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PAS > WK 6- PHARMACODYNAMICS- ADDICTION VS ACUTE INTOXICATION > Flashcards

WK 6- PHARMACODYNAMICS- ADDICTION VS ACUTE INTOXICATION Flashcards

1
Q

What is the definition of intoxication

A

condition that follows administration of a psychoactive substance and results in disturbances in the level of consciousness, judgement, behaviour or psychophysiological functions and responses

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2
Q

What is the definition of addiciton

A

Condition characterized by an overwhelming desire to continue taking a drug that a person has become habituated to, through repeated consumption- desire to take drug it to receive its affects - usually alteration of mental status

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3
Q

What are 3 CNS depressants

A
  1. Alcohol
  2. Benzodiazepines
  3. Opiates (heroin)
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4
Q

What are 2 CNS stimulants

A
  1. Cocaine

2. Amphetamines (Ice, Ecstasy)

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5
Q

What is the mechanism of action of alcohol- how does it alter mental status

A

Allosteric inhibition of NMDA receptors and facilitation of GABA (increase chloride influx)–> results in dopamine release into the synapses of the mesolimbic reward pathway causing a ‘relaxed’ feeling

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6
Q

What is the mechanism of withdrawal from alcohol (what happens to receptors)

A
  1. Internalisation and decreased surface expression of normal GABA-A receptors
  2. Increase in surface expression of ‘low alcohol sensitivity’ GABA-A receptors (don’t respond to alcohol)
  3. Increased phosphorylation of NMDA receptors containing high conductance subunits-> causes influx of Ca-> causes muscular contractions (delirium tremors)
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7
Q

What is the mechanism of action of benzodiazepines

A

1) Nerve impulse cause release of GABA from
storage sites on presynaptic neuron
2) GABA released into synaptic cleft and interacts with receptors on the posty-synaptic neuron
3) the reaction allows chloride ions (Cl-) to enter the neurons
4) This effect inhibits further progress of the nerve
impulse
5) Benzodiazepines react with booster site on GABA receptor and enhances the inhibitory effects of GABA

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8
Q

What is a schedule 8 drug

A 
Schedule 8 (S8) drugs and poisons are
substances and preparations for therapeutic use which have high potential for abuse and addiction→ making possession without authority illegal
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9
Q

True or false- the shorter the half life of a drug, the more addictive it is

A

True- this is why benzodiazepines are so addictive

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10
Q

What are examples of opiods

A

Codeine, Heroin, Methadone, Oxycodone

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11
Q

What is the mechanism of action of opiods

A
  1. Heroin reaches the brain and becomes morphine
  2. Morphine will interact with kappa, delta and mu receptors
  3. This causes decreased release of GABA
  4. The lower amount of GABA= less inhibition→ causes flood of dopamine to enter the cortex- relaxed feeling
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12
Q

What is the mechanism of withdrawal from opioids

A

1) Increased mu-opiod receptor internalization and degradation (can’t get relaxing feeling)
2) Decreased efficacy of mu-opiod signal transduction)
3) Hyperactivation of adenylyl cylase signalling, leading to enhanced GABA release and to increased gene transcription via activation of transcription factors

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13
Q

What is the MOA of methamphetamine

A

methamphetamine causes release of all stored dopamine→ dopamine transporters move dopamine into synaptic cleft→ interacts with all receptors

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14
Q

Does ecstasy cause release of dopamine

A

NO- ecstasy works by blocking serotonin re-uptake, causing high levels of serotonin in synaptic cleft→ causes a relaxed feeling of euphoria

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15
Q

What is the MOA of cocaine

A

blocks dopamine reuptake transporter and floods the synapse with dopamine

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16
Q

What is the mechanism of withdrawal from cocaine

A
  1. Dopamine amine transporter expression increases
  2. The number of postsynaptic dopamine receptors decreases
  3. Presynpatic dopamine is depleted
    - over time, cocaine addicts require more and more levels due to dopamine release reducing
    - cause of death is normally always cardiac→ dopamine goes to NA, causes reflex tachycardia
17
Q

What are some ways of monitoring what drugs are being used in the community

A
  1. Sewage monitoring
  2. Needle/syringe program
  3. Hospitalisations/coronial inquest
18
Q

What are some factors that drive people to drug use

A

Genetic= some people are more likely to feel the effects of certain drugs (eg. codeine metabolised to morphine-> predisposes to addiction) or some people are bad metabolisers (ie acetaldehyde deficiency)
Social and environment= SES, family history, exposure, education
Biomedical/neurochemical= drugs hijack the reward pathway and put it at the top of the ‘needs’ list

19
Q

What are the 3 ‘reductions’ of the National Drug Strategy

A
  1. Supply reduction= police decreasing availability of drugs in the community
  2. Harm reduction= Harm minimisation through safe injecting rooms/syringe programs
  3. Demand reduction= School based education programs
20
Q

What are the 4 different routes of administration- what are their slang terms

A 
Oral= Drop it
Inhalation= Chase it
Injection= Boot it
Rectal= Shaft it
21
Q

If a patient presents to the ED after taking a drug, why is it important to know what route was taken

A

The route can affect the pharmacokinetics of the drugs-> change it’s peak time and the effects-> eg. Drugs that are inject have immediate action, whilst those ingested take longer to peak

22
Q

What are the 5 patterns of drug use (pyramid)

A
  1. Dependent
  2. Regular
  3. Recreational
  4. Occasional
  5. Experimental
23
Q

At what stage of the patterns of drug use is acute harm most likely to occur and why

A

Experimental phase- this is where people have less tolerance to a drug and less education- allows for easy overdose

24
Q

With drug use, what are the 3 categories of acute harm

A
  1. Social- broken relationships, employment issues, child protection, issues with the law
  2. Physical- overdose, loss of consciousness, IV drug use harm
  3. Mental- psychosis, aggression, anxiety, depression
25
Q

What kind of diseases can result due to IV drug use

A

Injection injury= vasospasm, embolic events, vessel rupture
Secondary disease= septicaemia, endocarditis, infection, organ failure, embolus
Blood borne disease= HIV, HEP C, HEP B

26
Q

Rhabdomyolysis, MI, Stroke, renal failure and seizures are due to which type of drug class- stimulants or depressants

A

Stimulants

27
Q

Respiratory failure, Aspiration, Hypoxix brain injury, Leukoencephalities and seizures are due to which type of drug class- stimulants or depressants

A

Depressants

28
Q

What 5 types of harm are due to chronic drug use

A
  • Social Harm= assaults, unplanned pregnancy, broken relationships, homelessness, incarceration
  • Financial harm
  • Mental harm= psychosis, dependence, depression, anxiety
  • Physical harm= organ damage, rapid ageing, STI’s, malnutrition, BBV and other IVDU injuries
29
Q

What are the 9 physiological steps of dependence

A
  1. Exposure to substance with abuse potential (can cross BBB, can activate reward pathway)
  2. Positive aspects of neurochemical activation outweigh negative aspects in the individual
  3. Environmental context is conducive to repeated use
  4. Repeated use results in receptor adaptation (function or number)
  5. Downstream neurological function alters to adjust for receptor adaptation (homeostasis)
  6. Same amount of drug produces less physiological response-more drug required for equal outcome-tolerance
  7. Tolerance fuels desire for more drugs to achieve same outcome
  8. ‘Normal’ function now requires increased levels of binding (presence of the drug)-dependence
  9. Removal of substance produces adverse effects-withdrawal
30
Q

Why is it important to use psychotherapy in addiction treatment

A

Allows the person to deal with underlying trauma/things that drove them to using drugs and to then develop coping strategies and resilience

31
Q

When quitting a drug, what are the 4 ways in which cessation of the drug can be achieved (4 S’s)

A 
Stop= cold turkey- way most people do it
Soothe= provide symptomatic relief to withdrawal symptoms
Swap=  substitute therapies 
Slow= controlled gradual reduction
32
Q

What are some advantages and disadvantages of rehab- ‘detox’

A 
Advantages= protected and supportive environment, peer support, monitoring
Disadvantages= Expensive, limited places, not the 'real world' and some patients may relapse when they have to face the real world
33
Q

What are the pharmacotherapies for alcohol

A

Withdrawal= thiamine with diazepam/oxazepam
Stopped but dependent= naltrexone (opiate antagonist), acamprosate (GABA agent, anti-craving) or disulfam (alcohol dehydrogenase antagonist)
Long term= thiamine

34
Q

What are the pharmacotherapies for opiates

A
  • Methadone= full acting angonist- stabilises behaviour and allows for ‘headpsace’-> but risk of resp depression and overdose, helps with withdrawal
  • Buprenorphine= partial agonist= ow risk of resp depression, patient must be in withdrawal when starting buprenorphine
  • Buprenorphine/naloxone= naloxone is an antagonist, buprenorphine is a partial agonist
  • Naltrexone= oral form of naloxone
  • Rapid detox= clear body of opiates whilst under sedation
35
Q

Why is buprenorphine given with naloxone

A

If you inject the bup/nal combination, the naloxone is in its environment (the bup is optimised for oral use)- the naloxone wins, binds to the receptors, blocks them and the buprenorphine can’t bind and they get NO or MINIMAL EFFECT→ stops people injecting

36
Q

What are the pharmacotherapies for nicotine

A
  • Verenicline (champix): nicotinic acetylcholine-receptor partial agonist, not to be used in pregnancy, childhood or those with significant psychiatric distress, reduce dose in renal impairment-lack of serious adverse effects (only nausea in 30%)
  • Buproprion: anti-depressant so has co-positive aspects. Is a non-competitive nicotine receptor antagonist and at high concentrations inhibits the firing of noradrenergic neurons in the locus caeruleus.

PAS (11 decks)

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