dfg1032-drugs of abuse part 1

8/7/2019 DFG1032-DRUGS OF ABUSE PART 1

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DFF 1022 INTRODUCTION TO PHARMACY PRACTICE

KOLEJ TEKNOLOGI & PROFESIONAL INDERA KAYANGAN


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DFG 1032

DRUG AND SOCIETY

DRUGS OF ABUSE

Part 1

LECTURER :

Mohammad Rosdi Omar

B.Pharm(AUST) RPh. MMPS


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Learning ObjectiveLearning Objective

Upon completion of this topic, the students

should be able to:

1. Identify the different types of drugs ofabuse

2. Understand the characteristics of each type

of drugs of abuse


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Definition of drug abuse

Drug abuse is the non-medical use of drugs or

other chemicals for the purpose of changing

mood or inducing euphoria

Drug abuse that results in the physical,

mental, emotional, and social impairment of

the user


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Classification of abused drug

Barbiturates - phenobarbitone

Alcohol - ethanol

The opioid drugs codeine, morphine, heroine

Cocaine

Cannabis

Amphetamines ketamine, methamphetamine

Hallucinogen - lysergic acid diethylamide

Volatile organic solvents glue, petrol, acetone

Tobacco - nicotine


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Tolerance and dependence of drug

Tolerance: Body adaptation to drugs & larger

doses are required to produce the original effects

Cross Tolerance: Development of tolerance to one

drug confers tolerance to another drug,

e.g. barbiturates, alcohol & othersedatives/hypnotics


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Dependence

It is an adaptive state and has the following properties:

1. Need to continue to take a drug pleasure & prevent withdrawal

2. Appearance of symptoms when abruptly

suspended

3.Need to increase the dose to sustain the initial

effects


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Physical Dependence

The body has adjusted to the presence of a drug to

avoid withdrawal symptoms

The withdrawal symptoms is an abnormal andunwell physiological state if the dependent

drug is stopped abruptly, it may be manifested by

yawn, flowing tears, fatigue, diarrhea, fear,

shivering, nausea, vomiting, and others.


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Withdrawal Syndrome


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Psychological Dependence

Strong desire to experience the effects of the drug

repeatedly

Craving for a drug is the most commonwithdrawal symptom leading to continued

self-administration & compulsive drug

taking

Psychological & physical dependences are not

mutually exclusive


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METHODS OF TAKING DRUGS

Oral ingestion

Injection: intravenous(IV),

intramuscular(IM), orsubcutaneous(SC)

Inhaling smoke

Nasal sniffing


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HEROIN AND OTHER OPIOD DRUGS

Heroin (diacetylmorphine), also known

as diamorphine, is a semi-synthetic

opioid drug synthesized frommorphine, a derivative of the opium

poppy. The white crystalline form is

commonly the hydrochloride saltdiacetylmorphine hydrochloride .


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Opium Poppy (Papaver somniferum)


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Poppy Flower


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Opium Extraction


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Heroin


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Type of Opioids

Natural opiates: alkaloids contained in the resin ofthe opium poppy, primarily morphine, codeine,and thebaine. The leaves from Mitragyna speciosa

(also known as Ketum) contain a few naturally-occurring opioids.

Semi-synthetic opioids: created from the naturalopiates, such as hydromorphone, hydrocodone,

oxycodone

Fully synthetic opioids: such as fentanyl,pethidine, methadone, tramadol


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Routes of Administration

Injection also known as "slamming", "banging", "shooting up" or "mainlining", is a

popular method used by addicts which carries relatively greater risks than othermethods of administration.

Diacetylmorphine base, when prepared for injection will only dissolve in waterwhen mixed with an acid (most commonly lemon juice) and heated.

Diacetylmorphine hydrochloride salt form, requiring just water to dissolve. Users tend to initially inject in the easily accessible arm veins, but as these

veins collapse over time, through damage caused by the acid, the user willoften resort to injecting in other veins. Intravenous users can use a varioussingle dose range using a hypodermic needle.

The dose of diacetylmorphine used for recreational purposes is dependant on

the frequency and level of use, thus a first-time user may use between 5 and20 mg, while an addict may require several hundred mg per day. As with theinjection of any drug, if a group of users share a common needle withoutsterilization procedures, blood-borne diseases, such as HIV or hepatitis, can betransmitted.


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Injection


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Smoking

Smoking heroin refers to vaporizing it to inhale theresulting fumes, not burning it to inhale the resultingsmoke.

It is commonly smoked in glass pipes made from lightbulbs.

It can also be smoked off aluminium foil, which is heatedunderneath by a flame. This method is also known aschasing the dragon"


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Insufflation (Snorting) Another popular route to intake diacetylmorphine is

insufflation (snorting), where a user crushes thediacetylmorphine into a fine powder and then sharplyinhales it (sometimes with a straw or a rolled up

banknote, as with cocaine) into the nose wherediacetylmorphine is absorbed through the mucousmembrane of the nose and straight into the bloodstream.

This method of administration redirects first passmetabolism, with a quicker onset and higherbioavailability than oral administration, though theduration of action is shortened.

This method is sometimes preferred by users who do notwant to prepare and administer diacetylmorphine forinjection or smoking, but still experience a fast onsetwith a rush.


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Suppository Little research has been focused on the suppository (anal

or vaginal insertion) method of administration, also

known as "plugging". This method of administration is commonly administered

using an oral syringe. Diacetylmorphine can be dissolvedand withdrawn into an oral syringe which may then belubricated and inserted into the anus or vagina before the

plunger is pushed. The rectum and the vaginal canal is where the majority of

the drug would likely be taken up, through themembranes lining its walls.


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Oral Oral use of heroin is less common than other methods of

administration, mainly because there is little to no "rush",

and the effects are less potent. Diacetylmorphine is entirely converted to morphine by

means of first-pass metabolism, resulting in deacetylationwhen ingested.

Heroin's absorption following oral administration is rather

low where about half of the dose only is being absorbedand the bioavailability also is also low therefore makingoral route as a less popular choice.


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Effects


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BARBITURATES


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BARBITURATES The barbiturates are a group of barbituric acid derivatives

used in medicine as sedatives and hypnotics.Classification:

long-acting barbiturates - onset of action 2 hours andduration of action is 6 to 12 hours: barbitone,

phenobarbitone, phenytoin. Intermediate-acting barbiturates - onset of action half to one

hour and duration of action is 3 to 6 hours: amytal,pentobarbitone, butobarbitone.

Short-acting barbiturates - duration of action is less than 3hours: secobarbital, thiopentone.

Ultra short acting - onset of action is immediate andduration of action is about 5 to 10 minutes Eg . Pentothalsodium, hexobarbital sodium


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Absorbtion, Distribution and Elimination

They are rapidly absorbed from the

gastrointestinal tract including the rectum

and from the subcutaneous tissues.

They are concentrated in the liver for a

short time and then evenly distributed in the

body fluids.

They are partly destroyed in the liver and excreted

in urine.


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Signs and Symptoms

Acute poisoning may result from a single large

dose or repeated small dose.

Usually the first symptom is drowsiness.A short period of confusion, excitement, delirium

and hallucinations is common.

Ataxia, vertigo, slurred speech, headache,

paraesthesias, visual disturbance may occur


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Signs and Symptoms

A stupor progressing to deep coma with lossof superficial and deep reflexes and gradualloss of painful stimuli occur.

The Babinski sign may become positive.

Respiration may be rapid and shallow or

slow and laboured. There is fall in cardiac output and an

increase in capillary permeability leading toan increase in extracellular fluid.

Progressive cardiovascular collapseevidenced by cyanosis, hypotension, weakrapid pulse and cold clammyskin occurs.


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Signs and Symptoms

The pupils are usually slightly contracted butreact to light.

Decrease peristalsis may occur in deeplycomatose patient.

The urine may be scanty or suppressed and maycontain sugar and albumin.

Incontinence of urine and faeces may occur.

Blister on the skin, often on an area of erythemastrongly suggest barbiturate poisoning. It occursdue to direct toxic action on the epidermis.


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Signs and Symptoms

Death may occur from respiratory failure

and ventricular fibrillation in early stages

and bronchopneumonia or irreversible

anoxia with pulmonary edema in the laterstages.

The combination of alcohol and barbiturates

causes rapid death.


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AMPHETAMINES


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AMPHETAMINES

Amphetamine is a psychostimulant drug of thephenethylamine class that is known to produce increasedwakefulness and focus in association with decreasedfatigue and appetite.

Amphetamine is a class of potent drugs that act byincreasing levels of dopamine and norepinephrine in the

brain, inducing euphoria.

The drug is also used recreationally and as a performanceenhancer. Recreational users of amphetamine have givennumerous street names for amphetamine, such as speed,ice, ecstacy and syabu.


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Effects

Physical Effects

Physical effects include anorexia, hyperactivity, dilated

pupils, blood shot eyes, flushing, restlessness, dry mouth,

bruxism (grind teeth), headache, tachycardia, bradycardia,tachypnea, hypertension, hypotension, fever, diaphoresis,

diarrhea, constipation, blurred vision, aphasia, dizziness,

twitching, insomnia, numbness, palpitations, arrhythmias,

tremors, dry and/or itchy skin, acne, pallor, convulsions,and with chronic and/or high doses, seizure, stroke, coma,

heart attack and death can occur.


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Effects

Psychological effects

Psychological effects can include euphoria, anxiety,

increased libido, alertness, concentration, energy, self-

esteem, self-confidence, sociability, irritability,aggression, psychosomatic disorders, psychomotor

agitation, grandiosity, excessive feelings of power and

invincibility, repetitive and obsessive behaviors,

paranoia, and with chronic and/or high doses,amphetamine psychosis can occur.


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Effects

Withdrawal effects

Withdrawal symptoms of amphetamine primarilyconsist of mental fatigue, mental depression and an

increased appetite. Symptoms may last for days with occasional use and

weeks or months with chronic use, with severitydependent on the length of time and the amount ofamphetamine used.

Withdrawal symptoms may also include anxiety,agitation, excessive sleep, vivid or lucid dreams, deepREM sleep and suicidal ideation.


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Amphetamines Harm Reduction


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dfg1032-drugs of abuse part 1

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