Flashcards in Substance Misuse Deck (55)
Any natural synthetic or natural chemical substance that is used in the treatment, prevention or diagnosis of disease.
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
The ____ the onset of the drug effects, the better the ______
Finish the chain, from slow to fast:
- Chewing tobacco, _____, ____
- _____ _____, paste, _______, ____
- ________, _________, snorted, __ ________
- snuff, cigarettes
- cocoa leaves, cocaine, crack
- methadone, morphine, IV heroin
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.
The nucleus accumbens has high levels of ____ receptors
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
Opiates are ______ substances ; e.g. ______, ______
Opioids are ____- _______; e.g __________, _______
or ______; e.g. ______
What receptors do opioids act as agonists at?
What effects are seen when opioids bind to delta receptors?
antidepressant, physical dependence, analgesia
What effects are seen when opioids bind to kappa receptors?
sedation, dysphoria, miosis, inhibition of ADH release
What effects are seen when opioids bind to mu receptors?
analgesia, euphoria, +ve reinforcement, respiratory depression
What effects are seen when opioids bind to nociceptin receptors?
anxiety, depression, appetite, tolerance to mu agonist
What are some chronic effects of opioids?
depression, insomnia, constipation, dependence, ahedonia
What are some acute affects of opioids?
itching, miosis, nausea, euphoria, drowsiness, tranquility
Mechanism of tolerance is?
not well understood
How are opioids taken?
smoked, swallowed, injected, inhaled
- 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)
What are some symptoms of withdrawal?
Opioid withdrawal is associated with
increased noradrenergic activity due to opioid affect on locus coeruleus... tachycardia, piloerection
short term opioid detoxification takes
long term opioid detoxification takes
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
rapid opioid detoxification takes
ultra rapid opioid detoxification takes
ultra rapid opioid detoxification:
withdrawal is precipitated using?
What's the risk of rapid/ ultra rapid opioid detoxification
respiratory distress, renal complications
How does methadone work?
Attenuates withdrawal + craving but patient does not experience 'rush'
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)