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BB2 > Drug Dependence > Flashcards

Drug Dependence Flashcards

1
Q

How many of the adult British population have taken illegal drugs?

A

One in three

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2
Q

What is addiction?

A

Chronic disease characterised by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences.

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3
Q

Define drug abuse.

A

A pattern of drug use in which the users consume the substance in amounts or using methods which are directly or indirectly harmful to themselves or others.

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4
Q

Define drug dependence.

A

An adaptive state that develops after repeated drug use and which results in withdrawal symptoms upon cessation of drug use.

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5
Q

Define drug tolerance.

A

The diminishing effect of a drug which results after repeated administration at a set dose.

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6
Q

Define psychological dependence.

A

Dependence that involves emotional–motivational withdrawal symptoms (e.g. dysphoria, depression, anhedonia, restlessness).

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7
Q

Define physical dependence.

A

Dependence that involves significant physical–somatic withdrawal symptoms (e.g. fatigue, nausea, seizures, pain, delirium tremens).

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8
Q

Classification of drugs under the Misuse of Drugs Act 1971 - give examples for class A, B and C.

A

Class A: heroin, methadone, cocaine, crack cocaine, ecstasy, LSD, magic mushrooms, methadone…

Class B: amphetamines, barbiturates, ketamine, methylphenidate, codeine, cannabis…

Class C: anabolic steroids, benzodiazepines, gamma hydroxybutyrate, gamma butyrolactone, khat…

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9
Q

What are the receptors for…
Opiates?
Cocaine?
Amphetamine?

A

Mu and delta opioid receptors - agonist
DA, NAd and 5-HT uptake systems - antagonist
Monoaminergic transmission:uptake systems - agonist of TAAR1

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10
Q

What are the receptors for…
Ethanol?
Nicotine?
Cannabinoids?

A

GABA A and NMDA receptors - modulator
Nicotinic receptors - agonist
CB1 receptors - agonist

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11
Q

What are the receptors for…
Ketamine and phencyclidine?
Hallucinogens?
Barbiturates and benzodiazepines?

A

NMDA glutamate receptors - antagonist
5-HT 2A receptors - agonist
GABA A receptors - agonist

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12
Q

What neurotransmitter is particularly important in pleasure?

A

Dopamine - occupancy of dopamine receptors by labelled marker decreases when the stimulant induces pleasure, as it is displaced by dopamine.

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13
Q

The dopaminergic projection from _____ to _____ is essential in drug dependence.

A

Ventral tegmental area

Nucleus accumbens

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14
Q

What are the four stages of the addiction cycle?

A
  1. Intoxication – positive reinforcement. Impaired self-awareness.
  2. Bingeing - loss of control.
  3. Withdrawal/negative affect - negative reinforcement. Amotivation and anhedonia.
  4. Craving – conditioned positive and negative reinforcement. Drug expectation and attention bias.
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15
Q

Mechanisms underlying withdrawal.

A

Activation of kappa opioid receptors (endogenous receptor for dynorphin-like peptides) can trigger dysphoria, by reducing dopamine release. Administration of drugs of abuse increases the release of dopamine. Chronic intake leads to up-regulation of dynorphin, which might inhibit drug-induced dopamine release. After stopping the drug, these adaptations remain unopposed which contributes to the negative emotional state associated with drug withdrawal.

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16
Q

Brain areas involved in the development of drug dependence. (6)

A 
Ventral tegmental area
Nucleus accumbens (one of first to be involved)
Insula
Hippocampus
Prefrontal cortex
Amygdala (last to be involved)
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17
Q

Brain connectivity changes occurs during the development of addiction. There is gradual involvement of many CNS structures. There is increasing ________ with increasing use of drugs, and increasing ______/________.

A

Neuroplasticity

Compulsivity/loss of control

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18
Q

In addicts what can be said about the availability of dopamine D2 receptors and cerebral metabolism?
In what brain area is this particularly prevalent?

A

Reduced - these have a linear relationship, they increase/decrease with each other.
Orbitofrontal cortex and cingulate gyrus

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19
Q

In addicts, there are processes that are impaired. These include:
Self-control, emotional regulation, motivation, attention, memory, decision making, insight and salience attribution.
What area of the brain is this associated with?

A

Prefrontal cortex

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20
Q

Addicts show iRISA. What does this stand for?

A

Impaired response inhibition and salience attribution

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21
Q

Chronic drug abuse affects gene regulation. How?

A

Gradual accumulation in gene expression changes.

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22
Q

Which opiates and psychostimulants can particularly effect neuronal structure? What effect do they have?

A

Cocaine and morphine

Morphine decreases the total dendritic length and dendritic spine density. Cocaine increases it.

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23
Q

What classifies as hazardous drinking?

A

Regular consumption of over 5 units a day for men and over 3 units a day for women.

24
Q

What does acute alcohol intoxication cause?

A

Euphoria followed by depressed mood, slurring of speech, ataxia, general incoordination, and pupillary dilatation.

25
Q

How does acute alcohol ingestion affect transmission?

A

Depresses excitatory transmission and potentiates inhibitory transmission.

26
Q

What is the long term consequence of alcohol abuse on the brain?

A

Shrinkage of grey matter

27
Q

What are some of the long terms effects of alcohol abuse?

A 
Peptic ulcer, GI haemorrhage, varices
Pancreatitis
Alcoholic liver disease 
Peripheral neuropathy
Korsakoff syndrome
AF
Hypoglycaemia 
Thiamine deficiency etc etc...
28
Q

What does MDMA stand for?

A

Methylene dioxymethamphetamine - ecstasy

29
Q

What are some of the systems and receptors that MDMA target? (5)

A 
5-HT uptake system
Dopamine uptake system
5-HT2 receptors
H2 histamine receptors
α2 adrenergic receptors
30
Q

What mediates the behavioural actions and temperature effects of MDMA?

A

5-HT

31
Q

Psychomotor effects of MDMA are mediated by ____ stimulation of dopamine release and activation of _________ receptor.
What are these motor effects?

A

5-HT
5-HT 1B receptor
Repetitive movements and hyperlocomotion

32
Q 
MDMA users (for a median of 3.66 years) - what effect is seen on their regional glucose metabolism?
What does this cause?
A 
Significantly decreased (prefrontal hypometabolism)
Verbal memory deficits
33
Q

What are the signs and symptoms of acute MDMA toxicity? (6)

A 
Body temperature elevation
Disseminated intravascular coagulation
Rhabdomyolysis (blocked by dantrolene)
Increased renal reabsorbtion of water
Hyponatraemia
Cerebral oedema
34
Q

What three factors determine the development of addiction?

A

Environment
Drug-induced effects
Genes

35
Q

Overuse of MDMA leads to loss of what type of axon?

A

Serotonin axons

36
Q

CB 1 receptors are concentrated in which part of the body?

A

Central nervous system

37
Q

CB 2 receptors are concentrated in which part of the body?

A

Immune system

38
Q

What type of receptor is CB 1?

A

G protein-coupled

39
Q

What are the symptoms of cannabinoid intoxication?

A

Hypothermia
Rigid immobility
Decreased motor activity

40
Q

Cannabinoids exert mainly what type of effect?

A

Inhibitory

41
Q

What are the risks of long-term cannabis use?

A

Increases risk of developing schizophrenia and major depression, memory problems and paranoia.

42
Q

What is cannabidiol?

A

Major non-psychotropic cannabinoid compound present in the plant Cannabis sativa

43
Q

What two things does Sativex combine? What ratio?

A

THC and CBD

1:1

44
Q

What is nabilone?

A

Synthetic analogue of THC

45
Q

What ratio does Cannador combine THC and CBD in?

A

2:1

46
Q

What are the key methods of management of addiction? (5)

A 
Detoxification
Psychological support
Medication
Evaluation and treatment for co-occurring mental health problems
Long-term follow-up
47
Q

What is nalmefene used for?

A

Reduction of alcohol consumption (opiate antagonist)

48
Q

What is ceftriaxone? What has it shown potential to do?

A

Antibiotic

Attenuate cocaine relapse after abstinence

49
Q

Why is disulfiram given to alcoholics? How does it work?

A

To prevent relapse

It is a aldehyde hydrogenase inhibitor, allows build up of acetaldehyde (toxic product).

50
Q

Why are GABA agonists such as benzodiazepines and anti-epileptic agents given to alcoholics?

A

To help withdrawal symptoms

51
Q

What kind of drug is naltrexone? What about acamprosate? Why is it given to alcoholics?

A

Opioid antagonist (also given to opiate addicts)
Affects glutamate receptors
To prevent relapse

52
Q

Bupropion – what is it used for? How does it work?

A

Monoamine reuptake inhibitor for smoking cessation

53
Q

Buprenorophine – what is it used for? How does it work?

A

Opioid mu receptor partial agonist, kappa antagonist to help with opiate withdrawal symptoms.

54
Q

Clonidine and lofexidine – what are they used for? How do they work?

A

Alpha-2 adrenoreceptor agonists to help with opiate withdrawal symptoms.

55
Q

What drug was recently introduced for nicotine addiction? How does it work?

A

Varenicline (α4β2 selective partial agonist

at nicotinic receptors)

56
Q

What are the two main side effects of varenicline?

A

Nausea and psychiatric disturbances

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