DISCUSSION POINTS

1. Examine the diagram below. Dicuss about Drug Tolerance

behavioral
abused drug tolerance
dependence

pharmacodynamic
tolerance

physical DRUG TOLERANCE

phenomenon

tolerance
drug
tolerability
pharmacokinetic drug
tolerance sensitization

Vocabulary
Tolerance /tɒlərəns/- diminishing effect of a drug resulting from repeated administration at a given dose.
Drug tolerance- a pharmacological concept describing subjects' reduced reaction to a drug following its
repeated use.
Drug tolerability--the degree to which overt adverse effects of a drug can be tolerated by a patient.
Drug sensitizationˌ/sensɪtəˈzeiʃən/ or reverse tolerance – the escalating effect of a drug resulting from
repeated administration at a given dose.
Pharmacodynamic tolerance - a type of drug tolerance wherein the chemistry of the brain comes to be
acclimated to the existence of the drug, that in turn then loses its ability for changing brain activity.
Addiction – a biopsychosocial disorder characterized by compulsively seeking to achieve a desired effect,
such as intoxication, despite harm and adverse consequences to self and others.
Addictive behavior – a behavior that is both rewarding and reinforcing
Addictive drug – a drug that is both rewarding and reinforcing.
Dependence – an adaptive state associated with a withdrawal syndrome upon cessation of repeated
exposure to a stimulus.
Drug withdrawal – symptoms that occur upon cessation of repeated drug use.
Physical dependence – dependence that involves persistent physical–somatic withdrawal symptoms.
Psychological dependence – dependence that involves emotional–motivational withdrawal symptoms.
Pharmacokinetic tolerance occurs because of a decreased quantity of the substance reaching the site it
affects.
Behavioral tolerance--drug's decreased potency in affecting a specified behavior after repeated or
continuous exposure to the drug.

READING & WRITING

 DRUG TOLERANCE

The phenomenon of tolerance emerges as one of the chief characteristics in the physiological and
psychological make-up of every abuser, addict, or chemically dependent person. Tolerance refers to the
process by which the body acclimates to the presence of an abused drug. Drug tolerance is
a pharmacological concept describing subjects' reduced reaction to a drug following its repeated use.
Increasing its dosage may improve the drug's effects; however, this may accelerate tolerance, further
reducing the drug's effects. Drug tolerance is indicative of drug use but is not necessarily associated
with drug dependence or addiction. Adaptive changes occur in response to the repeated exposure to a
particular drug, the result is usually a loss of sensitivity to the drug. This decreased response is tolerance.
Professionals say the drug tolerance definition is as a state of progressively decreased responsiveness to a
drug. Consequently, a larger dose of the drug is necessary to achieve the effect originally obtained by a
smaller dose. The drug tolerance definition refers to the body’s ability governed by genetic factors and
adaptive changes by the body and it includes various symptoms. Some of the more common features of
tolerance include: irreversibility, meaning that once this psychic damage develops there is no known
remedy that will enable the addict to revert back to a time before the establishment of tolerance.
The opposite concept to drug tolerance is drug reverse tolerance (or drug sensitization), in this case
subject's reaction or effect will increase following its repeated use. The two notions are not incompatible
and tolerance may sometimes lead to reverse tolerance. For example, heavy drinkers initially develop
tolerance to alcohol (requiring them to drink larger amounts to achieve a similar effect) but excessive
drinking can cause liver damage, which then puts them at risk of intoxication when drinking even very
small amounts of alcohol.
Drug tolerance should not be confused with drug tolerability, which refers to the degree to which
overt adverse effects of a drug can be tolerated by a patient. Tolerance occurs along the entire spectrum of
abuse of some medication prolonged consumption, be it sedative, stimulant and painkiller, tolerance can
manifest via several routes, which means it can develop regardless of whether the person is injecting, or
smoking their drugs. Complicating matters is the fact that physiological tolerance, which invariably
develops in tandem with psychological dependence, frequently manifests as secondary mental health
disorders such as depression, anxiety, or some form of mood disorder.
 Remember, it is common for people to develop a tolerance to their pain medication and to need higher
doses to achieve the same level of pain relief. Such a situation is normal and is not a sign of addiction.
Symptoms of drug withdrawal tend to be the opposite of the effects of the drug. If the effect of the drug is
sedation, the withdrawal effect will likely be hyper-excitability. If the effect was stimulation the
withdrawal effect will likely be emotional depression.
 Physiological tolerance also occurs when an organism builds up a resistance to the effects of a
substance after repeated exposure. Ironically this can occur with environmental substances, such as salt or
pesticides.
It should be noted again that drugs designed to treat chronic pain are highly addictive, and that there is a
very real ratio between the painkiller’s effectiveness controlling pain and the intensity of the euphoria that
is generated. Any analgesic or sedative will be proportionately as addictive as it is effective. Opiates,
which are the most common drugs doctors prescribe to treat pain, generate effects similar to those of
opium or morphine and are highly addictive. These drugs include: hydrocodone, vicodin, morphine,
oxycodone, meperidine. A fair question is who is at risk to develop tolerance. Most individuals who take
pain medications in the manner consistent with what the physician orders do not become addicted to drugs
nor do they exhibit tolerance (it does, however, happen from time to time). This scenario changes when
dealing with someone for whom addiction is part of their history. People previously addicted to some
medication in the past, or those with a family history of addiction to drugs or alcohol may be at increased
risk of becoming addicted to narcotics.
2. Agree or disagree with the following statements, give arguments to support your
opinion.

1. Tolerance can happen if you’ve been using a medication or other drug for a while. Don’t suddenly stop
taking the drug. There are steps your doctor can take to manage drug tolerance and help you feel better.
Some medications and conditions with reports of tolerance include: anti-depressants, antibiotics, anxiolytics.
2. When tolerance develops, doctors have to find new ways to effectively manage symptoms. Risks from
developing tolerance can include: relapse or flare-up of a condition, need for higher doses,
addiction, unintentional medication errors.
3. Tolerance can develop to many classes of medications and is a normal reaction. In some cases, your
doctor might slowly stop the medication and restart it after a break, depending on the condition. This gives
your body a chance to reset. It doesn’t always work long term but can be one option to try.
4. Developing tolerance means your doctor will need to reevaluate your treatment. This can be challenging
sometimes, because increasing the dose might mean more side effects. It might be harder to find other
medications that work. For other, unregulated drugs, there are more risks of overdose and other
complications.

3. Tell whether the following statements are true or false according to the texts. Correct
those that are false.

1. The drug tolerance definition refers to the body’s ability governed by genetic factors and adaptive
changes by the body and it includes various symptoms. T/F
2. Drug tolerance should be confused with drug tolerability, as it refers to the degree to which
overt adverse effects of a drug can be tolerated by a patient. T/F
3. Physiological tolerance never occurs when an organism builds up a resistance to the effects of a
substance after repeated exposure. T/F
4. Tolerance refers to the process by which the body acclimates to the absence of an abused drug. T/F
5. Drug tolerance is a pharmacological concept describing subjects' reduced reaction to a drug
following its repeated use. T/F

4. Make up 5 special questions in order to point out the key points that should be
emphasized concerning the text „Drug Tolerance”.
5. In your group read one of the following passages to learn more about Gastrointestinal
drugs. Insert the words and phrases into the correct place in your text. Analyze the
obtained information with the other group.
Pharmacodynamic tolerance begins when the cellular response to a ____________is reduced with repeated
use. A common cause of pharmacodynamic ___________is high concentrations of a substance constantly
binding with the receptor, desensitizing it through constant__________. Other possibilities include a
reduction in receptor density, or other mechanisms leading to changes in action __________firing
rate. Pharmacodynamic tolerance to a receptor antagonist involves the reverse, i.e., ___________receptor
firing rate, an increase in receptor density, or other mechanisms. While most occurrences of
pharmacodynamic tolerance occur after sustained ____________to a drug, instances of acute or instant
tolerance can occur. Pharmacokinetic tolerance (dispositional tolerance) occurs because of a
decreased___________ of the substance reaching the site it affects. This may be caused by an increase
in induction of the enzymes required for ___________of the drug. This type of tolerance is most evident
with oral ingestion, because other routes of drug administration bypass first-pass ___________. Enzyme
induction is partly responsible for the _________of tolerance, in which repeated use of a drug leads to a
reduction of the drug's effect.
Substance, exposure, tolerance, metabolism, phenomenon, quantity, interaction,
degradation, increased, potential.

Behavioral tolerance occurs with the use of certain psychoactive drugs, where tolerance to a __________
effect of a drug, such as increased motor activity by methamphetamine, occurs with repeated use. It may
occur through drug-independent __________or as a form of pharmacodynamic tolerance in the brain; the
former mechanism of behavioral tolerance occurs when one learns how to actively __________drug-induced
impairment through practice. Behavioral tolerance is often context-dependent, meaning tolerance depends
on the ___________in which the drug is administered, and not on the drug itself. Behavioral
sensitization describes the opposite___________. By the time tolerance has developed, the addict has likely
experienced the symptoms of other disorders; which essentially means that the person’s ___________is now
compromised by competing disorders. This is clinically significant because it will shape the nature of the
treatment___________. Occurring simultaneously with tolerance is another physical phenomenon, dependence which
emerges alongside tolerance and is the ___________by which body requires increasingly larger _________to
experience the same results one initially experienced before_________ set in. In this regard, the two phenomena are
not only bound to one another but predictable hallmarks of addictive__________.

Behavioral, environment, learning, tolerance, overcome, doses, administered, phenomenon,

psychology, process, pathology.

9. Project work. Make a presentation on Drug Tolerance. Be ready to present it to your

colleagues.
 LISTENING

Drug Tolerance meaning and explanation. https://www.youtube.com/watch?v=_9TnRoEkXiE

1. Watch the video. Underline the right variant

A common cause/source of pharmacodynamic tolerance is high concentrations of a substance constantly

binding with the receptor decensitising through constant interaction/direction. Other possibilities include a
reduction/deduction in receptor density usually associated with receptor/detector agonists or other
mechanisms leading to changes in action potential firing date/rate. Pharmacodynamic tolerance occurs after
maintained/sustained exposure to a drug instances of acute or instant tolerance tachyphylaxis can occur.
Pharmacokinetics differs/refers to the absorption, distribution, metabolism and excretion of drugs. All
psychoactive drugs are first absorbed into the bloodstream, carried/varied to various parts of the body
including the site of action distribution broken down in some fashion metabolism and ultimately removed
from the body. All of these factors are very/merry important determinants of crucial pharmacological
properties of a drug its potency side-effects and duration of action. Pharmacokinetic tolerance, dispositional
tolerance occur because of a decreased/increased quantity of the substance reaching/reechy the cited effects.
Behavioral tolerance occurs with the use of certain psychoactive drugs being often context dependent i.e. on
the environment in wich drug is edministered and not on the drug itself. Behavioral sensitization
describes/prescribes the opposite phenomenon.

2. Answer the questions

1. What is drug tolerance?

2. What factors does drug tolerance involve?
3. What is drug desensitisation?
4. What is the reverse concept to drug tolerance?
5. What may tolerance lead to?

3. Tell whether the following statements are true or false according to the texts. Correct those that are
false.

1. Heavy drinkers initially develop tolerance to alcohol requiring to drink larger amounts to achieve a
similar effect.
2. Excessive drinking can cause liver damage which can lead to intoxication when drinking even small
amounts of alcohol.
3. Drug tolerance should not be confused with drug tolerability, which refers to the degree to which
overt effects of a drug can be tolerated by a patient.
4. Tachyphylaxis is a subcategory of drug tolerance referring to cases of sudden short term onset of
telerance following the administration of a drug.
5. Pharmacodynamic tolerance begins when the cellular response to a substance is reduced with
repeated use.
References
https://www.healthline.com/health/drug-tolerance
https://www.articlecity.com/blog/drug-tolerance-definition-psychology/
https://en.wikipedia.org/wiki/Drug_tolerance
https://www.youtube.com/watch?v=_9TnRoEkXiE