What is drug abuse?
What is inappropriate drug use?
What is inappropriate drug non-use?
What is recreational or non medical use of drugs?
Drug abuse- any use of a drug that does more harm than good for the individual or for society
Inappropriate use- wrong from the start (amoxicillin for viral sore throat), initially reasonable (tetracycline in all livestock feed)
Inappropriate non use- needless patient suffering, social consequences of non treatment
Recreational or non medical use of drugs- not necessarily drug abuse
What is addiction?
Addictive drug vs addictive person?
Compulsive use of a drug
Craving and avoidance of withdrawal
Not the same as development of tolerance
Existence of withdrawal symptoms isn’t the same as addiction
Addictive drug has pleasant direct effects and short half lives
Addictive people currently can’t be identified before addiction
What are the natural and synthetic stimulant recreational drugs?
Natural- nicotine, caffeine, cocaine, and ephedrine
Synthetic- amphetamine and relatives (methylphenidate)
What is the dopamine reward pathway?
Dopamine induces feelings of euphoria and pleasure and activates dopamine reward path (feelings of pleasure in response to certain stimuli)
Ex: eating to relieve hunger, drinking to relieve thirst, engaging in sex, cocaine, heroin, nicotine
What are the natural and synthetic depressant recreational drugs?
Natural- marijuana, opium (morphine/codeine), ethanol
Synthetic- barbiturates, opioids (heroin), benzodiazepines
What does combining upper and downer do?
Taking upper and downer at the same time increases the high
Potentiates the euphoria
Heroin + cocaine = speedball
Methylphenidate + pentazocine + R & T’s
What are hallucinogens?
What are the natural and synthetic examples?
Hallucinogens alter or distort perception (interpretation of sensory input)
Increase neural activity in NE, DA, serotonin pathways or reduce activity in acetylcholine pathways
Natural- ergotamines, mescaline (peyote), psilocin (shrooms)
Synthetic- LSD, benztropine, amphetamine analogues (MDMA)
What is phencyclidine?
Dissociative anesthetic agent similar to ketamine that antagonizes the glutamate NMDA receptor
It produces an altered body image, detachment of the mind from the body
How do you treat opioids substance abuse?
Opioid dependency treated with methadone (long acting oral dose) and/or with naloxone/naltrexone
Methadone itself is addictive but it calms cravings and has few side effects
What is ethanol?
How it’s digested
Alcohol is a depressant
Low to moderate ethanol consumption has health benefits
Ethanol converted to acetaldehyde by ADH, then converted to acetic acid by ALDH
Acts on GABA, NMDA, serotonin receptors
Suppressed neuronal excitability in a concentration dependant manner
What is methanol?
How it’s digested
Methanol is metabolized by ADH to form formaldehyde which ALDH metabolizes to form Formica acid
Must saturate ADH with ethanol to treat methanol poisoning
What is ethylene glycol?
How’s it digested
Metabolized by ADH and ALDH to toxic aldehydes and oxalic acids
Severe metabolic acidosis develops 4 to 12 hours after ingestion
Use ethanol to treat
Look at calculation of blood alcohol concentration (BAC) slide 27