Download File

SUBSTANCE RELATED DISORDERS
COCAINE
 LSD
 BENZODIAZEPINES
 BARBITURATES

Dr.Y R Bhattarai
TMU
Dependence on illegal and prescribed drugs is
a major problem in western countries.
Many drug users take a range of drugs”polydrug” misuse
Commonly misused drugs
 Benzodiazepines
 Opiates
 Cannabis
 Hallucinogens
 Organic solvents
Barbiturates
Amphetamines
Cocaine
Ecstasy(MDMA)
Anabolic steroids

Cocaine, a central nervous system stimulant produced by the Erythroxylon
coca plant.

Cocaine hydrochloride powder is usually snorted through the nostrils, or
it may be mixed in water and injected intravenously.

Cocaine hydrochloride powder is also commonly heated (“cooked up”) with
ammonia or baking soda and water to remove the hydrochloride, thus
forming a gel-like substance that can be smoked (“freebasing”).

“Crack” cocaine is a precooked form of cocaine alkaloid that is sold on the
street as small “rocks”.
DSM-IV-TR Diagnostic Criteria for Cocaine Intoxication
Recent use of cocaine.
• Clinically significant maladaptive behavioral or psychological changes
• Two (or more) of the following, developing during, or shortly after, cocaine
use:
•
–
–
–
–
–
–
–
–
–
•
tachycardia
Pupillary dilation
Elevated blood pressure
perspiration or chills /cold sweets
nausea or vomiting
Hallucinations
psychomotor agitation or retardation ,euphoria
muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias
confusion, seizures, or coma
The symptoms are not due to a general medical condition and are not
better accounted for by another mental disorder.
DSM-IV-TR Diagnostic Criteria for Cocaine Withdrawal
Cessation of cocaine use that has been heavy and prolonged.
• Dysphoric mood and two (or more) of the following
physiological changes, developing within a few hours to
several days
•
–
–
–
–
–
fatigue
vivid, unpleasant dreams
insomnia or hypersomnia
increased appetite
psychomotor retardation or agitation
The symptoms ,clinically significant distress or impairment in
social, occupational areas of functioning.
• The symptoms are not due to a general medical condition
and are not better accounted for by another mental disorder
•
Management principle
Initiation of abstinence through
disruption of binge cycles and
 Prevention of relapse.











Oxygenation
ECG and temperature monitoring
Activated charchol to any patients presenting within
one hour of oral ingestion, irrespective of the amount.
Muscle relaxants
Intravenous diazepam for hypertension in doses up to
0.5 mg/kg administered over an 8-h – IV
IV nitrate or sodium nitroprusside for HTN with stroke
or encephalopathy
IV Verapamil for supraventricular tachycardia (no beta
blockers)
Oral diazepam for psychosis (no haloperidol)
Vitamin C to increase excretion
Urine screening to differentiate from psychosis.
Cocaine withdrawal features
Depression
 Fatigue
 Increased appetite
 Unpleasant dreams

Drugs for cocaine withdrawal

Antidepressants like desipramine
Cocaine induced disorders
Cocaine Intoxication Delirium
 Cocaine-Induced Psychotic Disorder
 Cocaine-Induced Mood Disorder
 Cocaine-Induced Anxiety Disorder
 Cocaine-Induced Sexual Dysfunction
 Cocaine-Induced Sleep Disorder

Drugs for chronic cocaine use
These drugs reduce the craving
 Amantidine
 Bromocriptine
Hallucinogens & Volatile Inhalants




Hallucinogens are subdivided into two major
categories:
D -lysergic acid diethylamide [LSD],
dimethyltryptamine [DMT], psilocin,
psilocybin(magic mushroom)
3-4-methylenedioxy methamphetamine
(MDMA ,called "ecstasy" on the streets)
Phencyclidine (PCP; called "angel dust,“
"crystal,“ "weed," and "hog" on the streets)
and ketamine.

Volatile inhalants include aromatic,
aliphatic, and halogenated hydrocarbon
compounds such as gasoline, solvents (eg,
acetone), paints, glues, refrigerants (eg,
Freon), and paint thinners (eg, turpentine).
Nitrous oxide (an anesthetic) and amyl
nitrite (a vasodilator; called "poppers" on
the streets
Hallucinogen Intoxication
Behavioral or psychological changes
 Perceptual changes

◦
◦
◦
◦
◦
◦
◦
pupillary dilation
tachycardia
sweating
palpitations
blurring of vision
tremors
incoordination
Hallucinogen Intoxication Delirium
 Hallucinogen-Induced Psychotic Disorders
 Hallucinogen-Induced Mood Disorder
 Hallucinogen-Induced Anxiety Disorder


LSD is a synthetic base derived from the
lysergic acid nucleus from the ergot
alkaloids. compounds was discovered in rye
fungus
Treatment
Hallucinogen Intoxication
 oral administration of 20 mg of diazepam
Hallucinogen Persisting Disorder
 clonazepam , carbamazepine and
antipsychotic agents
drawings done whilst under its influence of LSD
BARBITURATES




Anxiolytics, hypnotics, antiepileptics,
anesthetics, anticonvulsants, tranquilizers
Commonly used drugs: Secobarbital,
pentobarbital, amobarbital
slurred speech, staggering gait, sustained
vertical or horizontal nystagmus, slowed
reactions, lethargy, and progressive
respiratory depression, which is
characterized by shallow and irregular
breathing, leading to coma and possibly
death.
600-800mg/day for >1 month
Management
Symptomatic
 Induction of vomiting
 Give activated charcoal

BENZODIAZEPINES
Benzodiazepines are used primarily as
anxiolytics, hypnotics, antiepileptics, and
anesthetics
 The indications for their use are anxiety,
muscle spasm, seizures, and treatment of
acute alcohol withdrawal symptoms
 Prolonged use of > 4-6 weeks, >60-80mg/day
develop dependence.
 Anxiety, irritability, tremors, insomnia,
vomiting, weakness, suicidal ideation

Street names for Benzodiazepines include:
•
•
•
•
•
•
•
•
•
“blue”
“zani”
“zanibars”
“vallies”
“moggies”
“rugby balls”
“roofies”
“peaches
“football”
Rx
Symptomatic
 Flumazenil (specific benzodiazepine
antagonist) 0.3-1.0 mg IV over 1-2 min if
coma. Flumazenil must never be used in
patients with a history of convulsions or
those who have co-ingested TCA.
 Diazepam 15mg/day for low dose
dependence by reduction of 10% of the
dose daily.

MANAGEMENT OF DRUG MISUSE
First step, determine whether the patient wishes
to stop using the drug.
 If not, patients need advice about “harm
minimization” e.g. use of clean needles,
 If they do want to stop, initial management is to
help them withdraw from the drug.
 When there are signs of severe physical
dependence, withdrawal is best undertaken in
hospital.

MANAGEMENT OF DRUG MISUSE
Decreasing doses of the relevant drug are
given over a period of 1-3 weeks
 Oral methadone is used as a substitute for
heroin in patients with opiate dependence.
 Good results can be achieved if doctors build
a good rapport with the patient.
 Complicated or relapsing patients should be
referred to specialist drug misuse services.
