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Psychiatry > Substance misuse > Flashcards

Substance misuse Flashcards

1
Q

What is tolerance?

A

Reduced responsiveness to a drug caused by previous administration.
An examples of homeostasis.

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2
Q

What drugs can commonly cause you to develop tolerance to?

A

Opioids
Ethanol
Barbiturates
Benzodiazepines

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3
Q

What is the dispositional mechanism of tolerance?

A

Less drug reaches the active site.
Less drug is absorbed.
Drug is metabolised faster
More drug excreted.

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4
Q

What is the pharmacodynamic mechanism of tolerance?

A

Drug has less action at the active site.

Fewer drug receptors
Less efficient drug receptors.

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5
Q

What is the withdrawal phenomena?

A

The withdrawal effect of a drug is usually the reverse of the acute effect.
Development of tolerance may lead to physical dependance in order avoid the unwelcome withdrawal effects.

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6
Q

What is the reward pathway?

A

Neurones project from the ventral tegmental area of nucleus accumbent and prefrontal cortex.

VTA neurones are stimulated, releasing dopamine. This causes a sensation of pleasure/reward.

Encourages healthy behaviours e.g. eating, sex, drinking that propagate genes.

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7
Q

What are some examples of how drugs affect the reward pathway?

A

Heroin increases firing rate of dopaminergic neurones.
Amphetamine increases dopamine release.
Cocaine inhibits dopamine uptake.

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8
Q

What are the 2 distinct components of Drug dependence?

A

Physical dependence - develops as a consequence to tolerance.

Psychological craving - result of stimulation of reward pathway.

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9
Q

What are some features of cocaine?

A 
Stimulant drug. 
Extracted from Coca plant leaves. 
Increased alertness and energy.
Increased confidence and impaired judgement. 
Lessens appetite and desire for sleep. 
Damage to nose and airways esp. if snorted. 
Convulsions and respiratory failure. 
Cardiac arrhythmias and MI
Hypertension and CVA
Toxic confusion
Paranoid psychosis.
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10
Q

How long does it take for cocaine to have an effect

A

Smoking - immediate
Injecting - 15-30secs
Snorting 3-5 mins

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11
Q

What are the withdrawal effects of cocaine?

A 
Depression
Irritability
Agitation
Craving
Hyperphagia
Hypersomnia
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12
Q

What are some features of Amphetamines?

A

Amphetamine sulphate.
Effects similar to cocaine but longer lasting staying body for a few hours.
Toxic confusion occasionally with convulsions.
Amphetamine psychosis in heavy chronic use.

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13
Q

What are some features of Heroin?

A 
Opiate
Available as diamorphine or as diamorphine hydrochloride. 
Analgesic
Drowsiness 
Euphoria and intense pleasure. 
Respiratory depression
Cough reflex depression
Nausea and vomiting
Decreased sympathetic outflow
Lowers body temp
Pupillary constriction
Constipation
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14
Q

What are some side effects of Opiates?

A

Short- term = nausea, vomiting, headache.
Mid-term = Phlebitis, Anorexia, Constipation
Long-Term = Tolerance, withdrawal, social and health problems.

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15
Q

What are the symptoms of opiate withdrawal syndrome?

A 
Cravings
Insomnia
Yawning
Muscle pain and cramps
Increased salivary, nasal and lacrimal secretions.
Dilated pupils
Piloerection.
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16
Q

What is used as harm reduction treatment in opiate use?

A

Methadone

17
Q

What are some features of Ecstasy (MDMA)?

A

3,4-methylenedioxymethamphetamine
Relaxed euphoric state without hallucinations. Followed by feeling of calm.
Increased sociability
Inability to distinguish between what is desirable and what isn’t.
Effects after 20mins and lasts 2-4hours.

18
Q

What are the side effects of Ecstasy?

A 
Nausea and dry mouth
Increased BP and Temp
Anxiety and panic in large doses. 
Drug induced psychosis. 
Liver and brain cell damage potential.
19
Q

What are the features of Cannabis?

A 
Tetrahydrocannabinol is the psychoactive agent. 
Relaxing or stimulating
Increased sociability and hilarity
Increased appetite
Changes in time perception
Synaesthesia
Anxiety
Panic
Persecutory ideation
Hallucinations
Toxic confusion
20
Q

What are some features of anabolic steroids?

A

Family of drugs comprising of testosterone and many synthetic analogues.
Legitimately prescribed in hypogonadism, muscular dystrophy, anaemia and wasting in AIDS.
Increase muscle mass and reduce body fat.
Muscle hypertrophy particularly marked in upper body.

21
Q

What are some side effects of steroid use?

A

Skin - acne, stretch marks, balding.

Feminisation in males, with hypogonadism and gynaecomastia.

Virilisation in women including hirsutism, deep voice, clitoral enlargement, menstrual irregularities, hair thinning.

Cardio - increased cholesterol and hypertension.

Growth deficits due to premature closure of epiphyses.

Liver disease - cholestatic jaundice, liver tumours.

Irritability and anger. Hypomania and mania.
Depression and suicidality on withdrawal.

Psychiatry (13 decks)

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