Symposium 3 - Addictions

Question 1

What mechanisms are involved with substance misuse?

Answer 1

Tolerance (dependence)
Reward centre (cravings)

Question 2

What is tolerance?

Answer 2

Reduced responsiveness to a drug caused by previous administration
Form of homeostasis

Question 3

What are the mechanisms for dispositional drug tolerance?

Answer 3

Decreased absorption
Increased metabolism to INACTIVE metabolites
Decreased metabolism to ACTIVE metabolites
Increased excretion

Question 4

What are the mechanisms for pharmacodynamic drug tolerance?

Answer 4

Down-regulation of drug receptors

Reduced signalling of drug receptors

Question 5

What are the main mechanisms of tolerance?

Answer 5

Dispositional tolerance - less drug reaches active site

Pharmacodynamic tolerance - drug has less action at site

Question 6

What is the mechanism of withdrawal?

Answer 6

Reverse of the acute effect of a drug

Question 7

What is physical dependence?

Answer 7

Avoidance of withdrawal effects of a drug

Question 8

What is the reward pathway?

Answer 8

Neurones project from ventral tegmental area to nucleus accumbens & prefrontal cortex
VTA neurones release dopamine
Leads to pleasure

Question 9

What is the function of the reward pathway?

Answer 9

Reward the individual for eating, drinking and sex to encourage healthy behaviours

Question 10

How does heroin effect the reward pathway?

Answer 10

Increases firing of dopaminergic neurones

Question 11

How does amphetamine effect the reward pathway?

Answer 11

Increase dopamine release

Question 12

How does cocaine effect the reward pathway?

Answer 12

Inhibits dopamine reuptake

Question 13

How long do the modalities of cocaine take to onset?

Answer 13

Smoking - immediate
Injecting - 15-30s
Insufflating - 3-5mins

Question 14

What are the recreational effects of cocaine?

Answer 14

Stimulant and Euphoriant 
Alertness and energy
Confidence
Impaired judgement
Lessens appetite & desire for sleep

Question 15

What are the harmful effects of cocaine?

Answer 15

Damage to nose/airways
Convulsions
Arrhythmias and MI
HTN
Toxic confusion
Paranoid psychosis

Question 16

What are the withdrawal effects of cocaine?

Answer 16

Depression
Irritability
Craving
Agitation
Hyperphagia
Hypersomnia

Question 17

What are the harmful effects of amphetamines?

Answer 17

Toxic confusion
Convulsions
Death
Amphetamine psychosis

Question 18

What are the recreational effects of heroin use?

Answer 18

Analgesia
Drowsiness
Euphoria
Decreased sympathetic outflow

Question 19

What are the harmful effects of heroin use?

Answer 19

Respiratory depression
Cough reflex suppression
N+V
Hypothermia 
Pupillary constriction
Constipation

Question 20

What are the overdose effects of heroin use?

Answer 20

Respiratory arrest with pulse
Unreactive pupils 
Bradycardia
Hypotension
Coma

Question 21

What are the side effects of opiates?

Answer 21

First time - N+V, headache
Medium term: 
 - phlebitis
 - anorexia
 - constipation
Long term: - tolerance, withdrawal

Question 22

What are the withdrawal effects of heroin use?

Answer 22

Craving
Insomnia
Yawning
Muscle pain
Increased parasympathetic secretions
Dilated pupil 
Piloerection

Question 23

How is heroin addiction managed?

Answer 23

Methadone maintenance

Question 24

What are the pros/cons of methadone maintenance?

Answer 24

Decriminalises drug use
Normalises lifestyle
Reduces IV misuse
Leaks to black market

Question 25

What are the recreational effects of MDMA?

Answer 25

Relaxed euphoric state without hallucinations Sociability 2-4hrs duration

Question 26

What are the side effects of MDMA?

Answer 26

``` Nausea Dry mouth HTN Hyperthermia Dehydration risk Anxiety and panic Psychosis ```

Question 27

How has THC content of cannabis changed over time?

Answer 27

1% in 70s | 17% now

Question 28

What are the psychological effects of cannabis?

Answer 28

Relaxing/stimulating Euphoriant Increased sociability, appetite Synaesthesia

Question 29

What are the high dose effects of cannabis?

Answer 29

``` Anxiety Panic Persecutory ideations Hallucinations Exacerbation of mental illness ```

Question 30

What are the legitimate indications for anabolic steroids?

Answer 30

Hypogonadism Muscular dystrophy Anaemias Muscle wasting in AIDS

Question 31

Marked muscle mass increase is seen where in anabolic steroids use?

Answer 31

Pectoralis Deltoids Trapezius Biceps

Question 32

What are the general side effects of anabolic steroids?

Answer 32

``` Acne Stretch marks Baldness Cholesterol Hypertension Growth deficits Liver disease Roid rage, mania Depression and suicidality in withdrawal ```

Question 33

What are the male side effects of anabolic steroids?

Answer 33

Hypogonadism | Gynocomastia

Question 34

What are the female side effects of anabolic steroids?

Answer 34

``` Virilisation Hirsutism Deep voice Clitoral enlargement Menstrual abnormalities Hair thinning ```

Question 35

How can D2 antagonists be used in addiction?

Answer 35

D2 receptors are blocked which stops addiction, but causes lethargy and low mood

Question 36

Amphetamine psychosis may present similar to what?

Answer 36

Schizophrenia

Question 37

Heavy chronic amphetamine use can lead to what?

Answer 37

Amphetamine psychosis

Question 38

How does the route of heroin use change over the course of addiction?

Answer 38

Starts with smoking (often) which is more expensive, leads to injection over time due to losing money