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Drug Abuse. Self administration of drug or drugs in manner not in accord with accepted medical or social patterns. Drug Abuse. Psychological Dependenc (Habituation) addiction. Drug necessary to maintain user’s sense of well-being Physical Dependence, dependence

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drug abuse

Drug Abuse

Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

drug abuse1
Drug Abuse
  • Psychological Dependenc (Habituation) addiction.
    • Drug necessary to maintain user’s sense of well-being
  • Physical Dependence, dependence
    • Physical symptoms if intake is reduced
slide3

Addiction

Compulsive, relapsing drug use despite negative consequences, at times triggered by cravings.

    • Includes
      • Tolerance (dose has to be progressively increased to maintain rewarding or analgesic effect)
      • Psychological dependence
      • Physical dependence
      • Compulsive use
molecular mechanism of action
Molecular Mechanism of Action
  • Mesolinbic dopamine system is the prime target of addictive drugs.
  • The system originates in the ventral tegmental area (VTA).
  • Drug of abuse are rewarding and reinforcing.
classification of drugs of abuse
Classification of drugs of abuse
  • Drugs that activate G Protein-Coupled Receptors

Opioids

Cannabinoids

γ-hydroxybutyric acid (GHB)

LSD, mescaline

  • Drugs that bind to ionotropic receptors and ion channels

Nicotine

Alcohol

Benzodiazepines

Phencyclidine, ketamine

slide7

Opiates are drugs that are derived from the Poppy Plant and are Central Nervous System (CNS) depressants.

  • The most common opiates are:
      • Opium
      • Heroin
      • Morphine
      • Codeine
  • Opiates are known by several different names:

OPIATES

  • Smack
  • Soapium
  • Chiva
  • Poppy
  • Flower
  • Hazel
  • Morf
  • H
narcotics
Narcotics
  • Examples
    • Opium
    • Morphine
    • Heroin
    • Codeine
  • Oxycodone (Percodan)
  • Meperidine (Demerol)
  • Propoxyphene (Darvon)
  • Talwin
  • Fentanyl
mechanism of action
Mechanism of Action
  • Acts on μ, κ and delta opioid receptors
slide10

Effects

    • Analgesia
    • CNS depression
      • Euphoria
      • Drowsiness
      • Apathy
    • Antidiarrheal action
    • Antitussitive action
opiates adverse effects
Opiates adverse effects
  • Absence of Stress
  • Altered Mental Process
  • Liver Damage
  • Nausea/Vomiting
  • Collapsed Veins
  • Kidney Damage
  • Lung Damage
  • Sleepiness
  • Constipation
  • Brain Damage
  • Immune System Damage
  • Itchy Skin
  • Menstrual Irregularities
  • Impaired Vision
  • Loss of Sex Drive
  • Overdose/Death
narcotics1
Narcotics
  • Overdose
    • Mild to Moderate
      • Lethargy
      • Pinpoint pupils
      • Bradycardia
      • Hypotension
      • Decreased bowel sounds
      • Flaccid muscles
  • Severe
    • Respiratory depression
    • Coma
    • Aspiration
    • Seizures with certain compounds (meperidine, propoxyphene, tramadol)
narcotics2
Narcotics
  • Overdose
    • Management
    • Naloxone
    • Treatment of opioid addiction
    • Long acting opioids
narcotics3
Narcotics
  • Withdrawal
    • Insomnia
    • Restlessness
    • Irritability
    • Anorexia
    • Tremors
    • Back, extremity pain
  • Watery eyes
  • Yawning
  • Rhinorrhea
  • Sneezing
  • Diarrhea
  • Diaphoresis

Resembles Severe Influenza

cannabinoids
Cannabinoids
  • Marijuana (Tetrahydrocannabinol (THC)

Endogenous cannabinoids (Anandamide)

Act on CB1 receptors, presynaptically and inhibit the release of glutammateor GABA

Leading to disinhibition of dopamine neurons.

Onset of effects: within minutes

Effects: Euphoria, relaxation, visual distortions, drowsiness, diminished coordination and memory impairment.

hallucinogens
Hallucinogens
  • LSD
  • Mescaline
  • Psilocybin
slide17

Produce altered/enhanced sensation

  • Increased dose does not intensify effect
  • Mechanism of action
  • Act on 5HT2A receptor------G proteins ------ IP3 ---intracellular calcium-------- increase glutamate release.
slide18

Signs and symptoms

    • Anxiety, excitement
    • Nausea, vomiting
    • Tachycardia, tachypnea
hallucinogens1
Hallucinogens
  • Moderate Intoxication
    • Tachycardia
    • Mydriasis
    • Diaphoresis
    • Short attention span
    • Tremor
    • Hypertension
    • Hyperreflexia
    • Fever
hallucinogens2
Hallucinogens
  • Life-threatening toxicity (rare)
    • Seizures
    • Severe hyperthermia
    • Hypertension, arrhythmias
    • Agitated
    • Diaphoretic, hyperreflexic
    • Untreated hyperthermia can lead to hypotension, coagulopathy, rhabdomyolysis and multiple organ failure
drugs that mediate their effects via ionotropic receptors
Drugs that mediate their effects via ionotropic receptors
  • Nicotine
  • Smoking of tobacco through different routes.
  • Agonist of nicotinic acetylcholine receptor (nAChR),role in cognitive processes.
  • Rewarding effect of nicotine requires involvement of VTA in which (nAChR) are expressed on dopamine neurons.
  • Nicotine withdrawal : irritability, sleep problems.
treatment
Treatment
  • Slowly absorbable form of nicotine.
  • Cytisine, varenicline (partial agonists)
  • Act by occupying nAChRs on dopamine neurons of the VTA.
  • Bupropion + behavioural therapy
benzodiazepines and barbiturates
Benzodiazepines and barbiturates
  • Anxiolytic and sleep medications
  • Abused for their EUPHORIC effects
  • GABAA receptors on interneurons, disinhibition of mesolimbic dopamine system-----rewarding effects.
  • Withdrawal symptoms include
  • Irritability, insomnia, photophobia, depression, muscle cramps and even seizures.
ketamine and phencyclidine
Ketamine and Phencyclidine
  • General anesthetic
  • Non-competitive antagonism of NMDA receptor.
  • Increased blood pressure, impaired memory function & visual alterations.
  • ‘Club drugs’ and sold as ‘angel dust’
phencyclidine pcp
Phencyclidine (PCP)
  • Street names
    • Angel dust
    • Peace Pill
    • Hog
    • Krystal
    • Animal tranquilizer
  • Used as veterinary anesthetic
inhalants
Inhalants
  • Examples
  • Nitrates , ketones , aliphatic and aromatic hydrocarbons
    • Gases (freon, halon fire extinguishing agent)
    • Metallic paints
    • Sniffing
    • Huffing
    • Bagging
drugs that bind to transporters of biogenic amines
Drugs that bind to transporters of biogenic amines
  • Examples
    • Cocaine
    • Amphetamines
      • Benzedrine (bennies)
      • Dexedrine (dexies, copilots)
      • Methamphetamine (ice, black beauties)
    • Ephedrine
    • Caffeine
    • Ritalin
slide28

Cocaine

local anesthetic

used to treat depression

Block of dopamine transporter, by increasing conc in nucleus accumbens

Increased risk of intracranial haemorrhage, ischemic stroke, myocardial infarction and seizures.

amphetamines
Amphetamines
  • Produce
    • euphoria
    • hyperactivity
    • alertness
    • sense of enhanced energy
    • anorexia
stimulants
Stimulants
  • Overdose signs/symptoms
    • Euphoria, restlessness, agitation, anxiety
    • Paranoia, irritability, delirium, psychosis
    • Muscle tremors, rigidity
    • Seizures, coma
    • Nausea, vomiting, chills, sweating, headache
    • Elevated body temperature
    • Tachycardia, hypertension
    • Ventricular arrhythmias
stimulants1
Stimulants
  • Withdrawal
    • Drowsiness
    • Profound depression (“cocaine blues”)
    • Increased appetite
    • Abdominal cramps, diarrhea, nausea
    • Headache
ectasy
Ectasy
  • Include derivatives of amphetamine related compound methylene-dioxymethaamphetamine (MDMA)
  • Increases extracellular concentration of serotinin
  • Long term cognitive impairement in heavy users of MDMA.
  • Withdrawal lead to depression
treatment of addiction
Treatment of addiction
  • Transdermal nicotine patches for smoking
  • Baclofen is a GABAB receptor agonist
  • Rimonabant is inverse agonist of CB1 receptors