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Drug abuse and dependence Flashcards

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1
Q

What professionals are required for the management of drug abuse and dependence?

A

Social scientists

Psychologists

Pharmacologists

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2
Q

Why is drug dependence important?

A

It is a global burden with high social cost

100 million people affected

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3
Q

What is substance dependence?

A

A state in which an organism functions normally only in the presence of a drug

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4
Q

Symptoms of psychological dependence

A

Craving

Compulsive seeking behaviour

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5
Q

Symptoms of physical dependence

A

Withdrawal upon cessation of drug use

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6
Q

Examples of harm caused by recreational drug use

A

Overdose

Direct physical damage

Inappropriate behaviour

Drift into criminal subculture

Self-neglect

Spread of disease

Exposure to unknown substance

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7
Q

Example of direct physical damage caused by drug use

A

Liver cirrhosis

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8
Q

Example of inappropriate behaviour caused by drug use

A

Driving while drunk

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9
Q

Why do drug abusers often show self-neglect?

A

They’re pleasure comes solely from a drug

So there is no need to find pleasure anywhere else

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10
Q

How do drug users get exposed to unknown substances?

A

Drugs are often laced with dangerous impurities

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11
Q

Characteristics of drug dependence

A

Psychological dependence - craving, compulsive drug-seeking behaviour

Physical dependence - tolerance associated with withdrawal syndrome

Tolerance - the need to increase dose to maintain the desired effect

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12
Q

What is the Misuse of Drugs Act?

A

Drugs are categorised A-C reflecting their addictive and harmful power

Their unauthorised possession is a criminal offence

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13
Q

Examples of class A drugs

A

Heroin

Cocaine

LSD

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14
Q

Examples of class B drugs

A

Amphetamine

Cannabis

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15
Q

Examples of class C drugs

A

Tranquilisers

Some pain killers

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16
Q

Length of criminal offence for each class of drug

A

Class A
Possession: 7 years
Dealing: up to life

Class B
Possession: 5 years
Dealing : 14 years

Class C
Possession: 2 years
Dealing: 14 years

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17
Q

What happened under prohibition in 1910-1930

A

Alcohol was banned

This lead to a rise in gang, crimes and cirrhosis

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18
Q

What did a rat study show about addiction?

A

Persistence in drug-seeking behaviour - forget to eat and only push the lever

Resistance to punishment - push the lever even when this is coupled with electrical shock

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19
Q

Where in the brain is the rewards system found?

A

Mesolimbic and mesocortical parts

Midbrain-forebrain bundle formed by dopaminergic neurons

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20
Q

What happens normally in the midbrain-forebrain bundle?

A

Dopaminergic neurons release dopamine from their synaptic terminus, leading to pleasure

A modulatory system controls this pathway through negative feedback

They do this through the release of dynorphins, pre-synaptic inhibitory modulators of dopaminergic neurons

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21
Q

What happens in the brain following drug addiction?

A

The pleasure system is constantly activated

Along with dopamine and dynorphin, Delta-fos-b (TF) is also released with the stimulation of pleasure center

The build up of delta-fosb transcription factors inhibit the dynorphin production and therefore causes the pleasure pathway to become overactivated

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22
Q

Why is the brain of an addict changed?

A

Plasticity of the brain

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23
Q

What mechanisms induce tolerance to a drug?

A

Increase in enzyme production of pathway that is inhibited

Downregulation of receptors

Receptor desensitisation

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24
Q

Classes of drugs abused for their central effects

A

Opioids

Stimulants

Anxiolytics

Depressants

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25
Where is cocaine derived from?
Erythroxylon coca plant
26
Mechanism of action of cocaine
Inhibits reuptake of dopamine by neurons through dopamine transporter inhibition Inhibits sodium channels
27
Mechanism of action of ethanol
Activates GABA-gated chloride channels Enhances chloride influx Causing hyperpolarization Also inhibits NMDA receptors and voltage gated Ca2+ channels
28
How does ethanol stimulate the reward center?
Inhibition of the inhibitory input
29
Symptoms of ethanol abstinence
Tremors Nausea Sweating Hallucinations Aggressiveness
30
Unwanted effects of ethanol use
Motor incoordination Feminisation of men due to reduced testosterone levels Dementia Liver disease Fetal alcohol syndrome
31
Mechanism of action of nicotine
Desensitisation of central nicotinic acetylcholine receptors Long term use = large increase in the number of nicotinic receptors in the CNS
32
How is tolerance observed in nicotine addiction?
Normally tolerance is correlated with a decrease in receptor density Paradoxical increase in receptor number is likely because of the high proportion of receptors being in the desensitised state
33
What are three ways to treat alcoholism?
Opioid antagonists such as Naloxone Aversion therapy Behavioural aspects of the addiction
34
Describe aversion therapy
Disulfiram is used to make the alcohol taste badly Inhibits one of the metabolic mechanisms using aldehyde dehydrogenase Acetylaldehyde builds up as a response and causes a toxic bad feeling
35
Why do alcoholics most often die?
Vitamin B1 deficiency due to malnutrition Which leads to encephalopathy and coma
36
Where are cannabinoids found?
Derived from cannabis sativa Endocannabinoids are found naturally in the body
37
What are the two active component of cannabinoids?
Tetrahydrocannabinol Cannabidiol
38
Components of the endocannabinoid system
Endogenous THC-like substances At least two types of receptors Enzymes that synthesize ECs Systems that transport ECs into and out of cells Enzymes that degrade ECs
39
What is the effect of the endocannabinoid system in the body?
Endocannabinoids are involved in many physiological functions and pathological states involving most of the systems of the body
40
Which receptors does THC interact with?
CB1 CB2
41
Which receptors does CBD interact with?
CB1 CB2 Weakly*
42
Where are CB1 receptors found?
Neurons
43
Where are CB2 receptors found?
Immune system C-fibres
44
How are endocannabinoids made?
By demand Through enzymatic cleavage of membrane lipid precursors
45
What is the effect of endocannabinoids on pre-synaptic neurons?
Endocannabinoids are made in the post-synaptic neuron and act on the pre-synaptic neuron to inhibit the release of the neurotransmitter
46
Which type of neurons do endocannabinoids act on?
GABAergic Glutamatergic
47
How do endocannabinoids affect the inflammatory cells?
Autocrine mediators Inhibits the production of inflammatory mediators via CB receptors
48
What is the main endogenous cannabinoid?
Anandamide It is an arachidonic acid derivative
49
What type of receptors are CB receptors?
G-protein coupled Gi
50
Main sites of function of CB1 receptors
Association regions of the cerebral cortex Hippocampus Cerebellum Hypothalamus
51
Which cells primarily express CB2 receptors?
Leukocytes
52
Effects of the CB1 receptor
Higher brain function Increases appetite Inhibits nausea and vomiting Modulate muscle contraction
53
Effects of the CB2 receptor
Inhibition of macrophages Inhibition of T cell activation
54
Difference between THC and CBD
THC binds strongly to CB receptors CBD has weak interactions, does not cause euphoria and reduces anxiety probably by activation of 5HT1A receptors
55
Medical uses of THC and CBD
Patients with multiple sclerosis-related muscle spasticity Adults with vomiting or nausea caused by chemotherapy Children and adults with rare, severe, untreated forms of epilepsy
56
Main unwanted effect of Cannabinoids
Increase schizophrenia rates in children
57
Diseases targeted by CB1 agonists
MS PD Cancer Chemotherapy-induced nausea Glaucoma
58
Diseases targeted by CB1 antagonists
Obesity Alcoholism Smoking
59
Diseases targeted by CB2 agonists
Inflammatory conditions
60
5 main categories of drugs
Cannabinoids - relaxation, euphoria Opioids - euphoria Hallucinogens - altered perception Depressants - release of inhibition, sedation Stimulants - increased alertness
61
Examples of depressants
Ethanol Benzodiazepine
62
Examples of stimulants
Amphetamines Cocaine Nicotine
63
Examples of hallucinogens
LSD Psilocybin
64
Why are opioids particulalry dangerous?
High addiction rates due to causing both euphoria and depressant action

Pharmacology (13 decks)

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