Drug abuse: Use of drugs for non-medical purposes Drug misuse: wrong use of drugs: Wrong choice Wrong dose & wrong duration e.g. misuse of antibiotics Dependence is associated with abuse 1
Repeated, periodic or continuous use of a drug resulting in harm to individuals and to society Subjects have strong craving (desire) to continue using the drug Abrupt deprivation results in withdrawal manifestations 2
Defination Stimulants are a substance which tends to increase behavioral activity when administered Psychomotor stimulants cause: Excitement, Euphoria, Decrease feeling of fatigue & Increase motor activity Methylxanthines (caffeine, theophylline), Nicotine Cocaine Amphetamine, Methylphenidate.
Signs and symptoms: 1- Elevate Mood 2- Increase Motor Activity 3- Increase Alertness 4- Decrease need for Sleep In case of overdose lead to convulsion and death.
Obesity (anorectic agents). Attention Deficit Hyperactivity Disorder (ADHD); lack the ability to be involved in any one activity for longer than a few minutes. Narcolepsy: It is a relatively rare sleep disorder, that is characterized by uncontrollable bouts of sleepiness during the day.
Patients with anorexia, insomnia, asthenia, psychopathic personality, a history of homicidal or suicidal tendencies
Personal factors to obtain: Euphoria, pleasure, psycho-stimulation Relaxation Sexual arousal Chemical relief of painful emotions Cultural factors (smoking, alcoholism, khat) Iatrogenic factor (sedatives, analgesics) in ICU Increase availability and low price of drugs 7
Psychological dependence: Craving for the drug and emotional distress on drug withdrawal Physical dependence: Physical illness on drug withdrawal Tolerance: Reduced response to drugs with use 8
Social and legal problems Health problems: Hepatitis B, HIV infection Overdose toxicity Withdrawal syndrome Teratogenic effects: Foetal alcohol syndrome, Small baby in smokers Premature death Psychoses: Amphetamines, Cannabis, Cocaine 9
Morphine-type drugs Sedative (Benzodiazepine-type) Stimulants & Amphetamine-type Cannabis-type Cocaine-type Alcohol-type Tobacco-type Glue sniffing Mixtures (heroin-cocaine) 10
Severe psychological & physical dependence Morphine, heroin, codeine Heroin (Diamorphine) Is more potent than morphine Oral, IV or by inhalation Gives a rapid intensely pleasurable experience often accompanied by increased sexual arousal 11
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Causes: Abrupt drug withdrawal Naloxone or Pentazocine administration to addicts Manifestations within 12 hours: Intense craving, rhinorrhoea, hyperventilation, shivering, vomiting, colic Tachycardia, increase ABP, mydriasis, flushing Treatment: Clonidine-naltrexone for withdrawal Methadone replacement for chronic addiction 13
Diazepam, Lorazepam Severe psychological & physical dependence Anxiolytics & hypnotics Withdrawal syndrome: Severe anxiety More with short acting-drugs as lorazepam 14
Caffeine: Widely used (tea, coffee, cocoa, chocolate) Methylxanthine alkaloid Blocks adenosine receptors Inhibits phosphodiesterase enzyme (PDE ) Increases cyclic AMP Withdrawal symptoms: Headache, irritability With more than 600 mg (six cups) daily 15
It has CNS stimulant properties similar to those of amphetamine and may also lead to abuse, although its addictive potential is controversial. It is taken daily by 4-6 million children in the USA for ADHD. Methylphenidate is a more potent dopamine transport inhibitor than cocaine, thus making more dopamine available. It has less potential for abuse than cocaine, because it enters the brain much more slowly than cocaine and, does not increase dopamine levels as rapidly.
Adverse reactions: GIT effects are the most common; abdominal pain and nausea. In seizure patients, methylphenidate seems to increase the seizure frequency, especially if the patient is taking antidepressants.
Widely used agent in cigarettes Tolerance develops Craving & psychological dependence Smoking - related death: 20 % of all deaths 30 % of cancer death COPD is associated with smoking 18
is the active ingredient in tobacco. Used in smoking cessation therapy, Nicotine remains important, because: Actions of Nicotine: Low dose: ganglionic depolarization. High dose: ganglionic blockade.
I. CNS: 1. Low dose: euphoria, arousal, relaxation, improves attention, learning, problem solving and reaction time. 2. High dose: CNS paralysis, severe hypotension (medullary paralysis) II. Peripheral effects: Stimulation of sympathetic ganglia and adrenal medulla BP and HR (harmful in HTN patients) Stimulation of parasympathetic ganglia motor activity of the bowel. At higher doses, BP falls & activating ceases in both GIT and bladder.
CNS; irritability and tremors Intestinal cramps, diarrhea HR & BP Withdrawal syndrome: nicotine is addictive substance, physical dependence on nicotine develops rapidly and can be severe. Bupropion: can reduce the craving for cigarettes Transdermal patch and chewing gum containing nicotine
Acts indirectly centrally Increases release of NA & dopamine 22
MOAs : Block the reuptake of norepinephrine and dopamine into the presynaptic neuron and increase the release of these monoamines into the extraneuronal space. - Clinical use: 1. Narcolepsy. 2. Attention-deficit hyperactivity disorder
Cardiovascular: Hypertension (7% to 22%, pediatric ) Endocrine metabolic: Weight loss (4% to 9%, pediatric; 11%, adults ) Gastrointestinal: Abdominal pain (11% to 14%, pediatrics ), Loss of appetite (22% to 36%), Xerostomia (35% ) Neurologic: Headache (26% ), Insomnia (12% to 17%, pediatric; 27%, adults ) - Psychiatric: Feeling nervous (6% )
Psychological dependence Central psychostimulant effects: Increase energy & concentration, improved mood Suppression of appetite Withdrawal manifestations: Rebound depression, anxiety Psychosis with chronic use (schizophrenia-like) 25
Fresh leaves & stem of Catha edulis plant contain khat Main active constituent is cathinone alkaloid Effects similar to those of amphetamines Psychological dependence Withdrawal: Exhaustion, mental depression for several days 26
In Yemen, Ethiopia, Somalia Well being, increase libido & work performance Increase arterial blood pressure ABP, urinary catecholamines, respiratory rate & body temperature Effects disappear after 18 hours Increase oral cancer Increase low birth weight babies 27
Cannabis smoked with tobacco Commonest illegal drug in western countries Psychological dependence Other Hallucinognic drugs: LSD, mescaline, psilocybin 28
From leaves of Cannabis sativa Illegal cultivation Sensation of relaxation and well being Psychological dependence Heavy consumption: Acute toxic confusional state Long-term consequences: Amotivational syndrome with apathy Schizophrenia-like psychosis 29
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LSD: semisynthetic, related to ergot alkaloids Mescaline & psilocybin: natural Hyperarousal state of CNS LSD interacts with serotonin receptors & alter serotonin turnover in the brain 31
Most commonly used hallucinogens Alter perception, thoughts & feelings Visual hallucinations: of colours, images Distorted perception of time, sounds and tactile sensation (bad trip): Colours are heard Sounds are seen Chronic psychosis after regular LSD use 32
Psychological dependence IV, sniffing Stimulant effects similar to amphetamine Toxic psychosis, ulceration of nasal mucosa Absorption through nasal mucosa occurs Smokable: highly addictive form Toxic psychosis with high use 33
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Severe psychological & physical dependence Tolerance & cross tolerance Serious neurological & mental disorders: Brain damage, memory loss, psychosis, epilepsy Vitamin deficiencies GI & liver disorders Alcoholism is harmful to individuals, to the family & the society 35
Psychological dependence Slight physical dependence Smoking-associated disease: Lung cancer, COPD Heart disease, atherosclerosis. Laryngeal, oral cancer & oesophageal cancers Intrauterine growth retardation & low birth weight. 36
Craving, irritability, poor concentration Sleep disturbances, hunger In the first days Subside over weeks Nicotine replacement reduces withdrawal 37
Non-pharmacological strategy: Education, Support of friends & family Avoidance of fatty food, use fruit & healthy exercise Pharmacological strategy: Nicotine replacement Nicotine chewing gum Trans-dermal preparation Other drugs 38
Volatile organic solvents In adolescents Acute intoxication: Euphoria, excitement Sometimes loss of consciousness & death Long term: electrocerebral changes Neuropathy 39
Withdraw patients from the drugs: In hospitals or in drug treatment center Decrease doses of the drug over 1-3 weeks Oral methadone for opiate dependence Long term support Drug advisory centers 40