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*Psychiatry > Symposium 3 - Addictions > Flashcards

Symposium 3 - Addictions Flashcards

1
Q

What mechanisms are involved with substance misuse?

A 
Tolerance (dependence)
Reward centre (cravings)
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2
Q

What is tolerance?

A

Reduced responsiveness to a drug caused by previous administration
Form of homeostasis

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3
Q

What are the mechanisms for dispositional drug tolerance?

A

Decreased absorption
Increased metabolism to INACTIVE metabolites
Decreased metabolism to ACTIVE metabolites
Increased excretion

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4
Q

What are the mechanisms for pharmacodynamic drug tolerance?

A

Down-regulation of drug receptors

Reduced signalling of drug receptors

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5
Q

What are the main mechanisms of tolerance?

A

Dispositional tolerance - less drug reaches active site

Pharmacodynamic tolerance - drug has less action at site

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6
Q

What is the mechanism of withdrawal?

A

Reverse of the acute effect of a drug

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7
Q

What is physical dependence?

A

Avoidance of withdrawal effects of a drug

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8
Q

What is the reward pathway?

A

Neurones project from ventral tegmental area to nucleus accumbens & prefrontal cortex
VTA neurones release dopamine
Leads to pleasure

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9
Q

What is the function of the reward pathway?

A

Reward the individual for eating, drinking and sex to encourage healthy behaviours

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10
Q

How does heroin effect the reward pathway?

A

Increases firing of dopaminergic neurones

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11
Q

How does amphetamine effect the reward pathway?

A

Increase dopamine release

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12
Q

How does cocaine effect the reward pathway?

A

Inhibits dopamine reuptake

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13
Q

How long do the modalities of cocaine take to onset?

A

Smoking - immediate
Injecting - 15-30s
Insufflating - 3-5mins

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14
Q

What are the recreational effects of cocaine?

A 
Stimulant and Euphoriant 
Alertness and energy
Confidence
Impaired judgement
Lessens appetite & desire for sleep
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15
Q

What are the harmful effects of cocaine?

A 
Damage to nose/airways
Convulsions
Arrhythmias and MI
HTN
Toxic confusion
Paranoid psychosis
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16
Q

What are the withdrawal effects of cocaine?

A 
Depression
Irritability
Craving
Agitation
Hyperphagia
Hypersomnia
17
Q

What are the harmful effects of amphetamines?

A

Toxic confusion
Convulsions
Death
Amphetamine psychosis

18
Q

What are the recreational effects of heroin use?

A

Analgesia
Drowsiness
Euphoria
Decreased sympathetic outflow

19
Q

What are the harmful effects of heroin use?

A 
Respiratory depression
Cough reflex suppression
N+V
Hypothermia 
Pupillary constriction
Constipation
20
Q

What are the overdose effects of heroin use?

A 
Respiratory arrest with pulse
Unreactive pupils 
Bradycardia
Hypotension
Coma
21
Q

What are the side effects of opiates?

A 
First time - N+V, headache
Medium term: 
 - phlebitis
 - anorexia
 - constipation
Long term: - tolerance, withdrawal
22
Q

What are the withdrawal effects of heroin use?

A 
Craving
Insomnia
Yawning
Muscle pain
Increased parasympathetic secretions
Dilated pupil 
Piloerection
23
Q

How is heroin addiction managed?

A

Methadone maintenance

24
Q

What are the pros/cons of methadone maintenance?

A

Decriminalises drug use
Normalises lifestyle
Reduces IV misuse
Leaks to black market

25
Q

What are the recreational effects of MDMA?

A

Relaxed euphoric state without hallucinations
Sociability
2-4hrs duration

26
Q

What are the side effects of MDMA?

A 
Nausea
Dry mouth
HTN
Hyperthermia 
Dehydration risk
Anxiety and panic
Psychosis
27
Q

How has THC content of cannabis changed over time?

A

1% in 70s

17% now

28
Q

What are the psychological effects of cannabis?

A

Relaxing/stimulating
Euphoriant
Increased sociability, appetite
Synaesthesia

29
Q

What are the high dose effects of cannabis?

A 
Anxiety
Panic
Persecutory ideations
Hallucinations
Exacerbation of mental illness
30
Q

What are the legitimate indications for anabolic steroids?

A

Hypogonadism
Muscular dystrophy
Anaemias
Muscle wasting in AIDS

31
Q

Marked muscle mass increase is seen where in anabolic steroids use?

A

Pectoralis
Deltoids
Trapezius
Biceps

32
Q

What are the general side effects of anabolic steroids?

A 
Acne
Stretch marks
Baldness
Cholesterol
Hypertension
Growth deficits
Liver disease
Roid rage, mania
Depression and suicidality in withdrawal
33
Q

What are the male side effects of anabolic steroids?

A

Hypogonadism

Gynocomastia

34
Q

What are the female side effects of anabolic steroids?

A 
Virilisation
Hirsutism
Deep voice
Clitoral enlargement
Menstrual abnormalities
Hair thinning
35
Q

How can D2 antagonists be used in addiction?

A

D2 receptors are blocked which stops addiction, but causes lethargy and low mood

36
Q

Amphetamine psychosis may present similar to what?

A

Schizophrenia

37
Q

Heavy chronic amphetamine use can lead to what?

A

Amphetamine psychosis

38
Q

How does the route of heroin use change over the course of addiction?

A

Starts with smoking (often) which is more expensive, leads to injection over time due to losing money

*Psychiatry (18 decks)

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