Psychiatry: Substance Abuse Flashcards by Olivia Chrisp

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

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Name some recreational stimulants ?(5)

caffeine
nicotine
cocaine
meth-amphetamine
MDMA

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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)

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why is nicotine so addictive ?

reaches the brain v quickly (7 secs)
- build up tolerance

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what are some of the effects of nicotine ?

(recreational stimulant)
- sympathetic innervation
- suppress appetit

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what drugs are used to help with smoking cessation ?

varencline
bupropion

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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)

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what are some of the effects of cocaine ?

SNS (recreational stimulant)
- euphoria
- agitation
- myoriasis (wide dilated pupil)
- increase heart rate
- increase BP

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describe cocaine withdrawal ?

PSNS (opposite of the high)
- Sedation
- Lethargy
- Craving
(unpleasant bu not dangerous)

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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

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what is meth withdrawal like ?

(PSNS)
- depression
- lethargy
- increased appetite and hunger

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what are the effects of MDMA ?

recreational stimulant
- derealization
- mania
- hulluciantions
- increase HR
- increase BP

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MDMA withdrawal ?

(recreational stimulant withdrawal => PSNS)
- depression
- irritailty
- fatigue
- bruxism (high yield - grind/crush teeth)

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name some recreational depressants ? (3)

Alcohol
benzodiazepiens
opiates

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on what NT does alcohol work ? (2)

(recreational depressant)
GABA agonist
(and inhibits glutamate)

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What are the overall effects of alcohol withdrawal ? (6)

anxiety
insomnia
tremor
siezures
hyptertension
delirium tremens

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What are the effects of benzodiazepines ? (4)

recreational depressant
- Sedation
- Euphoria
- Ataxia
- Amnesia

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what are the withdrawal syndomps associated with benzos ?

panic
anxiety
insomnia
tachycardia
siezures

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what is the managment of benzodiazepine withdrawal ?

controlled with benzo taper

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what would you give to treat a benzodiazepine overdose ? what type fo drug is this ?

flumazenil (GABA antagonist)

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What are the effects of opiates ? (6)

euphoria
CNS depression
Miosis (pin point pupil)
reduces gag reflex
drowsiness
constipation

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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