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Medical Effects of Drugs of Abuse by dffhrtcv3

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									Medical Effects
      of
Drugs of Abuse

   Pierre Rouzier, M.D.
         Goals and Objectives
•   Learn how drugs work
•   How you get high
•   How you OD
•   How you die fast
•   How you die slow
•   Understand drug
    dependence/addiction/withdrawal
               Classes of Drugs
•   Depressants
•   Stimulants
•   Opiates
•   Cannabis
•   Hallucinogens
•   “Designer/Club Drugs”
               Basic principles
• Receptors - part of nervous
  system where drugs bind
• Neurotransmitters -
  “messengers” send signals
  ex: serotonin
• Tolerance - need for “more”
  to get the same effect
• Addiction - receptors “need
  and want” drug to feel
  normal
               UMass survey-
        664 random students polled spring 2003

• Alcohol use: Average # drinks/week:
          males-15 females-7
• “Binge drinking” - # of drinks in a “sitting”
          (males-5 females-4)
  72% of all students in past 2 weeks.
               Survey
        Why do students drink...
•   89% gives people something to do
•   82% facilitates a connection with peers
•   80% allows people to have more fun
•   55% makes it easier to deal with stress
•   65% facilitates sexual opportunities
•   26% makes them sexier
          Survey - Drug use
• Marijuana - 61% smoked in past year,
  31% smoke once a week
• 10% used designer drugs, hallucinogens,
  cocaine, sedatives
                Depressants
• Examples: alcohol, benzodiazepines (valium),
  barbituates (secobarbital), etc.
• Tolerance - all
• Addiction - physiologic, psychologic
          Depressants, cont.
• Effects - slurred speech, decreased
  inhibition, disorientation, staggering,
  drunken behavior
• Overdose - decreased respirations, loss of
  consciousness, coma, death
• Withdrawal - anxiety, insomnia, elevated
  BP/pulse, tremor, hallucinations, seizures,
  death
                Alcohol levels
•   0.08 legally drunk
•   0.1 “delightfully dizzy”
•   0.2 “drunk and disorderly”
•   0.3 “death’s doorstep”
•   0.4 “dead drunk”
               What’s your alcohol level?
          1 drink = 12 oz. beer, 4 oz. wine, 1 oz. Liquor
                   # drinks/time (hours 1-2-3)

Weight (lbs)    2             4             6              8
100             .07/.04/.02   .14/.12/.10   .22/.12/.18    .27/.25/.23
120             .06/.03/.01   .12/.09/.08   .18/.16/.14    .26/.24/.22
140             .05/.02/-     .10/.07/.05   .15/.13/.11    .20/.18/.16
160             .045/.02/-    .09/.06/.04   .13/.10/.09    .18/.15/.13
180             .04/.02/-     .08/.05/.03   .115/.09/.07   .16/.14/.12
200             .035/-/-      .07/.04/.02   .10/.08/.06    .14/.12/.10
The problem drinker
        •   Family, friends, you?
        •   CAGE
        •   Cut down
        •   Annoy anyone
        •   Guilty
        •   Eye-opener
        •   Repeatedly do stupid things
        •   Bring out the demons?
        Alcohol - how to die slowly
•   Liver disease
•   Stomach and esophagus
•   Pancreas
•   Brain atrophy
•   Bleeding problems
•   Trauma, injuries
•   Making bad choices
                Stimulants
• Examples - caffeine (oral), ephedrine (oral),
  cocaine (snorted, smoked, IV),
  amphetamine, (oral, SS,IV),
  methylphenidate (Ritalin)
• Tolerance - all
• Addiction - physiologic and psychologic
            Stimulants, cont.
• Effects - increased alertness, excitation,
  euphoria, increased pulse and BP, decreased
  appetite
• Overdose - agitation, fever, hallucinations,
  seizures, heart attack, death
• Withdrawal - severely depressed mood,
  prolonged sleep, apathy, irritability,
  disorientation
                  Opiates
• Examples - heroin (IV, smoked), opium
  (oral, smoked), morphine (oral, IV),
  codeine, etc. (oral), methadone (oral, IV)
• Tolerance - all
• Addiction - physiologic and
  psychologic
           Opiates, cont.
• Effects - euphoria, drowsiness, nausea,
  decreased respirations
• Overdose - clammy skin, constricted pupils,
  respiratory arrest, coma, death
• Withdrawal - watery eyes, runny nose,
  goose bumps, yawning, decreased appetite,
  nausea, chills and sweats, panic, tremor,
  cramps (“COLD TURKEY”)
               Cannabis
• Examples - marijuana (smoked, oral), THC
  (oral), hashish (smoked)
• Tolerance - all
• Addiction - psychologic, minimal
  physiologic
            Cannabis, cont.
• Effects - Euphoria, relaxation, loss of
  inhibition, increased appetite, decreased
  memory and attention.
• Overdose - can get panic attacks,
  hallucinations, paranoia
• Chronic effects - problems with short term
  memory, cognitive skills
• Withdrawal - rare, insomnia, hyperactivity
               Hallucinogens
• Examples - LSD, psilocybin, peyote, mescaline
• Tolerance - all
• Addiction - psychologic, minimal physiologic
• Effects - altered perception of body,
  hallucinations, visual illusions, increased
  emotions
• Overdose - prolonged episodes, psychotic states
• Withdrawal - none
               Ecstasy
• MDMA - “methylenedioxymethamphetamine”
• Early 1900’s used in psychotherapy
• Hallucinogenic stimulant
• Euphoria, enhanced mental or
  emotional clarity, “tingling”
  sensation, “love to be touched”
• Tablet, pill, powder $10-$30
• High 3 -4 hours (longer?)
Ecstasy side effects
          • nausea, vomiting, loss
            of appetite
          • blurred vision
          • anxiety, paranoia
          • seizures
          • dehydration
          • hyperthermia
          • coma and death
          • dumping of serotonin
            depression
                 Ketamine
• aka “special K”
• Veterinary anesthetic
• Effects - Relaxation, loss of sense of time and
  identity, hallucinations, visual distortion
• Adverse effects - delirium, amnesia, depression,
  tachycardia, respiratory depression
          PCP (Phencyclidine)
•   aka angel dust, to be “dusted”
•   Veterinary anesthetic
•   dissociative effects
•   Adverse effects - aggression, violence,
    panic, loss of appetite, decrease BP/HR
                    Rohypnol
• Date Rape drug (“roofies”, “roache”, etc.)
• Benzodiazepine - 10 times stronger than Valium
• Oral - “slipped in to a drink”, colorless, odorless,
  tasteless
• Effects - intoxicated, sleepy, sedated, blackouts,
  amnesia
• Adverse effects - rape, memory loss, respiratory
  depression, hallucinations
                      GHB
• Gamma-hydroxybutyrate. Depressant.
• Initially a weight lifting supplement.
• Date rape
• Oral - tablet, powder ,dissolved in liquid
  @$5.00 per dose
• Effects - start within 1 hr, lasts 1 to 3 hrs,
  euphoria, intoxication, disinhibition, sedation
• Adverse effects - nausea, vomiting, seizures,
  respiratory depression, coma
                     Inhalants
• Aerosols - paint, hair
                               • Sniffing, bagging,
  spray, whippets
                                 huffing
• Solvents - gasoline, glue,
                               • euphoria, intoxication
  paint thinner, nail polish
  remover, white out           • Bad for you!! Dizzy,
                                 headache, irregular
• Gases - nitrous oxide,
                                 heartbeat, sudden
  butane lighters
                                 death
• Nitrites - air fresheners,
                               • Can attach to fatty
  video head cleaners
                                 tissues causing brain
                                 and nerve damage

								
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