Abuse Of Rx And Otc

Substance Abuse

Dependence• Psychological

• Feelings of satisfaction and pleasure.

• Physical• Physiological adaptation to chronic use, so

that unpleasant symptoms occur when the drug is stopped, or antagonized by another drug or dose decreased.

• Tolerance requires increasing doses to obtain psychological effects or avoid physical withdrawal symptoms.

• Drug effects vary according to the type of substance being abused, the amount, route of administration, duration of use and phase of substance abuse.

• Acute intoxication produces profound behavioural changes.

• Chronic abuse often leads to serious organ damage and impaired ability to function.

• Withdrawal symptoms are usually opposite of the effects originally produced.

• Smoking and inhaled drugs like marijuana, cocaine, and nicotine are absorbed rapidly.

• IV abusers face serious risk because of impure drugs, OD, poor needle hygiene, and infections.

Ethanol• Profound metabolic and physiologic

effects on all organ systems.• ETOH is lipid soluble and crosses cell

membranes easily.• Excited behaviour may occur

because of depression of the cerebral cortex, which normally controls behaviour. Talkative, relaxed, outgoing, impulsive and aggressive because inhibitions have been lessened.

ETOH and Medications• CNS depressants

• Excessive sedation, resp depression

• Anti-hypertensives• Potentiates vasodilation and hypotension.

• Oral anti-diabetic drugs• Potentiates hypoglycemic effects

• Oral anti-coagulants• Increased bleeding

• Ranitidine• Peak ETOH level 34% increase

• Disulfiram, Flagyl, Nizoral, Orinase, Diabinese• Distress-tachycardia, bronchospasm, n &v

• Epival• Potentiate intoxicating effects

ETOH dependence• Acute or chronic to the extent that

physical health and relationships are impaired.

Created by Amanda McBride 11

Prescription Drug Abuse


Commonly Abused Rx•Opioids•CNS depressants•Stimulants


Opioids•Rx for pain relief, cough, and diarrhea•Attach to opiod receptors in the brain, spinal cord and GI tract•Cause euphoria by affecting the brain regions that mediate what we perceive as pleasure


How they work•Attach to specific proteins called opioid receptors, found in the brain, spinal cord and GI tract•Can be snorted, injected, and ingested


Consequences•Tolerance•Physical dependence and addiction•Risk of OD


Symptoms of withdrawal•Restlessness•Muscle or bone pain•Insomnia•Diarrhea•Vomiting•Cold flashes•Involuntary leg movements•Seizures

Treatment for Opioid dependence

• Clonidine used to relieve withdrawal symptoms associated with excessive stimulation of the SNS.

• Methadone works by suppressing the chronic craving for narcotics, without developing tolerance. May block euphoria, acts longer, and reduces preoccupation with drug use.

• Narcan• Opiate antagonist, occupies receptor sites.



CNS depressants• Slow brain function• Treat anxiety and sleep disorders• Barbiturates, Nembutal• Benzodiazepines, Valium, Librium,

Xanax• General anesthetics


How they work• Increase neurotransmitter GABA• GABA works by decreasing brain

activity• Produces a drowsy or calming effect,

beneficial to those suffering anxiety or sleep disorders


Consequences• Tolerance• Physical dependence and addiction• Risk for OD• Withdrawal, the brains activity can

rebound and race out of control, potentially leading to seizures

Benzodiazepine Withdrawal• Gastrointestinal Abdominal pains, cramps, diarrhea, bloated, diarhea, constipation, cramping, Dry throat, Dyspepsia

(indigestion) jaw/mouth/head Aching or painful jaw, dental/tooth pain, band around head, Bruxism (teeth grinding), Dysphagia (difficulty eating or swallowing), Increased or decreased saliva, Painful or tingling scalp, pains in temple, migraine, severe headaches, twitching of the head joints/muscles Aching joints, aching muscles, shaking. myoclonic jerks, severe muscle rigidity Behaviour Aggressive behaviour, Agitation, Hyperactivity, hysterical or inappropiate laughter, Irrational rage, Irritability, obsessive behaviour Phobia's Agoraphobia, fear of being alone, fear of insanity, fear of losing control, fear of water, monophobia (fear of being alone) Allergic reactions hayfever, rash, blotches on skin Anxiety Anxiety, Dyspnea (breathing difficulty), Fear, feelings of impending doom, Nervousness, Panic attacks, thoughts and feeling that you are dying emotions Apathy, Hostility, Rapid mood changes, unusually sensitive (unable to watch the news on television or read the newspaper) Depersonalisation arms and legs feel detached from body, feel like you don't exist, look strange/unfamiliar in the mirror Urinary Tract System Bladder incontinence, Bleeding between menstrual cycles, urinary frequency and urgency, (continence or incontinence) eyes/vision Blepharospasm (eye twitches), Blurred vision, seeing spots/flashes of light, vivid vision, double vision, dilated pupils, rapid eye blinking, waves, sparks and perceptional disturbances body feels like jelly, objects appear to be leaning, distortions and inanimate objects moving, feeling of the ground moving, hypersensitivity to light, sound, touch and other stimuli, sensation of brain moving within the skull, feelings of extreme cold or hot, itching Respiratory System Breathing difficulties, breathlessness, hyperventilation (overbreathing) Sensorary Burning, electrical shocks, Balance clumsiness, Dizziness, Gait disturbance, Lack of co-ordination, Loss of balance, vertigo Appetite Increased or decreased appetite, extreme thirst, Rapid weight loss, nausea, vomiting Mental status changes Delirium, confusion, psychosis, disorientation, hallucinations (auditory, tactile, visual), Dysphoria (inability to feel pleasure or happiness), Excitability, Paranoia Depression suicidal thoughts, negative thinking, lack of hope for teh future, early morning waking Derealisation Feelings of unreality Skin itching, tingling, burning, electrical sensations Peripheral Nervous System Electric shock feelings, Burning sensations, numbness, altered sense of touch, nerve pain, neuralgia, Paraesthesia, Pins and needles Energy levels Extreme lethargy, Flu-like symptoms, tiredness, energyless Hallucinations feelings of worms under scalp, Formication (sensations of bugs crawling on skin), fuzzy feeling in head (tactile hallucinations), Memory/Cogitive function flashbacks, impaired memory, inability to comprehend the simplest things, inability to cope with a lot of information, Lack of concentration, amnesia, short-term memory impairment, Speech difficulties Heart Fluctuations in blood pressure, Heart palpitations, Heartburn, heavy pounding heart, Mild hypertension (See doctor about these symptoms to be on safe side) Nervous system responses Hyperreflexia (Exaggeration of reflexes.) Sleep disorders Hypnogogic hallucinations (usually auditory of a single loud voice or bang as drifting off to sleep), Insomnia, Nightmares, restless legs in bed Sexual Impotence, Libido disturbances (usually decreased sex drive rarely increased) Body neck and shoulder pain, Loss of control of the movement, Muscle spasms, Muscular aches and pains, muscular rigidity, pains in neck and shoulders, perspiring, night sweats, severe sweating, Pseudo-Multiple sclerosis (Medically documented cases of misdiagosed MS who have recovered after withdrawal), Tremor, feeling of inner vibration, shaking (occasionally epileptic seizures from abrupt withdrawal from high doses) Speak to doctor if you suffer seizures these can sometimes endanger life! Personality Severe changes in personality, loss of interest in people and things, loss of self respect, total loss of confidence, vulnerable personality Taste and appetite Loss of taste or metallic taste, reduced or increased appetite, nausea, vomiting, weight loss or gain Female problems Menstrual irregularities, Menstrual problems (painful periods, irregular periods, cessation of periods) Thought problems Morbid thoughts, Obsessions or obsessional repetative thinking, Persistent, unpleasant memories, suicidal feelings (see doctor if you feel you will act on them) Motor System Restlessness, Shaking Hearing Altered sense of sound (Louder or distorted), Tinnitus (buzzing or ringing in the ears)


http://www.benzo.org.uk/asholdm.htm

• Resembles ETOH dependence in symptoms of intoxication and withdrawal.

• Physical and psychological dependence.

• Tolerance and cross-tolerance.• Seizures are more likely to occur

during the 1st 48 hours of withdrawal and delirium after 48-72 hours.


Treatment for dependence.• Anexate

• Reverses sedation, coma, and resp depression.

• Competes with benzos for receptor sites.

• Short duration of action.• May precipitate acute withdrawal in

abusers.• Withdrawal can be life-threatening,

cardiovascular collapse, tonic clonic seizures, acute psychotic episodes.



• Haldol can lower seizure threshold




Stimulants•Enhance brain activity•Increase alertness, attention and energy•Elevate BP, HR, RR•Narcolepsy•ADHD•Depression, that has not responded to other tx•Ritalin, Dexedrin•Methamphetamine, cocaine.


How they work•Increase norepinephrine and dopamine•Increases BP, HR, constricts blood vessels, increases blood glucose and opens resp pathways•Increase Dopamine is associated with a sense of euphoria

• Large amounts may cause psychosis.• Psychosis is a psychiatric condition that causes a

person to lose his or her sense of reality. People with psychosis have hallucinations, delusions, or disorganized thinking that cause them to lose touch with reality. Someone who is psychotic may hear voices that no one else can hear, or perceive threats that are not real. Psychosis can be very disturbing when it happens to someone you know and care about. The person might not acknowledge that anything is wrong, and may resist efforts to help.

• The use or withdrawal of drugs and alcohol can cause intense visual hallucinations and confusion. Symptoms usually come on suddenly and may disappear once the intoxicating effect of the substance has worn off.


Cocaine• Physical effects of crack use include constricted

blood vessels, dilated pupils, and increased temperature, heart rate and blood pressure. Users may also experience feelings of restlessness, irritability, and anxiety, which can lead to a period of paranoid psychosis, particularly after bingeing.

• Other complications associated with cocaine and crack use are heart attack, respiratory failure, stroke, seizure, and gastro-intestinal problems.

• In addition, many crack users are malnourished as a result of the appetite suppression caused by

the drug.


Treatment• Not physical dependency.• May experience hyperactivity,

agitated, hallucinations, tachycardia, fever.

• Symptomatic.•Sedation•Lowering body temp•Anti-psychotic meds


Nicotine• When a person inhales cigarette smoke, the nicotine in the smoke

is rapidly absorbed into the blood and starts affecting the brain within 7 seconds. In the brain, nicotine activates the same reward system as do other drugs of abuse such as cocaine or amphetamine, although to a lesser degree. Nicotine's action on this reward system is believed to be responsible for drug-induced feelings of pleasure and, over time, addiction. Nicotine also has the effect of increasing alertness and enhancing mental performance. In the cardiovascular system, nicotine increases heart rate and blood pressure and restricts blood flow to the heart muscle. The drug stimulates the release of the hormone epinephrine, which further stimulates the nervous system and is responsible for part of the "kick" from nicotine. It also promotes the release of the hormone beta-endorphin, which inhibits pain.

• People addicted to nicotine experience withdrawal when they stop smoking. This withdrawal involves symptoms such as anger, anxiety, depressed mood, difficulty concentrating, increased appetite, and craving for nicotine. Most of these symptoms subside within 3 to 4 weeks, except for the craving and hunger, which may persist for months


Nicotine Dependence• Physical dependence characterized by

compulsive use and tolerance.• Mental depression associated with

dependence.• Withdrawal

• Anxiety• Irritability• Restlessness• Headache• Increased appetitie• Weight gain• Sleep disturbances


Treatment• Wellbutrin• Nicotine replacement

• Contraindicated in CVS disease.


Hallucinogenics


Marijuana• Hash 5-10x more potent than leaves

and stems.• THC main psychoactive compound.• Marinol is Rx• Marihuana Medical Access

Regulations deal with medical use. Severe pain, nausea from cancer, HIV.

• Treatment• Psychological dependence with tolerance.• Abstinence


LSD• Action unknown, very potent.• Alters sensory perceptions and thought

processes, impairs intellectual functions, such as memory, problem solving, time and space.

• Produces sympathomimetic reactions, increased BP, HR, temp.

• Suicide, psychotic episodes, flash backs, birth defects.

• Tolerance develops and psychological dependence.

• Abstinence.Created by Amanda McBride 37

Inhalants• High rate of abuse in First Nation and

Inuit populations.• Symptoms like acute ETOH intoxication.

May include hallucinations, recklessness, and loss of control.

• Large doses may cause seizures, coma and death.

• Substances containing gasoline, benzene, or carbon tetrachloride can cause serious damage to liver, kidneys, and bone marrow.

• Psychological dependence and tolerance.Created by Amanda McBride 38

Harmful irreversible effects that may be caused by abuse of specific solvents include:

Hearing loss—toluene (spray paints, glues, dewaxers) and trichloroethylene (dry-cleaning chemicals, correction fluids. Peripheral neuropathies, or limb spasms—hexane (glues, gasoline) and nitrous oxide (whipped cream dispensers, gas cylinders) Central nervous system or brain damage—toluene (spray paints, glues, dewaxers) Bone marrow damage—benzene (gasoline) Serious but potentially reversible effects include: Liver and kidney damage—toluene-containing substances and chlorinated hydrocarbons (correction fluids, dry-cleaning fluids) Blood oxygen depletion—aliphatic nitrites (known on the street as poppers, bold, and rush) and methylene chloride (varnish removers, paint thinners)



Consequences•Addictive/compulsive•Frequent high doses can lead to hostility and paranoia•High body temperature•Irregular heartbeat•Cardiovascular failure •Lethal seizures•Withdrawal can lead to depression, sleep disturbances


Trends•Older adults•Adolescents•Women•Health care professionals


Preventing Abuse•Screening•Documentation•Teaching•Referral to support groups•Rehab•Social work•Therapy•Effective treatment of pain, depression, anxiety.•Education


Treating addiction• Detoxify• Methadone• Cognitive and behavioural therapy• Narcan• Support groups• Medical supervision


Drugs that are self-administered by lab animals

• alcohol • amphetamine • barbiturates • caffeine • cocaine • nicotine • opiates e.g. morphine • phencyclidine (PCP) • THC (active component in marijuana) •


OTC Abuse• Cough suppressants,

dextromethorphan• Sleep aids, Unisom• Anti-histamines, Benadryl• Dimenhydrinates, Gravol• Coupled with alcohol can produce

dangerous effects• Laxatives• Ephedra, diet supplements, energy

booster


Who abuses • Mentally ill• Physical, psychological abused• Chronic and acute pain sufferers• Elderly

Date post:	18-Dec-2014
Category:	Health & Medicine
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Abuse Of Rx And Otc

Health & Medicine