Substance Abuse Flashcards
How is addiction formed?
Reward pathway in brain.
Some drugs release dopamine which act on prefrontal cortex to produce pleasure and others increase rate of cell fire to release more dopamine
Name 4 substances of abuse that are stimulants
• Methylphenidate (Ritalin)
• amphetamines eg adderall, speed, cocaine, diet mixtures
• methamphetamine eg tic, cat, crystal meth, khat
• caffeine
Empathogens: MDMA (ecstasy), NMDA
Increase dopamine
Name 3 substances of abuse that are CNS depressants
• Opiates (nyaope)
• benzodiazepines (sedative hypnotic)
• barbiturates eg methaqualone mandrax
Alcohol
Name 3 substances of abuse that are CNS hallucinogenic
- Deliriant’s eg diphenhydramine. Atropine (belladonna alkaloids)
- dissociative (nmda) eg ketamine , ibugaine (sigma r), GHB, PCP (phencyclidine)
- Psychedelic. (5HT2A) eg LSD ergot fungus on rye, psilocybin (magic mushrooms), NMDA (ecstacy)
Name 5 substances of abuse that have mixed effects
- Alcohol (Initially excitatory, higher depressants)
- nicotine
- cannabis
- designer / club drugs
- nitrates (“poppers”)
- Bath salts with synthetic cathinones (same as meth khat ): mdpv methylenedioxypyrovalerone and flaka alpha pyrrolidinopentiophenone - not criminalised.
Medical use of methamphetamine?
Second line treatment ADHD and obesity
Name 4 strong agonists of opioid ligands - substances of abuse
- Fentanyl
- heroin
- methadone -used as replacement for heroin addiction but no high
- Morphine
What are synthetic opioids metabolised to, and how?
Morphine by CYP2D6
Name 2 low agonists of opioid ligands
- Codeine
* propoxyphene
Name 2 partial agonists of opioid ligands
- Suboxone, subutex: for replacement opioid addiction maintenance treatment
- buprenophine
Name 2 cures of opioid overdose
• Naloxone
• naltrexone
Opioid ligand antagonist
What is most commonly used for opioid addiction treatment?
Subutex
Name 3 treatment options for nicotine addiction
• Bupropion: increase dopamine (antidepressant to replace euphoric feeling addiction )
. Nicotine agonists: gum, stickers, ecigarettes
• varencicline: partial agonist. Prevent high from smoking
Name 6 symptoms and complications cannibinoids
- Tachycardia
- decreased intraocular pressure
- Red conjunctiva
- decreased pupil reaction to light, pupil dilation
- decreased reaction stimuli
- long term: lung carcinoma, memory changes, schizophrenia
Ethanol effects on body? ( 6)
depressant.
• Range from increased self confidence and motor incoordination to unconscious and coma.
• CVS: tachycardia and vasodilation
• pupils: dilation, decreased reaction, tunnel vision, red conjunctivae
• kidney: suppress ADH, diuresis
• endocrine: hypoglycaemia, increase A and Na
• sex: desire but decrease performance
Name 8 adverse effects Ethanol
- Wernicke encephalopathy: confusion, ataxia, ophthalmoplegia due to thiamine deficiency
- respiratory depression
- neurodgeneration due to vitamin deficiency
- dementia
- liver damage
- Pancreatitis
- psychiatric: depression or psychosis
- ataxia
- nystagmus
Ethanol moa?
- Depressant
- inhibit CNS calcium entry reducing transmitter release
- potentiate inhibitory GABA transmission.
Supportive treatment for Ethanol dependency?
Disulfiram - aldehyde dehydrogenase inhibitor
What is “atom bomb” drug?
Marijuana and opiates
What is “sugar grass” drug?
Marijuana and PCP
What is “white pipe” drug?
Marijuana and methaqualone (mandrax)
What is “slow boat” drug?
Marijuana and cigarettes
Cocaine moa?
A strong stimulant
• inhibit reuptake catecholamines (noradrenaline, dopamine, serotonin) into noradrenergic neurones
• enhance sympathetic activity
Clinical use cocaine?
Numbing agent, vasoconstrictor dentistry
Clinical symptoms cocaine? (3)
• CVS: arrhythmia, ht, stroke, tachycardia.
. CNS: euphoria, arousal, alert, paranoid psychosis toxic doses
• pupils: dilate
• serotonin syndrome
Treatment cocaine induced arrythmia?
Benzo
Not beta blocker, can cause ht crisis
Amphetamine toxicity? (5)
- CVS: ht, mi, remodelling heart, DIC
- respiratory: pulmonary ht, pe
- CNS: euphoria and excitement,stereotyped behaviour and paranoid psychosis, CNS haemorrhages
- kidney: rhabdomyolysis, excessive thirst especially ecstasy
- hyperthermia
Crystal meth/tik clinical presentation? (5)
- Pupil dilation
- Aggression, power, confidence
- anorexia and insomnia, anxiety
- rapid speech, psychosis
- headache
Ecstasy MDMA symptoms and effects? (5)
- Euphoric empathy, increased sensory perception, hyperactive
- tachycardia, ht
- acute hyperthermia: skeletal muscle damage and renal failure
- dry mouth
- inappropriate secretion ADH leading to overhydration and hyponatraemia
- pupil dilation
Opiates vs opioids
Opiates: natural opioids eg heroin, morphine, codeine
• opioids: all natural, semisynthetic (oxycodone), synthetic (tramadol, fentanyl, heroin)
Clinical effects opioids such as heroin? (6)
- Well-being
- initial excitement followed by sedation and coma on overdose
- respiratory decline, bronchospasm
- vomiting
- pupil constriction
- “mad cow” like disease rare- bovine spongiform encephalopathy
Withdrawal symptoms heroin? (3)
• Irritable and aggressive
• autonomic:
- fever, sweat, pupil dilatation, piloerection
- yawn
• goose flesh, rhinorrhea, lacrimation, abdominal and muscle pain
Name 2 drugs used in sexual assault
- GHB (gamma hydroxybutyric acid)
* rohypnol “rosshies”: flunitrazepam
LSD moa?
- Psychodelic
- act on 5-ht2 inhibitory autoreceptors on serotonergic neurones to reduce their firing.
- also dopamine, histamine.
Which 2 hallucinogens bind to 5ht2a receptors?
LSD and MDMA.
Describe the 4 step approach of subutex maintenance treatment for opioid addiction.
- Induction
- stabilisation
- maintenance
- withdrawal
Which 2 dissociative act on NMDA receptors?
- Ketamine
* Ibugaine
