Stimulant and Synthetic Drugs-Piasecki Flashcards
You are working in an ER and a patient comes in confused and clearly intoxicated with something. The patient’s pupils look jumpy. This finding (nystagmus) is a associated with….?
PCP
A patient’s backpack opens and you see a baggy fall out. Inside of the baggy are small colored tablets that look like candy and a pacifier. This is suspicious for abuse of:
Ecstacy
What are all the stimulants?
Cocaine
Methamphetamine
Ecstasy
Abuse of Rx meds: Ritalin, Focalin, Adderal
What will your eyes, vital signs and behavioral findings look like with stimulants?
-dilated pupil
-
Lateral nystagmus is seen in (Blank)
alcoholism
What are the three types of nystagmus?
horizontal, vertical, rotary
What foods raise dopamine levels?
fats, sweets, and salts (had evolutionary benefit because it allowed us back in the day to survive longer)
What are some natural rewards? What do you see elevations in?
foods, sex
dopamine!
Food gets dopamine up to 150
sex gets dopamine to 200
What is the pleasure center of the brain?
nucleus accumbens
What did the mouse experiement show us
that sex was better (200) than food (150) and he would work harder for sex than for food and worker harder for food than for nothing.
Then we gave him amphetamines and his dopamine shot up to 1100
If you do amphetamines for the first time and his dopamine release went up sooooo high. What happens the second time you use it?
it never gets that high again. SO you always chase the high
Which has the highest amount of dopamine release?
Amphetamine>cocaine> nicotine> ethanol
What are the chronic drug effects?
-you get intracellular and functional brain changes that result in behavior changes (psychiatric and addiction)
What did the baboon amphetamine party show?
that if you give an animal amphetamines for 10 days straight, it will result in brain changes and reduced release of dopamine
What are the structural changes due to mehtamphetamine?
decreased gray matter
decreased volume
increased white matter
What are the three major changes with chronic methamphetamine use?
Cognition and Mood
Judgment
Craving
What parts of cognition can be messed up by SUD?
What can cause this?
intoxication
withrawal
persistent effects
-alcohol, marijuana, methamphetamine
When utilizing cocaine, what happens to your DA and 5HT levels during and after use?
your Dopamine and serotonin levels rise significantly and then when undergoing withdrawal dip far below baseline leaving you more sad than you started an hence wanting more cocaine
What happens to your exec function? What problems will result from this?
you lose it and hence get memory problems, impulse control problems, information processing problems, and motor skills problems
When you give someone cognitive tests after chronic amphetamine use, what happens?
reduced mental flexibility, reduced logical abilities, reduced learning, reduced memory
What were the adult neuropsychological findings at intake of chronic amphetamine users?
Co-Morbid Mental Health Diagnosis (96%) Executive Functioning Deficits (82%) Attention Cognitive Flexibility Working Memory Problem-Solving Organization Learning Disabilities (77%) Math (92%) Reading (58%) Writing (25%) Visual-Spatial/Organizational Deficits (76%) Language Deficits (45%) Memory Deficits (49%) Below Average Intellectual Abilities (12%) Above Average Intellectual Abilities (12%)
(blank) is the most neurotoxic stimulant
methamphetamine
Sooo researchers looked at exectuive functioning right when someone quits using stimuants, what did it show?
executive functioning is far below normal, then right after quiting will drop even farther below (due to inflammation from withdrawal symptoms) then you slow get increased functioning and are back to baseline if clean for 2 years
What are some other related brain changes from chronic use?
mood and psychosis problems
Ridilin and methamphetamine are known for induced (blank) psycosis
paranoid!
Meth users often gain depression due to reducing in dopamine and serotonin levels, can their brain ever recover
yes if they quit for a long time they can get back to being normal
How do you treat and what is the prognosis of stimulants abuse?
general substance use disorder tx
- court involvment helps, mandatory monitoring helps
- Behavioral therapy
What are the clinical signs of synthetic cannabinoid (SPICE) intoxication?
- Altered mental status (confusion, bizarre and agitated behavior)
- Vomiting
- Rapid heart rate
- Elevated blood glucose
- Elevated potassium.
What are the traditional designer drugs?
Opioids, hallucinogens, anabolic steroids
What are the new wave designer drugs?
Stimulants (MDPV)
Synthetic cannabinoids (SPICE)
Others in the pipeline
NBOMe
Why would anyone want to take designer drugs?
- dont show up in drug screens
- “legal”
- online availabilty
- sensation seeking “psychonauts”
How expensive is it to screen for synthetic cannabinoids? How about bath salts?
95$
250$
What is spice (AKA K2, synthetic cannabinoids)?
a liquid compound that is sprayed on to something that you can smoke
Our brain is full of (blank) receptors because we have endogenous cannabinoids. The nucleus accumbens especially.
THC
(blank) is a mixture of herbs or spices sprayed with synthetic chemicals similar to THC in marijuana but more potent
Smoked
Spice or K2
What are the synthetic cannabinoid receptor agonists?
nabilone and dronabinol
JWH compounds
WHy is JWH so hard to detect?
- Vit E added to mask active components
- new compounds regularly emerge with no available reference in lab “libraries”
- some JWH compounds are identifiable
What are the effects of spice on the mind?
Agitation Anxiety including panic attacks Depression Paranoia Hallucinations Visual Auditory Flashbacks
Is spice regulated, tested, or helpful medically?
no
What are the effects of spice on the body?
Increased blood pressure Increased heart rate Cardiac arrest Blood shot eyes Insomnia Tingling, numbness Vomiting Seizures Tremors Suicidal Thoughts
What are bathsalts (MDPV)?
synthetic stimulants
Has there been any systemic testing on humans with spice or have their been any long term studies with spice?
no
Spike/K2 is (blank) addicting and one time use has resulted in (blank)
physicaly
death
How do you use bath salts?
same manner as cocaine and methamphetamine
-snorting, smoking, injection (slam em), swalllowing in water
What are the effects of bath salts?
- insomnia
- agitation, easily angered
- extreme energy
- hallucinations
- high body temp
- kidney failure
- increased blood pressure
- increased heart rate
What schedule are cannabimemetic agents in and what do they bind to?
schedule 1
-cannabinoid type 1 receptor
Why doesnt the government outlaw cannabimemtic agents?
because they just keep changing the chemical compound.
Is there any medicinal value in cannabimemetic agents?
no
What can you band to help people from killing themselves with synthetics?
a chemical class
How many JWH series compounds are there and how many are being used?
470
24
What are screening specific questions?
Have you ever used marijuana?
Have you experimented with Spice or synthetic marijuana?
Have you ever used methamphetamine (or cocaine)?
Have you experimented with Bath Salts?
Since there are no comprehensive tests for detection- what do you use?
screening questions
