Substance Misuse Flashcards

1
Q

What are the mechanisms of substance misuse and what are they the basis of

A

Tolerance - basis of dependence

Reward - basis of craving

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2
Q

What is tolerance

A

Reduced responsiveness to drug caused by previous administration

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3
Q

What drugs can you become tolerant too

A

Opioids
Ethanol
Barbiturates
Benzodiazepine

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4
Q

What is dispositional tolerance

A

Less drug reaches active site
Decreased absorption
Increased metabolism
Increased excretion

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5
Q

What is pharmacodynamic tolerance

A

Down regulation so less efficient or fewer receptors

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6
Q

What does tolerance lead too

A

Withdrawal symptoms
Drug tries to return body to homeostasis when drug administered
When drug is stopped body’s response to combatting drug causes withdrawal symptoms
Often opposite to drug effect as body trying to do opposite

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7
Q

Why does tolerance cause dependance

A

Body becomes dependent to avoid withdraw symptoms

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8
Q

What is the reward pathway - where does it project

A

Neurones project from ventral segmental area to nucleus accumbens and cortex

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9
Q

What happens when VTA stimulated

A

Dopamine is released

Causes sense of pleasure / reward

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10
Q

What do drugs do

A

Heroin / cocaine / amphetamine
Can stimulate this pathway
Causing craving of reward feeling

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11
Q

What will D2 antagonist do

A

Treat craving as blocks reward pathway but not dependence

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12
Q

Why are some people more prone to addiction

A

Dopamine receptors can vary

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13
Q

What do you do for drug addiction

A
Hx
21 day referral to services
BBV and urine drug screen
Follow up 
Possible methadone
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14
Q

Who is high risk and may get faster referral

A

Neck injector
Pregnancy
Sex
Illness

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15
Q

What do you need before starting methadone

A

ECG

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16
Q

What can you say about methadone

A
Green liquid from pharmacy 
Dispensed daily 
Get heart tracing before
Do you use any other drugs
Any questions
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17
Q

What is cocaine

A

A stimulant

Blocks uptake of NA, dopamine and serotonin

18
Q

How is it taken

A

Injected
Snorted
Smoked

19
Q

+ve effects

A
Stimulant 
Euphoria - dopamine
Alert
Energy
Confidence 
Decreased appetite
Decreased need for sleep
20
Q

-ve effects

A
Vasoconstrictor 
Raised BP
Resp failure
Cardiac arrhythmia - QT prolonged 
MI due to coronary vasospasm 
Aortic dissection 
Ischaemic colitis
Hyperthermia
Metabolic acidosis 
Rhabdomyolysis 
Tachy or Brady 
Paranoid psychosis
Financial / social
21
Q

What does cocaine do to pupils and what are withdrawal affects

A

Dilate

Depression
Irritable
Craving
Desire for food and sleep

22
Q

How do you Rx toxicity

A

Benzo = 1st line
Add GTN if chest pain then PCI if MI develops
Add sodium nitrprusside if high BP

23
Q

Amphetamine

A

Similar to cocaine but last longer

Toxic confusion, convulsions and death

24
Q

Examples of opiates

A
Opium
Morphine
Heroin 
Methadone
Codeine
25
Q

How can heroin be taken

A

Injected
Snorted
Smoked

26
Q

What does heroin do

A
Analgesia
Drowsy
Resp depression 
Cough reflex depression
Causes 'a rush'
N+V
Decreased sympathetic - Brady / hypotension
Decreased body temp
Constipation
Viral infection - hep B / C / HIV by sharing needles
Bacterial infection - IE / SA / necrotising fascitis/ sepsis
VTE 
Social issues
27
Q

What is characteristic sign of overdose

A

Respiratory arrest with a pulse

28
Q

What are other signs

A

Pinpoint pupils
Resp <8
Braydcardia
Hypotension

29
Q

How do you Rx overdose

30
Q

What are symptoms of withdrawal

A
Craving
Insomina 
Muscle pain
Dilated pupils 
Increased gland secretion
31
Q

What is methadone

A
Long term opiate to decrease craving
Can also use bupronephrine
Decriminaise drug use
Reduce IV
Compliance monitored using urinalysis
32
Q

What is ecstasy

33
Q

What does ecstasy cause

A
Same as cocaine / LSD
Dilated pupils
Tachycardia 
High BP 
Hyperthermia
Hyponatraemia 
Dehydration
Liver and brain cell damage

Rx = supportive or dantrolene if hyperthermia

34
Q

What is psychoactive agent in cannabis

35
Q

What are affects of cannabis

A
Relax
Increased sociable
Increased appetite
Change in time
Merging of senses - synaesthesi
36
Q

What does high THC cause

A
Anxiety
Persecutory ideation
Hallucination 
Rest issue 
Exacerbate mental illness
37
Q

What are novel psychoactive substances

A

Legal high

38
Q

When are anabolic (androgenic) steroids prescribed

A

Hypogonadism
Muscular dystrophy
AIDs wasting

39
Q

What are SE

A
Muscle hypertrophy
Acne
Stretch marks 
Feminisation
Hypogonadism
Gynaecomastia
Virilisation 
Growth
Cholesterol
BP
Liver 
Mania
40
Q

What is Virilisation

A
Hirsutism
Deep voice
Clit enlargement
Menstrual irregularity 
Thin hair