HLTH 237 Midterm #2 (weeks 5-7)

What do depressants do to the CNS and PNS?

Slow respiratory system

Decrease heart rate

Slow thought processes

Decrease reaction time

Name a culturally acceptable depressant

Alcohol

Effects of depressants (feelings)

Euphoria, relaxation, dulling pain

What are barbiturates?

Barbiturates are sedative-hypnotics that act on GABA

When were barbiturates developed and why?

Developed at the beginning of the 20th century to aid sleep, treat psychosis, and reduce anxiety

When were barbiturates popularized?

1960s-70s

How long of a period of use can lead to barbiturate dependency?

As little as 2-4 weeks

Which psychoactive drug has the most severe withdrawal?

Barbiturates

Examples of barbiturates

Pentobarbital, Phenobarbital, Primidone

Describe non-barbiturate sedative-hypnotics

Developed in 1953 as "safe, non-addictive" alternatives to barbiturates (Qaaludes, Mandrax). They still created high dependency and tolerance, disruption of REM sleep, and their withdrawal can kill.

What proportion of "older Canadians" are prescribed benzodiazepines?

Over 1/3

Why were benzodiazepines developed?

They were developed as safer, non-addictive barbiturates and sedative-hypnotics to reduce anxiety and help with sleep

How long of a use period is required for dependence on benzodiazepines?

Under 4 weeks

Name an example of benzodiazepines

Rohypnol, Xanax, diazepam, lorazepam

What do sedative-hypnotics do?

Sedative: relieve anxiety

Hypnotic: induce sleep (disrupt REM)

Name some short-term effects of benzodiazepines

Muscle relaxation

anxiety relief

combating withdrawal effects

impair muscle coordination

produce dizziness

inhibit short-term memory

True or false: benzodiazepines can only usually cause fatal overdose if mixed with other drugs like alcohol

true

What are z-drugs?

developed in the late 1980s to treat insomnia, have a less severe withdrawal, e.g. ambien, lunesta

What are inhalents/solvents?

Depressants with minor hallucinogenic effects such as mood enhancement, exhilaration, and feelings of invincibility

What are organic inhalants/solvents?

Substances that are legally available but not meant for human consumption (e.g. gasoline, paint, glue). Young people are more likely to use

What are anesthetic inhalants/solvents?

Substances legally approved for medical use but are also used recreationally to produce euphoria (ether, chloroform, nitrous oxide) - can do permanent brain damage

Describe GHB and GBL

Gamma hydroxybutyrate (GHB) and gamma butyrolactone (GBL) - when combined with alcohol, cause memory loss and unconsciousness

What are the long-term effects of inhalants/solvents?

Physical and psychological dependence

Nerve, liver, kidney damage

Neurological damage

Tolerance and withdrawal

Describe the use of antihistamines

Used to combat allergic reactions, nausea, as sleep aids, to suppress muscle spasms, or treat stomach acid. Chronic use can diminish effects

Describe the effects of alcohol

Small amounts diminish area of brain that tempers aggression

Short term effects include relaxation, impaired coordination, slowed reflexes, and increased risk taking

What is a hangover?

Result of withdrawal from alcohol and dehydration

True or false: lethal overdose on alcohol is common

False

What are some things alcohol can cause?

Physical injury, emotional injury, assault, trauma, damage to body systems, cancer, fetal alcohol syndrome

In Canada, __% of road traffic deaths are attributed to alcohol impairment

33

How are opioids different from other psychoactives?

Enhanced ability to produce physical and psychological dependency

Analgesic effect

Intense euphoria

Risk of overdose

Medical uses of opioids

Pain relief (risky when for chronic pain)

Treatment for some types of heart failure

Diarrhea control

How long does it take for opioid tolerance to develop?

A few days

How long does it take for opioids to be metabolized?

a few hours (methadone and buprenorphine are exceptions)

What is neonatal abstinence syndrome?

drug dependency acquired in utero - can be fatal but easily treatable, no long-term cognitive effects

What effects does chronic opioid use have on the brain and cells?

Produces lasting changes in brain neurochemistry and cell development/structure

Symptoms of opioid withdrawal

Uneasiness, chills, nausea/vomiting, stomach cramps, diarrhea, fever, excessive sweating, crawling skin sensations

What are the three categories of opioids?

natural, semi-synthetic, synthetic

Why does opioid overdose death occur?

Depressed respiration

What are 3 natural opioids?

Opium, morphine, codeine

What is opium?

A raw substance extracted from poppy seeds, usually smoked through a pipe, and rarely used medically

What is morphine?

Discovered and named in 1805 - primary active ingredient in opium, 10x stronger than opium on its own

What is codeine?

Derivative of opium used for analgesic effects, cough suppressants, and antidiarrheal - less popular recreationally because of relative non-potency

What are semi-synthetic opioids?

A combination of naturally-occuring opioids with other chemical substances

Name examples of semi-synthetic opioids

Buprenorphine, hydromorphone, heroin, oxycodone/oxycontin

What is buprenorphine?

Decreases opioid cravings, prevents withdrawal, has a lower risk of overdose compared to methadone, is more expensive than methodone

What is hydromorphone?

7-8x stronger than morphine, used for pain when other methods unsuccessful, similar effects to heroin

What is heroin?

Most prohibited opioid globally

Developed 1874

Initially presented as non-addictive

5-10x more potent than morphine

What is oxycodone?

First manufactured in 1938, synthesized from part of the opium plant, chemically similar to codeine, quickly metabolized

Percodan

oxycodone + aspirin

Percocet

oxycodone + acetaminophen

What is OxyContin?

Time-released oxycodone, 16x potency of Percocet, heavily marketed to doctors as nonaddictive

Canadian sales of Oxycontin

1998: $3 million

2010: $243 million

Treatment for OxyContin dependence at CAMH

2000: 4%

2004: 55%

What are some drivers of the current opioid crisis?

Introduction of OxyNeo, decreased prescribing leading to black market sales and mixed chemicals, no increase in treatment availability

What are synthetic opioids?

No origin in poppy plant but similar effects, many different types

What is fentanyl?

100x stronger than morphine, used in medical settings for pain, dramatically increased chances of death due to street drugs, massive potential for tolerance/withdrawal/dependence

What is methadone?

No euphoric effects, long-acting (24h), used as maintenance or substitution therapy for opioid misuse, potential for tolerance/withdrawal/dependence

What is carfentanil?

10x more potent than fentanyl, developed for veterinary use for large animals

What are some opioid antagonists?

Naloxone, naltrexone, pentazocine

Effects and use of naloxone

No pain relief or psychoactive properties, reverses respiratory depression, quick-acting, only effective for opiates, easy to administer

Describe psychotherapeutic drugs

Bring about homeostasis; alter thought processes, mood, and emotional reactions - can produce unpleasant side effects

What are the 3 categories of psychotherapeutics?

Antipsychotics, mood stabilizers, antidepressants

symptoms of psychosis

delusions, hallucinations, apathy, social withdrawal, anxiety, restlessness, depression

What are the effects of antipsychotics?

Reduce behavioural and psychological responses to stimuli, produce drowsiness and emotional quieting, work well on delusions and hallucinations

Negative side effects of antipsychotics

insomnia, nightmares, disorientation, headaches, impairment of voluntary movement, involuntary movement

In BC, there was a __x increase in antipsychotics between 1996 and 2011

18

When did second-generation antipsychotics become available?

1990s

Off-label uses of antipsychotics

OCD, disruptive behaviour disorder, depression, eating disorders, anxiety, insomnia, bipolar disorder

3 states of bipolar disorder

Depression, homeostasis (euthymia), mania

Examples of mood stabilizers

lithium, carbamazepine, valproate (all have unpleasant side effects)

Primary effects of antidepressants

mood elevation, improved appetite, improved physical activity, improved thinking/memory, lessened feelings of guilt/helplessness/inadequacy

General side effects of antidepressants

Initial restlessness, nausea, headache, insomnia, weight gain, sexual dysfunction, decreased REM, nausea

What is discontinuation syndrome?

Similar to withdrawal - tingling, numbness, dizziness, vertigo, lethargy, headaches, anxiety, etc

3 categories of antidepressants

first generation, second generation, atypical antidepressants

What are first-generation typical antidepressants?

Monoamine oxidase inhibitors and tricyclic antidepressants - negative side effects, increase neurotransmitter concentration

What are second-generation typical antidepressants?

Block reuptake of neurotransmitters, e.g. selective serotonin reuptake inhibitors, selective serotonin-norepinephrine reuptake inhibitors, norepinephrine-dopamine reuptake inhibitors

Atypical antidepressants

Change neurotransmitter levels by a process other than blocking reuptake, such as wellbutrin and trazadone

Examples of stimulants

cocaine, amphetamines, anorexiants, decongestants, khat, bath salts

Basic effects of stimulants

• increase CNS and PNS activity

• Reduced fatigue and appetite

Mood changes due to stimulants

euphoria, excitement, agitation, feelings of power

What happens with higher doses of stimulants?

Irritability, violence, spasms/convulsions, death (infrequent)

Where did cocaine originate?

South American andes mountains, used for centuries by Indigenous people

When was cocaine hydrochloride isolated?

1860

How was cocaine initially seen?

A cure-all, used as an anaesthetic

Describe the profits of Cocaine sales

1% at source, 10% in transit, 66% at point of final distribution

What does cocaine do to the synapses?

Dopamine reuptake inhibitor, increases dopamine in synapses

True or false: Cocaine is a local anaesthetic and stimulant

True

Symptoms of cocaine withdrawal

fatigue, mood depression, lethargy, irritability

Cocaine has the _____ behaviourally reinforcing qualities of all psychoactive drugs

strongest

What are the two types of cocaine?

Powder: usually snorted, can be injected or rubbed into gums
Crack: usually smoked, rapid absorption

Powder and crack cocaine are ___ substances

identical

How is crack cocaine made?

powdered cocaine is mixed with water and a weak base (e.g. baking soda)

Effects of infrequent use of cocaine

• enhanced mood

• increased energy

• increased sex drive

• talkativeness and alertness

• decreased appetite

• increased anxiety, respiration, heart rate

Effects of high doses of cocaine

• bizarre, erratic, violent behaviour

• cardiac arrhythmia, hypothermia, seizures

• respiratory depression (unique among stimulants)

Effects of chronic cocaine use

• nasal tissue damage

• lung damage

• damage to pleasure centres of brain

• memory loss

• renal failure

• anorexia

• impotence

• aneurysms, strokes, seizures

General effects of amphetamines

raised energy, reduced appetite, reduced need for sleep, feelings of clear-headedness

How were amphetamines first used?

In WWII for combat fatigue

Symptoms of amphetamine withdrawal

• depression

• fatigue

• disrupted REM

• irritability

• hunger

• violence

Why is methamphetamine popular?

Powerful rush and euphoria

Long term effects of methamphetamine use

• organ damage, malnutrition, premature death

• anxiety, depression, insomnia

• meth mouth

• violence and homicidal/suicidal thoughts