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

  • 1. SUBSTANCE
    ABUSE
    &
    TOXICOLOGY
    BY
    TIKAL KANSARA
    BARODA MEDICAL COLLEGE (BMC)
  • 2. 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.
  • 3. Activated by all substances that have the tendency to produce dependence.
    The most common examples are:
    Gambling
    Being in LOVE…
  • 4. NAC PATHWAY
  • 5. 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.
  • 6. 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
  • 7. MEDICAL COMPLICATIONS
    Fatty liver, Alcoholic hepatitis, Cirrhosis
    Gastric & Duodenal ulcers
    All complications of cirrhosis
    Peripheral Neuropathy
    Myopathies
    Wernicke-Korsakoff Syndrome
  • 8. http://www.encognitive.com/files/images/alcohol-addiction-alcoholism-side-effects-treatment-cure.jpg
  • 9. FETAL ALCOHOL SYNDROME
    Leads to mental retardation
    Craniofacila abnormalities
    Limb dislocation
  • 10. http://www.aafp.org/afp/2005/0715/afp20050715p279-f1.jpg
  • 11. http://www.aafp.org/afp/2005/0715/afp20050715p279-f3.jpg
  • 12. http://www.aafp.org/afp/2005/0715/afp20050715p279-f5.jpg
  • 13. TREATMENT
    Behavioral modifications
    Pharmacologic treatments
  • 14. 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.
  • 15. 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.
  • 16. MECHANISM OF ACTION OF DISULFIRAM
    Disulfiram inhibits
    Aldehyde dehydrogenase
    Alcohol dehydrogenase
  • 17. OTHER DRUGS USED
    ACAMPROSATE
    Helps prevent relapse
    Reduce activity of glutamate receptors (chronic alcoholism increases its activity)
    Effect persists even after treatment has ended
  • 18. TOPIRAMATE (ANTICONVULSANT)
    Helps support abstinence
    Abstinence 6x more likelyy if not on any other drug for the last one month
  • 19. BENZODIAZEPINES (e.g. lorazepam)
    Helps prevent seizures
    Seizures occur during heavy drinking & also during detoxification
    FLUMAZENIL
    Benzodiazepine receptor antagonist
    Can help prevent relapse.
  • 20. 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%
  • 21. TOBACCO INTOXICATION
    Forms of tobacco intake are:
    • Chewing tobacco
    • 22. Cigars
    • 23. Hookahs
    • 24. Snuff
  • http://c3.yousaytoo.com/rss_temp_image/pics/75/29/67/5731375/remote_image20110620-22305-k55ud9-0.jpg
  • 25. http://t1.gstatic.com/images?q=tbn:ANd9GcSD1yJUkMe5HdkUc9l4xMbQqjbLYt7dB-2Ha9T0V_HIMBTqrhNN&t=1
  • 26. DRUGS OF ABUSE
    The drugs of abuse are categorized as follows:
    CNS stimulants
    CNS depressants
    Opioids
    Hallucinogens
    Miscellaneous Abused Drugs.
  • 27. CNS STIMULANTS
    The most common drugs are:
    Cocaine
    Amphetamines
    caffeine
  • 28. COCAINE & AMPHETAMINES
    Amphetamines – Release DA, weak MAO-I
    Cocaine – Prevent reuptake of DA, NE & 5HT
  • 29. COCAINE & AMPHETAMINES
  • 30. CAFFEINE
  • 31. CNS DEPRESSANTS
    The most common drugs are:
    Benzodiazepines
    Barbiturates
    Ethanol
    Neurotransmitter involved : GABA
  • 32.
  • 33. 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
  • 34. 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.
  • 35.
  • 36. HALLUCINOGENS
    The most common hallucinogens are divided into two groups:
    Cannabis
    Marijuana
    Hashish
    Halucinogens
    LSD
    Ketamine
    Mescaline
  • 37.
  • 38.
  • 39. MISCELLANEOUS ABUSED DRUGS
    PCP (Phencyclidine) – Horizontal & vertical nystagmus, paranoia, asssaultive, combative, agitated, violant behavior, decreased response to pain, psychosis.
    MDMA (Ecstasy) - hallucinogenic
  • 40. 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
  • 41. 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
  • 42. 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
  • 43. 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.
  • 44. HEAVY METAL POISONING
  • 45. KEY VIGNETTES
  • 46. THANK YOU
    TIKAL KANSARA
    INTERN
    CIVIL HOSPITAL
    AHMEDABAD