Transcript bs9

Substance abuse
Substance abuse, dependence, withdrawal,
tolerance, and demographics
 Definitions
 Substance abuse is a pattern of abnormal
substance use that leads to impairment of
occupational, physical, or social
functioning.
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Substance dependance is substance abuse
plus withdrawal symptoms, tolerance, or a
pattern of repetitive use.
 Withdrawal is the development of physical
or psychological symptoms after the
reduction or cessation of intake of a
substance.
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Tolerance is the need for increased amounts of the
substance to achieve the same positive
psychological effect.
Cross tolerance is the development of tolerance to
one substance as the result of using another
substance.
Epidemiology and demographics
-caffeine, alcohol, nicotine, marijuana and to a
lesser extent, cocaine, amphetamines, and heroin,
are the most commonly used.---
The use of illegal substance is more
common among young adults and is three
times more common in males.
 Classes of abused substance includes
stimulants, sedatives, opiods, and
hallucinogens.
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Stimulants
 --overview
 Stimulants are central nervous system
activators that include caffeine, nicotine,
amphetamines and cocaine.--
Caffeine is found in coffee(125mg per cup),
tea (65mg\cup), cola(40mg\cup),
nonprescription stimulants, and diet agents.
 Nicotine is a toxic substance present in
tobacco. Cigarette smoking decreases life
expectancy more than any other substance.,
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Amphetamines are used clinically and are also
drugs of abuse.
They are medically indicated in the treatment of
attention- deficit hyperactivity disorder (adhd )
And narcolepsy. They are sometimes used to treat
depression in the elderly and terminally ill,
depression and obesity in patients who do not
respond to other treatments.
The most common clinically used amphetamines
are dextroamphetamine, methamphetamine, and a
related compound, methylphenidate.
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-speed, ice and ecstacy { methylene dioxymethamphetamine are street names for
amphetamine compounds.
Cocaine
-crack and freebase are smokable forms of
cocaine: in pure form cocaine is sniffed into the
nostrils
 -hyperactivity
and growth retardation
are seen in newborns of mothers who
used cocaine during pregnancy.
 Tactile hallucinations of bugs crawling
on the skin (fornication) is seen with
use of cocaine (cocaine bugs)
Neurotransmitter associations
 --stimulant drugs work primarily by
increasing the availability of dopamine.
 Amphetamine use causes the release of
dopamine.
 -both the release of dopamine and the block
of dopamine reuptake result in increased
availability of this neurotransmitter in the
synapse.
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Increased availability of dopamine in the synapse
is apparently involved in the euphoric effects of
stimulates and opiates. as in schizophrenia
,increased dopamine availability may also result in
psychotic symptoms.
Sedatives
--overview
--sedatives are central nervous system depressants
that include alcohol , barbiturates, and
benzodiazepines.
Sedative agents work primarily increasing
gaba.
 Hospitalization of patients for withdrawal
from sedatives is prudent.
 The withdrawal syndrome may include
seizures and cardiovascular symptoms.
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Alcohol
 Acute associated problems
 --traffic accidents, homicide, suicide, and
rape, are correlated with the concurrent use
of alcohol.
 Child physical sexual abuse, spouse abuse,
and elder abuse are also associated with
alcohol use.
 Chronic problems
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Thiamine deficiency resulting in wernicke
and korsakoff syndromes is associated with
long term use of alcohol.
 Liver dysfunction, gastrointestinal problems
and reduced life expectancy are also seen .
 Fetal alcohol syndrome (including facial
abnormalities, reduced height and weight,
and mental retardation) is seen in the
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Offspring of women who drink during
pregnancy.
 A childhood history of problems such as
attention-deficit hyperactive disorder and
conduct disorder.
 Intoxication
 Legal intoxication is defined as 0.08-0.15
percentage blood alcohol concentration,
depending on individual state laws.--
Coma occurs at a blood alcohol
concentration of 0.40-0.50 percentage in
non alcoholics.
 Delirium tremens (dts)
 Alcohol withdrawal delirium may occur
during first week of withdrawal from
alcohol
 Delirium tremens is life threatening: the
mortality rate is about 20 percentage.
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Barbiturates
 -used medically as sleeping pills,
tranquilizers, anticonvulsants and
anesthetics.
 Frequently used/abused barbiturates include
amobarbital, pento barbital & secobarbital.
 Cause respiratory depression. most
commonly used for suicide
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Benzodiazepines
 --sedatives, anticonvulsants,& anesthetics.
to treat alcohol withdrawal.
 Safety margin high.
 Opiods
 -agents used medically as analgesics—
morphine and as drugs of abuse—heroin
 heroin more potent
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Methadone
Synthetic opiod used treat heroin addiction it can
be taken orally
Has longer duration of action
Causes less euphoria and drowsiness
Hallucinogens
--include lsd, pcp, canabis and mescaline.
Promote altered states of consciousness
Increased availability of serotonin
Marijuana
 --tetrahydrocannabinol (thc) is the primarily
active compound
 Marijuana increases appetite and causes
relaxation
 Chronic use causes lung problems and
amotivational syndromes
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Lsd and pcp
 Lsd is ingested and is pcp is smoked
 They cause altered perception
 Er findings for pcp include hyperthermia
and nystagmus
 Consumption of more than 20mg of pcp
may cause convulsions, coma & death
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