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    Drug Abuse and Drug Dependence: DR Keli F Med III Lectures

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    theintrov
    Drug abuse and dependence can involve prescription drug misuse as well as illicit drugs. Successful treatment may require detoxification, counseling, and sometimes addiction medications. Counseling can be done individually or in group therapy sessions. Drug abuse has physiological and psychological consequences at both the individual and societal levels. International agreements and national programs aim to control drug abuse through education, treatment, and regulation.

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    Drug Abuse and Drug Dependence: DR Keli F Med III Lectures

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    theintrov
    72 views49 pages
    Drug abuse and dependence can involve prescription drug misuse as well as illicit drugs. Successful treatment may require detoxification, counseling, and sometimes addiction medications. Counseling can be done individually or in group therapy sessions. Drug abuse has physiological and psychological consequences at both the individual and societal levels. International agreements and national programs aim to control drug abuse through education, treatment, and regulation.

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    Drug abuse and dependence can involve prescription drug misuse as well as illicit drugs. Successful treatment may require detoxification, counseling, and sometimes addiction medications. Counseling can be done individually or in group therapy sessions. Drug abuse has physiological and psychological consequences at both the individual and societal levels. International agreements and national programs aim to control drug abuse through education, treatment, and regulation.

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    Attribution Non-Commercial (BY-NC)
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    72 views49 pages

    Drug Abuse and Drug Dependence: DR Keli F Med III Lectures

    Uploaded by

    theintrov
    Drug abuse and dependence can involve prescription drug misuse as well as illicit drugs. Successful treatment may require detoxification, counseling, and sometimes addiction medications. Counseling can be done individually or in group therapy sessions. Drug abuse has physiological and psychological consequences at both the individual and societal levels. International agreements and national programs aim to control drug abuse through education, treatment, and regulation.

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    Attribution Non-Commercial (BY-NC)
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    Download as ppt, pdf, or txt
    of 49

    Drug abuse and drug dependence

    Dr Keli F Med III lectures

    Drug abuse
    addiction to prescription drugs increases when they are used in ways other than as prescribed (e.g., at higher doses, by different routes of administration, or combined with alcohol or other drugs) Physicians, their patients, and pharmacists all play a role in identifying and preventing prescription drug abuse
    2

    Drug abuse treatment


    Successful treatment may need to incorporate several components, including
    detoxification, Counseling sometimes the use of addiction medications

    Multiple courses of treatment may be needed for the patient to make a full recovery

    Counseling session/group therepy

    Broad definition of drug abuse:


    drug abuse

    Unreasonable administration of drugs

    Narrow definition of drug abuse: psychological dependence mental disorder , compulsive drug seeking behavior to use a drug repeatedly despite the drugs risk physiological dependence symptoms occurring after drug withdrawal due to a new level of homeostasis Psychologic dependence often precedes physiologic dependence but not always lead to it

    Drug abuse intro


    Addiction = physiologic and psychologic dependence Tolerance decreased response to a drug necessitating larger doses to achieve the same effects Metabolic tolerance increased disposition of the drug Behavior tolerance ability to compensate for the drugs effects Functional tolerance compensatory changes in receptors effector enzymes and membrane actions of drugs

    Illicit drugs use


    Depends on the society US caffeine, nicotine, alcohol ME cannabis not illicit alcohol illicit Native Americans peyote not illicit, cocaine allays hunger and increases endurance Kenya illicit cannabis, alcohol, cocaine others 50% drug dependence is due to polygenic inheritance
    8

    poppy flower of California (1998.5)

    Opium

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    marijuana

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    Marijuana

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    Heroine

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    Possible drugs of abuse


    narcotic drugs psychotropic drugs Barbiturates Hallucinojens Marijuana Anaesthetics Steroids inhalants
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    WHO classification abused drugs


    Suppressant s of the central nerve Nicotine or tobacco Opioid cannabis hallucinogenic drug

    15

    Consequences of drug abuse


    Individual physical and mental health Intoxation death immunity infection Society Common family and life destroyed Criminality hold-back development
    16

    Control of drug abuse


    International 1961 convention 1971 convention 1981 strategy National institute system Education medical centers for treatment of drug withdrawal
    17

    CNS deppresants
    Include sedatives and tranquilizers; Benzodiazepines, such as diazepam (Valium) and alprazolam (Xanax) sometimes prescribed to treat anxiety, acute stress reactions, and panic attacks, zolpidem, zalepon Barbiturates, such as mephobarbital (Mebaral), phenobarbital (Luminal Sodium), and pentobarbital sodium (Nembutal), are used less frequently to reduce anxiety or to help with sleep problems because of their higher risk of overdose compared to benzodiazepines. Also treat seizures Ethanol Sedative hypnotics such as gamma hydroxybutyric acid - GHB 18

    CNS Depressants pharmacology


    They result to sedation, hypnosis, anesthesia, coma and death Barbiturates and BDZ can be short or long acting GHB short acting Most abuse involves short acting drugs such as secobarbital, pentobarbital Drugs with T1/2 8-12hrs have a rapid severe withdrawal unlike T1/2 48-96 hrs T1/2 >96hrs less chances of withdrawal reactions
    19

    Clinical aspect BZD


    Physiologic dependence Diazepam occurs with 40mg/d Often core dependent on other drugs At 15-30 mg/d wt loss changes in perception, paresthezias, headache occur Used in date rapes in small doses Flunitrazepam commonly used Date rape; one gets intoxicated and amnesic Tolerance develops for sedative effect but not respiratory depression thus risky if used together with other respiratory depressants alcohol, opioids
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    Clinical aspect CNS deppendants


    Sedatives Withdrawal effects is like from alcohol includes anxiety, twitches, tremor, N, V Long acting drugs symptoms are delayed Convulsions rare until day 8 or 9 then the syndrome subsides Severe cases are associated with delirium and hallucinations

    21

    Treatment
    BDZ If short acting drugs are involved long acting are used such as phenobarbital, chlodiazepox If long acting drugs continue the same The drugs are then withdrawn gradually 15-25% of daily dose and later by 5-10% Sedatives No specific programs of Rx exist Treat the underlying mental disorder
    22

    Alcohol
    Relives anxiety, fosters feeling of well being, and euphoria Pharmacokinetics Water soluble Rapidly absorbed peaks in serum in 30 min in fasting state and in delayed by meals due to grastric emptying Volume of distri same as body water women have a higher peak conce
    23

    Alcohol kinetics
    90% oxidized in the liver, rest excreted via lungs and urine zero order kinetics alcohol dehydrogenase is an enzyme found in the liver, stomach and brain Alcohol acetaldehyde a H+ is transferred to NADH generating reducing equivalents and generating excess NADH which underlies many of the met disorders of chronic alcoholism
    24

    Alcohol p,kinetics
    Metabolized via mixed function system or microsomal ethanol system MEOS Its (MEOS) activity is increased in chronic alcoholism barbiturates induce alcohol clearance Acetaldehyde oxidized in the liver by aldehyde dehydrogenase to acetate the latter to CO2 and water Acetate oxidation is deterred by disulfiram
    25

    Pkinetics Alcohol
    Asians lack aldehyde dehydrogenase and on alcohol consumtion they aldehyde accumulates to high concetration and they experience a disulfiram effect - flushing

    26

    Pdynamics Alcohol
    CNS Alcohol causes sedation, anxiety higher concetration, slurred speech, ataxia, impaired judgement, disinhibited behaviour (drunkeness intoxication) Depresses CNS induces coma respiratory failure death It affect numerous membrane proteins that participate in signaling including amines, amino acids, opioids, Na/k ATPase adenyl cyclase, phosphoinositide, Ca2+
    27

    pdynamics alcohol
    Enhances GABA action It inhits the opening of NMDA channels causing black outs Heart Depresses the myocardium contractility Acetaldehyde alters cardiac functions by altering myocardial catecholamines

    28

    Pdynamics alcohol
    Smooth muscle Its a vasodilator directly and indirectly may cause hypothermia in overdose It relaxes the uterus used previously to suppress premature labour

    29

    Chronic alcohol consumption


    Alcohol dealdehyde and Alcohol Affects vital organs directly and indirectly by making them susceptible oxidative stress, depletion of glutathione, pontentiation of cytokine induced injury Liver and GI ; fatty liver, hepatitis, LF risk factors hepatitis B/C infection GI;pancreatitis, formation of protein plugs and carbonate containing stones, gastritis, anemia, protein malnutrition, Small intestines injury vit def

    30

    Chronic alcohol consumption


    Nervous system Results to physical, psychologic dependance and tolerance Withdrawal presents with seizures, psychosis and Delirium Psychologic dependance is characterised by a compulsive desire to experience rewarding effects of alcohol and desire to avoid withdrawal
    31

    Chronic alcohol consumption


    Alcohol is a neurotoxin results to a bilateral neuropathy, ataxia, abnormal gait, dementia, demyelinating disease Optic nerve degeneration, methanol causes visual impairement Wernickes korsakoff z ataxia, extraoccular muscle paralysis, prolonged confusion coma death Associated with thiamine def Korsakofs psychosis; chronic memory disorder
    32

    Chronic alcohol consumption


    CVS Heavy alcohol consumption causes worse DCM, LVH, fibrosis, arrythmias, HPT, It interferes with cell organelles It interferes with HF medication Blood Affects hematopois through nutritional and metabolic effects Depresses the BM

    33

    Chronic alcohol consumption


    Blood; inhibits folic acid def , causes GI bleeding, hemolysis = anaemia Endocrine and Electrolytes Causes steroid derrangement resulting to testicular atrophy and gynaecomastia Electrolyte disordres result to ascites, edema and effusions portal HPT reduced proteins Vomiting and diarrhea lower K+ causing weakness Interferes with gluconeogenesis = hypoglycemia sometimes ketosis due to excessive lipolysis
    34

    Chronic alcohol consumption


    Fetal alcohol syndrome; IUGR, Microcephally, Poor cordination, poor dev of mid facial region, minor joint anomalies Chronic abuse associated with teratogenicity, mental retardation and malformations The fetal liver hardly has alcohol dehydrogenase

    35

    Chronic alcohol consumption


    Immune system Immune inhibition in lungs, enhanced in pancreas and liver Risk of cancer Increases risk of cancer of the mouth, larynx, esophagus, liver, breast Alcoholic beverages may contain carcinogens, produced during fermentation
    36

    Ethanol abuse alcoholism


    recurring use of alcoholic beverages despite its negative consequences Has environmental and genetic determinants Two types of alcoholics:
    those who have anti social and pleasure-seeking tendencies those who are anxiety-ridden- people who are able to go without drinking for long periods of time but are unable to control themselves once they start

    37

    Ethanol abuse
    Binge drinking is another form of alcohol abuse > 5units men 4 units women Frequent binge drinking or getting severely drunk more than twice is classed as alcohol misuse Excessive use of alcohol leads to tolerance, physical dependence, societal and medical costs
    38

    Alcohol withdrawal
    withdrawal syndrome is largely due to the central nervous system being in a hyper-excitable state sseizures and delirium tremens and may lead to excitoneurotoxicity Alcohol withdrawal occurs as a result of neuro-adaptation resulting from chronic exposure to alcohol Alcohol withdrawal is characterized by neuropsychiatric excitability and autonomic disturbances

    39

    Pharmacotherapy of Alcoholism
    Various drugs are used alongside psychological therapy to treat alcohol dependance Disulfirum an inhibitor of aldehyde dehydrogenase and alcohol dehydrogenase is used to deter alcohol intake Other drugs blunt pleasure caused by alcohol or reduce alcohol craving eg Naltexone Treat concormitant psychiatric problems
    40

    Disulfiram
    Anti oxidant Causes extreme discormfort when taken with alcohol; flushing, throbing headache, N,V,sweating, hypotension confusion lasting upto several hrs Rapidly absorbed takes 12 hrs to take effect elimination is slow Dose 250mg at bed time Safety in pregnancy unknown

    41

    Drugs with Disulfiram like effects


    Drugs with disulfiram effects on ethanol metabolism
    metronidazole certain cephalosporins sulphomylureas hypoglycemic agents cloral hydrate,

    42

    Naltrexone
    Opioid receptor anatgonist it blocks at usual doses of opioids In combination with psychosocial therapy decreases reduces relapse or craving Dose 50mg/d Caution in abnormalities of serum aminotransferase activity and those dependant on opioids In combination with disulfiram potential hepatotoxin Other drugs;Topiramate may reduce alcohol cravings
    43

    Manifestations of alcohol abuse


    include poor judgment; chronic anxiety, irritability, and insomnia In the liver elevated liver enzymes AST is at least twice as high as ALT Subsequently liver cirhosis and failure abuse causes neuroinflammation and leads to myelin disruptions and white matter loss developing adolescent brain is at increased risk of brain damage abuse has both short-term and long-term risks
    44

    Alcohol Withdrawal Treatment


    BZD effective for the management of symptoms as well as the prevention of seizures Other agents used Barbiturates, clonidine, vitamins diazepam or lorazepam, are the most commonly used drug are safe and effective Chlordiazepoxide and diazepam are most commonly used in alcohol detoxification BZD should only be used short term in alcoholics who aren't already dependent on BZD as they share cross tolerance with ethanol thus a risk of replacing the addiction with a BZD dependence or worse still adding an additional addiction
    45

    Alcohol withdrawal Rx
    BZD decreases cravings and volume of alcohol consumed The combination of BZD and alcohol can amplify the adverse psychological effects of each other causing enhanced depressive effects on mood and increase suicidal ideation Antipsychotics eg haloperidol, are sometimes used for alcohol withdrawal as an add-on to first-line Rx benzodiazepines to control agitation or psychosis
    46

    Alcohol withdrawal Antipsychotics


    they lower the seizure threshold and can worsen withdrawal effects Clozapine, olanzapine or low potency phenothiazines (e.g. chlorpromazine) are particularly risky Concern prolonging the QT interval, sometimes leading to fatal heart dysrhythmias

    47

    Alcohol withdrawal Antipsychotics


    Anticonvulsants Carbamazepine Shown to have less rebound withdrawal symptoms Appears to have a higher success rate for abstinence from alcohol post detoxification compared to benzodiazepine

    48

    Treatment of alcohol Withdrwal


    Barbiturates superior to diazepam in the treatment of severe alcohol withdrawal syndromes such as delirium tremens Equally effective in milder cases of alcohol withdrawal Clomethiazole an anti convulsant inhibits the enzyme alcohol dehydrogenase, which is responsible for breaking down alcohol in the body preventing sudden fall in alcohol levels
    49

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