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Psychoactive Drugs (ALCOHOL
- GABA agonist, dopamine, serotonin and…
Psychoactive Drugs
ALCOHOL
- GABA agonist, dopamine, serotonin and glutamate, depressant
- Relaxation, disinhibition, aggression
- Withdrawal - Risk of delirium tremens, Wernicke's encephalopathy
Delirium tremens
- 5% of alcohol dependants
- 1-3 days after last drink
- Decreased consciousness, sweating, increased HR, increased BP, nausea, vomiting, dehydration, insomnia, visual hallucinations, autonomic dysfunction, seizures
- Manage with benzodiazepines and support
Wernicke's encephalopathy
- Thiamine deficiency
- Confusion, ataxia and opthalmoplegia
- Treat with parenteral thiamine
- 70% develop Korsakoff's syndrome (irreversible impaired memory)
CAGE
- Screening for dependency
- Have you ever tried to cut down your drinking?
- Do you ever feel annoyed when asked about your drinking?
- Do you ever feel guilty for drinking?
- Do you ever have an eye opener?
-
7 Signs of Dependency
- Continuing to drink despite evidence of harm
- Starting again after trying to stop
- Compulsion to drink
- Withdrawal
- Prioritising drinking over other activities
- Narrowing of repertoire
- Tolerance
Detoxification
- Daily supervision
- Vitamins (thiamine) - IV Pabrinex, then oral
- Chlordiazepoxide 20mg QDS - reduces tremor and agitation
Treatment of Dependance
- Psychological, group therapy
- Acamprosate (anti-craving)
- Naltrexone (decreases pleasurable effects)
- Disulfarim/Antabuse (causes unpleasant reaction to alcohol consumption)
BENZODIAZEPINES
- GABA agonist
- Class C
- Oral or IV
- Anxiolytic, hypnotic, amnesic
- Adverse effects: tolerance, dependance, respiratory depression
- Overdose - esp when with alcohol (very dangerous)
- Withdrawal - anxiety, tremors, nausea
- Antidote = FLUMAZENIL
- Management - harm reduction advice, maintenance prescribing to a long half-life benzo i.e. diazepam and wean off over several months
GHB/GBL
- GABA agonist
- Class C
- Liquid (oral)
- Euphoria, reduced inhibitions and drowsiness
- Nausea, dizziness, drowsiness, agitation, visual disturbances, respiratory depression, unconsciousness, coma, death
- Withdrawal - insomnia, anxiety, tremor, delirium
- Management - tapered benzodiazepines
AMYL NITRATE / POPPERS
- Inhaled liquid
- Rush/high
- Enhanced sexual experiences
- Hypotension, unconsciousness, nausea, headache, confusion, arrhythmias, sudden death
CANNABIS
- Cannabinoid receptors in CNS
- Class B
- Medical uses
- Addictive
- Relaxation, euphoria, hungry
- Anxiety, paranoia, nausea, poor memory
- 'Gateway drug'
- Increased risk of psychosis
- Withdrawal - irritability, mood changes, nausea, insomnia, sweating, shaking, diarrhoea
- Management - supportive, calming environment, benzos for agitation/psychosis, substance abuse counselling
AMPHETAMINES
- Monoamines - increased levels of dopamine and noradrenaline by blocking reuptake
- Class B
- Oral, inhaled, smoked, IV (Class A)
- Crystal meth, speed
- Addictive
- Wide awake, excited, talkative, confidence, insomnia, dry mouth, pupil dilation, increased HR BP and temp
- Dependancy, insomnia, anxiety, paranoia, psychosis and cardiac problems
- Withdrawal - fatigue, depression, poor concentration, cravings
- Overdose - severe hypertension, arrhythmia, coma
- Management - benzos for agitation, manage hypertension, tachycardia, arrhythmia and hyperthermia
KETAMINE
- NMDA antagonist
- Class B
- Sniffed powder
- Addictive
- Dissociative anaesthetic, relaxation, floating feelings, altered body sensations, altered perceptions, hallucination
- Risk of ulcerative cystitis, bladder pain, amnesia, confusion, agitation
MEPHEDRONE / MCAT
- Monoamines
- Class B
- Alert, confident, talkative, euphoric, reduced appetite, increased affection
- Nausea, anxiety, headaches, vomiting, agitation, seizures, self harm, epistaxis
- Management - supportive, benzos for agitation, monitor temperature and sodium
MDMA / ECSTASY
- Increases noradrenaline, dopamine and serotonin
- Class A
- Oral: pills or powder
- Energised, happy, alert, increased affection, chatty, dilated pupils
- Anxiety, panic attacks, confusion, paranoia, psychosis, tachycardia, hyperpyrexia, electrolyte disturbance, dehydration, over hydration, death
- Withdrawal - lethargy, depression, amnesia
- Management - advice regarding keeping cool and avoiding over hydration or dehydration
COCAINE
- Monoamine reuptake inhibitor
- Class A
- Inhaled, snorted, smoked, IV
- Addictive
- Confidence, wide awake, reduced hunger, short-acting
- Tachycardia, raised temp, MI, HF, HTN, seizure, depression, anxiety, panic attack, necrosis of nasal septum, psychosis, hallucinations of bugs crawling on skin
- Withdrawal, psychological - low mood, unwell, dependence
- Management - harm reduction advice, ?fluoxetine
LSD
- Dopamine and serotonin agonist
- Class A
- Not addictive
- 8-14 hour duration
- Hallucinations, sensory distortion, altered perceptions
- 'Bad trips', anxiety, panic, depression, flashbacks, accidents, psychosis
- Management - harm reduction advice, manage acute psychosis and agitation
PSILOCYBIN MUSHROOMS
- Serotonin agonist
- Class A
- Euphoric, disorientated, perceptual and sensory changes, hallucinations
- Poisoning, death, nausea, diarrhoea, stomach pains, anxiety, paranoia, bad trips, flashbacks
- Management - supportive, manage acute psychosis and agitation
HEROIN
- Opioid agonist - mu receptors
- Class A
- Smoked, oral, IV
- Addictive
- Warm feeling, euphoria, relaxed, drowsy, analgesia, pinpoint pupils
- Constipation, addiction, dependancy, respiratory depression, hallucination, tolerance
- Withdrawals from 8-10hrs and last 7-10 days- sweating, malaise, depression, anxiety, akathisia, yawning, sneezing, tears, rhinorrhoea, sleep problems, chills, myalgia, nausea, vomiting, diarrhoea, cramps, watery eyes, limb spasms, goose pimple skin, clammy skin
- Overdose - respiratory depression and death
- Management - harm reduction (IV), managed detox?
- Detox - symptom relief Lofexidine (alpha agonist), Loperamide, Metoclopramide, Ibuprofen
- Substitute - Methadone or Buprenorphine or Dihydrocodeine
- Maintenance - Methadone, dose reduction when stable
- Antidote - NALOXONE - opiate antagonist, aid to relapse prevention, can be used in rapid detox