Augustina

Dr. J.D.Pascual
Abelardo, MD, Patho 1
FPSP, MIAC 3
211
OS 215 Reproduction andPsychiatry
Hormonal Regulation

Substance Abuse
Lec 2A: Pathology of the Female Genital Tract (Vulva and Vagina)
EXAM
\ 3
reported as a way to elicit the psychoactive effects of the
EXAM 2
OUTLINE
Introduction
S excreted muscimol).
II. Substances Abused Datura metel (angel’s trumpet, talampunay)
III. Why Drugs?
Epidemiology of Use: Initiation of Use
Epidemiology of Use: Categories of Use
• Common uses and properties:
- Asthma
Dopaminergic Pathways of the Brain
• Adverse effects:
CONCLUSION: The DOWNSIDE of Recreational - Hallucinogenic, anticholinergic effects
I. Introduction
• Plants
- Family Solanaceae: Genera Atropa, Datura,
• 3.4 million Filipino illeicit drug users (2002) Hyoscyamus, Lycium, and Solanum
• 8,189 admissions (2003) - Principal alkaloids: solaninine, atropine and
• Discrepancy in the incidence and admissions scopolamine
underscores the possibility of addressing the magnitude • Pharmaceuticals
of the problem at the tip of the iceberg. - Antiparkinsonian agents: trihexyphenidyl and
• Drugs presently available for use and abuse: benztropine mesylate (euphora and hallucinogenic
- Alcohol effects): Have potent dopamine reuptake inhibition
- Amphetamine type stimulants (Ritalin for ADHD) with excess in dopamine (craving)
- Cannabis - Note that as dopamine increases, acetycholine
- Inhalants (rugby) decreases; this stimulates the brain’s pleasure
- Cough/cold preparations center, causing the “high”
- Datura, mushroons, areca
- Sedative-hypnotics Cannabis sativa and indica plants
- Narcotics/analgesics
- Nicotine • Alleged anti-emetic, anti-convulsant, anti-anxiety,
analgesic, anti-inflammatory properties.
II. Substances Abused • The Misuse of Drugs Act 1971
- Cannabis oil (class A)
Pinang, nga-nga (Areca Nut) - Cannabis resin or grass (class B)

• Cultural meaning:
- Used in important ritual in restoring harmony and
peace between individuals or within a community
• Common uses and properties:
- Stimulant and euphoriant effects
• Causes teeth to turn black-brown and strains the
tongue and oral mucosa
• Use has been associated with oral cancer
• Arecoline: a cholinomimetic alkaloid
- A potent diaphoretic
- Stimulates the salivary, lacrimal, gastric, pancreatic,
intestinal and the mucosal cells of the respiratory
tract
- Increase muscle tonus and muscle movement
throughout the body
• Mimics the action of acetylcholine in the body
- Slows the heart rate, constrict the pupils of the eyes
Aga, Shrooms (Amanita Muscaria)
• Context of use:
- Food
- Religious ceremonies
- Medication by herbal healers
- Substance of abuse
• Adverse effects:
- Dizziness, vomiting, abdominal pain, movement
disorders, muscle cramps, psychic stimulation,
followed by deep sleep, confusion, mania,
unconsciousness, coma and, death
• Contain cholinergic alkaloid muscarine (structurally
similar to acetylcholine)
• Many cases of poisoning occur in individuals who
deliberately seek and ingest the mushroom for its
hallucinogenic properties (purposeful ingestion of urine
from people who have eaten these mushrooms has been
Nicotine
• Effects mediated through nicotinic cholinergic
receptors (nAChRs) in the brain. Important areas include
the ventral tegmental area (VTA) and the nucleus
accumbens (NA), considered as the pleasure centers.
• Exposure results to activation then desensitization
of nAChR > tolerance
• Chronic exposure:
- Increased nAChR (slower turnover of desensitized
receptors) > recovery (desensitization) >
hyperexcitable nicotinic system
- 1st cigarette: most pleasurable
• Nicotine releases…
- Dopamine - Pleasure, appetite suppression
- Norepinephrine - Arousal, appetite suppression
- Acetylcholine - Arousal, cognitive enhancement
- Vasopressin - Memory improvement
- Serotonin - Mood modulation, appetite suppression
- Beta-endorphins - Reduction of anxiety and tension
Alcohol
• Beer: still a favorite among Filipinos
• Accounts for 15% of the Philippine’s 4 billion-bottles-
a-year market.
• Native Drinks
- Confined to small scale production due to influx and
supremacy of commercial drinks
–Lambanog (coconut wine)
–Tapuy (rice wine)
–Basi (sugar cane wine)
–Tuba (palm wine)
• The impact databank, a US alcoholic beverage
research firm, cited the Filipinos as the world’s top gin
drinker.

Casti, Franco, Migz, Lance WED, 19 Dec. 2011 Page 1 of 4


211
OS 215 Reproduction andPsychiatry
Hormonal Regulation
Substance Abuse
Lec 2A: Pathology of the Female Genital Tract (Vulva and Vagina)
\ 3
• Ginebra San Miguel is the top gin brand in the world
in terms of sales at 27.4 million cases or P12 billion.
• Mechanism of Action:
- Action on µ receptor sites in the VTA
- Action on GABA receptors resembles that of
benzodiazepines (increase in GABA
neurotransmission). This is the reason why the
depressed usually resort to alcohol first.
- Antagonist effect of some receptors for the
excitatory neurotransmitter glutamate (NMDA)
- Increase release of dopamine in nucleus
accumbens
- Stimulation of 5-HT receptors (serotonin)
- Note: Speed-balling is the method used by drug
users to achieve the desired high: a stimulant is
taken to counteract the sedating effect of alcohol.
Opiates
• Sedative-hypnotics
• Binding to GABA A receptor  GABA coupling to
Transducer (G protein)  Opening of Chloride ion
channels  Neuron hyperpolarization; RMP stabilization
 Dampening of Neuronal Excitability
CLUB DRUGS
Amphetamines
• Stimulating properties of Ephedrine by the Chinese
5000 years ago
• Introduction of amphetamine, a synthetic analogue
of ephedrine in 1932 as an appetite suppressant
• Limited therapeutic use to the treatment of attention
deficit-hyperactivity disorder (ADHD) - Ritalin
• Mechanism of Action
- Indirect monoamine agonists with both central and
peripheral actions
- Release of norepinephrine, serotonin, dopamine
from presynaptic terminals
Ketamine
• K, Special K, Vit K, Cat valiums
• High doses: delirium, amnesia, impaired motor
function, respiratory depression
• Low doses: impaired attention, learning ability and
memory
Ecstasy
• (3,4- methylenedioxy-n- methylamphetamine)
• XTC, X, E, Adam, Clarity, Lover’s Speed
• Euphoria, comfort, empathy
• Users become hypersexual.
• ↑ HR and BP,cognitive impairment
• Given to rape victims 1 hours prior to therapy to help
patient talk about their experience
Cocaine (benzoylmethylecgonine)
• Mood elevating
• High doses: irritability, psychosis, seizure,
unconsciousness, coma
Casti, Franco, Migz, Lance WED, 19 Dec. 2011
Augustina
Dr. J.D.Pascual
Abelardo, MD, Patho 1
FPSP, MIAC 3
EXAM
If you want a lifetime supply of Red Horse, contact
EXAM
S 09167974321 2
If you want a lifetime supply of San Mig Light, contact
09228555102
If you want a lifetime supply of cocaine, contact
0922855101
For other concerns, e-mail Lance Isidore Catedral at
bottledbrain.com
III. Why Drugs?
Fig.1 Effects of Drugs
Drug addicts want to experience the Rush Phase or the
Normal Phase.
IV. Epidemiology of Use: Initiation of Use
• As a normal consequence of development of
adolescents attempt to assert their individuality while
conforming to peer norms
- Separation from family
- Membership within a social group
- Peer-sanctioned illicit activities
- Life transitions
• Substance use is a progressive process beginning
with alcohol and cigarettes, progressing to recreational
licit and illicit drug use, marijuana, and then to hard-core
drug use (each stage not invariably followed by the
next).
• Social forces (peers, parents, siblings, family
dynamics, psychological profile and popular culture).
Popular Culture
• Creation of several images of drug use driven by
advertisements, television, movies and music videos
• Tanduay, Red horse, San Miguel
Drugs of Abuse: Sought After Effects
• weight reduction
• anti-fatigue, activity – sustaining effect
• performance enhancing effects
Marked individual differences
• Relief of anxiety
• Intoxication and relaxation
• Alertness
• Mood elevation
“Some individuals who use drugs in ordinary circumstances
eventually increase their dosage to develop misuse”
Page 2 of 4
 Augustina
Dr. J.D.Pascual
Abelardo, MD, Patho 1
FPSP, MIAC 3
211
OS 215 Reproduction andPsychiatry
Hormonal Regulation

Substance Abuse
Lec 2A: Pathology of the Female Genital Tract (Vulva and Vagina)
EXAM
\ 3
V. Epidemiology of Use: Categories of Use EXAM 2
S
• Those who inject intravenously or smoked “ICE”
- Individuals who switched to amphetamines from
other IV drugs;
- Polysubstance abusing individuals;
- Those who previously used oral amphetamines;
- Experimenting adolescents and young adults

Drug, drugs and drugs: Polysubstance use

• Polysubstance abuse is very dangerous because
users run the risk of having adverse drug-drug
interactions.
• Self-detoxification is also dangerous because users
can have deadly withdrawal symptoms Fig. 3 The Downside of Drug Use
• Stimulants: Benzodiazepines and alcohol taken to
alleviate stimulant withdrawal Amphetamine
• Alcohol: to modulate and enhance effects • Reduced dopaminergic functioning in the
mesolimbic system, ↓D2 receptor levels (withdrawal,
The Medical paradigm in Substance: Use, Misuse and early abstinence up to 4 months)
Dependence
• Anxiety • Dysphoria, anhedonia, irritability, craving, drug-
seeking behaviour.
• Depression
• Psychosis
Specific symptoms encountered with Recreational
VI. Dopaminergic Pathways of the Brain Amphetamine Use
• Hypertension
- Amphetamine
- Cocaine
- MDMA
- Methamphetamine
• Hypotension
- Heroin
- Opiates
• Diaphoresis
• Mydriasis
• Miosis
- Opiates
- Sedative hypnotics

• Bradycardia
- Opiates/narcotics
• Tachycardia
Fig. 2 Dopaminergic Pathway • Respiratory depression
- Opiates/narcotics
• Increased levels of dopamine in the NA critical in
mediating rewarding effects or positive reinforcement for Reasons for entry into Health System
drugs of misuse (Koob and Le Moal, 2004) • Associated trauma
• Mesolimbic dopamine pathway is the most important • Overdose (accidental, suicidal)
pathway because it involves the emotion center, the • Panic reaction ( “bad trip” ) or significant
nucleus accumbens. intoxication
• Inappropriate behavior
• Drug-seeking behavior (withdrawal)
• “Coerced” by the legal system

Specific symptoms encountered with Recreational

Substance Use
• Disorientation
• Confusion
• Destructive and assaultive behavior
• Depression
• Hallucinations
• Delusions
• Trauma

Casti, Franco, Migz, Lance WED, 19 Dec. 2011 Page 3 of 4

 Augustina
Dr. J.D.Pascual
Abelardo, MD, Patho 1
FPSP, MIAC 3
211
OS 215 Reproduction andPsychiatry
Hormonal Regulation

Substance Abuse
Lec 2A: Pathology of the Female Genital Tract (Vulva and Vagina)
EXAM
\ 3
• Although young Filipinos may limitEXAM
their recreational
Recognition of Problem
S drug use, which is associated with lower rates of 2
• History impairment and addiction, such recreational use may
• Questionnaires progress to use of higher-risk drugs.
• Biological markers • Recreational use may progress to higher doses
• Toxidrome • Theories of addiction have mainly been developed
from neurobiological evidence and data from studies of
General Approach learning behaviours and memory mechanisms.
• Emergency stabilization • They overlap in some aspects and are not mutually
• Clinical evaluation exclusive.
• Elimination of the drug/drugs • Continued use induces adaptive changes in the
• Excretion of the absorbed drug/drugs central nervous system that lead to tolerance, physical
• Administration of antidotes and/or pharmacotherapy dependence, sensitization, craving, and relapse.
• Supportive therapy and observation • This session discussed substance abuse as well as
• Disposition the dangerous side effects of recreational use, some of
which are irreversible.
Intoxication and Overdose • It is hoped that this may eventually encouraged
• Proceed with basic ABCs of life support health workers to persuade users to quit and prevent
• Management of medical emergency individuals from initiating use.
• Emergency stabilization:
- airway obstruction, breathing difficulties,
- circulatory inadequacies, drug-induced CNS
stimulation or depression, electrolyte or metabolic
abnormalities
• Establish etiology
• General management: Diazepam 5 mg IV for
agitation, restlessness or seizures

• Psychic agitation:
- Diazepam 5 mg oral/parenteral
- 1st generation antipsychotic: Haloperidol 2 mg deep
im
- 2nd generation antipsychotic: Olanzepine 5 mg
deep im
- Risperidone quicklet SL
• Depression and Suicide
- Basic suicide precautions (physical restraints)
- Drug induced or autonomous?
- Careful evaluation by an experienced health worker

Clinical Issues with Drug Use

• Single drug or a mixture?
• Illicit amphetamine or prescriptions or both?
• Drug-drug interaction or cocktail of death?

Long-Term Issues with Drug Use

• Psychological deterioration
• Psychosocial deterioration

Real Issues with Recreational Drug Use

• Returning to environment associated with previous
substance use after many years of abstinence can
induce withdrawal symptoms and initiate drug taking
behavior, especially if the reformed user is under
STRESS;
• CUES in the environment may renew addiction even
years after abstinence;
• Qoute from Dr. Pascual:
“You can have closure but you can never forget”
• It is nearly impossible to “detoxify” long-term
memories of the context of use.

CONCLUSION: The DOWNSIDE of Recreational Drug Use

• While rates of drug use have remained stable or

declined, recreational drug use among Filipinos has
reflected current trends in recreational drug use in
Filipino society.

Casti, Franco, Migz, Lance WED, 19 Dec. 2011 Page 4 of 4