Substance Misuse Flashcards Preview

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Flashcards in Substance Misuse Deck (55):
1

Define drug

Any natural synthetic or natural chemical substance that is used in the treatment, prevention or diagnosis of disease.

2

Why do people take drugs?

- For pleasure, to get a 'rush', euphoria --> positive reinforcement/ reward
- As anxiolytics or to overcome withdrawal --> negative reinforcement
- Because people are addicted and cannot control their use --> overwhelming urge

3

The ____ the onset of the drug effects, the better the ______

faster
rush

4

Finish the chain, from slow to fast:
- Chewing tobacco, _____, ____
- _____ _____, paste, _______, ____
- ________, _________, snorted, __ ________

- snuff, cigarettes
- cocoa leaves, cocaine, crack
- methadone, morphine, IV heroin

5

Explain the science of addiction.

- Drugs of abuse increase DA in the nucleus accumbens of the mesolimbus
- Increase in DA is key to +ve reinforcement
- DA increased by cocaine, amphetamines, alcohol, opiates, nicotine and cannabinoids.

6

The nucleus accumbens has high levels of ____ receptors

D3

7

The nucleus accumbens:

- high levels of D3 receptors
- DA release here is involved in learning associations
- Reduced DA is noted in withdrawal states and is likely to be associated with depression, irritability and dysphoria.
- DA is modulated mu opioids

8

Opiates are ______ substances ; e.g. ______, ______

Opioids are ____- _______; e.g __________, _______
or ______; e.g. ______

natural
morphine, codeine

semi synthetic
dihydrocodeine,heroin

synthetic
methadone

9

What receptors do opioids act as agonists at?

delta
kappa
mu
nociceptin receptors

10

What effects are seen when opioids bind to delta receptors?

antidepressant, physical dependence, analgesia

11

What effects are seen when opioids bind to kappa receptors?

sedation, dysphoria, miosis, inhibition of ADH release

12

What effects are seen when opioids bind to mu receptors?

analgesia, euphoria, +ve reinforcement, respiratory depression

13

What effects are seen when opioids bind to nociceptin receptors?

anxiety, depression, appetite, tolerance to mu agonist

14

What are some chronic effects of opioids?

depression, insomnia, constipation, dependence, ahedonia

15

What are some acute affects of opioids?

itching, miosis, nausea, euphoria, drowsiness, tranquility

16

Mechanism of tolerance is?

not well understood

17

How are opioids taken?

smoked, swallowed, injected, inhaled

18

Opioid withdrawal:

- may occur within hours of the last 'fix'
- may peak between 2 - 4 days
- usually will not last beyond 7 days

THE ONSET, INTENSITY AND DURATION IS MULTIFACTORIAL. (e.g. previous experiences of withdrawal may be an important variable)

19

What are some symptoms of withdrawal?

Depression
Diarrhoea
Shivering
Restlessness
Insomnia
Dilated eyes
Myalgia
Tachycardia
Piloerection
Rhinorrhoea

20

Opioid withdrawal is associated with

increased noradrenergic activity due to opioid affect on locus coeruleus... tachycardia, piloerection

21

short term opioid detoxification takes

30 days

22

long term opioid detoxification takes

180 days

23

what are some pharmacological aids for opioid detoxification?

In order to suppress all aspects of withdrawal:
methadone - full mu agonist
buprenorphine - partial mu agonist


In order to suppress autonomic signs - not subjective discomfort
clonidine - a2 adrenoceptor agonist

24

rapid opioid detoxification takes

3-10 days

25

ultra rapid opioid detoxification takes

1-2days

26

ultra rapid opioid detoxification:
withdrawal is precipitated using?

naloxone
naltrexone
PLUS: -
clonidine
benzodiazepine
general anaesthesia

27

What's the risk of rapid/ ultra rapid opioid detoxification

respiratory distress, renal complications

28

How does methadone work?

Attenuates withdrawal + craving but patient does not experience 'rush'

29

Why is methadone administration supervised?

to reduce risk of abuse (there is some evidence of a black market for methadone - addicts sell methadone to finance buying heroin)

30

Maintenance therapy of methadone.

Talk about it's half life

It can be v. effective but there is risk of dependence.

It has a long half life. One oral dose of methadone can suppress craving for heroin + withdrawal symptoms for 36 hours.

31

Acute action of opioid is to _____ cAMP and _______ NA neuronal firing.

inhibit
reduce

32

Chronic action of opioid is ________ __-_____ of cAMP. This results in an _______ in NA tone which is revealed on _________ symptoms

compensatory
up-regulation
increase
withdrawal

33

Compare methadone and buprenorphine for maintenance/ detoxification

Methadone:
- full mu opioid agonist
- half life: 24hrs but on chronic dosing; 36hrs.

Buprenorphine
- partial mu opioid agonist therefore reduced risk of respiratory depression
- Antagonist at kappa therefore less likely to cause dysphoria
- half life: 24hrs therefore withdrawal syndrome less

34

If heroin is injected, buprenorphine is useful because it's ______ property will prevent relapse

antagonist

35

What is naltrexone?

- oral
- non-selective opioid antagonist (blocks acute opioid effects)
- used to prevent relapse in drug-free subjects
- most common adr's are GI

36

Most common ADR for Naltrexone is?

GI disturbance

37

What are some acute affects of cocaine?

formication
euphoria
increase heart rate and bp
confusion
psychosis

38

What are some chronic affects of cocaine?

paranoia
depression
psychosis
anorexia
variable effects on D1 and D2 receptors

39

What happens when cocaine use stops?

'CRASH'
- depression
- anxiety
- hypersomnia (sleepy throughout the day)
- anergia (abnormal lack of energy)

40

What is the current therapy for cocaine use?

Partial D3 agonist

41

THC alters both ______ and ________ neuronal activity

hippocampal
cerebral

42

Acute effects of THC?

relaxation
confusion
distorted perceptions
anxiety
impaired memory, concentration and coordination

43

The most commonly abuse drug in the UK is?

alcohol

44

Alcohol misuse results in

Psychological
Physiological
Psychiatric
and
Societal damage

45

Alcohol misuse is when:

a patient drinks to the extent of causing harm to self or others

46

EQUATION FOR ALCOHOL UNITS

Alcohol by Volume (%) x Litres = units

47

IF <50 units/week;

May not be required

48

IF 50-100 units/week;

Consider detox

49

IF >100 units/week

Detox required

50

What are some risk factors that have an increased need for alcohol detox

- older patients
- severe dependence
- Hx of failed community detox
- Psychiatric co-morbidities - Poor physical health e.g. Diabetes, Liver damage, HTN
- Hx of DTs and alcohol withdrawal seizures
- Poor social support
- Cognitic impariment

51

What are some pharmacological agents for alcohol detox

- Benzodiazepines e.g. Diazepam
- Thiamine; High Potency Parenteral; Pabrinex IV / IM; 1 pair ampoules daily for
3-5 days.
- Then; long-term Vit B Co.Strong; One Tab PO; OD.

ALSO BREAKTHROUGH DOSE OF:
Diazepam 10mg PO Max TDS should be prescribed for ‘breakthrough’ withdrawal symptoms, WHEN REQUIRED


ALSO, FOR SEIZURES:
Diazepam 5 – 10mg PR; PRN for seizures should also be prescribed. WHEN REQUIRED

52

Alcohol:
Pharmacological ‘Tools’ to support continued abstinence include:

- Disulfiram ~ Antabuse
- Acamprosate
- Naltrexone
- Nalmefene

53

MOA of Disulfiram

Irreversibly inhibits effects of ALDH. SO, acetaldehyde accumulates. Leads to:
- N&V
- Headache
- Sweating
- Palpitations/ Tachycardia
- Flushing

54

Large doses of alcohol + disulfiram =

- hypotension
- collapse
- arrhythmias

55

Adverse effects of Disulfiram?

- N & V
- Halitosis
- Psychiatric reactions; paranoia , depression
- Hepatic cell damage