DRUGS OF ABUSE

-GUIDED BY LAXMI MAM-PRESENTED BY ROOPA(170611881010)

CONTENTSINTRODUCTIONDEFINITIONSCLASSIFICATION OF ABUSED DRUGSSYMPTOMSSINGS OF USE & DEPENDENCEPHARMACOLOGICAL EFEECTSTHERAPEUTIC USESADVERSE EFEECTSTREATMENTCONCLUSIONREFERANCE

DRUGA drug is a substance (natural or synthetic) when taken into the living-organism, may modify one or more of its function.

INTRODUCTIONDRUG ABUSEDRUG ABUSE is the persistent (continual) (or) sporadic (random) excessive drug use inconsistent with , (or) unrelated to medical practice.Drug abuse goes well beyond mere misuse of drugs.

FACTORS WHICH FACILITATE INTIATION OF DRUG ABUSEReady availability of drug as in case of doctor & medical students.General public acceptance of the use of mood modifiers such as alcohol.Increasing mobility particularly of youth.Peer group pressure.An abundance (plenty) of information about drug effects & sources.Lack of adequate publicity given to harm full effects of these agents.Unstable (or) broken homes , socioculture pressure & social ills.

A POTENTIAL ADDICTION MAY START & CONTINUE TAKING A DEPENDENCE INCLUDING DRUGFollowing its medicinal use.To achieve a sense of relief from stress & tension of life.To satisfy curiosity about drugs effects. To achieve a sense of belonging , to be accepted by others in the group.To express hostility(or) independence.To have pleasurable

DRUGS OF ABUSE MAY BE GROUPED INTO

PRESCRIPTIVE DRUGSThese drugs are used therapeutically for their beneficial effects & are available on a physicians (legal substances) prescription.The same drugs can be abused by vulnerable individuals.EG :AMPHETAMINE, ANALGESIC,ANXIOLYTICS,BARBITURATES,BZD,NON_BARBITURATES,SEDATIVES_HYPNOTICS,STEROIDS &TRANQUILIZERS.

PERMISSIVE DRUGSThe use of these drugs is generally permitted by the society as almost a norm(standard).Eg :caffeine , nicotine , ethyl alcohol..CAFFEINE:TEA,COFFEE,COLA BEVERAGES.NIOCOTINE:SMOKING,CHEWING,INTRA NASAL ADMINISTRATION.ETHYL ALCOHOL:Readily available in a great variety of beverages to adults in unlimited quantities.

PROSCRIPTION DRUGSThose drugs which have been placed under street drug control to avoid their illicit(or)illegal use.Some of the medically used drugs like :OPIOIDS , SEDATIVES ,STIMULANTS.when these drugs used for non medical purposes belong to the proscriptive group of drugs.In addiction , marihuana & other hallucinogens like LSD(lysergic acid diethylamide) which have no established medical use belong to these group.

DRUG DEPENDENCEIt is a state, PSYCHIC & sometimes also PHYSICAL , now denoted as DEPENDENCE ,characterized by behavioral and other responses include a compulsion to take the drug.HABITUATIONIt is a pattern of repeated drug usage ,although the actual physical need for the drug is minimal.TOLERANCEIt describes the reduced effect of a drug resulting from repeated exposure to a similar drug. ADDICTION It refers to compulsive drug usage ,the necessity of obtaining the drug at any cost ,and appearance of withdrawal symptoms if the drug is unavailable.DRUG MISUSEThis term refers to improper use of medicines in a way that can lead to acute and chronic toxicity

It is a state , psychic & sometimes also physical, resulting from the interaction between a living-organism & a drug, characterized by behavioral & other responses that always induce a compulsion to take the drug on a continuous or periodic basis in order to experience its psychic effectsAbsents of the drug impairs the ability of the person to function in a socially acceptable manner.Two distinct types of dependence psychological(psychic) dependence.Physical dependence.DRUG DEPENDENCE

PSYCHOLOGICAL (PSYCHIC) DEPENDENCEIt denotes the compulsive need to experience a pleasurable drug reaction , ranging from a mild desire for the drug to an over whelming(across the goal edge) need to have the drug at any costThe psychic drive requires periodic or continuous use of the drug to produce pleasure or to avoid discomfort.

PHYSICAL DEPENDENCEIt is an altered physiological state resulting from prolonged use of a drug , & regular usage becomes necessary to avoid intense physical disturbances manifested as the withdrawal (or) abstinence syndrome.Withdrawal reactions are often (over and over again) severe (dangerous depending) on the drug & duration of use.Physical dependence is usually associated with tolerance.

classification of abused drugs

TypeExampleDependence LiabilityOpioidsMorphineDiamorphineMethadoneOxycodoneVery StrongVery StrongVery StrongVery StrongGeneral CNS DepressantsEthanolBarbituratesGENERAL ANAESTHETICS (E.G. No2 , Propofol )KetamineSolventsStrongStrong

ModerateModerateStrong

TYPEEXAMPLEDependence LiabilityAnxiolytics & Hypnotics DrugsBZDGHBModerateProbably ModeratePsychomotor StimulantsAmphetaminesCocaineMDMA (Ecstasy)Nicotine StrongVery StrongWeak or absentVery StrongPsycomimetic agents LSDMescalineCannabis Weak / absentWeak /absentWeak

TOOLS USED IN DRUG COSUMPTION

DRUG ADDICTION SYMTOMS/BEHAVIORSDrug addiction symptoms or behaviors include:

Feeling that you have to use the drug regularly - this can be daily or even several times a dayFailing in your attempts to stop using the drugMaking certain that you maintain a supply of the drugSpending money on the drug, even though you can't afford itDoing things to obtain the drug that you normally wouldn't do, such as stealingFeeling that you need the drug to deal with your problemsDriving or doing other risky activities when you're under the influence of the drugFocusing more and more time and energy on getting and using the drug

Marijuana and hashish

Signs of use and dependence can include:A heightened sense of visual, auditory and taste perceptionPoor memoryIncreased blood pressure and heart rateRed eyesDecreased coordinationIncreased appetiteSlowed reaction timeParanoid thinkingDifficulty concentrating

Barbiturates & benzodiazepines

Signs of use and dependence can include:

DrowsinessSlurred (confused) speechLack of coordination (management)Memory problemsConfusionSlowed breathing and decreased blood pressureDizzinessDepression The signs and symptoms of inhalant use vary depending onwhat substance is inhaled. Some commonly inhaled substances include glue,paint thinners,correction fluid,felt tip marker fluid, gasoline, cleaning fluids &household aerosol products.When inhaled, these products can cause brief intoxication &a decreased feeling of inhibition.Long-term use may cause seizures anddamage to the Brain ,liver and kidneys.Inhalant use can also cause death.Inhalants...

Methamphetamine, cocaine & other stimulantsSigns of use and dependence can include:EuphoriaDecreased appetiteRapid speechIrritabilityRestlessnessInsomnia (Sleeplessness)Paranoia (Fear)Weight lossDepression as the drug wears offNasal congestion and damage to the mucous membrane of the nose in users who snort drugsIncreased heart rate, blood pressure and temperature

Narcotic painkillersSigns of narcotic use and dependence can include:

Reduced sense of painSedationDepressionConfusionConstipationSlowed breathingNeedle marks (if injecting drugs)

ADVERSE EFFECTS OF DRUG ABUSERSDamage gums & teethStained nails & fingersHair fallPsoriasisEye wrinklesBrittle bonesAge spotsLines & wrinkles around the lipsSagging arms & breastsUneven skin tones

THE DIFFERENCE BETWEEN HEALTHY & DRUG ABUSER BRAIN

DRUGS THAT ACTIVATE G PROTEIN-COUPLED RECEPTORSNAMEMAIN MOLECULEPHARMACOLOGYEFFECT ON DOPAMINE (DA) NEURONSRR2OpioidsMu-OR (Gio)AGONISTDISINHIBITION4CannabiniodsCB1R (Gio)AGONIST

DISINHIBITION

2Gamma hydroxybutyric acid(GHB)GABAbR (Gio)WEAK AGONISTDISINHIBITION

?LSD , Mescaline , Psilocybin5_HT2aR (Gq)PARTIAL AGONIST

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Mu_OR = mu Opioid receptor;CB1R = Cannabiniods-1;5_HTxR = serotonin receptor;

DRUGS THAT BIND TO IONOTROPIC RECEPTOR & ION CHANNELSNAMEMAIN MOLECULEPHARMACOLOGYEFFECT ON DOPAMINE (DA) NEURONSRR2NICOTINEnAChR (a2 b2)AGONIST

EXCITATION , DISINHIBITION(?)4ALCOHOLGABAaR , 5_HT3R , nAChR , NMDAR , Kir3 channel_EXCITATION , DISINHIBITION (?)3BZDGABAaR +VE MODULATORDISINHIBITION

3PHENCYCLIDINE , KETAMINENMDARAGONIST

_1

Kir3 channel = G protein-coupled inwardly rectifying potassium channels;RR2 = Relative risk of addiction; 1 = non addictive; 5 = highly addictive.NMDAR = N_methyl D_aspartate receptor ;

RR2 = Relative risk of addiction; 1 = non addictive; 5 = highly addictive.DAT = dopamine transporter;SERT = serotonin transporter;VMAT = vesicular monoamine transporter.DRUGS THAT BIND TO TRANSPORTERS OF BIOGENIC AMINESNAMEMAIN MOLECULEPHARMACOLOGYEFFECT ON DOPAMINE (DA) NEURONSRR2COCAINEDAT , SERT , NETINHIBITORBlocks DA uptake5AMPHETAMINEDAT , NET , SERT , VMAT

REVERSES TRANSPORTBlocks DA uptake , synaptic depletion 5ECSTASYSERT> DAT, NET

REVERSES TRANSPORT

Blocks DA uptake, synaptic depletion?

TREATMENT FOR DRUG ABUSER

Psychedelic Addiction Therapy:

In the past, doctors used a shotgun approach to treating drug addiction. They were willing to try anything to get their patients to kick the habit, even things that would seem pretty crazy today. For example, in the 1950s and 1960s, drugs like LSD were used experimentally, In an attempt to treat .Alcoholism and other addictions.

Addiction Treatments Past and Present:

In the past, society viewed drug addiction as a moral flaw. Popular "treatments" involved imprisonment, sentencing to asylums (withdraw) and church-guided prayer. Not surprisingly, these methods were generally ineffective.Today we understand that addiction is a brain disease characterized by fundamental and long-lasting changes in the brain. Modern treatments are based on scientific research. Treatment is tailored to the individual and typically involves a combination of drug and behavioral therapy. Today's methods are very effective, with 40-70% of patients remaining drug-free.

Victorian-era treatments for alcoholism wereoften both ineffective and inhumane.EARLER TREATMENTThe idea of using hallucinogenic drugs to treat drug addiction was abandoned as the drugs themselves became illegal. However, addiction treatment with hallucinogens is experiencing a renaissance (recovery) with the increasing popularity of Ibogaine therapy. Ibogaine is derived from a root used in an African religion to visit the ancestors. Although illegal in the US, some 20 or 30 Ibogaine clinics are in operation worldwide, primarily to treat heroin addiction. Ibogaine is thought to rewire (Analyses) the addicted brain as the patient undergoes the intense multi-day treatment. Ibogaine is very controversial for many reasons, including the occurrence of fatal heart arrhythmia in some patients.

Ibogaine RootTREATMENT OF DRUG ABUSERS INVOLVE FOLLOWING DRUGS(used now-a-days)

Relationship between the Immediate & Delayed effects of Drug taking & Drug withdrawalDRUG-TAKINGDRUG-WITHDRAWALSTATE PRODUCEDEffectMechanismReward Tolerance , dependenceWithdrawal syndromeCraving Activation of mesolimbic DA pathway ?other reward pathwaysAdaptive changes in receptors, transporters,2nd messengers,etc. (e.g. Adenylyl cyclase,DA transporter)Not knownUncompensated adaptive changes (e.g. DA , glutamate )

TREATMENT

CONCLUSIONToday no single pharmacological treatment (even in combination with behavioral interventions) efficiently eliminates addiction.Although its cellular mechanism is unclear , data in rodents (mammals of the order Rodentia) convincingly demonstrate that this compound can reduce self administration in nave (inexperienced) as well as in drug-experienced animals.

REFERANCEBASIC & CLINICAL PHARMACOLOGY 10th edition by BERTRAM G & KATZUNG.ESSENTIALS OF PHARMACOTHERAPY-by F.S.K BARAR.PHARMACOLOGY & PHARMACOTHERAPY-by SATOSKAR , NIRMALA N.REGE & S.D BHANDARKAR.7th edition RANG & DALES PHARMACOLOGY (INTERNATIONAL EDITION)-by ELSEVIER , CHURCHILL , LIVING STONE.INTERNET.

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