Nervous System- Non-Medical Drug Use By Schriefer

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Nervous System- Non-Medical Drug Use by Schriefer

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Nervous System- Non-Medical Drug Use by Schriefer

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Drug abuse

Use of a drug in a way that differs from the accepted patterns in a society
Use of drugs in a manner which causes major and continuing problems in life

experimental, recreational, circumstantial, compulsive, tolerance, psychological dependence drug use.

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Experimental: Use of a drug on a few occasions because of curiosity about it

Recreational: The casual use of modest amounts of a drug for its pleasurable effects

Circumstantial: Use of a drug in certain situations

Compulsive (drug dependence): Continued use of a drug despite adverse medical or social consequences

Tolerance: Decreased response to a given dose of drug after repeated doses
Pharmacokinetic, pharmacodynamic, behavioral


Psychological dependence: Drug needed for optimal state of mental well-being: Minimax principle – drug minimizes discomfort or maximizes pleasure

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Physical dependence
An altered physiological state produced by repeated use of a drug, which requires continued use of drug in order to prevent an abstinence or withdrawal syndrome

Abstinence syndrome
A physiological reaction to the absence of a drug to which a person is physically dependent

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Cross dependence
The ability of one drug to block the withdrawal syndrome of another drug and to maintain the dependent state

Addiction
An extreme pattern of compulsive drug use with a high possibility of relapse after withdrawal

Substance dependence (DSMIV)
A cluster of symptoms indicating that the individual continues use of the substance despite significant substance-related problems

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Factors in the Development of Compulsive Drug Use

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A person may initiate drug use in order to:
-Escape from reality
-Obtain a sense of euphoria
-Escape high levels of anxiety
-Gain membership in a social group
-Relieve physical pain
-Bolster a poor self image
-Enhance introspection or creativity
-Have a novel experience

Compulsive drug abuse develops due to a number of factors (physiological, sociological, and psychological)

Reinforcement of behavior:
Positive reinforcement: Some drugs seem to reinforce or reward drug taking behavior; Some drugs terminate aversive or unpleasant situations
Social reinforcement: drug usage results in special status, membership in desired group, approval of friends
Negative reinforcement: fear of withdrawal

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Tolerance and physical dependence

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-Tolerance and physical dependence contribute to drug use
-Tolerance to euphoria → more drug → more physical dependence
-The more physically dependent an individual, the more drug they have to use to avoid the aversive withdrawal syndrome
-Prolonged abstinence syndrome

Vulnerability: Even though a drug produces euphoria, it is not inevitable that exposure to the drug will lead to compulsive drug use. Genetics and environment contribute to vulnerability (50/50).

Drug abuse among physicians: The incidence of drug abuse among physicians and related health professionals is high. The improvement in mood and the easy availability of drugs produce a high risk of dependency in a physician.
-Internet pharmacies have made it easier to obtain prescription drugs with abuse potential

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Commonly abused opioids.

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Commonly abused drugs in this class include
Heroin- drug of choice because of quick entry
Hydromorphone (Dilaudid)- drug of choice because of quick entry
Oxymorphone (Numorphan)
Meperidine (Demerol)
Methadone
Morphine
Fentanyl (and congeners)
Current concern about Oxycontin and methadone

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Oxycontin

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Non-medical use and/or self prescribed use of Oxycontin (“prescription heroin”) has increased dramatically in recent years, and is a significant problem in West Virginia and surrounding states. Nationally ~5% of high school seniors used Oxycontin in 2005.

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are opioids toxic to organs?

when do withdrawl symptoms start?

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Symptoms: Opioids do not appear to cause direct toxicity to organs

Tolerance, physical dependence, and withdrawal: The degree of tol/dep is determined by the dose, frequency, and duration of use
-Withdrawal symptoms begin to occur 6-12 hours after last dose of heroin – purposive behavior and nonpurposive (restlessness, lacrimation, rhinorrhea, yawning, sweating)

spend all your money on these and not on other things. and the source of drugs and the needles may not be clean.

no tolerance to miosis and constipation in opioid abuse!!!! give IV naloxone to wake them up from opioid (ex heroine) overdose.

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12-24 hours, 48-72 hours in withdrawl.

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Tolerance, physical dependence, and withdrawal

12-24 hours – restless sleep, dilated pupils, anorexia, piloerection, irritability, tremor

48-72 hours – peak intensity of syndrome, all earlier symptoms increased in intensity plus weakness, depression, nausea, vomiting, intestinal spasm, diarrhea, increase HR and BP, chills and flushes, muscle pain, and involuntary movements of limbs

-These symptoms disappear in 7-10 days. Protracted abstinence syndrome may last for months
-Withdrawal is traumatic but seldom life threatening

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treatment for methadone, etc.

detox,
maintenance,
opioid antagonists (when do you use this?)
clonidine (tx of HTN and what else in regards to withdrawl?)
buprenorphine (partial agonist...agonist alone, antagonist with other opioid)

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Methadone detox – substitute and withdraw over next 3 weeks. (oral, legal, longer, less intense)

Methadone maintenance – substitute and maintain. Newer drug, levomethadyl (Orlaam), also available

Opioid antagonists – to induce quick withdrawal or to prevent relapse

Clonidine – a2 agonist to suppress autonomic signs of withdrawal

Buprenorphine (Subutex, Suboxone) maintenance – first drug approved to maintain opioid dependence outside of specialized clinics. Physician must be certified by FDA to prescribe

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name some general CNS depressants.

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Short acting barbs,

BDZs like diazepam and flunitrazepam (“roofies”),

non-barbs such as methaqualone, gamma hydroxybutyrate (GHB), and ketamine

About 1% of U.S. population reported non-medical use of sed/hyps. Use among HS students is much higher and is increasing. Problems following medical use generally develop gradually, with self prescribed escalation of dose and frequency. Be aware that insomnia and anxiety which develops when drugs are withdrawn could be sign of withdrawal

*use a benzo antagonist, flumazenil

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symptoms, tolerance, physical dependence withdrawl

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Symptoms: May be no recognizable signs of chronic use; or may be state of mild intoxication similar to alcohol; or may be rapid mood changes. Neurological effects of chronic intox include slurred speech, nystagmus, diplopia, vertigo, and others

Tolerance, physical dependence, and withdrawal: Chronic intox results in pharmacokinetic and pharmacodynamic tolerance. Considerable tolerance develops to the sedative and intoxicating effects of these drugs but not to the lethal effects.
-Withdrawal varies in severity according to degree of physical dependence. Mild-paroxysmal EEG abnormalities, REM rebound, insomnia, anxiety.

Moderate – tremulousness and weakness
Severe – seizures (status epilepticus) and delerium
Withdrawal is potentially lethal

tx: substitute a long acting BZD and slowly withdraw

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Amphetamine - type drugs and cocaine (HCl and freebase crack), MDMA (ecstasy... combo of amphetamine and a hallucinogen)

Incidence: Use of these agents fluctuate with time. About 1% of U.S. population used cocaine and 1% had used amphetamine-type stimulants. MDMA was used by 1.3%

Patterns of cocaine use in U.S. range from occasional nasal use, to freebasing, to intravenous use. (often in combination with opioids – speedballing). Have changed since introduction of crack. Smoking crack now most common pattern.

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Patterns of amphetamine use are the occasional situational use, recreational oral, nasal, and intravenous use. Use of methamphetamine has increased due to the relative ease with which it can be made. Methamphetamine accounts for the majority of amphetamine use in US (~12 million users) in adults; ADHD drugs in teens.

Speed Cycle – due to drug effect, user is hyperactive and may continue to inject methamphetamine to maintain high; does not eat or sleep during this period. As toxic levels accumulate, person develops psychotic symptoms. When drug runs out or exhaustion prevents further use, person lapses into a sleep lasting 1-2 days. May be prolonged depression following sleep.

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methyphenidate is for

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ADD

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Symptoms of CNS stimulants

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Euphoria, increased energy and libido, motor restlessness (both cocaine and amphetamines)

Psychological changes such as paranoia, delirium, hallucinations (tactile and visual) (both cocaine and amphetamines)

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adverse effects of CNS stimulants

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Symptoms:
Acute adverse effects, Anorexia, Insomnia, Tachycardia, Tachypnea, Hypertension, Hyperthermia,seizures

Acute methamphetamine toxicity lasts longer than cocaine because of long T1/2
Septal damage with intra-nasal use of cocaine

Serious toxic effects of chronic cocaine use include:
Cardiac arrhythmias, Myocardial ischemia or infarction, Myocarditis, High output congestive heart failure, Dilated cardiomyopathy, Intracerebral hemorrhage, Aortic dissection, Disseminated intravascular coagulation

Chronic methamphetamine use associated with may of the previously mentioned effects plus: Memory loss, Learning impairment, Motor deficits
Psychiatric disorders, Dental decay

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Tolerance, physical dependence, and withdrawal:
Tolerance develops to the desired CNS effects of amphetamines. Tolerance develops to some of the CNS effects of cocaine; sensitization occurs to other effects

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Tolerance, physical dependence, and withdrawal
-Psychological dependence
-Physical dependence does develop with cocaine but the withdrawal signs are so mild that they might not be recognized as such
-Fatigue, Increased appetite, Depression with suicidal ideation

Treatment:
Drug treatment to prevent abuse has had little success. An anti-cocaine vaccine is in clinical trials.

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tobacco... why do they want to inhale all that crap?

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the nicotine

About 30% of U.S. population smoked cigarettes; 3.3% of U.S. population used smokeless tobacco

Nicotine has reinforcing properties (animal will self-administer nicotine). Causes alerting and muscle relaxing effects as well as euphoria. 2 pack a day smokers have a mortality rate 2x that of non-smokers.

Tolerance does develop to some but not all effects of nicotine
Withdrawal signs do occur after cessation of smoking:
Irritability, Anxiety, Restlessness, Sleep disturbances, Headaches

Tx: Nicotine replacement - Nicotine containing gum, transdermal patch, nasal spray, and now lozenge available to ease withdrawal from smoking. This appears to be helpful when combined with a formal program. Relapse occurs in 60-80% of smokers after 1 year.
-bupropion (Zyban) decreases urge to smoke; other antidepressants may work. Combination of patch plus bupropion may improve results

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Varenicline

what is it? what's bad about it?

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Varenicline – partial nicotine agonist.
-Blocks nicotine receptor in presence of full agonist (nicotine from cigarette smoke) This blocks pleasurable effect if person smokes.
-Stimulates receptor slightly to decrease cravings
-Thought to be the most effective drug for smoking cessation

Adverse effects:
-Nausea most common
-Abnormal dreams, constipation etc.
-More weight gain than with nicotine replacement or bupropion
-Current concern over psychiatric symptoms (agitation, hostility, depression, suicide)

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Marijuana

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Marijuana contains many of the same toxic compounds as tobacco as well as some additional ones

Incidence: About 6% of U.S. population used marijuana (33% HS seniors). It is the most commonly used illicit drug. A “gateway” drug.
-Most marijuana is smoked with some taken orally (significant 1st pass metabolism).

Symptoms: Chronic users may exhibit apathy, impairment of judgment, concentration and memory, and loss of interest in conventional goals (amotivational syndrome)
-No evidence of irreversible changes in brain. Effects in young adolescents may be more serious.

Tolerance, physical dependence, and withdrawal: Sensitivity to the subjective effects may increase
-Abrupt withdrawal following chronic high dose use may be accompanied by mild symptoms such as irritability, restlessness, nervousness, decreased appetite, and insomnia

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Hallucinogens

LSD, psilocybin compounds and mescaline

incidence:
-About 4% of U.S. population used hallucinogens. Generally used only occasionally
-Most users discontinue use after a year or two

tolerance?

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Tolerance
Tolerance develops to the behavioral effects
Physical dependence and withdrawal signs do not occur

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name a new hallucinogen

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Salvia divinorum –contains salvinorum A (a κ-opioid agonist), a short acting hallucinogen.

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Inhalants.. name some.

incidence.

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Industrial solvents such as toluene, aerosol propellants, and organic nitrates such as amylnitrate

Incidence: A widespread problem that continues to increase. Among teenage boys, inhalant use trails only alcohol, cigarettes, and marijuana. About 4% of young adults used inhalants; rate was 2-3x that in younger teens.

Pharmacodynamics: These compounds act generally as anesthetics. They produce euphoria, a relaxed intoxicated feeling, and hallucinations.
-They have a short duration of action, so frequent inhalations required to maintain desired state.
-Produce psychological dependence

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Adverse effects

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Adverse effects:
Industrial solvents
Brain
Liver and kidney damage
Peripheral nerve damage
Bone marrow suppression
Pulmonary disease

Fluorocarbons: Sudden death due to asphyxiation or ventricular arrhythmias

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anytime someone is seriously agitated or stimulated, use what?

(emergency treatment of drug intoxication)

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lorazepam or a fast acting thing like haloperidol