Substance Disorders part 2 Flashcards
What are the major stimulants?
Amphetamines (methamphetamine, MDMA)
Amphetamine-like drugs (methylphenidate (Ritalin))
Cocaine
What are the major stimulant symptoms?
Psychological ( MANIA, hallucinations, euphoria)
Physical ( elevated heart rate and bp ; appetite loss and insomnia; mydriasis; seizures)
(Note: increased HR can be lethal)
What is a key symptom of cocaine?
seizures
Cocaine and Methamphetamines, what are the key similarities?
both produce and intense rush followed by euphoria
both drugs are addictive
Cocaine and Methamephetamines, what are the key differences?
Duration of Effect: Meth= 12 hrs ; Cocaine= 30 min
Frequency of administration= cocaine more frequent
Physical changes with meth
Stimulant intoxication may mimic symptoms of what?
Schizophrenia and/or bipolar I (manic) episodes
Clinically how do you differentiate between stimulants and schizophrenia/bipolar?
drug screen needed (does not rule out schizophrenia/bipolar)
What are the key symptoms of major stimulant withdrawal?
Like Atypical Major Depressive Disorder
- ->dysphoric mood (MUST BE SEEN)
- -> fatigue and psychomotor slowing
- -> hypersomnia with vivid unpleasant dreams
- -> increased appetite
Are the major stimulant withdrawal symptoms life threatening?
No just uncomfortable —-> BUT THATS WHAT YOU GET!
Another drug stimulant is Ecstasy, referred to as a spotlight amphetamine, what are some effects?
stimulant effects plus mild hallucinogenic effects (perceptual alterations):
Misperception of safe drug
Can you use Ecstasy for psychotherapy particularly PTSD?
small number of patients have seen prolonged effects
Another drug stimulant is Bath Salts, what doe this drug contain?
drug containing, in part, amphetamine-like chemicals (MDPV)
What are the minor stimulants?
nicotine and caffeine
What are the effects of minor stimulants?
both nicotine and caffeine cause improved mood, increased alertness/attention and decreased appetite
What are key symptoms of nicotine withdrawal?
Depressed mood insomnia and increased appetite irritability and anxiety restlessness and difficulties concentrating decreased heart rate
Why is insomnia a withdrawal symptom of nicotine which is a stimulant?
because nicotine is a muscle relaxant
What are some treatments of nicotine use disorder?
1) Nicotine Replacement Therapy
2) Buproprion and Varenicline –> black box warning due to suicidal and erratic behavior
What is considered caffeine intoxication?
after a dose of >250mg of caffeine
What are the key symptoms of caffeine intoxication?
increased energy restlessness, insomnia rambling thoughts tachycardia diuresis and GI disturbance
Can you have withdrawal to caffeine?
of course
Can you have a caffeine-use disorder?
not according to DSM-5
What are the Hallucinogens and related substances?
Classic Hallucinogens: LSD/Mescaline/Psilocybin
Cannabis: Marijuana/Hashish
Dissociative Anesthetics: PCP/Ketamine
What are hallucinogens known for?
perceptual altering abilities
What are the perceptual altering abilities for the various hallucinogens?
Classic Hallucinogens: Hallucinations
Cannabis: Distortions
Dissociative Anesthetics: Depersonalization
In general with hallucinogens are they mellow?
yes, mind calming
With classic hallucinogens, which is the most powerful?
LSD
long lasting; 8-12hrs
What are some key symptoms of LSD?
Visual, poorly formed hallucinations (unlike those in schizophrenia)
They see shapes and colors very vividly
Are there withdrawal symptoms associated with LSD?
NO
LSD is associated with flashback perceptual experiences long after LSD is metabolized, what is the name of this disorder?
Hallucination Persisting Perception Disorder
What is the most commonly used illegal substance?
Cannabis
Does one experience hallucinations when taking cannabis?
no
What is the main difference between LSD and cannabis?
time
LSD: 8-12 hrs
Cannabis: 2-4 hrs
In regards to Cannabis use, what is amotivational syndrome?
laying around smoking and not really engaging
What are some key symptoms of Cannabis use?
Psychological (perceptual distortions)
Physical (increased appetite; dry mouth; conjunctival injection)
What are some key withdrawal symptoms of Cannabis use?
Psychological (depressed mood, decreased appetite, sleep difficulty –> feeling agitated)
Physical ( abd. pain, shakiness, sweating, fever or headache)
What substance level is Cannabis?
Schedule I substance
One of the dissociate anesthetics is PCP what are some key symptoms of this?
depersonalization agitation, belligerence, and confusion impulsivity and unpredictability nystagmus and hyperacusis decreased responsiveness to pain
What are the treatments for acute intoxication of PCP?
benzodiazepines or antipsychotics
reduced environmental stimulation
restraints may be needed
Are there withdrawal symptoms associated with PCP?
NO
The last class of drugs are opioids (narcotics), what is the main medical use of them?
Analgesia (help pain)
however does cause euphoria
Which opioid causes the greatest euphoria?
Heroin
What are some key symptoms of opioid intoxication?
Initial Intense Rush Followed by: euphoria and drowsiness and dysphoria
Miosis (pinpoint pupils)
Unconscious
Respiratory Depression (can be lethal)
what is the treatment for opioid overdose?
Naloxone (Narcan) –> short acting opioid receptor antagonist
(acute overdose NOT opioid addiction)
What are the opioid withdrawal symptoms (remember FLU LIKE symptoms)?
dysphoria nausea, vomiting, diarrhea muscle aches, lacrimation and rhinorrhea piloerection, sweating, fever yawning pupillary dilation
Opioid Withdrawal is unpleasant but is it life threatening??
NOPE
What are some treatment approaches for opioids?
1) Abstinence Based Theory: often involves use of naltrexone (a long acting opioid receptor blocker) to block effects if relapse occurs
2) Replacement Therapy (RT): Involves giving patient a safer opioid drug
RT tends to be more effective then abstinence
What are the drug choices for RT?
1) Methadone –> schedule II opioid drug
can not be prescribed for the purpose of addiction treatment; federally regulated
2) Buprenorphine–> Schedule III opioid drug
when used for addiction can be prescribed by doctor
3) Suboxone –> buprenorphine + naloxone (only released if medication is abused)
How long does RT usually last?
1-2 years
Which drugs are potentially life threatening?
Sedative intoxication (resp. depression) and Sedative withdrawal (increased HR) Stimulant Intoxication (increased HR) Opioid Intoxication (resp. depression)
