Augustina D. Abelardo, MD, Dr. J. PascualFPSP, MIAC
Patho 1
211 OS 215
3
Psychiatry Reproduction and Hormonal Regulation
Lec 2A: Pathology of the Female Genital Tract (Vulva and Vagina)
Substance Abuse \OUTLINE II. III. Introduction Substances Abused
Why Drugs? Epidemiology of Use: Initiation of Use Epidemiology of
Use: Categories of Use Dopaminergic Pathways of the Brain
CONCLUSION: The DOWNSIDE of Recreational
EXAM
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reported as a way to elicit the psychoactive effects of the EXAM
excreted muscimol). Datura metel (angels trumpet, talampunay)
Common uses and properties: Asthma Adverse effects: Hallucinogenic,
anticholinergic effects 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) Note that as dopamine
increases, acetycholine decreases; this stimulates the brains
pleasure center, causing the high
I.
Introduction
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3.4 million Filipino illeicit drug users (2002) 8,189 admissions
(2003)
Discrepancy in the incidence and admissions underscores the
possibility of addressing the magnitude of the problem at the tip
of the iceberg. Drugs presently available for use and abuse:
Alcohol Amphetamine type stimulants (Ritalin for ADHD) Cannabis
Inhalants (rugby) Cough/cold preparations Datura, mushroons, areca
Sedative-hypnotics Narcotics/analgesics Nicotine II. Substances
Abused
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Cannabis sativa and indica plants Alleged anti-emetic,
anti-convulsant, anti-anxiety, analgesic, anti-inflammatory
properties. The Misuse of Drugs Act 1971 Cannabis oil (class A)
Cannabis resin or grass (class B) Nicotine
Pinang, nga-nga (Areca Nut) Cultural meaning: Used in important
ritual in restoring harmony and peace between individuals or within
a community Common uses and properties: Stimulant and euphoriant
effects
Causes teeth to turn black-brown and strains the tongue and oral
mucosa Use has been associated with oral cancer Arecoline: a
cholinomimetic alkaloid A potent diaphoretic Stimulates the
salivary, lacrimal, gastric, pancreatic, intestinal and the mucosal
cells of the respiratory tract Increase 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
Aga, Shrooms (Amanita Muscaria) Context of use: Food Religious
ceremonies Medication by herbal healers Substance of abuse Adverse
effects: Dizziness, vomiting, abdominal pain, movement disorders,
muscle cramps, psychic stimulation, followed by deep sleep,
confusion, mania, unconsciousness, coma and, death Contain
cholinergic alkaloid muscarine (structurally similar to
acetylcholine) Many cases of poisoning occur in individuals who
deliberately seek and ingest the mushroom for its hallucinogenic
properties (purposeful ingestion of urine from people who have
eaten these mushrooms has been
Effects mediated through nicotinic cholinergic receptors
(nAChRs) in the brain. Important areas include the ventral
tegmental area (VTA) and the nucleus accumbens (NA), considered as
the pleasure centers. Exposure results to activation then
desensitization of nAChR > tolerance Chronic exposure: -
Increased nAChR (slower turnover of desensitized receptors) >
recovery (desensitization) > hyperexcitable nicotinic system -
1st cigarette: most pleasurable Nicotine releases Dopamine -
Pleasure, appetite suppression Norepinephrine - Arousal, appetite
suppression Acetylcholine - Arousal, cognitive enhancement
Vasopressin - Memory improvement Serotonin - Mood modulation,
appetite suppression Beta-endorphins - Reduction of anxiety and
tension Alcohol Beer: still a favorite among Filipinos Accounts for
15% of the Philippines 4 billion-bottlesa-year market. Native
Drinks Confined to small scale production due to influx and
supremacy of commercial drinks Lambanog (coconut wine) Tapuy (rice
wine) Basi (sugar cane wine) Tuba (palm wine) The impact databank,
a US alcoholic beverage research firm, cited the Filipinos as the
worlds top gin drinker.
Casti, Franco, Migz, Lance
WED, 19 Dec. 2011
Page 1 of 4
Augustina D. Abelardo, MD, Dr. J. PascualFPSP, MIAC
Patho 1
211 OS 215
3
Psychiatry Reproduction and Hormonal Regulation
Lec 2A: Pathology of the Female Genital Tract (Vulva and Vagina)
Substance Abuse \ Ginebra San Miguel is the top gin brand in the
world in terms of sales at 27.4 million cases or P12 billion.
Mechanism of Action: Action on receptor sites in the VTA Action on
GABA receptors resembles that of benzodiazepines (increase in GABA
neurotransmission). This is the reason why the depressed usually
resort to alcohol first. Antagonist effect of some receptors for
the excitatory neurotransmitter glutamate (NMDA) Increase release
of dopamine in nucleus accumbens Stimulation of 5-HT receptors
(serotonin) Note: Speed-balling is the method used by drug users to
achieve the desired high: a stimulant is taken to counteract the
sedating effect of alcohol.
EXAM
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If you want a lifetime supply of Red Horse, contact EXAM
09167974321 If you want a lifetime supply of San Mig Light, contact
09228555102 If you want a lifetime supply of cocaine, contact
0922855101 For other concerns, e-mail Lance Isidore Catedral at
bottledbrain.com III. Why Drugs?
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Opiates
Sedative-hypnotics
Binding to GABA A receptor GABA coupling to Transducer (G
protein) Opening of Chloride ion channels Neuron hyperpolarization;
RMP stabilization Dampening of Neuronal Excitability CLUB DRUGS
Amphetamines Stimulating properties of Ephedrine by the Chinese
5000 years ago Introduction of amphetamine, a synthetic analogue of
ephedrine in 1932 as an appetite suppressant Limited therapeutic
use to the treatment of attention deficit-hyperactivity disorder
(ADHD) - Ritalin Mechanism of Action Indirect monoamine agonists
with both central and peripheral actions Release of norepinephrine,
serotonin, dopamine from presynaptic terminals 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 EcstasyFig.1 Effects of Drugs
Drug addicts want to experience the Rush Phase or the Normal
Phase. IV. Epidemiology of Use: Initiation of Use As a normal
consequence of development of adolescents attempt to assert their
individuality while conforming to peer norms Separation from family
Membership within a social group Peer-sanctioned illicit activities
Life transitions Substance use is a progressive process beginning
with alcohol and cigarettes, progressing to recreational licit and
illicit drug use, marijuana, and then to hard-core drug use (each
stage not invariably followed by the next). Social forces (peers,
parents, siblings, family dynamics, psychological profile and
popular culture). Popular Culture Creation of several images of
drug use driven by advertisements, television, movies and music
videos Tanduay, Red horse, San Miguel Drugs of Abuse: Sought After
Effects weight reduction anti-fatigue, activity sustaining effect
performance enhancing 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
(3,4- methylenedioxy-n- methylamphetamine) XTC, X, E, Adam,
Clarity, Lovers Speed Euphoria, comfort, empathy Users become
hypersexual.
HR and BP,cognitive impairment Given to rape victims 1 hours
prior to therapy to help patient talk about their experience
Cocaine (benzoylmethylecgonine) Mood elevating High doses:
irritability, psychosis, seizure, unconsciousness, coma
Casti, Franco, Migz, Lance
WED, 19 Dec. 2011
Page 2 of 4
Augustina D. Abelardo, MD, Dr. J. PascualFPSP, MIAC
Patho 1
211 OS 215
3
Psychiatry Reproduction and Hormonal Regulation
Lec 2A: Pathology of the Female Genital Tract (Vulva and Vagina)
Substance Abuse \ V. Epidemiology of Use: Categories of Use
EXAM EXAM
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Those who inject intravenously or smoked ICE Individuals who
switched to amphetamines from other IV drugs; Polysubstance abusing
individuals; Those who previously used oral amphetamines;
Experimenting adolescents and young adults
Drug, drugs and drugs: Polysubstance use Polysubstance abuse is
very dangerous because users run the risk of having adverse
drug-drug interactions.
Self-detoxification is also dangerous because users can have
deadly withdrawal symptoms Stimulants: Benzodiazepines and alcohol
taken to alleviate stimulant withdrawal Alcohol: to modulate and
enhance effects The Medical paradigm in Substance: Use, Misuse and
Dependence Anxiety Depression
Fig. 3 The Downside of Drug Use
Amphetamine
Reduced dopaminergic functioning in the mesolimbic system, D2
receptor levels (withdrawal, early abstinence up to 4 months)
Dysphoria, anhedonia, irritability, craving, drugseeking behaviour.
Specific symptoms encountered with Recreational Amphetamine Use
Hypertension Amphetamine - Cocaine MDMA - Methamphetamine
Hypotension - Heroin
Psychosis
VI. Dopaminergic Pathways of the Brain
Opiates Diaphoresis Mydriasis Miosis Opiates Sedative hypnotics
Bradycardia Opiates/narcotics Tachycardia Respiratory depression
Opiates/narcotics
Fig. 2 Dopaminergic Pathway
Increased levels of dopamine in the NA critical in mediating
rewarding effects or positive reinforcement for drugs of misuse
(Koob and Le Moal, 2004) Mesolimbic dopamine pathway is the most
important pathway because it involves the emotion center, the
nucleus accumbens.
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Reasons for entry into Health System Associated trauma Overdose
(accidental, suicidal) Panic reaction ( bad trip ) or significant
intoxication Inappropriate behavior Drug-seeking behavior
(withdrawal) Coerced by the legal system Specific symptoms
encountered with Recreational Substance Use Disorientation
Confusion Destructive and assaultive behavior Depression
Hallucinations Delusions Trauma
Casti, Franco, Migz, Lance
WED, 19 Dec. 2011
Page 3 of 4
Augustina D. Abelardo, MD, Dr. J. PascualFPSP, MIAC
Patho 1
211 OS 215
3
Psychiatry Reproduction and Hormonal Regulation
Lec 2A: Pathology of the Female Genital Tract (Vulva and Vagina)
Substance Abuse \Recognition of Problem History Questionnaires
Biological markers Toxidrome General Approach Emergency
stabilization Clinical evaluation Elimination of the drug/drugs
Excretion of the absorbed drug/drugs Administration of antidotes
and/or pharmacotherapy Supportive therapy and observation
Disposition Intoxication and Overdose Proceed with basic ABCs of
life support Management of medical emergency Emergency
stabilization: - airway obstruction, breathing difficulties,
EXAM
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Although young Filipinos may limit their recreational EXAM drug
use, which is associated with lower rates of impairment and
addiction, such recreational use may progress to use of higher-risk
drugs. Recreational use may progress to higher doses
Theories of addiction have mainly been developed from
neurobiological evidence and data from studies of learning
behaviours and memory mechanisms. They overlap in some aspects and
are not mutually exclusive. Continued use induces adaptive changes
in the central nervous system that lead to tolerance, physical
dependence, sensitization, craving, and relapse. This session
discussed substance abuse as well as the dangerous side effects of
recreational use, some of which are irreversible. It is hoped that
this may eventually encouraged health workers to persuade users to
quit and prevent individuals from initiating use.
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 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 Depression and Suicide Basic suicide
precautions (physical restraints) Drug induced or autonomous?
Careful evaluation by an experienced health worker
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Clinical Issues with Drug Use Single drug or a mixture? Illicit
amphetamine or prescriptions or both? Drug-drug interaction or
cocktail of death? Long-Term Issues with Drug Use Psychological
deterioration Psychosocial deterioration 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; CUES in the environment may
renew addiction even years after abstinence; Qoute from Dr.
Pascual: You can have closure but you can never forget It is nearly
impossible to detoxify long-term memories of the context of use.
CONCLUSION: The DOWNSIDE of Recreational Drug Use While rates of
drug use have remained stable or declined, recreational drug use
among Filipinos has reflected current trends in recreational drug
use in Filipino society.
Casti, Franco, Migz, Lance
WED, 19 Dec. 2011
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