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Year 5 Core Conditions > Substance Abuse - Recreational Drug Abuse > Flashcards

Substance Abuse - Recreational Drug Abuse Flashcards

1
Q

Number of people taking illicit drugs?Most common age group?

A
  • 1 in 12 (1 in 3 for 16-24 yrs)
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2
Q

Most common illicit drug to be taken?

A
  • Cannabis most common
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3
Q

Risk factors for illicit drug use?

A 
o	Young age, male gender
o	Low socioeconomic class
o	Psychiatric disorders
o	Impulsive personality
o	Genetic
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4
Q

Origin, names, route and mechanism of illicit drug - cannabis?

A
  • Produced from dried leaves, flowers and seeds of Cannabis sativa
  • Called grass, marijuana, hash, dope, skunk
  • Route – smoked, eaten, drunk
  • Mechanism – Acts on specific cannabinoid receptor in CNS
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5
Q

Origin, names, route and mechanism of illicit drug - volatile substances?

A
  • Simple hydrocarbons such as acetone, toluene, butane have intoxicant properties
  • Found in glue, solvents, lighter fuel, paint stripper, aerosols, paints, petrol, nail varnish
  • Route – inhaled, sniffed
  • Mechanism – rapidly absorbed, cause non-specific increased permeability of nerve cell membranes
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6
Q

Origin, names, route and mechanism of illicit drug - cocaine?

A
  • White powder produced from leaves of coca shrub
  • Called – C, Charlie, Coke, Crack cocaine (pure), Snow
  • Route – inhaled (snorted), smoked, injected
  • Mechanism – Sniffed bypasses first-pass metabolism, local anaesthetic at mucous membranes, blocks neurotransmitter reuptake for dopamine, serotonin and noradrenaline
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7
Q

Name the 4 stimulant drugs?

A

Cocaine, amphetamines, MDMA, Mephedrone

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8
Q

Origin, names, route and mechanism of illicit drug - amphetamines?

A
  • Sold as tablets or white powder – used in narcolepsy and ADHD
  • Types - Crystal meth, speed, Ritalin (methylphenidate)
  • Called – Whizz, speed, billy, uppers, dexxies
  • Route – swallowed, inhaled or dissolved and injected
  • Mechanism – Similarity to dopamine and noradrenaline so is CNS stimulant
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9
Q

Origin, names, route and mechanism of illicit drug - MDMA?

A
  • High profile links to dance music culture in the late 80s and early 90s
  • Called – E, Eccies, MD, Mandy
  • Route – Oral tablets
  • Mechanism – Serotonin release and blocks reuptake
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10
Q

Origin, names, route and mechanism of illicit drug - mephedrone?

A
  • Closely related to speed and ecstasy
  • Called – meow meow, M-CAT, White magic, MC
  • Route – oral, nasal, inject
  • Mechanism – Releases dopamine and blocks reuptake
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11
Q

Name the 3 hallucinogen illicit drugs?

A

LSD, Magic Mushrooms, Ketamine

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12
Q

Origin, names, route and mechanism of illicit drug - LSD?

A
  • Occurs naturally in Morning Glory plant
  • Called - Acid
  • Route – impregnated on paper, tablets, powder
  • Mechanism – Serotonin agonist and acts on serotonergic and dopaminergic systems
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13
Q

Origin, names, route and mechanism of illicit drug - Magic mushroom?

A
  • About 12 varieties with Liberty cap most common in UK
  • Called - mushies
  • Route – eaten raw, cooked, dried, drank
  • Mechanism – Partial serotonin agonist
  • Possession and consumption is not illegal unless prepared for illicit consumption
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14
Q

Origin, names, route and mechanism of illicit drug - ketamine?

A
  • Structurally like phencyclidine used as anaesthetic in vets
  • Called – Special K
  • Route – Sniffed powder
  • Mechanism - NMDA antagonist - blocks glutamate
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15
Q

Name the opiate illicit drugs?

A

Heroin - codeine, morphine, methadone, pethidine, buprenorphine

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16
Q

Origin, names, route and mechanism of illicit drug - heroin?

A
  • Derived from opium poppy – opiates, opioids are synthetic compounds- Street heroin usually 25-50% pure
  • Called – Brown, Gear, Skag, Smack
  • Route – brown powder in wraps, smoking (chasing), orally, snorted, IV and IM
  • Mechanism – Opioid agonist, binds to endorphin receptors
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17
Q

Name the 2 illicit depressant drugs?

A

Benzodiazepines, GHB

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18
Q

Origin, names, route and mechanism of illicit drug - benzodiazepines?

A
  • Therapeutic uses anxiolytics, hypnotics, anticonvulsants and muscle relaxants
  • Short-acting (temazepam, oxazepam), medium-acting (lorazepam, alprazopam), long-acting (diazepam, nitrazepam, chlordiazepoxide)
  • Called – Vallies, downers
  • Route – oral, can be injected
  • Mechanism – GABA agonist
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19
Q

Origin, names, route and mechanism of illicit drug - GHB?

A
  • Synthetic compound seen in dance settings
  • Called – GBH, grievous bodily harm
  • Route – liquid form
  • Mechanism – GABA agonist
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20
Q

Which illicit drugs are non-addictive?

A

o LSD, mushrooms, MDMA

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21
Q

Describe the experimental pattern of illicit drug use?

A

o Explore effects
o Common and driven by availability and peer group
o Common for ‘softer’ drugs

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22
Q

Describe the situational pattern of illicit drug use?

A

o Limited to certain situations (e.g. parties, raves)

o Mainly stimulants or hallucinogenic

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23
Q

Describe the recreational pattern of illicit drug use?

A

o Regular but non-dependent use

o May be limited by period of life or may progress to dependent use

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24
Q

Describe the polydrug pattern of illicit drug use?

A

o Non-dependent use of variety of drugs

o Risks can be addictive or multiplicative

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25
Q

Describe the dependent pattern of illicit drug use?

A

o Use of drug for which dependence syndrome developed

o Continued use may be motivated by desire to avoid withdrawals

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26
Q

Effects of cannabis use?

A
  • Effects act within minutes when smoked, reach a peak of 30 minutes and lasts 2-5 hours
  • Mild euphoria, sense of enhance well-being, relaxation, increased appetite, talkative
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27
Q

Adverse effects of cannabis use?

A
  • Mild paranoia, panic attacks, cravings, anxiety/depression, insomnia, psychosis, precipitates schizophrenia
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28
Q

Effects of volatile substance use?

A

• Euphoriant effects, disinhibition, slurred speech and blurred vision

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29
Q

Adverse Effects of volatile substances?

A
  • Local irritation, headache, cardiac arrhythmias, unconsciousness, sudden death
  • Liver and kidney damage, memory impairment
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30
Q

Effects of cocaine?

A
  • Actions begin within a few minutes

* Increased energy, confidence, euphoria and no desire for sleep, reduces hunger

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31
Q

Adverse effects of cocaine?

A
  • Arrhythmias (MI), dry mouth, dilated pupils, tachycardia, anxiety, hypertension, impulsivity, impaired judgement
  • Nasal septum damage, panic disorders, delusions, psychosis
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32
Q

Effects of amphetamines?

A
  • Similar effects to cocaine but slower metabolism gives longer duration of action
  • Active, alert, confident, chatty, no need for sleep, improved focus, full of energy, reduced appetite
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33
Q

Adverse effects of amphetamines?

A
  • Tachycardia, tachypnoea, arrhythmias, hyperthermia, irritability, dilated pupils, quasi-psychotic state with hallucinations
  • Panic attacks, depression, psychosis, dependency, chronic sleep deprivation
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34
Q

Come down effects of amphetamine use?

A
  • Lethargy, anergic, anxiety, irritability, restless, unable to sleep
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35
Q

Effects of MDMA?

A
  • Hallucinogenic and stimulant properties
  • Effects start 30 mins after ingestion and tend to last 3-4 hours followed by gradual comedown
  • Energy buzz, alert, alive, feelings of love for people around them
36
Q

Adverse effects of MDMA?

A
  • Dilated pupils, dehydration, tightening of jaw muscles, hyperthermia, tachycardia, increased sweating, nausea, vomiting, reduced potency despite increased sexual libido
  • Anxiety, panic attacks, psychosis, paranoia
37
Q

Come down effects of MDMA?

A

• Come down (24-48 hours)

- Lethargy, anergia, anxiety, irritability, restless, unable to sleep

38
Q

Effects of mephedrone?

A

• Feel alert, confident, talkative, euphoric, increased affection, reduced appetite

39
Q

Adverse effects of mephedrone?

A
  • Nausea, anxiety, vomiting, hallucinations, palpitations, seizures, reduced circulation, epistaxis, addiction, paranoia
40
Q

Effects of LSD use?

A
  • Effects act within 30 mins and last for 6 hours

* Initial euphoria, hallucinations, sensory distortions and altered perceptions

41
Q

Adverse effects of LSD?

A
  • Nausea, anxiety, vomiting, hallucinations, palpitations, seizures, reduced circulation, epistaxis, addiction, paranoia
42
Q

Effects of Magic mushrooms?

A
  • Euphoria, lethargy, relaxed, perceptual and sensory changes, hallucinations
  • Tolerance develops quickly
43
Q

Adverse effects of magic mushrooms?

A
  • D&V, dizziness, poisoning, depression, anxiety, panic attacks, bad trips, flashbacks
44
Q

Effects of ketamine?

A

• Relaxation, altered bodily sensations, floating feelings, dissociation, altered perception, hallucinations

45
Q

Adverse effects of ketamine?

A
  • Nausea, ataxia, anaesthetic, amnesia, panic attacks
46
Q

Effects of opiates?

A

• Warm feeling, euphoria, relaxed, analgesic, constricted (pin-point) pupils, untethering from worries or concerns

47
Q

When does dependency develop in opiates?

A

• Opiate dependency develops in weeks and associated with withdrawal symptoms

48
Q

Adverse effects of opiates?

A
  • Constipation, nausea and vomiting, respiratory depression, loss of consciousness, injection site infections
49
Q

Effects of benzodiazepines?

A

• Relaxed, calm, sedated, euphoric

50
Q

What can develop in benzodiazepine use?

A

• Tolerance develops rapidly, and dependence develops over 4-6 weeks

51
Q

Adverse effects of benzodiazepines?

A
  • Respiratory depression, falls, hangover, memory loss, sedation, infection when injecting
  • Impaired concentration, memory and mood
52
Q

Effects of GHB?

A
  • Euphoria, reduces inhibitions, drowsiness, intoxication

* Effects start 15 minutes after ingestion

53
Q

Adverse effects of GHB?

A
  • Nausea, drowsiness, dizziness, agitation, visual disturbances, respiratory depression, unconsciousness, coma and death (mixed with alcohol)
54
Q

What are the signs of dependence in illicit drug use?

A
  • Tolerance
  • Withdrawal symptoms
  • Using more or for longer than intended
  • Unsuccessful attempts to reduce
  • Large time spent seeking, using and recovering from use
  • Drug use taking priority
  • Persistent use despite harm
55
Q

What is the criteria for dependent drug use?

A

o >3 dependent signs in last 12 months

56
Q

Withdrawal symptoms in cannabis? Management and advice given in cannabis use?

A
  • Withdrawal Symptoms- Irritability, mood changes, nausea, loss of appetite, difficulty sleeping, shaking and sweating
  • Illegal drug – reduce use and abstinence
  • Don’t drive or operate heavy machinery
57
Q

Management and advice given in volatile substances use?

A
  • Education of users and ‘at risk’ groups

* Most use will be experimental

58
Q

Withdrawal symptoms in cocaine use?Management and advice given in cocaine use?

A

• Withdrawal symptoms
- Low mood, unwell, insomnia, psychological dependence
• Harm reduction advice (clean needle)
• CBT and treat co-morbid psychiatric illness

59
Q

Withdrawal symptoms in amphetamine use?Management and advice given in amphetamine use?

A

• Withdrawal symptoms
- Lethargy, drowsiness, poor concentration
• Harm reduction advice

60
Q

Withdrawal symptoms in MDMA use?Management and advice given in MDMA use?

A 
•	Withdrawal symptoms
-	Lethargy, depression, memory problems
•	Harm reduction advice
•	Maintain hydration and avoid hypothermia
•	Take breaks from dancing
61
Q

Management and advice given in mephedrone use?

A

• Withdrawal symptoms
- Lethargy, drowsiness, poor concentration
• Harm reduction advice

62
Q

Management and advice given in hallucinogens (LSD, mushrooms, ketamine) use?

A
  • Harm reduction
  • Maintain safe environment and avoid behavioural toxicity
  • Acute psychosis managed with BDZ with expectant resolution
63
Q

Withdrawal symptoms in opiates?

A

COWS scale- Tachycardia, sweating, restlessness, dilated pupils, bone aches, runny nose, diarrhoea, tremor, anxiety and insomnia, gooseflesh skin

64
Q

Harm reduction advice given in opiate use?

A
  • Don’t use alone or in combination with other drugs
  • Avoid IV
  • Needle exchange programmes
65
Q

Safe injection advice given in opiates use?

A
  • Use new sterile needles each time, sterile water, never share needles, syringes, spoon
  • Rotate injection sites, avoid neck, breast, groin, infected areas
  • Inject with blood flow
66
Q

Symptomatic relief of opiate dependence?

A

a. Lofexidine (alpha-adrenergic agonist)
b. Loperamide (Tx diarrhoea)
c. Metoclopramide (Tx nausea, vomiting)
d. Ibuprofen

67
Q

Substitute prescribing in opiate dependence?

A

Methadone – daily dose for observed administration
Long-acting synthetic opiate – half-life 24 hours so daily dose
Near saturation of opiate receptors so minimises reward of further consumption
Coloured liquid, drank, sugar-free option availableiv
Used in opiate withdrawal and maintenance

68
Q

Alternative to methadone for substitute prescribing in opiate dependence?

A

Buprenorphine – once daily sublingual
Partial opiate agonist
Produces less euphoria than methadone
Treatment of drug dependence

69
Q

Advice for maintenance prescribing in opiate dependence?

A
  • Prevent under-dosing and overdosing
  • Methadone and buprenorphine review monthly/supervised
  • Aim to titrate up to maintenance dose then, look to dose reduce each fortnight for 4-6 months if possible
70
Q

Drugs used to prevent relapse in opiate dependence?Drug used in opioid toxicity?

A

• Opiate relapse prevention- Naltrexone
Aid abstinence in formerly depedent patients
• Overdose- Naloxone IV

71
Q

Withdrawal symptoms in benzodiazepines dependence?

A

• Withdrawal symptoms

- Poor concentration, nausea, vomiting, tremors, headaches, anxiety, panic, depression, seizures

72
Q

Substitute prescribing in benzodiazepines dependence?

A

Diazepam – taper off 1/8th dose per fortnight

73
Q

General advice in benzodiazepines dependence?

A
  • Do not operate heavy machinery

- Needle advice and safe injecting

74
Q

Drug used to treat overdose in benzodiazepines dependence?

A
  • Flumazenil
75
Q

Withdrawal symptoms in GHB dependence?

A
  • Insomnia, anxiety, tremor, delirium
76
Q

General management given to illicit drug users?

A 
o	Tailor to specific needs (residential, outpatient care or groups)
•	Counselling
•	Motivational therapy
•	Cognitive therapy
•	Family therapy
•	Narcotics Anonymous
77
Q

What advice should be given to IV drug users about risk?

A

o Educate about needle exchange, HIV, Hep C risk
• Safe injecting advice:
- Use new sterile needles each time, sterile water, never share needles, syringes, spoon
- Rotate injection sites, avoid neck, breast, groin, infected areas
- Inject with blood flow

78
Q

Dependence on cannabis, amphetamines, MDMA, LSD, hallucinogens provides what legal issues?

A
  • Loss of licence until 6-months (group 1) or 1-year (group 2) period of abstinence
  • Medical assessment and urine screen may be required
79
Q

Dependence on heroin, morphine, cocaine, methadone provides what legal issues?

A
  • Loss of licence until 1-year (group 1) or 3-year (group 2) period of abstinence
  • Independent medical assessment and urine screening needed
  • May need consultant recommendation
80
Q

Symptoms of overdose of opiates?

A

• Respiratory depression – death

81
Q

Symptoms of overdose of cocaine?

A

• Tremor, confusion, seizures, arrhythmias, MI (common), cardiomyopathy

82
Q

Symptoms of overdose of MDMA/Amphetamines?

A

• Arrhythmias, hypertension, stroke, circulatory collapse, seizures, coma

83
Q

Symptoms of overdose of LSD?

A

• Rare – nausea and vomiting, autonomic overactivity, hyperthermia, coma

84
Q

Symptoms of overdose of cannabis?

A

• Confusion, psychosis

85
Q

Symptoms of overdose of BDZs?

A

• Over-sedations, coma, death, respiratory arrest

Year 5 Core Conditions (55 decks)

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