DRUGS OF ABUSE

Addiction- A behaviour pattern of drug abuse characterised by compulsive use, drug seeking behaviour and a high tendency to relapse after discontinuation. Abuse- self- administration of any drug in a culturally disapproved manner that causes adverse consequences (legal, social, physical, psychological)

Drug

Cocaine

Mechanism of Action - Administration Snorted, injected or smoked (esp hydrochloride or crack) -Stimulates dopamine release and prevents dopamine reuptake. Results euphoria, alertness, sense of mental acuity. Withdrawal crash, anxiety, depression. Treatment abstinence to allow DA system to readapt. Future Treatment replete DA stores and readapt receptor sensitivity.

Side Effects - High dose tremor, pnic, paranoia, emotional lability, tachycardia, hypertension. - Psycosis, heart failure, stroke, seizure, - Respiratory depression at very high dose.

Amphetamines

Administration powder ingested, smoked, i.v. Increases dopamine release and 5-HT release

Hallucinogens a) LSD (lysergic acid dethylamide) b) Psilocybin (mushrooms) c) MDMA (ecstasy) (3,4 methylene dioxymetampheta mine)

Acts mainly on 5-HT receptors causes visual illusions and hallucinations. Trip Visual illusions, slowing of time, depersonalisation/derealisation Bad trip panic symptoms accompany the above

Delirium Frank psychosis Tolerance due to 5HT2A receptor desensitization. Fashbacks

MDMA - Increased sociability, sense of empathy and personal insight, confusion. Over dose can result in hyperthermia, SIADH, liver and renal failure, sub-arachnoid haemorrhage.

Cannabinoids Marijuana

Smoked or ingested acts on cannabinoid receptors. Intoxification well being, relax, friendliness, reduced short-term memory, slowed thought. Tolerance and dependence usually occur

High dose panic delirium, psychosis

Drug Nicotine

Mechanism of Action -Smoked - Intoxification enhanced mood, cognition and decreased apetite - Withdrawal craving (down regulated dopamine) Addiction treatment Nicotine replacement therapy.

Side Effects With drawal/ craving Cancer

Opiates

Intoxification Rush (brief and intense), tranquillity. Withdrawal dysphoria, autonomic overactivity (tachycardia, tremor, sweats, pilorection), lacrimation.

Treatments - Overdose Naloxone (synthetic opiate antagonist) - Detoxification 1) Methadone (opiate with long half life, less euphorant but avoid withdrawal. 2) Buprenorphine (partial agonist). 3) Clonidine- 2 agonist reduces autonomic over activity. Alcohol Acts on opioid and endocannabinoid receptors. Results euphoria Withdrawal (6-12 hrs), autonomic hyperactivity secondary to NMDA upregulation (tremor, sweats, tachycardia, hypertension, anxiety). Withdrawal seizures in some cases delirium tremens in some cases hallucinations, confusion, 5% mortality. -

Overdose respiratory depression, decreased consciousness, and pinpoint pupils. Tolerance and dependence develop rapidly soon dose for intoxification approaches fatal dose.

CNS depressant due to NDMA receptor antagonism and GABA A receptor agonism Amnesia Ataxia

Treatment - Acute Withdrawal Benzodiazepines- which enhances the effect of GABA. Similar good effects as alcohol but benzodiazepines with a longer half life make detoxification more tolerable. - Abstinence 1) Disulfiram - Acetaldehyde dehydrogenase inhibitor leads to accumulation of acetaldehyde when drinking (flushing, headache, nausea and vomiting) 2) Acamprosate NMDA receptor antagonist and GABA agonist reduce craving. 3) Naltrexone opiate antagonist reduces positive alcohol effects.