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BB2 > Drug Dependency > Flashcards

Drug Dependency Flashcards

1
Q

Define addiction

A

Chronic disease characterised by drug seeking

Compulsive and difficult to control despite harmful consequences

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2
Q

Define drug abuse

A

Pattern of drug use in which individual is using methods/amounts of substance which directly/indirectly harm themselves and/or others

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3
Q

Define drug dependence

A

Adaptive state that develops after repeated drug use (withdrawal symptoms)

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4
Q

Define psychological dependence

A

Dependence involving emotional/motivational withdrawal symptoms (e.g. depression/restlessness/dysphoria)

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5
Q

Define physical dependence

A

Dependence involving significant physical-somatic withdrawal symptoms (e.g. fatigue/nausea/seizures/pain)

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6
Q

Which drugs are the most harmful?

A

Alcohol

then heroin, crack cocaine, meth

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7
Q

What do opiates target?

A

Mu and delta opoid receptors

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8
Q

What does cocaine target?

A

DA (dopamine) , NAd (noradrenaline) and 5-HT uptake systems, inhibiting them

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9
Q

What does amphetamine target?

A

monoaminergic transmission amplifier: uptake systems, agonist of trace amine associated receptor 1

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10
Q

What does ethanol target?

A

GABA and NMDA receptors (glutamate) modulating both excitatory and inhibitory systems in the brain

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11
Q

What does nicotine target?

A

nicotinic receptors

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12
Q

What do cannabinoids target?

A

CB1 receptors

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13
Q

What do phencyclidine and ketamine target?

A

NMDA glutamate receptors

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14
Q

What do hallucinogens target?

A

5-HT2A receptors

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15
Q

What do barbiturates and benzodiazapines target?

A
  • GABAa receptors
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16
Q

What 3 factors determine addiction development?

A
  • environment
  • drug induced effects (pleasant/unpleasant, in pleasure there is a decrease in the occupancy of dopamine receptors)
  • genes (polymorphisms in the opoid MU, kappa and delta receptors)
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17
Q

What are the 3 stages of the addiction cycle?

A
  • binge/intoxication (positive reinforcement)
  • withdrawal/negative affect (negative reinforcement)
  • preoccupation/anticipation (conditioned positive and negative)
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18
Q

What are the core clinical symptoms of addiction?

A

Intoxication
bingeing
withdrawal
craving

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19
Q

What is the withdrawal mechanism?

A
  • acutely dopamine from the VTA stimulates the nucleus accumbens (reward system) causing pleasure
  • nucleus accumbens projection neurons releasing transmitters on the VTA’s kappa opoid receptors and act as regulatory break
  • drug abuse inhibits VTA = dopamine release reduced = dysphoria
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20
Q

What is the VTA?

A

ventral tegmental area
origin of dopaminergic cell bodies, mesocorticolimbic dopamine system and other dopamine pathways
natural reward circuitary of the brain

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21
Q

What is the mechanism of drug dependence?

A
  • involves excitatory amino acids and dopamine
  • when you crave the drug you know there are certain activities you need to get it so gives rise to planning of taking the drug making your a brain a slave to impulse
  • also reduced availability of D2 receptors and reduced metabolism
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22
Q

What structures are involved in drug dependence?

A
  • involved in craving/planning/taking:

VTA, nucleus accumbens, amygdala, insula, PFC, hippocampus

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23
Q

What is the mechanism of neuroplasticity in drug-seeking behaviour?

A

More dependent you become = more compulsive/uncontrolled you are to take it
- loss of control over various CNS structures

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24
Q

What changes are there to the prefrontal cortex in addiction?

A

impaired processes associated with PFC:

  • self control and motivation
  • emotional regulation
  • attention and flexibility
  • working memory
  • decision making
  • awareness and insight
  • learning and memory
  • salience attribution
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25
Q

How is chronic drug abuse related to gene regulation?

A
  • addiction changes gene expression throughout the brain

- increased expression of FosB gene

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26
Q

What is the alcohol consumption indicative of abuse?

A

Regular consumption of:
M - 5 units a day
W - 3 units a day

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27
Q

What are signs of acute alcohol intoxication?

A

Euphoria followed by depressed mood, slurring of speech, ataxia, general incoordination, pupillary dilatation
Modulates the activity of pharmacological targets - depressed excitatory transmission and potentiates inhibitory transmission

28
Q

What are the long term consequences of alcohol abuse?

A
  • gastritis, peptic ulcer disease, oesophageal varices, pancreatitis
  • shrinkage of grey matter in alcoholic patients
29
Q

What does MDMA target?

A 
5-HT uptake system
dopamine uptake system
5-HT2 receptors
H2 receptors
Alpha2 adrenergic receptors
30
Q

What mediates behavioural actions of MDMA?

A

5-HT release:

  • psychomotor effects: repetitive movements, hyperlocomotion (mediated by 5-HT and 5-HT1B receptor)
  • temperature effects
31
Q

What are the effects of acute MDMA toxicity?

A
  • temperature elevation
  • hyponatremia
  • cerebral oedema
  • increased renal absorption of water
  • rhabdomyolysis (muscles breaking down and blocking kidneys)
32
Q

What is the main agonist of cannabis/

A

THC - tetrahydrocannabinol

33
Q

What do cannabinoids bind to?

A

CB1 and CB2 receptors

34
Q

What are the properties of CB1 receptors?

A
  • concentrated in the CNS

- most abundant GPCR in mammalian brain

35
Q

What are the properties of CB2 receptors?

A
  • in peripheral organs

- associated with the immune system

36
Q

What is the mode of action of cannabis?

A

Produce inhibitory effects by inhibiting glutamate and GABA pre-synaptically

37
Q

What are the risks of cannabis?

A
  • LT use = increased risk of schizophrenia and major depression
  • acts as a gateway drug
  • related to depression, memory problems and paranoiea
38
Q

What are the forms of cannabis?

A
  • inhaled
  • THC/donabinol
  • cannabidiol
  • nabilone
  • sativex and cannador
39
Q

Which drugs target alcohol addiction?

A
  • benzodiazapines
  • AED (carbamazepine)
  • accamprosate
  • naltrexone
  • disulfiram
  • SSRIs
  • thamine
  • malmefene
40
Q

What is the mechanism of benzodiazepines?

A

direct GABA agonist

41
Q

What is the mechanism of carbamazepine?

A

GABA promoter

42
Q

What is the mechanism of accamprosate?

A

Effect of glutamate receptors reducing withdrawal related neuronal excitation

43
Q

What is the mechanism of naltrexone?

A

Opoid agonists

44
Q

What is the mechanism of disulfiram?

A

Aldehyde dehydrogenase inhibitor allowing build up of aldehyde (makes people feel bad)

45
Q

What are the indications for benzodiazepines?

A

withdrawal symptoms
seizures (prevention/treatment)
delirium (prevention/treatment)

46
Q

What are the indications for carbamazepines?

A

withdrawal symptoms

seizure prevention

47
Q

What is the indication for accamprosate?

A

Maintenance of abstinence

48
Q

What is the indication for naltrexone?

A

Maintenance of abstinence

49
Q

What is the indication for disulfiram?

A

Maintenance of abstinence

50
Q

What is the indication for SSRIs?

A

Maintenance of abstinence

Treatment of co-morbid depression

51
Q

What is the indication for thiamine?

A

Prevention of neurological symptoms

Treatment of Wernicke’s encephalopathy

52
Q

What is the indication for nalmefene?

A

For reduction of alcohol consumption

53
Q

Which drugs target nicotine addiction?

A

Nicotine replacement therapy - nicotine agonist
Bupropion
Varencicline

54
Q

What is the mechanism of bupropion?

A

Monoamine (especially dopamine) reuptake inhibitor

55
Q

What is the mechanism of varencicline?

A

Alpha-4-Beta-3 selective partial agonist of nicotinic receptors

56
Q

What are the indications for nicotinic replacement therapy?

A

Smoking cessation

57
Q

What are the indications for Bupropion?

A

Smoking cessation

58
Q

What are the adverse effects of varencicline?

A

Nausea

Psychiatric disturbances

59
Q

Which drugs target opoiate addiction?

A

Methadone opoid agonis
Buprenorphine
Clonidine and Lofexidine
Naltrexone

60
Q

What is the mechanism of methadone?

A

opoid agonist

61
Q

What is the mechanism of buprenorphine?

A

Opoid MU receptor partial agonist, kappa antagonist

62
Q

What is the mechanism of clonidine and lofexidine?

A

Alpha 2 adrenoreceptor agonists

63
Q

What are the indications of methadone opoid agonists

A

Withdrawal symptoms

64
Q

What are the indications of buprenorphine?

A

Withdrawal symptoms

65
Q

What are the indications of clonidine and lofexidine?

A

Withdrawal symptoms

66
Q

What are the indications for naltrexone?

A

Relapse prevention in selected patients

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