Addiction Part 2 HHD (15) Notes Crash Course CRACK NEET by Dr. Sheth

2. CNS DEPRESSANTS
Drug Barbiturate Benzo-
diazepines
…………..Opiates………………………
………………….
ALCOHOL Anti-histaminics
Basic
structure
Barbituric
acid
(synthetic)
fusion of
benzene
&
diazepine ring
(Synthetic).
alkaloids of Opium (opiates)
viz. morphine & codeine
Ethanol C2H50H Chlorphenara
mine (Avil)
Diphen hydra-
mine(Benadryl)
Physio-
logical
effect &
+ Action
GABA receptor agonists
(enhance effect of GABA –
inhibitory neurotransmitter )
Potent CNS depressants
Act on opioid receptor in Brain and
GIT & causes
-CNS Depression; relieve even
extreme pain + relaxing feel &
sedative action
-slows down mind-body functions &
awareness giving a
stimulation of GABA
receptors causes
CNS depression.
In low levels, it acts as
relaxant sedative
At higher levels it
causes disorientation,
coma & death (see
below)
opposes the
activity of
histamine
receptors
-Aslo weak
sleep indusers
and hypnotics
Source Not imp Not imp from latex of Papaver somniferum (a
flowering herb)
fermentation of
Sugars /starches
NA
Medical
Uses
general anesthesia, capital
/ death penalty, euthanasia.
Treatment of withdrawals
of other drugs (Benzo….)
As Pain killers + Sedatives
in terminal cancer, pains after
accident / surgery
disinfectant and solvent Cheap short-
term anti-
allergics and
hypnotics
Example phenobar-
bital
Valium
Diazepam
Calmpose)
Alprazolam(A
lprax)
-Natural : Opium latex / morphine
-Semi-synthetic : acetylated / di-acetyl
morphine (Heroin / Smack - more
potent & lighter, easy to smuggle
-Synthetic (non addictive) derivatives for
Medical use : (methadone / pethidine)
Beer, wine, hard drinks
(whisky, ataequila,
etc… see below)
Avil
Bebnadryl
cough syrup
Methods Injectable / Tablets Heroin - Snorting,
For others Injections / Tabs available
OTC No No Yes No
WADA Banned Banned Banned Banned

3. Prevention of alcoholism / Addiction
Create a support system)
-Individual – self control + Seek Professional Help
-Family Support, Love, Assertion and Firmness
-Society - group therapy or support / self help groups
State Responsibilities
-regulating and limiting the sale of alcohol,
-taxing alcohol to increase its cost, and
-providing inexpensive treatment
Psychologist -counseling
group therapy or support
Psychosocial Workers Counseling, self help groups
eg. Alcoholics Anonymous.
Self help group of earlier alcoholics
-Medical counseling
+ Withdrawal Management
+ Psychiatric/ Psychotropic Drugs
+ Psychiatrist
Social effects of Addiction
child abuse, domestic violence, rape, burglary and assault.
-drunk driving→accidents
Alcohol Effects
Diagnosis
Screening questionnaires and certain blood tests may
detect people with possible alcoholism.
1. ABT (Alcohol Breath Test)
A breathalyzer or breathalyser
(a device for estimating blood alcohol content (BAC) from a
breath sample.
2. BAC (Blood Alcohol Levels)
Binge drinking = too much alcohol at one time in short
time
→ g.r.t. inebriation/toxicity
-Light Drink (LOW BAC) causes
-overall mood elevation and euphoria (a "happy" feeling),
- decreased anxiety, sociability,
- flushed, red
Moderate Drink causes
-lethargy, sedation, blurred vision.
-Loss of co-ordination, imbalance,
-Impaired judgement / decision making
-Slow reaction time
Hence, avoid drinking while driving, operating aircraft
/ public Carrier or heavy machinery
Heavy Drink / (High BAC)
-profound confusion,impaired /slurred speech staggering,
dizziness and vomiting ("blackouts")
Intoxication (very high BAC)
-stupor, unconsciousness, disorientation
-anterograde amnesia (cannot remember recent past and
drinking episode)
Fatal Dose causes (High BAC)
coma (unconsciousness),
life-threatening respiratory depression and
-death
Women can process lesser quantities of Alcohol,
hence, GET DRUNK with lower doses
Long-term Alcoholism
-progressive worsening of health
- tolerance, dependency, withdrawal, addiction
+ following complications

4. Alcoholic liver disease (in sequence)
-Hepatitis-Acute & / or Chronic Inflamation
-Fatty liver (fatty degeneration of hepatocytes),
-Cirrhosis (areas of dead hepatocytes+ fibrosis)
-Cholestasis (blocking of bile flow) and
-cancer.
Digestive Tract
-Gastritis, Acidity, peptic ulcers
-Malory Weiss Syndrome (oesophageal tear d/t retching +
vomiting →g.r.t. hematemesis)
-pancreatitis, malabsorption (esp B vitamins)
→Wernike’s encephalopathy
/ Korsakoff’s sysndrome (d/t Thiamine deficiency) which is
common in alcoholics
-sexual dysfunction & infertility
-tendency to accidental injuries,
Women alcoholics have a higher mortality
-breast cancer risk.
-reproductive dysfunction.
-anovulation, irregular menstrual cycle, and
early menopause.
Pregnancy :
FAS – Fetal Alcohol Syndrome
(brain damage and stunted growth in infants of alcoholic
mothers)
Alcoholism always eventually reduces life expectancy
by 10 years & causes premature Death
Alcohol Concentration in different Drinks
-Beer (6-10% Alco) ,, wine (8-12%), or
-Distilled spirits – Hard Drinks (approx 40% alcohol) –
-Whisky (fermented grain-barley ),
-Rum (molasses, or sugarcane juice),
-Gin (barley +juniper berries),
-Vodka / Tequila - agave plant)
-Sherry - Grape Juice; Champagne - Grape Juice
-Sake (Japan ) – Rice ;
[Brandy : 60-70% - Peech/Apple / Cherries
-Tequila ( the blue agave plant)

5. Stimulants
Drug Tobacco Caffiene Amphetmine Ephedrine
/
Active
principles /
Alkaloids
Nicotine methyl-
xanthines
alpha-methyl-
phen-ethyl
amine
Psycho-
tropic
Action on
Brain
-Both stimulant & relaxant
-Initially stimulant effect (temporary) due to
release of epinephrine from adrenal medulla.
-This releases glucose from liver & causes
elevated mood, energy & ‘High’,
-Then its profile changes from stimulant to
relaxant with more intake (Nesbitt's paradox)
-High addictive potential
-Stimulates ANS &
Blocks action of
adenosine on
receptors; thus, it
prevents sleep &
drowsiness
(adenosine is a
depressant)
Activates
amine recep-
tors &
increases
nor-epineph-
rine
Stimulant.
Extracted
from /
Common
Source
Leaves of
Genus :Nicotiana
Species : tabacum
Family : Solanaceae
seeds, nuts, or
leaves of coffee
& tea leaves
Ephedra,
Blackbrush
(Synthetic form
is more
Common)
Ephedra
plant-
Common
Method
of
Consumptio
n
-smoking-bidis, cigarettes, cigars, pipe t
- Snuff, Chewing tobacco
-Hookah-water pipe for smoking
-Toothpaste / Mishri
- Gutka (betel nut, tobacco).
-Bottled medicine,
- sports drinks
- Colas & coffee
Oral liquid
bottles /
injections.
mouth, IV, I
M, SC
Side effects Cough, Gastritis, CAD, Heart ds, Infertility, Cancer NA NA NA
Imp Clinical /
practical use
Nicotine is addictive but not carcinogen
Tobacco causes Mouth, stomach / lung cancer. But
promoted by govts due to high revenues
Most common
stimulant used by
students & execut-
tives to stay
awake
Ehnance athletic
performance and
Improves alertness -
-recreational drug,
WADA Banned Banned Banned Banned
OTC
availablity
(see part 1)
Yes Yes No
(Schedule H)
Yes

6. Other Ingredients in Tobacco
-These are harmful to humans in different ways, esp d/t inhalation of poisonous chemicals in tobacco smoke
-cough producing Irritants
-Cillio-toxins (cannot remove dust /pollutants from airways)
Poionous Substances
1.Carbon Monoxide - interferes with transport & utilization of Oxygen; (replaces O2 from Hb→ carboxy Hb) → Hypoxia
2. Cyanides – derange mitochondrial function and aerobic respiration in cells,
Imp Carcinogens IN Tobacco
-Tar is burnt remains of tobacco dust in a bidi / cigar / pipe in Tobacco smoke) . It contains following carcinogens
-Formaldehyde, Acetaldehyde, Ethylene oxide,
-Heterocyclic amines, Nitrosamines , Polycyclic aromatic hydrocarbons, , phenols, Benzene, benzopyrine &
-Trace elements -cadmium, nickel, arsenic, Lead,
- Hydrazine, Vinyl chloride
Passive Smoking
Inhaling second-hand tobacco smoke
in non-smoking adults
(esp wives / family members) can also cause lung cancer .

7. The following drugs act as stimulants in low doses; but in higher doses , they cause Hallucinations also
Drug Crack / coke Cannabis /………...
…….
Lysergic acid diethyl-amide
(LSD)
Active principles /
Alkaloids
Coccaine Alkaloid : Cannabinoids:
THC : tetra-hydro-
cannabacinol
Ergotamine
Psycho-tropic
Action on Brain
-Interferes with dopamine
-Potent CNS Stimulant .
-Causes temporary euphoria /
exitement & increased energy
High doses g.r.t hallucinations
Acts on cannabinoid
receptors in Brain
-Primary Action-relaxation +
euphoria
-Secondary Action-
philosophical
-Tertiary Action = Rage &
Hallucinations of Grandeur
(I am great)
HALLUCINOGEN
(It’s a serotonin receptor
stimulator causing thought
and visual / auditory
Hallucinations
Extracted from /
Common
Source
From inflorescence of
Erythroxylum coca
(tropical flowering plant)
from inflorescence of .
family Cannabaceae ,
C. sativa
From fruiting body of
fungus Claviceps purpura
(Ergot)
Common Method
of Consumption
Snorting (inhaled as smoke) /
Iv – intra-venous
Marijuana leaves
Hashish, Ganja
(all orally)
white powder swallowed or
held under tongue
- sold on blotter paper / like
a sugar cube, or gelatin.
Can be injected
Imp Clinical /
practical use
- recreational drug.
Commonly abused in RAVE PARTIES
Max used is Cannabis
2nd
most frequently used is cocaine
Most commonly abused
Halluconogen (synthetic
preparation available)
OTC availability
(see part 1)
No Banned Yes, Especially Marijuana
and Bhang are
WADA Permission No. Banned No Banned No Banned