Fa Pharmacology 2009 - Substance Abuse

Front 1

Alcohol

Back 1

Intoxication
- Disinhibition, emotional lability
- slurred speech
- ataxia
- coma, blackouts
- Serum y-glutamyltransferase (GGT) - sensitive indicator of alcohol use

Withdrawal
- Tremor, seizures, delirium tremens (DTs), tremulousness, agitation, hallucinations (including tactile, e.g. fornication - feeling of ants crawling on skin).
- tachycardia
- hypertension
- malaise, nausea

Front 2

Opiods (e.g. morphine, heroin, methadone)

Back 2

Intoxication
- CNS depression
- nausea and vomitting.
- constipation
- pupillary constriction (pinpoint pupils)**
- seizures (overdose is life-threatening)
- Treatment: naloxone, naltrexone (opioid receptor antagonists)

Withdrawal
- Anxiety, insomnia
- anorexia
- sweating
- dilated pupils
- piloerection ("cold turkey")
- fever, rhinorrhea, nausea, stomach cramps, diarrhea ("flu-like symptoms")
- yawning
- Treatment: symptomatic

Front 3

Barbiturates

Back 3

Intoxication
- Low safety margin
- respiratory depression**
- Treatment: symptom management (assist respiration, ↑ BP).

Withdrawal
- Anxiety
- Seizures, delirium
- life-threatening cardiovascular collapse.

Front 4

Benzodiazepines

Back 4

Intoxication
- Greater safety margin
- Amnesia
- ataxia
- somnolence
- minor respiratory depression
- Additive effects with alcohol.
- Treatment: flumazenil

Withdrawal
- Rebound anxiety
- seizures, tremor
- insomnia

Front 5

Amphetamines - ↑ dopamine release

Back 5

Intoxication
- Psychomotor agitation
- impaired judgment
- pupillary dilation.
- hypertension, tachycardia
- euphoria
- prolonged wakefulness and attention
- cardiac arrhythmias
- delusions, hallucinations, fever.

Withdrawal
- Post-use "crash" -- depression, lethargy, headache
- stomach cramps, hunger.
- hypersomnolence.

Front 6

Cocaine - block dopamine reuptake

Back 6

Intoxication
- Euphoria
- psychomotor agitation, impaired judgment.
- pupillary dilation
- hypertension, tachycardia.
- hallucinations (including tactile, "cocaine bugs").
- paranoid ideation
- angina, sudden cardiac death.

Withdrawal
- post-use "crash" - severe depression and suicidality
- hypersomnolence
- fatigue, malaise
- severe psychological craving

Front 7

Caffeine

Back 7

Intoxication
- Reslessness, insomnia
- ↑ diuresis
- muscle twitching
- cardiac arrhythmias

Withdrawal
- headache, lethargy
- depression, weight gain.

Front 8

Nicotine - ↑ glutamate release

Back 8

Intoxication
- Restlessness, insomnia
- anxiety
- arrhythmias

Withdrawal
- Irritability, headache.
- anxiety
- weight gain
- craving.

Front 9

PCP

Back 9

Intoxication
- Beligerence***
- impulsiveness
- fever
- psychomotor agitation
- vertical and horizontal nystagmus
- tachycardia
- ataxia
- homicidality, psychosis, delirium

Withdrawal
- Depression
- anxiety, irritability, restlessness
- anergia
- disturbances of thought and sleep

Front 10

LSD

Back 10

Intoxication
- Marked anxiety or depression
- delusions, visual hallucinations
- flashbacks**
- pupillary dilation

Front 11

Marijuana

Back 11

Intoxication
- Euphoria
- anxiety
- paranoid delusions, hallucinations
- perception of slowed time, impaired judgment
- social withdrawal.
- ↑ apetite
- dry mouth.

Withdrawal
- Irritability
- depression, insomnia
- nausea, anorexia
- Most symptoms peak in 48 hours and last for 5--7 days.
- Can be detected in urine up to 1 month after last use.

Front 12

Heroin addiction

Back 12

- Users ↑ risk for hepatitis, abscesses, overdose, hemorrhoids, AIDS, and right-sided endocarditis
- Look for track marks (needle sticks in veins).

Treatment:
- naloxone and naltrexone (competetive opiod inhibitors); used in cases of overdose

Methadone
- long-acting oral opiate
- used for heroin detoxification or long-term maintenance.

Suboxone
- naloxone + buprenorphine (partial agonist)
- long acting with fewer withdrawal symptoms than methadone
- withdrawal symptoms if injected (but lower abuse potential).