Psychiatry: Substance Abuse Flashcards
drugs which stimulate which area of the brain (be specific - where is this located) are most addictive ? why is this ?
stimulants that stimulate the nucleus acumbens in the ventral tegmental area (rich in opioid + dopamine receptors) are most addictive
Name some recreational stimulants ?(5)
- caffeine
- nicotine
- cocaine
- meth-amphetamine
- MDMA
how does caffeine work ? on what NT does it have an effect ? what are the effects of it ?
(recreational stimulant)
inhibits adenosine => increase dopamine + serotonin + NAd => increase focus + alertness (+ autonomic (SNS): hypertension, tachycardia, increase uriantion frequency)
why is nicotine so addictive ?
reaches the brain v quickly (7 secs)
- build up tolerance
what are some of the effects of nicotine ?
(recreational stimulant)
- sympathetic innervation
- suppress appetit
what drugs are used to help with smoking cessation ?
- varencline
- bupropion
overall: what are the effects of stimulants and depressant ? and describe th withdrawal associated with each ?
- stimulant: SNS effects, withdrawal (PSNS, uncomfortable)
- Depressant: PSNS effects (relaxation + sedation), withdrawal (SNS, deadly)
what are some of the effects of cocaine ?
SNS (recreational stimulant)
- euphoria
- agitation
- myoriasis (wide dilated pupil)
- increase heart rate
- increase BP
describe cocaine withdrawal ?
PSNS (opposite of the high)
- Sedation
- Lethargy
- Craving
(unpleasant bu not dangerous)
what are the effects of meth-ampheatmine ? what is it similar to ?
(recreational stimulant)
amped up cocaine,, greater potency, more addiactive
- similar effects as cocaine (SNS) but also increased libido
what is meth withdrawal like ?
(PSNS)
- depression
- lethargy
- increased appetite and hunger
what are the effects of MDMA ?
recreational stimulant
- derealization
- mania
- hulluciantions
- increase HR
- increase BP
MDMA withdrawal ?
(recreational stimulant withdrawal => PSNS)
- depression
- irritailty
- fatigue
- bruxism (high yield - grind/crush teeth)
name some recreational depressants ? (3)
- Alcohol
- benzodiazepiens
- opiates
on what NT does alcohol work ? (2)
(recreational depressant)
GABA agonist
(and inhibits glutamate)
What are the overall effects of alcohol withdrawal ? (6)
- anxiety
- insomnia
- tremor
- siezures
- hyptertension
- delirium tremens
What are the effects of benzodiazepines ? (4)
recreational depressant
- Sedation
- Euphoria
- Ataxia
- Amnesia
what are the withdrawal syndomps associated with benzos ?
- panic
- anxiety
- insomnia
- tachycardia
- siezures
what is the managment of benzodiazepine withdrawal ?
controlled with benzo taper
what would you give to treat a benzodiazepine overdose ? what type fo drug is this ?
flumazenil (GABA antagonist)
What are the effects of opiates ? (6)
- euphoria
- CNS depression
- Miosis (pin point pupil)
- reduces gag reflex
- drowsiness
- constipation
what is with drawl from opiates like ?
recreation depressant
- sweating
- diarrhoea
- piloerection
- mydriasis
what is given to help with opiote withdrawal ? what type of drug ?
methadone (opiod analgesic)
what is given as treatment for opiates overdose ? what type of drug is this ?
naloxone
(opiod receptor antagonist)
what is a quick screening tool used to assess for alcohol dependance ?
CAGE
- Cut down ?
- Annoyed ? (when ppl ask about usage)
- Guilty
- Eye opener (ever need to drink immediately in morning)
what causes alcohol related liver disease ?
from long term excessive consumption of alcohol
what are the 3 stages in alcohol related liver disease ?
- Acoholic fatty liver (hepatic steatosis)
- Alcoholic hepatitis
- Cirrhosis
what is alcoholic fattly liver ? reversible ?
alcohol => build up of fat in liver
(reversible with abstinence)
what is alcoholic hepatitis ? reversible ?
chronic alcohol use => inflam in liver cells
- usually reversible with permanent abstinence
what is liver cirrhosis ? reversible ?
functional liver tissue replaced with scar tissue (irreversible)
what is recommended alcohol consumption in a week ? for men ? women ?
don’t regularly diner >14 units/week
- spread over 3 days
- no more than 5 in one day
- sam for men and women
what counts as bigne drinking ? men ? women ?
> 6 units (F)
8 units (M)
Name some of the complications of alcohol ? (7)
- alcohol related liver disease
- cirrhosis (=> HCC)
- alcohol dependance + withdrawal
- wernike korsikoff syndrome
- pancreatitis
- cardiomyopathy
- increase CVD risk
what would be seen OE of someone drunk ?
- smelling of alcohol
- slurred speech
- blood shot eyes
- dilated capillaries on face
- tremor
what investigations might you to for alcohol liver disease ? what would be seen on blood tests ?
- blood tests: raised MCV, high ALT, High AST:ALT ratio (wASTed), increased PTT
- liver US: may show changes related to cirrhosis
- Fibroscan: assess degree of fibrosis
- Liver biopsy: confirm Dx of ARH of cirrhosis
what is the Mx of ARLD ?
- stop drinking permanently
- psychotherapy (CBT)
- detox regime
- nutritional support (thiamine)
- corticosteoird (reduce inflam in hepatitis)
what is alcohol dependance ? symptoms (5)
- daily consumption
- stonr urges + cravings
- difficulty controlling consumption
- tolorance
- withdrawal when stopping
what are the symptoms of alcohol withdrawal ? time frame basis ?
- 6-12 hours: tremor, sweating, headache, craving, anxiety
- 36 hrs: siezures (peak incidence)
- 48-72 hrs: delirium tremens (coarse tremor,confusion, delusions, auditory and visual hallucinations, fever, tachycardia)
what is delirium tremens ? associated with what ?
medical emergency associated with alcohol withdrawal (35% mortality)
how does chronic alcohol use affect NT ?
alcohol stimulates GABA and inhibits glutamate
- chronic use => GABA system down regulated + glutamate system unregulated
what happens do brain NT when alcohol stops drinking ?
when alcohol removed
- (due to up/down regulation) GABA under functions + glutamate overfucntions => extreme excitability of brain + excessive adrenergic activity
Mx of alcohol withdrawal ? (3) drug type ?
chlordiazepoxide (long acting benzo) PO reducing regime
- high dose B its (pabroninex) + long term oral thiamine (prevent WKS)
what is wernike Korsakoff syndrome ? what causes it ?
alcohol excess => thiamine deficiency (poorly absorbed in presence of alcohol + poor diet associated)
(not related to withdrawal I think)
what is wernikes encephalopathy ? presentation ?
- confusion
- oculomotor disturbances
- ataxia
(medical emergency with high mortality)
what is Korsakoff syndrome ? presentation
- memory impairment (retrograde + anterograde)
- behavioural changes
(often irreversible)
wernike korsikoff syndorme Mx ?
thiamine supplementation + abstains from alcohol
Name some hallucinogenics ?
- serotinergic psychedelics (LSD)
- dissociate psychedelics (PCP)
(cannabis isn’t but doesn’t have any other group either)
how does cannabis work ? Px ? (6)
cannabis (cannabinoid receptor partial agonist)
- paranoia
- euphoria/relaxation
- eating
- red eyes
- impaired memory formation
- lack of motivation
what is spice ?
synthetic canncis: canabidno receptor agonist (not partial like cannabis)
- associated with withdrawal + psychosis
serotinergic psychedelics effects ?
(LSD, Shrooms)
- psychedelic: distortion of perception of objects that are there
- sensory distorion
- depersonalisation
- anxiety/paranoia
- openness
(no sig withdrawal)
what type of drug is PCP ? Sx ?
dissociative psychedelic
- halluciantions
- beligencere
- impulsiveness
patient present with mydriasis - what drug types could be causes this ?
- stimulant
- depressant withdrawal
patient present with miosis - what drug types could be causing this ?
- depressant
- stimulant withdrawal
reversible causes of cognitive impairment ? (6)
- normal pressure hydrocephalus
- thyroid problems
- vitamin B12 deficiency
- sleep depreviation
- depressions
- wernikes encephalopathy
