Substance abuse

Question 1

Define addiction

Answer 1

Chronic relapsing disorder characterised by compulsive drug seeking despite harmful consequences and long lasting changes in the brain

Question 2

Define tolerance

Answer 2

The phenomenon where a markedly increasing amount of drug is required over time to achieve the same pharmacological effect

OR

Markedly diminished pharmacological effect over time with the use of the same dose of substance

Question 3

Define withdrawal

Answer 3

The development of a constellation of unpleasant psychological and physical symptoms which manifest in the absence of a habitually administered substance.

Question 4

Define physical dependence

Answer 4

The development of withdrawal symptoms upon cessation of long term administration of a substance

Question 5

List the main anaesthetic effects of 6 commonly used recreational drugs

Answer 5

1. Ethanol
   - Acute: Decreased dose requirements: IA | VA | analgaesics
   - Chronic: Increased requirements IA | VA | Analgaesics
   - Liver insufficiency: Prolonged NDNMB
   - Caution with acetaminophen
2. Methamphetamine
   - SNS over-activation (CVS/temp/Eyes)
   - Caution with SNS drugs
3. Hallucinogen/Ketamine
   - SNS over-activation (CVS/temp/Eyes)
   - Caution with SNS drugs
4. Cocaine
   - Vasospasm and hypertension
   - Nitroglycerine (vasodilators)
5. Opioids
   - Acute: reduce anaesthetic doses
   - Chronic: increase anaesthetic doses
6. Marijuana
   - Acute: tachycardia with myocardial and respiratory depression
   - Chronic: N/A
   - Synthetic cannabinoids are worse: can cause seizures/coma/malignant hyperthermia