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PSYCHIATRY > SUBSTANCE MISUSE > Flashcards

SUBSTANCE MISUSE Flashcards

1
Q

What is a drug?

A

Psychoactive drugs are substances that, when taken in or administered into one’s system, affect mental processes, e.g. perception, consciousness, cognition or mood and emotions.

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2
Q

Whats the epidemiology of drug dependance?

A

6.7% of those age 16-24 and 0.5% of those aged 55-64
1/3rd of drug misusers are under 25
Male:female 3:1

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3
Q

What are the top 3 most used illegal drugs?

A

Cannabis
Powder cocaine
Ecstasy

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4
Q

Whats the most frequently reported problem drug?

A

Heroin

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5
Q

What are class A drugs?

A

Heroin
Morphine
Pethidine
Methadone
Dipipanone
Cocaine
Magic mushrooms
Methamphetamine (crystal meth)
Lysergic acid diethylamide
Phencyclidine (PCP/angel dust)
MDMA/ecstatic
All injectable class B substances

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6
Q

What are class B drugs?

A

Oral amphetamines, cannabis, codeine and barbiturates, ketamine, methylphenidate

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7
Q

What are class C drugs?

A

Benzodiazepines
Anabolic steroids
Gamma hydroxybutyrate (GHB)
Gamma-butyrolactone (GBL)
Peperazines (BZP)
Khat

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8
Q

Whats the maximum penalty for possession of class A drugs?

A

Up to 7 years in prison
Unlimited fine
Or both

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9
Q

Whats the maximum penalty for possession of class B drugs?

A

Up to 5 years in prison
Unlimited fine
Or both

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10
Q

Whats the maximum penalty for possession of class C drugs?

A

Up to 2 years in prison
Unlimited fine
Or both
Except anabolic steroids - its not an offence to possess them for personal use

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11
Q

Whats the maximum penalty for supply and production of class A drugs?

A

Up to life in prison
Unlimited fine or both

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12
Q

Whats the maximum penalty for supply and production of class B drugs?

A

Up to 14 years in prison
Unlimited fine
Or both

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13
Q

Whats the maximum penalty for supply and production of class C drugs?

A

Up to 14 years in prison
Unlimited fine
Or both

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14
Q

Whats the aetiological factors for illicit-drug dependance?

A

Biopsychosical factors
Operant conditioning model
Price, availability, cultural attitudes, peer pressure
Social deprivation, family environment of substance abuse, conduct disorder in childhood, antisocial PD, severe mental illness

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15
Q

What are common examples of opiates?

A

Morphine
Heroin/diamorphine
Condense
Methadone
Opium

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16
Q

What are the effects of opiates?

A

Euphoria
Drowsiness
Personality changes
Mitosis
Conjunctival injection/blood shot eyes
Nausea
Sweating
Pruritis
Constipation
Bradycardia
Resp depression
Coma

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17
Q

What are common examples of stimulants?

A

Amphetamine
Cocaine
Crack cocaine
MDMA
Nicotine
Methylphenidate

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18
Q

What are the effects of stimulants?

A

Alertness
Hyperactivity
Euphoria
Irritability
Aggression
Paranoid ideas
Hallucinations
Psychosis
Mydriasis tremor
Hypertension
Tachycardia
Arrhythmias
Perspiration
Fever
Convulsions
Perforated nasal septum

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19
Q

What are common examples of hallucinogens?

A

Lysergic acid diethylamine (LSD)
Mescaline psilocybin (magic mushrooms)

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20
Q

What are the effects of hallucinogens?

A

Marked perceptual disturbances (reduced perception of reaclity) e.g. chronic flashbacks, paranoid ideas, suicidal and homicidal ideas
Slurred speech
Confusion
Psychosis
Mydriasis
Conjunctival injection
Hypertension
Tachycardia
Perspiration
Fever
Loss of appetite
Weakness
Tremor

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21
Q

What are common examples of CNS depressants?

A

Benzos and barbiturates

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22
Q

What are the effects of CNS depressants?

A

Drowsiness
Disinhibition
Confusion
Poor concentration
Reduced anxiety
Feeling of well-being
Mitosis
Hypotension
Seizures
Impaired coordination
Resp depression
Blurred vision
Difficulty cooperating and poor judgement
Amnesia

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23
Q

What are common examples of cannabinoids?

A

Cannabis
Hashish
Hash oil

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24
Q

What are the effects of cannabinoids?

A

Euphoria
Relaxation/sleepy
Altered time perception
Psychosis
Impaired coordination and reaction time
Conjunctival injection
Nystagmus
Dry mouth
Tachycardia
Confusion and lack of focus
Increased cravings for snacks

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25
Q

What are common examples of dissociative anaesthetics?

A

Ketamine
Phencyclidine (PCP/angel dust)

26
Q

What are the effects of dissociative anaesthetics?

A

Hallucinations
Paranoid ideas
Thought disorganisation
Aggression
Mydriasis
Tachycardia
Hypertension
Time distortion

27
Q

What are common examples of inhalants/solvents?

A

Aerosols
Paint
Glue
Lighter fluid
Petrol
Benzene gases

28
Q

What are the effects of inhalants/solvents?

A

Disinhibition
Stimulation euphoria
Clouded consciousness
Hallucinations
Psychosis
Headache
Nausea
Slurred speech
Loss of motor coordination
Muscle weakness
Damage to brain, bone marrow, liver, kidneys, myocardium
Sudden death

29
Q

What can cause drug-induced psychosis?

A

Alcohol, amphetamines, phencyclidine (PCP), cocaine, and hallucinogens
Long term cannabis use

30
Q

What is ICD10 criteria for drug induced psychosis?

A

ICD-10 requires the condition to occur within 2 weeks and usually 48 hours of drug use and to persist for >48 hrs but <6 months

31
Q

What proportion of schizophrenia could be prevented if cannabis use ceased?

A

14%

32
Q

Can you develop tolerance from sniffing solvents?

A

Yes

33
Q

Why can nitrous oxide use cause neurological manifestations?

A

As its associated with vitamin B12 deficiency

34
Q

Why do amphetamines have a high potential for abuse?

A

Because of their activation of dopamine release from the nucleus accumbens = pleasure = positive reinforcement

35
Q

Where does cocaine come from?

A

Erythroxylon coca trees in the Andes.

36
Q

What is crack cocaine?

A

When cocaine hydrochloride is converted to its base by cooking it with baking powder
Aka rock

37
Q

Where does cannabis come from?

A

from dried leaves and flowers of the plant cannabis sativa

38
Q

What is hashish?

A

The dried resin from the flower tops of the cannabis sativa plant

39
Q

Whats the effect on mood of cannabis?

A

It exaggerates the pre-existing mood

40
Q

Is cannabis addictive?

A

There’s no true addiction but there is psychological dependance

41
Q

What does it mean when we say opiates have cross tolerance?

A

withdrawal effects of one are reduces by administration of another,

42
Q

When does opiate withdrawal syndrome reach its peak intensity?

A

2nd-3rd day after last dose of opiate and rapidly subsides over the next 7 days

43
Q

Outline the stages of opiate withdrawal syndrome?

A

Symptoms in the first 16 hours include sweating, restlessness, pupillary dilation, yawning and rhinorrhoea.
24-72 hours in you may experience muscular twitches, aches, pains, abdominal cramps, d+v, hypertension, insomnia, anorexia, agitation.

44
Q

What is drug plasticity?

A

the extent to which drugs effects are shaped by internal cues like anxiety and depression as well as external cues e.g. friends.
Drugs with low plasticity have predictable results from use e.g. heroin and alcohol
High plasticity e.g. can is and LSD and solvents

45
Q

Whats the role of management in substance misuse?

A

Treating physical dependance with detoxification
Maintenance of abstinence
Address bio/psyhco/social/cultural factors that led t substance misuse in first place

46
Q

How do you manage opiate dependance?

A

Education about risks of contaminated needles and unsafe sexual behaviour
Clean needles and injection equipment, hep B vaccination and condoms offered
Start withdrawal. Offer Lofexidine to alleviate some physical symptoms
Maintenance treatment using opiate-substitution therapy e.g. methadone to stabilise users life and prevent complications of injecting - aim is gradual reduction with long-term abstinence (Sublingual Buprenorphine may be used instead)

Once detoxified, naltrexone can be used to block euphoria effects of any continued opiate use
Psychological therapies include motivational interviewing, CBT and social support

47
Q

How do you manage opioid overdose?

A

Naloxone hydrochloride indicated if coma or bradypnoea

48
Q

What are signs of opioid overdose?

A

central nervous system and respiratory depression, miosis, and apnoea.

49
Q

When are methadone vs Buprenorphine used for opioid substitution therapy?

A

Methadone is more sedative so may be preferred fro those with increased anxiety about withdrawal. Oral so less risk of injections. More abuse potential. Daily dose frequency. Moderate-severe withdrawal

Buprenorphine is less sedating. Can be given sublingual, transdermal or as injections. Prolonged duration of action so can have alternate-day dosing regimes. Due to its weaker efficacy, buprenorphine is probably best restricted those with mild–moderate dependence. Less abuse potential. Mild withdrawal symptoms. Cheaper

50
Q

Whats the moa of methadone?

A

a synthetic opioid analgesic with full agonist activity at the µ-opioid receptor. While agonism of the µ-opioid receptor is the primary mechanism of action for the treatment of pain, methadone also acts as an agonist of κ- and σ-opioid receptors within the central and peripheral nervous systems.
It also has antagonism of the N-methyl-D-aspartate (NMDA) receptor and strong inhibition of serotonin and norepinephrine uptake, which likely also contributes to its antinociceptive activity.

51
Q

What are the side efefcts of methadone?

A

Arrhythmias; confusion; constipation; dizziness; drowsiness; dry mouth; euphoric mood; flushing; hallucination; headache; hyperhidrosis; miosis; nausea (more common on initiation); palpitations; respiratory depression (with high doses); skin reactions; urinary retention; vertigo; vomiting (more common on initiation); withdrawal syndrome: Asthma exacerbated; dry eye; dysuria; hyperprolactinaemia; hypothermia; menstrual cycle irregularities; mood altered; nasal dryness; postural hypotension; QT interval prolongation

52
Q

Whats the moa of Buprenorphine?

A

a partial agonist at the mu-opioid receptor and an antagonist at the kappa-opioid receptor

It demonstrates a high affinity for the mu-opioid receptor but has lower intrinsic activity compared to other full mu-opioid agonists like methadone
This means that buprenorphine preferentially binds the opioid receptor and displaces lower affinity opioids without activating the receptor to a comparable degree. Clinically, this results in a slow onset of action and a clinical phenomenon known as the “ceiling effect” where once a certain dose is reached buprenorphine’s effects plateau.

53
Q

What are the side effects of Buprenorphine?

A

Arrhythmias; confusion; constipation; dizziness; drowsiness; dry mouth; euphoric mood; flushing; hallucination; headache; hyperhidrosis; miosis; nausea (more common on initiation); palpitations; respiratory depression (with high doses); skin reactions; urinary retention; vertigo; vomiting (more common on initiation); withdrawal syndrome; postural hypotension; Anxiety; depression; diarrhoea; tremor

54
Q

Whats the moa of Lofexidine?

A

Replaces the opioid-driven inhibition of cAMP production by activating the alpha2-adrenergic receptor = decreases release of norepinephrine and moderates the symptoms of opioid withdrawal.

55
Q

Sudden withdrawal from which substances is potentially fatal?

A

Alcohol - seizures and delirium tremens and hallucinations
Benzodiazepines - hallcucinations, convulsions and delirium

56
Q

How do we treat benzodiazepine dependance?

A

Initially convert from short acting to long acting benzos e.g. lorazepam to temazepam
Dose slowly reduced by a small amount every few weeks

57
Q

What are symptoms and signs of alcohol overdose?

A

Marked mental confusion or stupor.
Difficulty remaining conscious (or being completely unconscious).
Lack of responsiveness, or being unable to be roused or woken up by others.
Seizures.
Vomiting (particularly dangerous given the potential for diminished gag reflex).
Slowed or irregular breathing.
Heart rate that slows or stops.
Very low body temperature.
Pale or blue-tinged, clammy skin.

58
Q

What are symptoms and signs of opioid overdose?

A

Loss of consciousness.
Markedly constricted or pinpoint pupils.
slowed, labored, and/or irregular breathing
Respiratory arrest
Bradycardia
Hypotension
Choking, gurgling, or snoring sounds.
Blue or purple lips or fingertips.
Being unresponsive to loud noises, shaking, or painful stimuli.

59
Q

What are symptoms and signs of sedative hypnotic (benzos, barbiturates, GHB, ketamine, rohypnol) overdose?

A

Profoundly impaired mental status.
Marked confusion.
Slurred speech.
Slowed, labored breathing or respiratory arrest.
Bradycardia and hypotension
Normal pupils
Coma.

60
Q

What are symptoms and signs of stimulant (cocaine, amphetamines, MDMA) overdose?

A

Dangerous fever
Hyperventilation
Tachycardiaheartbeat.
Very high blood pressure.
Dilated pupils
Sweating
Devastating cardiovascular events (e.g., stroke, heart attack, circulatory compromise).
Panic.
Hallucinations.
Paranoia and other features of psychosis.
Aggressive behavior.
Seizures and convulsions.

61
Q

Which drug overdoses cause dilated pupils?

A

Anticholinergics
Sympathomimetics

PSYCHIATRY (20 decks)

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