Symp 2 - Clinical Aspects of Substance Misuse Flashcards
what makes up the reward pathway?
view of the brain cut down the middle. An important part of the reward system is shown and the major structures are highlighted: the ventral tegmental area (VTA), the nucleus accumbens (nuc. acc.) and the prefrontal cortex. Also, the pathway connecting these structures is highlighted. The information travels from the VTA to the nucleus accumbens and then up to the prefrontal cortex. this pathway is activated by a rewarding stimulus
what things make drugs risky?
Why is drug use a problem and why do doctors need to be involved?
- Type of drug and effect (of that drug)
- Purity, dose, strength, tolerance (most of this isn’t know if you buy illicit drug)
- Route of administration (some drugs through nose, IV drugs = most risk, esp unsterile nature of drugs)
Legal Status – different jurisdictions
- Comorbid health conditions
- Likelihood of dependency
- Method of purchase – legal, prescribed,OTC (opiates), black market (traditional method of getting drugs), internet (purity and what you are actually buying)
no quality ocntrol of drugs
what are some examples of stimulants?
- Cocaine (probably the most abused stimulant)
- Amphetamine (speed, less widely used now)
- Methamphetamine (never been a big drug of abuse in UK, much bigger in USA and Australia as home made and don’t need a drug trade to come into country, to do with drug routes)
- methylphenidate (prescribed for ADHD, mild stimulant, unlikely to source illegally)
what is cocaine?
- Most potent natural stimulant
- Extracted from leaves of coca plant
- cocaine (powder) and crack cocaine (smoked)
- Crack produced by mixing cocaine with a base (sodium bicarbonate) and purified
how does cocaine work?
•Monoamine reuptake inhibitor - dopamine,serotonin,noradrenaline increase
Dopamine reuptake inhibitor – also has an effect on other things
Make dopamine more available in the presynaptic space
how fast are the effects of cocaine felt?
- depends on dose and rate of entry to the brain
- smoking - almost immediate
- injecting - 15 to 30 secs (high risk way)
- snorting - 3 to 5 mins (common way as its easy)
- the effects of crack smoking are very intense but quickly over ( 15 mins)
Cocaine causes a big effect due to shorting acting of the drug, can use as much as you have financial access to so associated with violence and criminality
what are the effects of cocaine?
- stimulant and euphoriant
- Anaesthetic effect
- Hypersensitive (lights and sounds)
- increased alertness and energy
- increased confidence and impaired judgement
- lessens appetite and desire for sleep
- If mixed with alcohol – cocaethylene (like cocaine with a longer half life)
- damage to nose and airways (Vasoconstriction of the small capillaries in the nose)
- convulsions with respiratory failure
- cardiac arrhythmia’s and MI
- hypertension and CVA
- toxic confusion
- paranoid psychosis
what are the withdrawl effects of cocaine?
- Depression
- Irritability
- Agitation
- Craving
- Hyperphagia (eat a lot)
- Hypersomnia (sleep a lot)
Broadly opposite of drug effect
what is Amphetamine and what is its effects?
- Generally amphetamine sulphate
- Sniffed, swallowed or injected
- Effects similar to cocaine but longer lasting
- Toxic confusion occasionally with convulsions and death
- Amphetamine psychosis in heavy chronic use
what are examples of different kinds of opiates?
- Opium
- Morphine
- Heroin (diamorphine)
- Methadone
- Codeine and dihydrocodeine
how is heroin taken?
Snorting (not common in UK)
Smoking(chasing the dragon)
Injection (cultural or tolerance reasons) - main method
•Smoking is safest, injecting the most dangerous method of use
how does heroin work?
- Opiod agonist
- Acts via mu (principally)
- Acts principally via Mu ,Delta and Kappa receptors
- Kappa and Delta – analgesia
- Mu – mood effects, analgesia and euphoria
- Half life of 30mins – multiple administrations needed if dependant (increased risk) - subjective effect of approx. 4hrs
what are the effects of heroin?
- Analgesia (very potent analgesia)
- Emotional analgesia
- Nausea initially
- Euphoria
- Pin point pupils
- Itching/sweating
- Constipation
- Decreased libido/menstrual irregularities
- Reduced cough reflex (issue in regards to risk of respiratory infections)
Main issue we worry about is its overdose risk
what effects are seen in heroin overdose?
•Naloxone – opiate antagonis - too much analgesia or an heroin overdose – this will immediately overturn the effect
- Respiratory depression
- Snoring indicates risk
- Bradycardia
- Hypotension
- Death
- Risk increased if mixed with other respiratory depressants – alcohol, benzodiazepines etc
what are the first time side effects of opiates?
nausea/vomiting and headache
Novel psychoactive substances are also known as what?
- NPS (New psychoactive substances (NPS) are a range of drugs that have been designed to mimic established illicit drugs)
- “legal highs”
It’s the chemical compound of MDMA that is illegal and if you change it slightly then it becomes legal
Most countries legal frameworks have caught up with this
