DRUG ABUSE

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By: Salman S. Farhady Waleed H. Nizam Ferdaws N. Ahmad DRUG ABUSE College of pharmacy Department of pharmacology & toxicology Fourth stage

DRUG ABUSE:

DRUG ABUSE

What is drug abuse? :

What is drug abuse? Drug abuse, also called substance abuse or chemical abuse, is a disorder that is characterized by a destructive pattern of using a substance that leads to significant problems or distress. Drugs are abused (used in ways that are not medically approved) because they cause strong feelings of euphoria or alter perception . However, repetitive exposure induces widespread adaptive changes in the brain . As a consequence drug use may become compulsive—the hallmark of addiction.

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It affects more than 7% of people at some point in their lives. Teens are increasingly engaging in prescription drug abuse, particularly narcotics (which are prescribed to relieve severe pain), and stimulant medications , which treat conditions like attention deficit disorder .

Drug addiction :

Drug addiction Drug addiction, also called substance dependence or chemical dependency. is a disease that is characterized by a destructive pattern of drug abuse that leads to significant problems involving tolerance to or withdrawal from the substance. More than 2.6% of people suffer from drug addiction at some time in their life.

Basic Pharmacology & classification :

Basic Pharmacology & classification Since all addictive drugs increase dopamine concentrations in target structures of the mesolimbic projections, we classify them on the basis of their molecular targets and the underlying mechanisms. The first group contains the opioids , cannabinoids , hydroxybutyric acid ( GHB) , and the hallucinogens , which all exert their action through G io protein-coupled receptors.

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The second group includes nicotine, alcohol, the benzodiazepines, dissociative anesthetics , and some inhalants , which interact with ionotropic receptors or ion channels. The last group comprises cocaine, amphetamines , and ecstasy , which all bind to monoamine transporters.

Types of drugs are commonly abused :

Types of drugs are commonly abused

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The Mechanistic Classification of Drugs of Abuse. Name Main Molecular Target Pharmacology Effect on Dopamine (DA) Neurons RR 2 Drugs That Activate G Protein-Coupled Receptors Opioids µ-OR (G io ) Agonist Disinhibition 4 Cannabinoids CB1R (G io ) Agonist Disinhibition 2 ɤ- Hydroxybutyric acid (GHB) GABA B R (G io ) Weak agonist Disinhibition ? LSD, mescaline, psilocybin 5-HT 2A R (G q ) Partial agonist . . . 1 Drugs That Bind to Ionotropic Receptors and Ion Channels Nicotine nAChR (α 2 β 2 ) Agonist Excitation 4 Alcohol GABA A R, 5-HT 3 R, nAChR, NMDAR, Kir3 channels Excitation, disinhibition (?) 3 Benzodiazepines GABA A R Positive modulator Disinhibition 3 Phencyclidine, ketamine NMDAR Antagonist . . . 1 Drugs That Bind to Transporters of Biogenic Amines Cocaine DAT, SERT, NET Inhibitor Blocks DA uptake 5 Amphetamine DAT, NET, SERT, VMAT Reverses transport Blocks DA uptake, synaptic depletion 5 Ecstasy SERT > DAT, NET Reverses transport Blocks DA uptake, synaptic depletion ?

Types of drugs are commonly abused:

Types of drugs are commonly abused Virtually any substance whose ingestion can result in a euphoric ("high") feeling can be abused. While many are aware of the abuse of legal substances like alcohol or illegal drugs like marijuana (in most states) and cocaine , less well known is the fact that inhalants like household cleaners are some of the most commonly abused substances.

Types of drugs are commonly abused:

Types of drugs are commonly abused The following are many of the drugs and types of drugs that are commonly abused and/or result in dependence: Alcohol : Although legal , alcohol is a toxic substance, particularly to a developing fetus when a mother consumes this drug during pregnancy .

Types of drugs are commonly abused:

Types of drugs are commonly abused The pharmacology of alcohol is complex, and no single receptor mediates all of its effects. On the contrary, alcohol alters the function of several receptors and cellular functions , including GABA A receptors, Kir3/GIRK channels , adenosine reuptake (through the equilibrative nucleoside transporter, ENT1), glycine receptor, NMDA receptor, and 5-HT 3 receptor. They are all, with the exception of ENT1, either ionotropic receptors or ion channels.

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Amphetamines : This group of drugs comes in many forms, from prescription medications like methylphenidate (Ritalin, Concerta ) and dextroamphetamine and amphetamine ( Adderall ) to illegally manufactured drugs like methamphetamine ("meth"). Overdose of any of these substances can result in seizure and death .

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Anabolic steroids : A group of substances abused by bodybuilders and other athletes , this group of drugs can lead to terrible psychological effects like aggression and paranoia , as well as devastating long-term physical effects like infertility and organ failure.

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Caffeine : While it is consumed by many, coffee, tea and soda drinkers , when consumed in excess this substance can produce palpitations, insomnia, tremors and significant anxiety.

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Cannabis : More commonly called marijuana , the scientific name for cannabis is tetrahydrocannabinol (THC). In addition to the negative effects the drug itself can produce i nfertility , paranoia & lack of motivation .

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Examples of ingredients that marijuana is commonly cut with include baby powder , oregano , embalming fluid, PCP , opiates, and cocaine.

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Cocaine : A drug that tends to stimulate the nervous system, cocaine can be snorted in powder form, smoked when in the form of rocks ( crack cocaine), or injected when made into a liquid.

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Ecstasy : Also called MDMA to denote its chemical composition ( methylenedioxymethamphetamine ), this drug tends to create a sense of euphoria and an expansive love or desire to nurture others . In overdose , it can increase body temperature to the point of being fatal.

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Hallucinogens : Examples include LSD and mescaline , as well as so-called naturally occurring hallucinogens like certain mushrooms . these drugs can be dangerous in their ability to alter the perceptions of the user.

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For example , a person who is intoxicated with a hallucinogen may perceive danger where there is none and to think that situations that are truly dangerous are not. Those misperceptions can result in dangerous behaviors (like jumping out of a window because the individual thinks they are riding on an elephant that can fly ).

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Inhalants : One of the most commonly abused group of substances due to its accessibility. inhalants are usually contained in household cleaners , like ammonia, bleach, and other substances that emit fumes.

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Brain damage , even to the point of death, can result from using an inhalant just once or over the course of time, depending on the individual. The addictive substance found in cigarettes , nicotine is actually one of the most habit-forming substances that exists. In fact, nicotine addiction is often compared to the intense addictiveness associated with opiates like heroin .

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Opiates : This group is also called narcotics and includes drugs like heroine, codeine , Vicodin , Percocet , and Percodan . This group of substances sharply decrease the functioning of the nervous system.

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opioids comprise a large family of endogenous and exogenous agonists at three G protein-coupled receptors: the µ- , Ƙ - , and ð - opioid receptors. µ - opioid receptors are selectively expressed on GABA neurons (which they inhibit), whereas Ƙ - opioid receptors are expressed on and inhibit dopamine neurons. This may explain why µ - opioid agonists cause euphoria, whereas Ƙ agonists induce dysphoria .

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Phencyclidine : Commonly referred to as PCP , this drug can cause the user to feel extremely paranoid, become quite aggressive and to have an unusual amount of physical strength. This can make the individual quite dangerous to others.

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Sedative , hypnotic , or antianxiety drugs : As these substances quell or depress the nervous system , they can cause death by respiratory arrest of the person who either uses these drugs in overdose or who mixes one or more of these drugs with another nervous system depressant drug (like alcohol or an opiate ).

Psychological effects of drug abuse and addiction :

Psychological effects of drug abuse and addiction Psychologically, intoxication with or withdrawal from a substance can cause everything from euphoria as with alcohol, Ecstasy , or inhalant intoxication to paranoia with marijuana or steroid intoxication, to severe depression or suicidal thoughts with cocaine or amphetamine withdrawal.

Causes of drug abuse and addiction :

Causes of drug abuse and addiction Like the majority of other mental-health problems, drug abuse and addiction have no single cause. there are a number of biological , psychological, and social factors , called risk factors, that can increase a person's likelihood of developing a chemical-abuse or chemical-dependency disorder.

Causes of drug abuse and addiction :

Causes of drug abuse and addiction The frequency to which substance-abuse disorders occur within some families seems to be higher than could be explained by an addictive environment of the family. Genetic aspect to the risk of drug addiction. Psychological associations with substance abuse or addiction include mood disorders like depression, anxiety, or bipolar disorder , as well as personality disorders like antisocial personality disorder .

Treatment :

Treatment An unfortunate fact about the treatment of drug addiction is that it remains largely unutilized by most sufferers of this condition. The primary goals of drug-abuse or addiction treatment (also called recovery ) are abstinence , relapse prevention , and rehabilitation . During the initial stage of abstinence, an individual who suffers from chemical dependency may need help avoiding or lessening the effects of withdrawal.

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That process is called detoxification or " detox ." The medications used for detox are determined by the substance the individual is dependent upon. For example: people with alcohol dependence might receive medications like anti-anxiety or blood pressure medications to decrease palpitations and blood pressure, or seizure medications to prevent possible seizures during the detoxification process. individuals who are addicted to narcotics like oxycodone hydrochloride ( Percodan ), & heroin often benefit from receiving longer-acting .

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less addictive narcotic-like substances like methadone ( Methadose ). Disulfiram ( Antabuse ) produces nausea , stomach cramping , and vomiting when mixed with alcohol. For people who may have less severe drug dependency, the symptoms of psychological addiction may be able to be managed in an outpatient treatment program. However, those who have a more severe addiction, have relapsed after participation in outpatient programs.

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or who also suffer from a severe mental illness might need the higher structure, support, and monitoring provided in an inpatient drug treatment center, sometimes called "rehab."

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Subclass Mechanism of Action Effects Clinical Application Pharmacokinetics, Toxicities, Interactions Opioid receptor antagonist Naloxone Nonselective antagonist of opioid receptors Reverses the acute effects of opioids; can precipitate severe abstinence syndrome Opioid overdose Effect much shorter than morphine (1–2 h), therefore several injections required Naltrexone Antagonist of opioid receptors Blocks effects of illicit opioids Treatment of alcoholism Half-life ~ 4 h Synthetic opioid Methadone Slow-acting agonist of µ- opioid receptor Acute effects similar to morphine. Substitution therapy for opioid addicts High oral bioavailability half-life highly variable among individuals (range 4–130 h) Toxicity: Respiratory depression, constipation, miosis , tolerance, dependence, and withdrawal symptoms Partial µ- opioid receptor agonist Buprenorphine Partial agonist at µ- opioid receptors Attenuates acute effects of morphine Oral substitution therapy for opioid-addicts Long half-life (40 h) formulated together with naloxone to avoid illicit IV injections

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Nicotinic receptor partial agonist Varenicline Partial agonist of nicotinic actylecholine receptor of the α 4 β 2 -type Occludes "rewarding" effects of smoking heightened awareness of colors Smoking cessation Toxicity: Nausea and vomiting, convulsions, psychiatric changes Cytisine : Natural analog (extracted from laburnum flowers) of varenicline Benzodiazepines Oxazepam , others Positive modulators of the GABA A receptors, increase frequency of channel opening Enhances GABAergic synaptic transmission; attenuates withdrawal symptoms (tremor, hallucinations, anxiety) in alcoholics prevents withdrawal seizures Delirium tremens Half-life 4–15 h pharmacokinetics not affected by decreased liver function Lorazepam : Alternate to oxazepam with similar properties N-methyl-D-aspartate (NMDA) Acamprosate Antagonist of NMDA glutamate receptors May interfere with forms of synaptic plasticity that depend on NMDA receptors Treatment of alcoholism effective only in combination with counseling Allergic reactions, arrhythmia, and low or high blood pressure, headaches, insomnia, and impotence hallucinations, particularly in elderly patients Cannabinoid receptor agonist Rimonabant CB 1 receptor agonist Decreases neurotransmitter release at GABAergic and glutamatergic synapses Approved in USA and Europe to treat obesity Smoking cessation is an off-label indication Major depression, including increased risk of suicide

Nonaddictive Drugs of Abuse :

Nonaddictive Drugs of Abuse Some drugs of abuse do not lead to addiction. This is the case for substances that alter perception without causing sensations of reward and euphoria, such as the hallucinogens and the dissociative anesthetics . Unlike addictive drugs, which primarily target the mesolimbic dopamine system. these agents primarily target cortical and thalamic circuits .

Can drug abuse and addiction be prevented ? :

Can drug abuse and addiction be prevented ?

Can drug abuse and addiction be prevented? :

Can drug abuse and addiction be prevented ? A number of different prevention approaches have been found to be effective in decreasing the risk of drug abuse and addiction . Simple lifestyle changes . More formal programs , For example , the Raising Healthy Children program. The prevalence of easier access to technology has led to the development of computer-based prevention programs.

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Drug addiction is a chronic disease that causes drug-seeking behavior and drug use despite negative consequences to the user and those around him. Though the initial decision to use drugs is voluntary, changes in the brain caused by repeated drug abuse can affect a person's self-control and ability to make the right decisions and increase the urge to take drugs .

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Drug abuse and addiction are preventable THANK YOU

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References : Goldman D, Oroszi G, Ducci F: The genetics of addictions: Uncovering the genes. Nat Rev Genet 2005;6:521. [PMID: 15995696] Hyman SE: Addiction: A disease of learning and memory. Am J Psychiatry 2005;162:1414. [PMID: 16055762] Kauer JA, Malenka RC: Synaptic plasticity and addiction. Nat Rev Neurosci 2007;8:844. [PMID: 17948030] Lüscher C, Ungless MA: The mechanistic classification of addictive drugs. PLoS Med 2006;3:e437. Redish AD, Jensen S, Johnson A: A unified framework for addiction: Vulnerabilities in the decision process. Behav Brain Sci 2008;31:461 Medicinenet.com

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