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Substance abuse & toxicology Tikal
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Substance abuse & toxicology Tikal

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    Substance abuse & toxicology Tikal Substance abuse & toxicology Tikal Presentation Transcript

    • SUBSTANCE
      ABUSE
      &
      TOXICOLOGY
      BY
      TIKAL KANSARA
      BARODA MEDICAL COLLEGE (BMC)
    • PHYSIOLOGY OF SUBSTANCE ABUSE
      Main addiction pathway is “Dopaminergic Pathway”.
      Activation leads to “positive reinforcement” feeling and makes us want to repeat the action that triggers the feeling.
      If there is an environmental stimulus, this pathway makes behavior adaptive and goal directed.
    • Activated by all substances that have the tendency to produce dependence.
      The most common examples are:
      Gambling
      Being in LOVE…
    • NAC PATHWAY
    • ROLE OF INSULA CORTEX
      Anterior insula:
      Direct projections from thalamus and amygdala
      Project directly to amygdala
      Amygdala important for emotional anticipation and conditional response
      Functions
      Conscious desires, “craving”
      Damage to this area, example by stroke, addiction to cigrette smoking eliminated.
    • ALCOHOLISM
      Costs to US health system more than $ 100 billion per year.
      Most common abused drug
      Binge drinking has become more common and per capita drinking is declining
      Implicated in:
      Auto accidents
      Homicides
      Hospital admissions
    • MEDICAL COMPLICATIONS
      Fatty liver, Alcoholic hepatitis, Cirrhosis
      Gastric & Duodenal ulcers
      All complications of cirrhosis
      Peripheral Neuropathy
      Myopathies
      Wernicke-Korsakoff Syndrome
    • http://www.encognitive.com/files/images/alcohol-addiction-alcoholism-side-effects-treatment-cure.jpg
    • FETAL ALCOHOL SYNDROME
      Leads to mental retardation
      Craniofacila abnormalities
      Limb dislocation
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    • TREATMENT
      Behavioral modifications
      Pharmacologic treatments
    • BEHAVIORAL MODIFICATIONS
      Psychotherapy and behavioral therapy useful
      Stages of behavioral therapy:
      Precomtemplation - unaware of the problem
      Contemplation – aware but ambivalent about the action
      Preparation – 1st decision to change
      Action – change begins. Trial & error
      Maintenance – new behaviors practiced. Focus on relapse prevention
      Relapse – efforts to change abandoned.
    • PHARMACOTHERAPY
      Disulfiram (Antabuse)
      Decreases alcohol consumption
      Interaction with alcohol produces
      Nausea, chest pain
      Hyperventilation, tachycardia, vomitting
      For short term use only
      Must be accompanied with psychotherapy.
    • MECHANISM OF ACTION OF DISULFIRAM
      Disulfiram inhibits
      Aldehyde dehydrogenase
      Alcohol dehydrogenase
    • OTHER DRUGS USED
      ACAMPROSATE
      Helps prevent relapse
      Reduce activity of glutamate receptors (chronic alcoholism increases its activity)
      Effect persists even after treatment has ended
    • TOPIRAMATE (ANTICONVULSANT)
      Helps support abstinence
      Abstinence 6x more likelyy if not on any other drug for the last one month
    • BENZODIAZEPINES (e.g. lorazepam)
      Helps prevent seizures
      Seizures occur during heavy drinking & also during detoxification
      FLUMAZENIL
      Benzodiazepine receptor antagonist
      Can help prevent relapse.
    • NALTREXONE
      Given to recovering alcoholics
      Reduces craving. Drinks don’t taste good. Helps them to stop the first drink
      On naltrexone, relapse = 50%, if not, relapse = 95%
    • TOBACCO INTOXICATION
      Forms of tobacco intake are:
      • Chewing tobacco
      • Cigars
      • Hookahs
      • Snuff
    • http://c3.yousaytoo.com/rss_temp_image/pics/75/29/67/5731375/remote_image20110620-22305-k55ud9-0.jpg
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    • DRUGS OF ABUSE
      The drugs of abuse are categorized as follows:
      CNS stimulants
      CNS depressants
      Opioids
      Hallucinogens
      Miscellaneous Abused Drugs.
    • CNS STIMULANTS
      The most common drugs are:
      Cocaine
      Amphetamines
      caffeine
    • COCAINE & AMPHETAMINES
      Amphetamines – Release DA, weak MAO-I
      Cocaine – Prevent reuptake of DA, NE & 5HT
    • COCAINE & AMPHETAMINES
    • CAFFEINE
    • CNS DEPRESSANTS
      The most common drugs are:
      Benzodiazepines
      Barbiturates
      Ethanol
      Neurotransmitter involved : GABA
    • TREATMENT OF TOXICITY
      Basic steps:
      Gastric lavage
      Supportive measures – patent airway, assisted respiration, oxygen, fluid infusion.
      For barbiturate toxicity
      Alkaline diuresis – jsod. Bicarb 1 mEq/kg IV with/without mannitol
      Hemodialysis & hemoperfusion.
      For BZD toxicity
      Flumazenil 0.2 mg/min till patient regains consciousness
    • OPIOIDS
      Most common drugs of abuse are Morphine, Heroin, Methadone, Fentanyls and Other Opioids.
      Activate opioid u, k & delta. Potent u receptor activators have the most abuse & dependence liability, via dopaminergic transmission.
    • HALLUCINOGENS
      The most common hallucinogens are divided into two groups:
      Cannabis
      Marijuana
      Hashish
      Halucinogens
      LSD
      Ketamine
      Mescaline
    • MISCELLANEOUS ABUSED DRUGS
      PCP (Phencyclidine) – Horizontal & vertical nystagmus, paranoia, asssaultive, combative, agitated, violant behavior, decreased response to pain, psychosis.
      MDMA (Ecstasy) - hallucinogenic
    • ORGANOPHOSPHATE POISONING
      Orgaanophosphates are irreversibly acting anticholinesterases
      They are available as agricultural & household insecticides
      Initial signs are of local manifestations & then signs of systemic involvement appears
    • CLINICAL FEATURES
      The very well known pneumonic is SLUDGE i.e.
      Salivation
      Lacrimation
      Urination
      Defecation
      Gastric upset
      Other symptoms include: fall in BP, brady/tachycardia, arrythmias, vascular collapse
      Excitement, tremers, ataxia, convulsions, coma & death
    • TREATMENT
      Termination of further exposure to the poison – freash air, wash the skin & mucus membrane with soap & water, gastric lavage with NS or KMnO4 solution
      Maintain airway, positive pressure ventilation if it is falling
      Supportive measure – maintain BP, hydration, control of convulsions
    • SPECIFIC ANTIDOTES
      ATROPINE: Effective in counteracting muscarinic effects.
      2 mg IV every 10 mins till symptoms subside or pupil dilation occurs
      OXIMES: Used only for OP poisoninig. Pralidoxime(2-PAM) is given 1-2 gm slowly IV, but within 24 hours.
    • HEAVY METAL POISONING
    • KEY VIGNETTES
    • THANK YOU
      TIKAL KANSARA
      INTERN
      CIVIL HOSPITAL
      AHMEDABAD