Drug dependency

Question 1

What’s dependence?

Answer 1

dependence - an adaptive state associated with withdrawal symptoms if exposure to the substance/stimulus is stopped

Question 2

What effects do opioids produce?

Answer 2

Opioids

• confident, warm, safe, pain-free, invincible /pl niepokonany/
• constricted pupils, hallucinations, addiction, withdrawal, overdose

Question 3

What effects do stimulants produce?

Answer 3

Stimulants

• increased energy
• increased HR, dilated pupils
• paranoia, anxiety
• sexual arousal but impotence

Question 4

What effects do empathogens produce?

Answer 4

Empathogens

• loved, connected, warmth, understanding, arousal, belonging
• depression, mood swing

Question 5

What effects do psychedelics produce?

Answer 5

Psychedelics

• ‘trips’, spiritual connection
• heightened senses, visual/auditory hallucinations
• anxiety, panic, mental health issues

Question 6

What effects do dissociatives produce?

Answer 6

Dissociatives

• ‘out of the body’, floating
• euphoric, disconnected, relaxed
• scared, unable to move, ‘in a hole’

Question 7

What effects do cannabinoids produce?

Answer 7

Cannabinoids

• calm, chilled out, giggly, sensual
• paranoid, dry mouth, lazy, sleepy, mental health issues

Question 8

What effects do depressants produce?

Answer 8

Depressants

• euphoric, confident, relaxed
• risk-taking, vomiting, withdrawal
• unconsciousness, coma, death

Question 9

Drugs belonging to class A

• examples
• prison length

Answer 9

Class A

Examples: ecstasy, LSD, crack, cocaine, magic mushrooms, amphetamines (injections)

Prison:

• possession - up to 7 years
• dealing - up to life in prison

Question 10

Drugs belonging to class B

• examples
• prison length

Answer 10

Class B drugs

Examples: Ketamine, Amphetamines (non-injection)

Prison:

• possession - up to 5 years
• dealing - up to 14 years

Question 11

Drugs belonging to class C

• examples
• prison length

Answer 11

Class C drugs

Examples: cannabis, tranquilizers, gamma hydroxybutyrate

Prison:

• possession - up tp 2 years in prison
• dealing - up to 14 years in prison

Question 12

What is the fastest method of drug delivery that affects drug concentration in the brain?

Answer 12

Inhalation, then injection

Question 13

What are the effects of cocaine similar to?

Answer 13

Halfway between amphetamine and ecstasy

(euphoria, love, agitation, isomnia)

Question 14

How do amphetamine, cocaine and Ecstasy (MDMA) work on a physiological level?

Answer 14

Amphetamine, cocaine and ecstasy:

• all increase levels of monoamines (dopamine, serotonin, noradrenaline)

*different balance of monoamines - different behaviors:

A. amphetamine - mostly dopamine

B. Ecstasy - mostly serotonin

Question 15

Physiological effects of cocaine

Answer 15

Cocaine

• Na+ channel blocker (anaesthetic)
• stimulant; appetite supressant
• Triple re-uptake inhibitor (noradrenaline, dopamine, serotonin)

Question 16

What is more dangerous: cocaine or amphetamine?

Answer 16

• Cocaine is more dangerous
• due to Na+ channel blockage (coronary and myocardial disease - sudden death)

Question 17

What’s ‘crack’?

• components
• effects

Answer 17

‘Crack;

Mixture of: cocaine + sodium bicarbonate (baking soda) + water

Effects: immediate ‘high’ when inhaled

Question 18

What’s ‘speedball’?

• components
• why it is dangerous?

Answer 18

‘Speedball’

Mixture of: heroin + cocaine (injection)

*it is particularly dangerous because it masks symptoms of OD

Question 19

What are the physiological effects of Ecstasy (MDMA)?

Answer 19

• block serotonin & dopamine re-uptake -> more in the synaptic cleft

Question 20

Ecstasy

What are the fatal adverse effects?

Answer 20

Ecstasy

• hyperthermia
• dehydration
• overhydration* - as ADH is suppressed

*due to fatal hyponatraemia - occurs in those who consume excess water without replacing electrolytes (ADH suppression)

Question 21

Ketamine

• class

Answer 21

Ketamine

• complex, multiple sites action

Class: NMDA receptor antagonist - glutamate receptor antagonist

Question 22

Effects of Ketamine

Answer 22

Ketamine effects

Overall: NMDA receptor antagonist (glutamate receptor antagonist)

Effects: disconnection of thalamocortical and limbic systems -> dissociation of CNS from outside stimuli (e.g. pain, sound, sight)

‘sensory isolation’ is produced

• anaesthesia -> slurred speech, immobilisation
• euphoria
• amnesia

Question 23

What happens to SNS with intake of Ketamine?

Answer 23

Ketamine

SNS stimulant -> ventilatory system is maintained

*used in paediatric sedation and in psychiatry

Question 24

LSD

*physiological effects

* what is the adverse effect?

Answer 24

LSD

Physiological effect: serotonin agonist

• very potent - even if people leak small amount - will have a powerful effect lasting even a week

Adverse effect: causes flashbacks - chronic psychiatric problems (10-20 years later)

Question 25

***gamma-hydroxybutyric acid*** (GHB) - physiology

Answer 25

***gamma - hydroxybutyric acid*** Physiology: * CNS agonist, an excitatory receptor agonist, GABA agonist (properties depend how much of the substance is taken)

Question 26

What do **low** concentrations of ***gamma-hydroxybutyric acids*** do? What do **high** concentrations do?

Answer 26

Low - stimulate dopamine High - inhibit dopamine via GABA

Question 27

What do the effects of OD with *gamma-hydroxybutyric acid* look like?

Answer 27

Similar to alcohol intoxication but less predictable

Question 28

***Magic mushroom*** - physiological effects

Answer 28

***Magic mushroom*** ## Footnote _Effects:_ - serotonin agonist - psychedelic

Question 29

What's the danger of 'magic mushrooms'?

Answer 29

It is easy to mistake with ***Psilocybin*** \*-\> cause acute renal and hepatic failure \*may be even picked in the forest

Question 30

What substances are included in ***Marijuana***?

Answer 30

Over **60 cannabinoids** in marijuana \*pharmacology of most cannabinoids is unknown

Question 31

What is the concern re long-term effects of Marijuana?

Answer 31

Possible link to **psychosis**

Question 32

what's the timeframe of the detection of marijuana?

Answer 32

***Marijuana*** has a half-life of a week -\> can be detected weeks after ingestion \*it is lipid soluble

Question 33

***Marijuana*** - physiological and psychological effects

Answer 33

***Marijuana*** ## Footnote _Physiological_: **increase** in **dopamine, serotonin** release \*also affects **Mu** and **Delta opioid** receptors _Effects_: anxiolytic, sedative, analgesic, psychedelic

Question 34

***Synthetic cannabinoids*** - example - risks

Answer 34

***Synthetic cannabinoids*** e.g. '*Spice'* \*synthesised - hundreds of times more potent than cannabis -\> acute presentation - high risk of seizures - psychosis - hyponatraemia

Question 35

***Heroin*** - physiological effect (what receptor) - effects

Answer 35

***Heroin*** ## Footnote _Physiology_: Mu opioid receptor agonist (GABA release is inhibited & reduced inhibitory effect of GABA on dopaminergic neurones) _Effects:_ euphoria, analgesia, anxiolytic

Question 36

Antidote for opioids

Answer 36

***Naloxone***

Question 37

***Desomorphine (Krokodil)*** - what is it synthesised from - what's the danger

Answer 37

***Desomorphine (Krokodil)*** \*morphine analogue - synthesised from codeine - 8 -10 times more potent and more addictive than heroin - limbs can be lost, death

Question 38

***Serotonin syndrome*** ***-*** what happens - clinical effects

Answer 38

***Serotonin syndrome*** ## Footnote _Cause:_ too much serotonin _Clinical effects_: altered mental status, hypertension, tachyarrhythmias, hyperthermia, rhabdomyolysis, muscular rigidity, clonus, hyperreflexia, seizures, death

Question 39

What drugs potentially increase risk of ***serotonin syndrome?***

Answer 39

***Serotonin syndrome*** Risk increased when multiple drugs are taken: SSRIs, MAOIs, TCAs, SNRIs, Amphetamines, Ecstasy, Cocaine etc

Question 40

Management of serotonin syndrome

Answer 40

Mx of ***Serotonin syndrome*** ## Footnote _Treatment is supportive_ - cardiac monitoring (telemetry) - cooling with IV fluid, ice bath - benzodiazepines - BP control - ***Cyproheptadine*** -\> anti-histamine with anti-serotoninergic properties

Question 41

Physiological (receptors) effects of **alcohol**

Answer 41

***Alcohol*** * GABA receptors are stimulated * NMDA (glutamate) receptors are inhibited * increased release of opiates

Question 42

What happens in dependency (on neurotransmitter level) and withdrawal

Answer 42

Body get used to a certain level of neurotransmitter (at the synaptic cleft) -\> if that level of neurotransmitter is changed (e.g. reduced) -\> withdrawal symptoms

Question 43

Symptoms of withdrawal of alcohol

Answer 43

- tremor - diaphoresis - tachycarida - anxiety - delirium - seizures

Question 44

Management of alcohol withdrawal

Answer 44

**Alcohol withdrawal management** ## Footnote Benzodiazepines +/- dextrose infusion \****Chlordiazepoxide*** is a benzodiazepine of choice

Question 45

Management of **Heroin withdrawal**

Answer 45

**Mx of heroin withdrawal** ## Footnote - ***Methadone*** (opioid analgesic) - anti-emetics - ***Buprenorphine*** (opioid antagonist-agonist used for the purpose of Rx of opioid withdrawal \* less commonly used due to its antagonist-agonist effects on opioids receptors -\> may increase withdrawal - mostly used in chronic pain)

Question 46

Stimulants withdrawal management

Answer 46

_Mx of stimulants withdrawal_ ## Footnote - mainly supportive - benzodiazepines _Monitor:_ - ECG - HR - make sure it goes down - CK - due to risk of rhabdomyolysis (potential arrhythmogenic and renal failure)