Escolar Documentos
Profissional Documentos
Cultura Documentos
Substance U
intoxication
jcpascual 2011
• Drugs presently available for use
and abuse:
alcohol;
amphetamine type stimulants ;
cannabis;
inhalants;
cough/cold preparations;
datura, mushrooms, areca;
sedative-hypnotics;
narcotics/analgesics and;
nicotine
(Pascual, 2000;Pascual, 2002; DDB, 2003)
nga-nga
Pinang,
Areca Nut
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ARECA NUT: Context of use
• Cultural meaning:
– Used in important ritual in restoring
harmony and peace between individuals or
within a community
• Stimulatory and euphoriant
effect *
* Herbal PDA, 2000; Weiss and Fintelmann, 2000
BETEL NUT
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BETEL NUT
• Arecoline: a cholinomimetic alkaloid
– A potent diaphoretic
– Stimulates the salivary, lacrimal, gastric, pancreatic,
intestinal and the mucosal cells of the respiratory tract
– Increases muscle tonus and muscle movement throughout
the body
• Mimics the action of acetylcholine in the body
– Slows the heart rate, constrict the pupils of the eyes
Shanon M., Herbal, tradittional and alternative medicine in Clinical Management of Poisoning an Overdose. Haddad,
Shanon and Manchester (eds) 2006
jcpascual 2011
Datura metel
(angel’s trumpet, talampunay)
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Datura metel
(angel’s trumpet, talampunay)
Shanon M., Herbal, tradittional and alternative medicine in Clinical Management of Poisoning an Overdose. Haddad,
Shanon and Manchester (eds) 2006
jcpascual 2011
Datura metel
(angel’s trumpet, talampunay)
• PLANTS
– Family Solanaceae: Genera Atropa, Datura, Hyoscyamus, Lycium, and
Solanum
– Principal alkaloids: solaninine, atropine and scopolamine
• PHARMACEUTICALS
– Antiparkinsonian agents: trihexyphenidyl and benztropine mesylate
(euphora and hallucinogenic effects):Have potent dopamine reuptake
inhibition with excess in dopamine (craving)
Shanon M., Herbal, tradittional and alternative medicine in Clinical Management of Poisoning an Overdose. Haddad,
Shanon and Manchester (eds) 2006
jcpascual 2011
2009
MUSHROOMS
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MUSHROOMS: Context of use
• Food
• Religious ceremonies
• Medication by herbal healers
• Substance of abuse
Shanon M., Herbal, tradittional and alternative medicine in Clinical Management of Poisoning an Overdose. Haddad,
Shanon and Manchester (eds) 2006
Aga, Shrooms
Amanita Muscaria
• Adverse effects:
– Dizziness, vomiting, abdominal pain, movement disorders, muscle cramps,
psychic stimulation, followed by deep sleep, confusion, mania,
unconsciousness, coma and, death*
JCPASCUAL 2009
Cannabis sativa and indica plants
Nicotine
• Chronic exposure:
increased nAChR (slower turnover of
desensitized receptors) > recovery
(desensitization) > hyperexcitable nicotinic system
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Alcohol and the Filipino
Culture
• Many Filipinos hang out together
in the streets, in front of their
houses and stores especially
among urban poor and rural
communities.
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• Confined to small scale production
due to influx and supremacy of
commercial drinks
Native Drinks
Source: Health Action Information Network, 2006
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2005 World’s Top 10 Spirits Companies. Impact (2005) Vol. 35, No.22.
Jinro
Stolichnaya
Tanduay
Kyoungwoul
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ALCOHOL
• Action on µ receptor sites in
the VTA
• Action on GABA receptors
resembles that of
benzodiazepines (increase in
GABA neurotransmission)
• Antagonist effect of some
receptors for the excitatory
neurotransmitter glutamate
(NMDA)
• Increase release of dopamine
in nucleus accumbens
• Stimulation of 5-HT receptors
(serotonin)
Koob G, Le Moal. Drug Addiction, dysregulation of reward, and allostasis. Neuropsychophramacology 2001; 24:97-129
Nutt D. Alcohol and the brain. Pharmacological insights for psychiatrists. Br J Psych 1999; 175:114-19
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Sedative-hypnotics
Rx
Opiates
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CL-
Cl- Binding Cl -
to GABA A receptor
Opening of
Chloride ion channels
GABA
BENZODIAZEPINE
Neuron hyperpolarization
RMP stabilization
Dampening of
Neuronal Excitability
Koob G, Le Moal. Drug Addiction, dysregulation of reward, and allostasis. Neuropsychophramacology 2001; 24:97-129 Nutt D. Alcohol and the
brain. Pharmacological insights for psychiatrists. Br J Psych 1999; 175:114-19
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CLUB DRUGS
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Cocaine
Methamphetamine
The Current Drug Scene
Designer drugs
Alcohol
Nicotine jcpascual 2011
Amphetamines:
1. Lit E. et al. The Epidemiology of Substance Use. In:Sourcebook of Substance and Addiction. Friedman L
and Fleming N. 2003
2. Kaufamn & Friedman,1996; Haut & Rovere, 1984) jcpascual 2011
Mechanism of Action
CH2 CH NH2
CH3
Amphetamine
CH2 CH NH
CH3 CH3
Methamphetamine
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club drugs
Ketamine
– K, Special K, Vit K, Cat valiums
– High doses:
delirium, amnesia, impaired motor
function, respiratory depression
- Low doses:
impaired attention, learning ability
and memory
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club drugs
Ecstasy
(3,4- methylenedioxy-n- methylamphetamine)
– XTC, X, E, Adam, Clarity, Lover’s
Speed
– Euphoria, comfort, empathy
HR and BP,cognitive impairment
Cocaine (benzoylmethylecgonine)
– Mood elevating
– High doses: irritability, psychosis,
seizure, unconsciousness, coma
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WHY DRUGS?
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Effects of Drugs
“Intoxication”
“Withdrawal”
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Epidemiology of Use
Initiation of Use
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Epidemiology of Use
Initiation of Use
Gail C et al. The Epidemiology of Substance Use. In:Sourcebook of Substance and Addiction. Friedman L and Fleming N. 2003
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Popular Culture
Wyszynski A, Yu V.: Patient using steroids, Manual of Psychiatric care for the
Medically Ill. Am Psych Press 2005
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DRUGS OF ABUSE:
Sought After Effects
– weight reduction
– anti-fatigue, activity – sustaining effect
– performance enhancing effects
Lit E. et al. The Epidemiology of Substance Use. In: Sourcebook of Substance and Addiction. Friedman L
and Fleming N. 2003
jcpascual 2011
DRUGS OF ABUSE:
Sought After Effects
• Marked individual differences
– Relief of anxiety
– Intoxication and relaxation
– Alertness
– Mood elevation
“Some individuals who use drugs in ordinary
circumstances eventually increase their dosage to
develop misuse”
Lit E. et al. The Epidemiology of Substance Use. In: Sourcebook of Substance and Addiction. Friedman L
and Fleming N. 2003
jcpascual 2009
Epidemiology of Use
Categories of Use
• Those who inject intravenously or smoked “ICE”
Gail C et al. The Epidemiology of Substance Use. In:Sourcebook of Substance and Addiction. Friedman L and Fleming N. 2003
jcpascual 2011
Drug, drugs and drugs:
Polysubstance use
• Self-detoxification
• Stimulants: Benzodiazepines and alcohol taken to
alleviate stimulant withdrawal
• Alcohol: to modulate and enhance effects
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Deliberate Self-harm
The Medical paradigm in Substance
Use, Misuse and Dependence
• Anxiety
• Depression
• Psychosis
Stahl S., Essential Psychopharmacology of Antipsychotics and Mood Stabilizes,
Cambridge University Press, 2002.
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Basal ganglia
Nigrostriatal
Dopamine pathway
Mesolimbic
dopamine pathway
Mesocortical
Substantia Dopamine pathway
nigra
Hypothalamus
Tuberoinfundibular
Dopamine pathway
m
ntu
The dopaminergicNA
pathways of
meg
Te
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AMPHETAMINE
↓D2
mesolimbic system,
receptor levels
(withdrawal, early abstinence up to
4 months) (Volkow et al., 2003)
1. Lingford-Hughes A, Nutt D. Neurobiology of addiction and implications to treatent. B J Psychiatry 1999; 175: 114-119.
2. Schultz W. Reward signaling by dopamine neurons. Neuroscientist 2001;7:293-302.
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Use
Continued drug use
Recreational use to ward off pscyhological and
and Reward physical symptoms
(Dependence)
Tolerance
(adaptive processes in the brain
The Downside of Withdrawal
Drug use
that diminishes the effects of (Unpleasant symptoms)
drug)
Unopposed
Abstinence Compensation Process
Adaptations
(sensitization, craving,
cues)
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• Associated trauma
• Overdose (accidental, suicidal)
• Panic reaction ( “bad trip” ) or significant intoxication
• Inappropriate behavior
• Drug-seeking behavior (withdrawal)
• “Coerced” by the legal system
Reasons for nt y er
into Health System
emergency
Gail C et al. The Epidemiology of Substance Use. In:Sourcebook of Substance and Addiction. Friedman L and Fleming N. 2003
jcpascual 2011
Specific symptoms encountered with
Recreational Substance Use
Disorientation
Confusion
Destructive and assaultive behavior
Depression
Hallucinations
Delusions
Trauma
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Recognition of Problem
• History
• Questionnaires
• Biological markers
• Toxidrome
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General Approach
TOXICOLOGY
• Emergency emer
stabilization gency
e• m e revaluation
Clinical g e n c y
• Elimination of the drug/drugs
e m e r
• Excretion of the absorbed drug/drugs
• Administration of antidotes and/or pharmacotherapy
• Supportive therapy and observation
e m e r g e n c y
• Disposition er
e m e r g e n c y
TOXICOLOGY
e m e r g e n c y jcpascual 2009
Intoxication and Overdose
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Intoxication and Overdose
• emergency stabilization:
– airway obstruction, breathing difficulties,
circulatory inadequacies, drug-induced CNS
stimulation or depression, electrolyte or metabolic
abnormalities
• Establish etiology
– general management: Diazepam 5 mg IV for agitation,
restlessness or seizures
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Intoxication and Overdose
DETOXIFICATION
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Intoxication and Overdose
•
psychic agitation: – Diazepam 5 mg oral/parenteral
–1st generation antipsychotic: Haloperidol 2 mg deep im
–2nd generation antipsychotic: Olanzepine 5 mg deep im
Risperidone quicklet SL
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Intoxication and Overdose
• Basic
suicide precautions (physical restraints)
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CLINICAL ISSUES
with drug use
• Single drug or a mixture?
TOXICOLOGY
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LONG-TERM ISSUES
with drug use
• Psychological deterioration
• Psychosocial deterioration
TOXICOLOGY
PSYCHIATRY
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REAL ISSUES
with recreational drug Use
• returning to environment associated with previous substance
use after many years of abstinence can induce withdrawal
symptoms and initiate drug taking behavior, especially if the
reformed user is under STRESS;
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CONCLUSION
The DOWNSIDE
of recreational drug use
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The DOWNSIDE
of substance Use, Misuse and Dependence
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The DOWNSIDE
of drug use
• Theories of addiction have mainly been developed from
neurobiological evidence and data from studies of
learning behaviours and memory
mechanisms.
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The DOWNSIDE
of recreational drug use
• This session discussed substance abuse as well as the
dangerous side effects of recreational use, some of
which are irreversible.
jcpascual 2009
THANK YOU