acute = injecting complications, SEs, OD, poor pregnancy outcomes - Chronic = BBV transmission, chronic illnesses
79
SUBSTANCE ABUSE What are the... i) psychological ii) social effects of dependent drug use?
i) MH issues, fearing withdrawal, craving, guilt, pre-occupation with finding next fix ii) Effects on relationships, criminality + imprisonment, social exclusion, poverty (no money for food)
80
SUBSTANCE ABUSE What is dependence?
- The inability to control the intake of a substance to which one is addicted to
81
SUBSTANCE ABUSE List 8 features of dependence
- Withdrawal - Cravings - Continued use despite harm - Tolerance - Primacy/salience - Loss of control - Narrowed repertoire - Rapid reinstatement
82
SUBSTANCE ABUSE What is withdrawal? Give an example
- Physiological withdrawal state when substance stopped with Sx + substance use to prevent - Early morning drinking
83
SUBSTANCE ABUSE What are cravings?
- Very strong desire for the substance
84
SUBSTANCE ABUSE What is continued use despite harm? Give an example
- Despite clear problems caused by substance, person cannot stop - Injecting heroin despite abscess formation
85
SUBSTANCE ABUSE What is tolerance? Give an example
- Larger doses required to gain the same effect as previously (NB: individuals often show no signs of being on a drug at dose ordinary people would) - Opiate-dependent people may inject enough heroin to kill a non-tolerant person
86
SUBSTANCE ABUSE What is primacy/salience? Give an example
- Obtaining + using substance becomes so important other interests are neglected - Not eating to save money for drugs
87
SUBSTANCE ABUSE What is loss of control? Give an example
- Difficulties controlling starting, stopping or amounts used - Becomes hard to say no
88
SUBSTANCE ABUSE What is narrowed repertoire? Give an example
- Less variation in types of substances used - Dependent drinker will drink same amount of same drink in same way (usually cheapest)
89
SUBSTANCE ABUSE What is rapid reinstatement? Give an example
- When a user relapses after period of abstinence, risk of returning to previous dependent pattern quicker - Someone who used to smoke 10/d may quickly return to this after 1 fag
90
SUBSTANCE ABUSE What are some primary care interventions for drug users?
- Health checks + BBV screening - Contraception, smear + sexual health advice - General immunisation status + hep A/B - Information on local drug services (needle exchange)
91
SUBSTANCE ABUSE How can harm be reduced in drug users?
- Not injecting or safe injecting (don't share, new one each time) - Not mixing resp depressants or using drugs alone - Reduce amount taken after intervals tolerance is lost
92
ALCOHOL DEPENDENCE What is alcohol abuse?
- Regular or binge consumption of alcohol which is sufficient to cause physical, neurological, psychiatric or social damage
93
ALCOHOL DEPENDENCE How do you calculate number of units in a drink?
- % ABV x volume (L)
94
ALCOHOL DEPENDENCE What is 1 unit of alcohol?
10ml or 8g
95
ALCOHOL DEPENDENCE What is the recommended weekly units for men and women?
14 units/week
96
ALCOHOL DEPENDENCE What are the components to alcohol abuse?
- Psychological dependence = feelings of loss of control, cravings, pre-occupation - Physiological dependence = physical withdrawal Sx - +ve reinforcement = drinking to feel euphoric - -ve reinforcement = drinking to avoid withdrawal Sx
97
ALCOHOL DEPENDENCE What areas of the brain can alcohol affect?
- Amygdala + nucleus accumbens - Cerebral cortex - Pre-frontal cortex - Cerebellum - Hypothalamus + pituitary - Medulla
98
ALCOHOL DEPENDENCE How does alcohol affect... i) amygdala + nucleus accumbens? ii) cerebral cortex? iii) pre-frontal cortex? iv) cerebellum? v) hypothalamus + pituitary? vi) medulla?
i) Euphoria, pleasure + reward centre ii) Slows thinking + speech iii) Slow behavioural inhibition centres (confident + relaxed) iv) Slows movement + impairs coordination v) Alters mood + hormones (libido increases) vi) Decreases breathing, consciousness + body temp
99
ALCOHOL DEPENDENCE How does alcohol affect the activity of neurotransmitters in the brain?
- Ethanol > ADH > acetaldehyde > ALDH > acetate > CO2 + H2O - Ethanol binds to GABA + makes inhibitor/depressant effect stronger - Glutamate antagonism which decreases excitatory neurotransmission - Activates opioid receptors to release endorphins - Release dopamine + serotonin
100
ALCOHOL DEPENDENCE What are some causes/risk factors for alcohol dependence?
- Genetics – more likely if FHx, M>F, less likely if acetaldehyde dehydrogenase deficiency - Occupation – army, Drs - Culture/beliefs/background – high in Scottish, Irish, lower in Muslims + Jews - Cost of alcohol - Early use of substances - Social reinforcement - Chronic illnesses - Traumatic life events
101
ALCOHOL DEPENDENCE What are the acute effects of alcohol intoxication? When is it classed as alcohol dependence?
- Euphoria, impaired judgement, reduced anxiety, ataxia, vomiting - ≥3 features of dependence
102
ALCOHOL DEPENDENCE What are the 3 stages of alcohol withdrawal?
- 6–12h = tremors, diaphoresis, tachycardia, anxiety, irritability + aggression - 36h = seizures - 48–72h = delirium tremens
103
ALCOHOL DEPENDENCE What are some chronic complications of alcohol dependence?
- Cardiac = dilated cardiomyopathy, arrhythmias - Liver etc – fibrosis, cirrhosis, oesophageal varices, pancreatitis - Wernicke's + Korsakoff's
104
ALCOHOL DEPENDENCE What are some common causes of death in alcohol dependence?
- Accidents + violence - Malignancies (head + neck, pancreatic, stomach, colon, hepatic, breast + gynae) - CVA, IHD
105
ALCOHOL DEPENDENCE What are some blood markers for alcohol consumption?
- Red blood cell mean corpuscular volume (MCV) raised - Gamma glutamyl transpeptidase (GGT) raised - Carbohydrate deficient transferrin (CDT) raised
106
ALCOHOL DEPENDENCE What are some clinical tools for assessing alcohol dependence or withdrawal?
- CAGE - AUDIT - Clinical Institute Withdrawal Assessment
107
ALCOHOL DEPENDENCE What are the CAGE questions?
- Have you ever felt you need to CUT down on your drinking? - Have people ANNOYED you by criticising your drink? - Have you ever felt GUILTY about your drinking? - EYE-opener – ever felt you need drink first thing in morning to steady your nerves?
108
ALCOHOL DEPENDENCE What are the AUDIT questions?
- How often do you have a drink containing alcohol? - How many units of alcohol do you drink on a typical day? - How often did you have >6 units on a single occasion in the past year?
109
ALCOHOL DEPENDENCE What is blood alcohol content? How is it affected? What is the drink drive limit?
- mg ethanol/100ml blood - Affected by amount of ethanol consumed, person's blood volume (males have increased), if eaten, any meds - Illegal to drive with BAC ≥0.08%
110
ALCOHOL DEPENDENCE What are public health measurements to help prevent alcohol abuse?
- Increasing tax on alcohol + restricting advertisement on alcohol - Drinkaware + know your limits campaign - Keeping alcohol out of site (behind counter + having to ask for it) - School alcohol education to reduce long-term alcohol use + binge drinking
111
ALCOHOL DEPENDENCE What are the indications for an inpatient detoxification?
- Withdrawal seizures or delirium tremens in past - Significant mental/physical illness, including suicidality - Lack of stable home environment
112
ALCOHOL DEPENDENCE What is the regime for acute detoxification?
- Chlordiazepoxide 1st line (2nd = diazepam) for withdrawal Sx + preventing seizures - Thiamine (PO or IV) - Rehydrate with fluids (often IV), correct electrolyte disturbance - Reducing regime (slowly reduce doses over days)
113
ALCOHOL DEPENDENCE What factors make detoxification more likely to work?
- Younger users with less time addicted + lower level of drug use
114
ALCOHOL DEPENDENCE What are the 3 biological treatments used in alcohol dependence?
- Naltrexone - Acamprosate - Disulfiram
115
ALCOHOL DEPENDENCE What is the mechanism of action of naltrexone?
- Opioid receptor antagonist - Blocks euphoric effects of alcohol - Helps people stick to detox programme + avoid relapse
116
ALCOHOL DEPENDENCE What is the mechanism of action of acamprosate?
- NMDA antagonist acts on GABA to reduce cravings + risk of relapse
117
ALCOHOL DEPENDENCE What is the mechanism of action of disulfiram? What affects does it have?
- Inhibits acetaldehyde dehydrogenase > build-up of acetaldehyde - Produces hangover-like Sx when alcohol is drunk = deterrent (flushing, headaches, anxiety, nausea, reduced BP)
118
ALCOHOL DEPENDENCE What are some psychological treatments for alcohol dependence?
- Motivational intervention - Aversion therapy - CBT, prevention measures (relapse prevention strategies)
119
ALCOHOL DEPENDENCE What is motivational intervention?
- Discuss potential harm caused, reasons for changing behaviour, cover obstacles to change, strategies to combat obstacles > motivation
120
ALCOHOL DEPENDENCE What is aversion therapy?
- Designed to put the patient off the undesirable habit by causing them to associate it with an unpleasant effect
121
ALCOHOL DEPENDENCE What is the social management of alcohol dependence?
- Housing, economical + employment issues - Alcoholics anonymous - Developing social routines that are not reliant on alcohol
122
OPIATES/OPIOIDS What are opiates?
- Derived from opium poppy, synthetic compounds with similar properties are called opioids with heroin most commonly abused
123
OPIATES/OPIOIDS How do opioids work?
- Bind to m-receptor > endogenous endorphins causing cortical inhibitor effects (analgesia) almost immediately - Addictive as high reward for minimal effort
124
OPIATES/OPIOIDS What routes can opioids be taken via? How long does it take for withdrawal symptoms to develop? What are some examples?
- Smoking, PO, snorted, parenterally (IM/IV) - 6h post-dose - Morphine, diamorphine (heroin), codeine, methadone
125
OPIATES/OPIOIDS What are some complications from opioids?
- Resp depression, constipation, N+V, coma, OD + death
126
OPIATES/OPIOIDS What are some complications with injecting heroin?
- Abscesses, cellulitis, infective endocarditis, BBV (hep B/C, HIV), VTE
127
OPIATES/OPIOIDS With opioids, what is the... i) psych effect? ii) physical effect?
i) Euphoria, relaxation, drowsiness, analgesia ii) Resp depression (esp. OD), pinpoint pupils, bradycardia, constipation
128
OPIATES/OPIOIDS With opioids, what are the symptoms of withdrawal
"Goose flesh" (piloerection), raised HR/BP, fever, pupil dilatation, abdo cramps, insomnia, agitation (everything runs > D+V, lacrimation, rhinorrhoea, diaphoresis)
129
OPIATES/OPIOIDS What is the management of opioid overdose?
- 400mg IV naloxone - M-receptor inverse agonist > blockade (almost immediate)
130
OPIATES/OPIOIDS What are some maintenance therapies for opioids?
- Methadone (full opioid agonist) or buprenorphine (partial agonist/antagonist) - Start low + titrate up
131
OPIATES/OPIOIDS What are the pros of methadone?
- Reduces mortality, drug-related morbidity, crime, spread of BBV
132
OPIATES/OPIOIDS How does maintenance therapies help?
- Don't get high but reduces cravings - Less dangerous than heroin + safe in pregnancy (risk of miscarriage if stop in pregnancy)
133
OPIATES/OPIOIDS What drug can be used to prevent relapses?
- Naltrexone - Opiate antagonist which prevents lapse > relapse
134
OPIATES/OPIOIDS What is the first line detox management in opioids? How long does detox last?
- Motivational intervention - Alternative therapies = exercise, art therapy, counselling - 4w = inpatient, 12w = community
135
SEDATIVES What are some types of sedatives? What is a 'date-rape' drug? What routes can it be taken?
- BDZs, barbiturates (increased duration of Cl- channels) often taken for their anxiolytic effects - Rohypnol > intoxicant, aphrodisiac + anterograde amnesia - PO + IV
136
SEDATIVES What are the... i) psych ii) physical effects of sedatives?
i) Euphoria + disinhibition, hallucinations, paranoid, agitation, time passes slowly ii) Unsteady gait, dysarthria, hypotension, nystagmus iii) Sweating, myalgia, tremors, risk of seizures
137
SEDATIVES What are the withdrawal effects of sedatives?
Sweating, myalgia, tremors, risk of seizures
138
STIMULANTS What is the action of stimulants?
- Potentiate mood enhancing neurotransmission (dopamine, serotonin, noradrenaline) by blocking their uptake + increase cortical excitability
139
STIMULANTS What are some examples?
Cocaine, ecstasy (MDMA), amphetamines (speed)
140
STIMULANTS What are the... i) psych ii) physical effects of stimulants?
i) Euphoria, increased alertness + endurance, grandiosity, hallucinations, aggression, impulsivity ii) Tachycardia, HTN, N+V, pupil dilation, CP + convulsions
141
STIMULANTS What are the withdrawal effects of stimulants?
Psychomotor agitation, dysphoric mood, insomnia bizarre/unpleasant dreams
142
STIMULANTS What different routes of taking these drugs?
- Cocaine inhaled or IV - MDMA + amphetamines PO - Crack cocaine releases all dopamine straight away when smoked
143
STIMULANTS What are some other adverse effects of cocaine?
- Arrhythmias, MI + damage to nasal septum if used chronically
144
CANNABINOIDS Why is cannabis addictive? What can heavy use lead to?
- Addictive as causes release of dopamine, anxiolytic - Anxiety + depression, use in youth > schizophrenia
145
CANNABINOIDS What are the... i) psych ii) physical effects of cannabinoids?
i) Euphoria + disinhibition, hallucinations, paranoid, agitation, time passes slowly ii) Increased appetite, dry mouth, tachycardia
146
CANNABINOIDS What are the withdrawal effects of cannabinoids?
Anxiety, irritable, tremor, conjunctival injection
147
HALLUCINOGENS Give some examples of hallucinogens
- LSD, magic mushrooms (PO)
148
HALLUCINOGENS What are some psych + physical effects of hallucinogens?
- Hallucinations, illusions, depersonalisation + derealisation, paranoia, impulsivity, anxiety, magic mushrooms > euphoria as serotonin release - Tachycardia, palpitations, sweating, blurred vision
149
VOLATILE SOLVENTS Give some examples of solvents.
- Aerosols, paint, glue, petrol (inhaled)
150
VOLATILE SOLVENTS What are some psych + physical effects of solvents?
- Apathy, lethargy, impaired judgement, psychomotor retardation - Decreased consciousness, unsteady gait, diplopia
151
VOLATILE SOLVENTS Are the effects of solvents dangerous?
Very – laryngospasm due to cold temp, brain damage, hypoxia

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