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Flashcards in Substance Misuse Deck (55)
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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.