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Psychiatry > Symposium - Addiction Psychiatry > Flashcards

Symposium - Addiction Psychiatry Flashcards

1
Q

What are the 2 mechanisms that explain why humans misuse drugs?

A
  • Tolerance (the basis of physical dependence)
  • Reward centre (the basis of psychological craving)
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2
Q

Of tolerance and reward centre, which is the basis of:

  • physical dependence
  • psychological craving
A
  • Tolerance (the basis of physical dependence)
  • Reward centre (the basis of psychological craving)
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3
Q

What is tolerance?

A

Tolerance = reduced responsiveness to a drug caused by previous administration

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4
Q

What are examples of drugs that tolerance develops in response to?

A

Develops in response to most but not all drugs, such as:

  • Opioids, ethanol, barbiturates, benzodiazepines
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5
Q

What are the 2 mechanisms of tolerance?

A
  • Dispositional tolerance
    • Less drug reaches the active site
    • Could happen due to
      • Decreased rate of absorption
      • Increased rate or metabolism to inactive metabolites
      • Decreased rate of metabolism to active metabolites
      • Increased rate of excretion
  • Pharmacodynamics tolerance
    • Drug has less action at the active site
      • Down-regulation or internalisation of drug receptors
      • Reduced signalling down stream of drug receptors
      • Some other compensatory mechanism
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6
Q

WHat is dispositional tolerance?

A
  • Less drug reaches the active site
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7
Q

What is pharmacodynamic tolerance?

A
  • Drug has less action at the active site
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8
Q

What could dispositional tolerance happen due to?

A
  • Decreased rate of absorption
  • Increased rate or metabolism to inactive metabolites
  • Decreased rate of metabolism to active metabolites
  • Increased rate of excretion
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9
Q

What could pharmacodynamic tolerance happen due to?

A
  • Down-regulation or internalisation of drug receptors
  • Reduced signalling down stream of drug receptors
  • Some other compensatory mechanism
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10
Q

What is tolerance closely related to?

A

Tolerance is closely related to dependence, as development of tolerance may also lead to withdrawal symptoms:

  • About balance between drug and adaptive response
    • When drug removed the adaptive response remains and so imbalance
    • Dependent on drug to keep normal response
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11
Q

How does the effect of withdrawal of a drug usually compare to the effect of a drug?

A

Withdrawal phenomena:

  • Withdrawal effect of a drug is usually the reverse to the acute effect
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12
Q

What is the acute effect and withdrawal effect of the following:

  • opiod
  • barbiturate
  • cocaine
A
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13
Q

Where do neurons of the reward pathway project?

A

The reward pathway:

  • Neurons project from the ventral tegmental area to the nucleus accumbens and prefrontal cortex
  • When VTA neurons are stimulated dopamine is release
  • This causes a sensation of pleasure/reward
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14
Q

What is released when VTA neurons are stimulated?

A
  • When VTA neurons are stimulated dopamine is release
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15
Q

What does VTA stand for?

A

Ventral tegmental area

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16
Q

What is the reward pathway supposed to be activated by?

A

These exist to be activated by normal healthy behaviours that propagate genes:

  • Eating, drinking and sex
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17
Q

What are examples of drugs that tap into the reward pathway?

A

Some drugs of abuse tap into reward pathway and increase dopamine levels to produce cravings:

  • Heroin increases firing rate of dopaminergic neurons
  • Amphetamine increases dopamine release
  • Cocaine inhibits dopamine uptake
  • Alcohol
18
Q

How do the following drugs affect the reward pathway:

  • heroin
  • amphetamine
  • cocaine
A
  • Heroin increases firing rate of dopaminergic neurons
  • Amphetamine increases dopamine release
  • Cocaine inhibits dopamine uptake
19
Q

What are the 2 distinct components of drug dependence?

A

So drug dependence has 2 distinct components:

  • Physical dependence which develops as a consequence of tolerance to drug
  • Psychological craving which is result of stimulation of the reward pathways in the brain
  • Discriminative (cue) effects
    • People taking drugs around the person
20
Q

What are discriminative (cue) effects?

A
  • Discriminative (cue) effects
    • People taking drugs around the person
21
Q

Different drugs have different associated risks, depending on what?

A
  • Type of drug and effect
  • Purity, dose, strength and tolerance
  • Route of administration
  • Legal status
  • Comorbid health conditions
  • Likelihood of dependency
  • Methods of purchase
    • Legal, prescribed, OTC, black market, internet
  • Drug related deaths
22
Q

What are the drugs with most impact on local health services and local communities?

A
  • Alcohol
  • Heroin/opiate misuse
  • Benzodiazepine misuse
  • Cocaine/crack cocaine misuse
23
Q

What are examples of stimulants?

A
  • Cocaine
  • Amphetamine (also called speed)
  • Methamphetamine
  • Methylphenidate
24
Q

For cocaine:

  • mechanism
  • administration
  • effect
  • problems
  • withdrawal
A
  • Cocaine
    • Mechanism - monoamine reuptake inhibitor, increasing dopamine, serotonin and noradrenaline
    • Administration – sniffed, inhaled
    • Effect – stimulant and euphoria, anaesthetic effect, hypersensitive, increased alertness and energy, increased confidence and impaired judgement
    • Problems – damage to nose and airways, convulsions with respiratory failure, cardiac arrhythmias and MI, hypertension and CVA, toxic confusion
    • Withdrawal – depression, irritability, agitation, craving, hyperphagia, hypersomnia
25
Q

What is amphetamine also called?

A

Speed

26
Q

For amphetamine:

  • administration
  • effect
  • problems
A
  • Amphetamine (also called speed)
    • Administration – sniffed, swallowed or injected
    • Effect – similar to cocaine but longer lasting
    • Problems – toxic confusion with convulsions and dependence, amphetamine psychosis in heavy chronic use
27
Q

What are examples of opiates?

A
  • Opium
  • Morphine
  • Heroin (diamorphine)
  • Methadone
  • Codeine and dihydrocodeine
28
Q

What is heroin also called?

A

Dimorphine

29
Q

For herion:

  • mechanism
  • administration
  • effects
  • side effects
  • overdose
  • treatment
A
  • Heroin (diamorphine)
    • Mechanism – opioid agonist, acts principally via Mi, Delta and Kappa receptors
    • Administration – injection, smoking, snorting
    • Effects – mood effects, analgesia and euphoria
    • Side effects – pin point pupils, itching/sweating, constipation, decreased libido/menstrual irregularities, reduced cough reflex
    • Overdose – respiratory depression, snoring indicates risk, bradycardia, hypotension, death
    • Treatment – methadone maintenance to allow for normalisation of lifestyle
30
Q

What are the side effects of opiates:

  • first time
  • medium term
  • long term
A
  • First time
    • Nausea/vomiting and headache
  • Medium term
    • Phlebitis
    • Endocarditis
    • Injection injuries
    • Anorexia
    • Constipation
  • Longer term
    • Tolerance
    • Withdrawal
    • Social and health problems
31
Q

What are clinical features of opiate withdrawal syndrome?

A
  • Craving
  • Insomnia
  • Yawning
  • Muscle pain and cramps
  • Increased salivary, nasal and lacrimal secretions
  • Dilated pupils
  • Piloerection
32
Q

For benzodiazepines:

  • drugs
  • mechanism
  • effect
A
  • Drugs
    • Diazepam (Valium)
    • Nitrazepam
    • Tamezepam
    • Alprazolam (Xanax)
    • Lorazepam
    • Etizolam
  • Mechanism
    • GABA agonist
  • Effect
    • Anxiolytics, sedatives
33
Q

What do different benzodiazepines differ in?

A

Half-life and potency

34
Q

What is ecstasy also called?

A

MDMA

35
Q

For ecstasy:

  • administration
  • effect
  • side effects
A
  • Administration
    • Oral
  • Effect
    • Relaxed euphoric state without hallucinations
    • Increased sociability
  • Side effects
    • Dry mouth
    • Increased BP and temperature
    • Dehydration in clubs
    • Large doses can cause anxiety and harm
36
Q

What are the main components of cannibis?

A
  • Tetrahydrocannabinol is psychoactive agent
  • Cannabidiol (CBD) is anxiolytic and antipsychotic effect
37
Q

For cannabis:

  • effects
  • side effects
A
  • Effects
    • Relaxing or stimulating, euphoriant, increases sociability and hilarity, increases appetite, changes in time perception, synaesthesia
    • In higher doses – anxiety, panic, persecutory ideation, hallucinatory activity
  • Side effects
    • Respiratory problems as with tobacco
    • Toxic confusion
    • Exacerbation of major mental illness
    • Cannabis psychosis
38
Q

What are examples of novel psychoactive substances?

A
  • NPS
  • “Legal highs”
    • Basically the drug with a slight change in lab to chemical structure to make legal, MDMA example of one modified
39
Q

What are examples of performance and image enhancing drugs?

A
  • Anabolic steroids
  • Growth hormone
  • Injectable tanning agents such as melotan
40
Q

What are the treatment principles for drug addiction?

A
  • Strong emphasis on risk reduction
  • Abstinence vs harm reduction debates
  • Treatment is effective

Psychiatry (20 decks)

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