Symposium 3 - Addictions Psychiatry

Question 1

Define tolerance.

Answer 1

Reduced responsiveness to a drug caused by previous administration

Question 2

Give examples of drugs that can develop tolerance?

Answer 2

Opioids
Ethanol
Barbiturates
Benzodiazepines

Question 3

What is dispositional tolerance?

Answer 3

Less drug reaches active site

Question 4

What is pharmacodynamic tolerance?

Answer 4

Drug has less action at active site

Question 5

What can cause dispositional tolerance?

Answer 5

decreased rate of absorption
increased rate of metabolism
increased rate of excretion

Question 6

What can cause pharmacodynamic tolerance?

Answer 6

Down-regulation of internalisation of drug receptors

Reduced signalling

Question 7

What can development of tolerance lead to?

Answer 7

Withdrawal symptoms –> increased response

from homeostasis compensatory mechanism

Question 8

What is the withdrawal phenomenon?

Answer 8

Withdrawal effect of drug usually reverse of acute effect

Question 9

Give an example of an acute vs withdrawal effect of a drug.

Answer 9

Opioid: acute = constipation, withdrawal = diarrhoea

Cocaine: cocaine = elevated mood, withdrawal = depressed mood

Question 10

What is the reward pathway?

Answer 10

Ventral tegmental area –> nucleus accumbens –> prefrontal cortex

Dopamine = neurotransmitters

Causes sensation of pleasure/reward

Question 11

Give examples of drugs of abuse that tap into reward pathway and increase dopamine?

Answer 11

Heroin -> increases firing rate of dopaminergic neurons

Amphetamine -> increases dopamine release

Cocaine -> inhibits dopamine uptake

Alcohol

Question 12

What are the two distinct components of drug dependence?

Answer 12

1. Physical dependence (consequence of tolerance)

2. Psychological craving (from reward pathway stimulation)

Question 13

What is the most addictive drug?

Answer 13

Heroin

Question 14

Name two classes of stimulant drugs?

Answer 14

Cocaine

Amphetamine

Question 15

What is cocaine made from?

Answer 15

Coco plant

Question 16

What type of cocaine is snorted or injected?

Answer 16

Cocaine hydrochloride

Question 17

When do you get effects form cocaine?

Answer 17

Smoking - almost immediate
Injecting 15-30s
Snorting 3-5 mins

Question 18

What are effects of cocaine?

Answer 18

Stimulant/euphoriant 
Increased alertness/energy 
Increased confidence/impaired judgement 
Lessens appetite and desire for sleep
Damage to nose and airways 
Convulcions
Respiratory failure
Arrhythmias
MI 
Hypertension 
Toxic confusion
Paranoid psychosis

Question 19

What are cocaine withdrawal effects?

Answer 19

Depression, irritability, agitation, craving, hyperplasia, hypersomnia

Question 20

What is the difference in side effects of amphetamines?

Answer 20

Same as cocaine but longer lasting effects

Psychosis in heavy chronic use

Question 21

Give examples of opiates.

Answer 21

Opium, morphine, heroin, methadone, codeine

Dihydrocodeine

Question 22

What are methods of taking amphetamines?

Answer 22

Sniffed

Swallowed Injected

Question 23

How is heroin taken?

Answer 23

Snorting, smoking, injection

Question 24

What are side effects/signs of heroin use?

Answer 24

Analgesia
Drowsiness and sleep 
Euphoria/intense pleasure
Respiratory depression
Cough reflex depression
N&V
Lowers BP
Pupillary constriction 
Constipation

Question 25

What are clinical signs of opiate overdose?

Answer 25

Pinpoint pupils, unreactive to light 
Snoring --> shallow respiration (<8 breaths/min)
Bradycardia
Hypotension 
Reduced consciousness/coma
Respiratory arrest with pulse

Question 26

What are signs of opiate withdrawal syndrome?

Answer 26

Craving, insomnia, yawning, muscle pain and cramps, increased salivary, Hal, lacrimal secretions, dilated pupils, piloerection (‘cold turkey”)

Question 27

Name 2 benefits and 2 disadvantages of methadone maintenance.

Answer 27

benefits - reduces IV misuse

Disadvantage - decriminalise drug, allow normalisation of lifestyle, leakage to illicit market

Question 28

What are effects of Ecstasy (MDMA)?

Answer 28

Relaxed euphoric state without hallucinations
Euphoria and then calm
Increased sociability

Question 29

What are side effects of Ecstasy (MDMA)?

Answer 29

Nausea
Dry mouth 
Hypertensive
Pyrexia
Dehydration 
Anxiety 
Drug induced psychosis

Question 30

What is the most commonly used illicit drug?

Answer 30

Cannabis

Question 31

What is the psychoactive agent in cannabis?

Answer 31

Tertahydrocannabinol (THC) - dissociative affect, positive affect on mood

Question 32

What are the psychological effects of cannabis?

Answer 32

Relaxing, stimulation, euphoriant, increases sociability, increases appetite, change in perception, synaesthesias

High dose: anxiety, panic, persecutory ideation, hallucinatory activity

Question 33

What are the effects of CBD?

Answer 33

Mild anxiolytic and antipsychotic

Question 34

List ill effects if cannabis.

Answer 34

Respiratory problems
Toxic confusion
Exacerbation of major mental illness

Question 35

Give examples of novel psychoactive substances.

Answer 35

NPS, “legal highs”

Question 36

What are anabolic steroids?

Answer 36

Family of drugs comprising of testosterone and many synthetic analogues

Question 37

Why do people use anabolic steroids?

Answer 37

Enhance muscle mass and strength, enhance appearance, reduce body fat.

Question 38

What are side effects of anabolic steroids?

Answer 38

Skin - acne, stretch marks, baldness

Feminisation in males

Virilisation in women including hirsutism, deep voice

Increased cholesterol
Hypertension

Liver disease

Question 39

What are psychological side effects of anabolic steroids?

Answer 39

Irritability and anger
Hypomania and mania
Depression and suicidality on withdrawal