Stimulants and Synthetics - Piasecki Flashcards
List some stimulants that are commonly abused.
- cocaine
- methamphetamine
- ecstasy
- ritalin, focalin, adderal
What are some physical findings for stimulants?
- dilated pupils
- nystagmus (rotary nystagmus seen with PCP use)
- behavioral changes
There is a natural reward center in our brain. What neurotransmitter is released here?
Pleasure is mediated by dopamine in the nucleus accumbens.
Sex and food are natural rewards that increase dopamine. If baseline is 100, what is the increase for these types of rewards?
- food - increases to about 150
2. sex - increases to about 200
Drugs and alcohol increase the release of dopamine in the nucleus accumbens. Give an example of the increase for a drug.
Amphetamines raise the dopamine levels from baseline of about 100 to about 1050 (first time use) - 5X as more than sex!
What are some chronic drug effects?
- changes go beyond immediate binding of drug and resultant euphoria
- intracellular structural and functional brain changes result
- these changes are the basis of long lasting behavioral changes
- over time there is a significant decrease in dopamine release due to drug binding and drugs can change the baseline release of dopamine
What are some structural and behavioral changes of the brain due to chronic use of methamphetamine?
- decreased gray matter
- decreased brain volume
- increased white matter
- changes in cognition and mood
- changes in judgement
- cravings are initiated
Withdrawal affects dopamine levels how?
It causes both dopamine and serotonin release to go below baseline levels.
Describe some of the cognitive changes associated with chronic drug use.
Causes deficits in executive functions such as:
- working memory
- impulse control
- information processing
- motor skills
- attention
- cognitive flexibility
- problem - solving
- organization
Besides executive function deficits, what are some other neuropsychological findings associated with substance abuse?
- co-morbid health diagnoses
- learning disabilities - math, reading, writing
- visual-spatial or organizational deficits
- language deficits
- memory deficits
- below average intellectual abilities
Are the deficits in executive functioning permanent in substance abuse?
No, but it takes time for near normalization to occur.
Stimulants may cause what psychiatric condition?
Psychosis - tends to be paranoid psychosis.
What is SPICE?
A synthetic marijuana (cannabinoid) drug. Also called K2. Is a liquid that is sprayed onto plant matter that is then smoked and is more potent than marijuana.
What are some clinical clues for SPICE use?
- AMS - confusion, bizarre and agitated behavior
- vomiting
- rapid heart rate
- elevated blood glucose
- elevated potassium
What are some things that make designer or synthetic drugs appealing to users?
- may not be picked up on typical drug screens
- are not illegal yet
- are available online
What makes screening for synthetic drugs problematic?
- there are often many metabolites that are possible and they are changing constantly
- the screens that are available are expensive
What is the active ingredient in marijuana?
THC
THC binds to what?
Cannabinoid receptors. These are dense in the brain and especially in the nucleus accumbens. Our bodies make endogenous cannabinoids so our brains are full of receptors.
What are the origins of SPICE?
THC compounds have therapeutic uses and researchers began making these synthetic compounds for medicinal purposes but they ‘got out’ into the general public. First there were the HU compounds and then the JWH compounds which are used now to make SPICE.
What makes the synthetic marijuana compounds hard to detect and identify?
- products are mislabeled
- Vit E is added to mask active components
- new compounds emerge regularly with no available reference in lab libraries
- some JWH compounds are identifiable
What are some of the effects of SPICE?
- agitation
- anxiety and panic attacks
- depression
- paranoia
- hallucinations - visual and auditory
- flashbacks
- increased BP
- increased heart rate
- cardiac arrest
- blood shot eyes
- insomnia
- tingling, numbness
- vomiting
- seizures
- tremors
- suicidal thoughts
What are some of the dangers of SPICE?
- unregulated, untested, no medicinal use
- no long-term studies, true effects are not yet known
- never systematically tested on humans
- physically addicting
- one time use has resulted in death
What are bath salts?
Synthetic stimulants - for example MDPV
What is the route of ingestion of bath salts?
They can be snorted, smoked, injected and swallowed in water - similar to how cocaine and meth are used.
