DRUGS AND SUBSTANCE ABUSE

DR MBURU
CLINICAL PHARMACIST

1
 Morphine

2
 Morphine ctd
 Morphine is the most abundant alkaloid found in opium, the
dried sap (latex) derived from shallowly slicing the unripe
seedpods of Papaver somniferum. Morphine was the first
active purified from a plant source and is one of at least 50
alkaloids of several different types present in opium.

 In clinical medicine, morphine is regarded as the gold

standard, or benchmark, of analgesics used to relieve severe
or agonizing pain and suffering. It has a high potential for
addiction; tolerance and psychological dependence develop
rapidly, although physiological dependence may take several
months to develop.

3
 Morphine ctd
Mode of administration

 Morphine is commonly available in the form of a tablet,

syrup, injection, or as a suppository.

 Depending on its form, morphine may be injected,

swallowed, or even smoked.

 Because of its high potency, morphine is sometimes abused

by heroin addicts when they are unable to obtain heroin

4
 Morphine ctd
Medical uses
 Acute and chronic severe pain.
 Pain due to myocardial infarction and labor
 Pulmonary oedema
 Shortness of breath due to both cancer and non cancer causes

Adverse effects
 Constipation
 Addiction
 Tolerance

5
 Morphine ctd
Withdrawal
 Cessation of dosing with morphine creates the typical
opioid withdrawal syndrome, which unlike that of
barbiturates, benzodiazepines, alcohol, or sedative-
hypnotics, is not fatal by itself in neurologically healthy
patients without heart or lung problems.

 Nonetheless, suicide, heart attacks, strokes, seizures

proceeding to status epilepticus, and effects of extreme
dehydration do lead to fatal outcomes in a small fraction of
cases.

6
 Morphine ctd

Acute morphine withdrawal presents in stages as follows

Stage I: Six to fourteen hours after last dose: Drug

craving, anxiety, irritability, perspiration, and mild to
moderate dysphoria.

Stage II: Fourteen to eighteen hours after last dose:

Yawning, heavy perspiration, mild depression lacrimation,
crying, running nose, dysphoria, also intensification of the
above symptoms. “yen sleep" (a waking trance-like state)

7
 Morphine ctd
Stage III: Sixteen to twenty-four hours after last dose:
Rhinorrhea (runny nose) and increase in other of the above,
dilated pupils, piloerection (gooseflesh), muscle twitches,
hot flashes, cold flashes, aching bones and muscles, loss of
appetite and the beginning of intestinal cramping.
Stage IV: Twenty-four to thirty-six hours after last dose:
Increase in all of the above including severe cramping and
involuntary leg movements ("kicking the habit"), loose
stool, insomnia, elevation of blood pressure, moderate
elevation in body temperature, increase in frequency of
breathing and tidal volume, tarchycardia, restlessness,
nausea.

8
 Morphine ctd
 Stage V: Thirty-six to seventy-two hours after last dose:
Increase in the above, vomiting, free and frequent liquid
diarrhea, which sometimes can accelerate the time of
passage of food from mouth to out of system to an hour or
less, involuntary ejaculation, which is often painful,
saturation of bedding materials with bodily fluids, weight
loss of two to five kilos per 24 hours, increased white cell
count and other blood changes.

9
 Morphine ctd
Stage VI: After completion of above: Recovery of appetite
("the chucks"), and normal bowel function, beginning of
transition to post-acute and chronic symptoms that are mainly
psychological but that may also include increased sensitivity to
pain, hypertension, colitis or other gastrointestinal afflictions
related to motility, and problems with weight control in either
direction.

 The withdrawal symptoms associated with morphine addiction

are usually experienced shortly before the time of the next
scheduled dose, sometimes within as early as a few hours
(usually between 6–12 hours) after the last administration.

10
 Alcohol(Ethanol)

11
 Alcohol ctd
 Alcohol dependence, as described in the DSM-IV, is a
psychiatric diagnosis (a substance related disorder DSM-
IV) describing an entity in which an individual uses alcohol
despite significant areas of dysfunction, evidence of
physical dependence, and/or related hardship.

 According to the DSM-IV criteria for alcohol dependence,

at least three out of seven of the following criteria must be
manifest during a 12 month period:

12
 Alcohol ctd
 Tolerance
 Withdrawal symptoms or clinically defined Alcohol
Withdrawal Syndrome
 Use in larger amounts or for longer periods than intended
 Persistent desire or unsuccessful efforts to cut down on
alcohol use
 Time is spent obtaining alcohol or recovering from effects
 Social, occupational and recreational pursuits are given up
or reduced because of alcohol use
 Use is continued despite knowledge of alcohol-related
harm (physical or psychological)

13
 Alcohol ctd
Long-term misuse
Physical
Long-term alcohol abuse can cause a number of physical
symptoms, including cirrhosis of the liver, pancreatitis ,
epilepsy, polyneuropathy, alcoholic dementia, heart disease,
nutritional deficiencies, and sexual dysfunction, and can
eventually be fatal.
Other physical effects include an increased risk of developing
cardiovascular diseases, malbsorption, alcoholic liver
diseaase and cancer. Damage to the central and peripheral
nervous systems can occur from sustained alcohol
consumption.

14
 Alcohol ctd
 Women develop long-term complications of alcohol
dependence more rapidly than do men. Additionally,
women have a higher mortality rate from alcoholism than
men. Examples of long-term complications include brain,
heart, and liver damage and an increased risk of breast
cancer.

 Heavy drinking over time has been found to cause

reproductive dysfunction such as anovulation, decreased
ovarian mass, problems or irregularity of the menstrual
cycle, and early menopause. Alcoholic ketoacidosis can
occur in individuals who chronically abuse alcohol.
15
 Alcohol ctd
Psychiatric
Long-term misuse of alcohol can cause a wide range of mental
health problems. Severe cognitive problems are common;
approximately 10 percent of all dementia cases are related to
alcohol consumption, making it the second leading cause of
dementia. Excessive alcohol use causes damage to brain function,
and psychological health can be increasingly affected over time.

Psychiatric disorders are common in alcoholics, with as many as

25 percent suffering severe psychiatric disturbances. The most
prevalent psychiatric symptoms are anxiety and depression
disorders.

16
 Alcohol ctd
 Psychiatric symptoms usually initially worsen during
alcohol withdrawal, but typically improve or disappear
with continued abstinence.

 Psychosis, confusion and organic brain syndrome may be

caused by alcohol misuse, which can lead to a misdiagnosis
such as schizophrenia. Panic disorder and major
depressive disorder may occur.

17
 Alcohol ctd
 Psychiatric disorders differ depending on gender. Women
who have alcohol-use disorders often have a co-occurring
psychiatric diagnosis such as major depression, anxiety,
panic disorder, bulimia, post traumatic stress disorder
(PTSD), or borderline personality disorder.

 Men with alcohol-use disorders more often have a co-

occurring diagnosis of antisocial personality disorder,
bipolar disorders, schizophrenia, impulse disorders or
attention deficit/ hyperactivity disorder.

18
 Alcohol ctd
 Women with alcoholism are more likely to have a history
of physical or sexual assault, abuse and domestic violence
than those in the general population, which can lead to
higher instances of psychiatric disorders and greater
dependence on alcohol

19
 Alcohol ctd
Withdrawal symptoms
 The severity of the alcohol withdrawal syndrome can vary
from mild symptoms such as mild sleep disturbances and
mild anxiety to very severe and life threatening including
delirium, visual hallucinations in severe cases and
convulsions (which may result in death).

 These symptoms appear characteristically on waking, due

to the fall in the blood alcohol concentration during sleep.

20
 Alcohol ctd
The severity of alcohol withdrawal depends on various factors
including age, genetics, and, most importantly, degree of
alcohol intake and length of time the individual has been
misusing alcohol and number of previous detoxifications.

The symptoms include; weakness agitation, hallucinations,

anxiety and panic attacks, catatonia, confusion, delirium
tremens, depression, diarrhea, euphoria, gastrointestinal upset,
headache, hypertension, hyperthermia, insomnia, irritability,
migraines, nausea and vomiting, palpitations, psychosis,
rebound REM sleep, restlessness, sweating, and tremors.

21
 Alcohol ctd
Treatment
Most treatments focus on helping people discontinue their alcohol intake, followed up

with life training and/or social support in order to help them resist a return to alcohol use.
Detoxification
Alcohol detoxification or 'detox' for alcoholics is an abrupt stop of alcohol drinking

coupled with the substitution of drugs, such as benzodiazepines, that have similar effects
to prevent alcohol withdrawal.
Individuals who are only at risk of mild to moderate withdrawal symptoms can be

detoxified as outpatients. Individuals at risk of a severe withdrawal syndrome as well as
those who have significant or acute comorbid conditions are generally treated as
inpatients.

22
 Alcohol ctd
Detoxification
 does not actually treat alcoholism, and it is necessary
to follow-up detoxification with an appropriate treatment program for
alcohol dependence or abuse in order to reduce the risk of relapse.
Psychological
Various forms of group therapy or psychotherapy can be used to
deal with underlying psychological issues that are related to alcohol
addiction, as well as provide relapse prevention skills. The mutual-
help group-counseling approach is one of the most common ways of
helping alcoholics maintain sobriety.
Medications
A variety of medications may be prescribed as part of treatment for

alcoholism.

23
 Alcohol ctd
Disulfiram (Antabuse)
 Prevents the elimination of acetaldehyde a chemical the
body produces when breaking down ethanol. Acetaldehyde
itself is the cause of many hangover symptoms from
alcohol use.

 The overall effect is severe discomfort when alcohol is

ingested: an extremely fast-acting and long-lasting
uncomfortable hangover.

 This discourages an alcoholic from drinking in significant

amounts while they take the medicine.
24
 Alcohol ctd
Calcium carbimide (Temposil)
Works in the same way as antabuse; it has an advantage in
that the occasional adverse effects of disulfiram, e.g
hepatotoxity and drowsiness, do not occur with calcium
carbimide

Naltrexone
It is a competitive antagonist for opioid receptors,
effectively blocking the effects of endorphins and opiates.

25
 Alcohol ctd
Naltrexone is used to decrease cravings for alcohol and
encourage abstinence. Alcohol causes the body to release
endorphins, which in turn release dopamine and activate the
reward pathways; hence when naltrexone is in the body there is a
reduction in the pleasurable effects from consuming alcohol.
Naltrexone is also used in an alcoholism treatment method called
the sinclair method, which treats patients through a combination of
Naltrexone and continued drinking

Acamprosate (Campral)
Stabilizes the brain chemistry that is altered due to alcohol
dependence via antagonizing the actions of glutamate a
neurotransmitter

26
 Alcohol ctd
Benzodiazepines
 Whilst useful in the management of acute alcohol withdrawal,
if used long-term cause a worse outcome in alcoholism.
Alcoholics on chronic benzodiazepines have a lower rate of
achieving abstinence from alcohol than those not taking
benzodiazepines.

 This class of drugs is commonly prescribed to alcoholics for

insomnia or anxiety management. Initiating prescriptions of
benzodiazepines or sedative-hypnotics in individuals in
recovery has a high rate of relapse.

27
 Alcohol ctd
 Those who are long-term users of benzodiazepines should
not be withdrawn rapidly, as severe anxiety and panic may
develop, which are known risk factors for relapse into
alcohol abuse. Taper regimes of 6–12 months have been
found to be the most successful, with reduced intensity of
withdrawal.

28
 Tobacco smoking

29
 Tobacco ctd
 Tobacco is the single greatest cause of preventable death
globally.

 Tobacco use leads most commonly to diseases affecting the

heart and lungs, with smoking being a major risk factor for
heart attack, strokes, chronic obstructive pulmonary disease
(COPD) (including emphysema and chronic bronchitis),
and cancer (particularly lung cancer, cancers of the larynx
and mouth and pancreatic cancer).

 It also causes peripheral vascular disease and hypertension

30
 Tobacco ctd
 The effects depend on the number of years that a person
smokes and on how much the person smokes.

 Starting smoking earlier in life and smoking cigarettes

higher in tar increases the risk of these diseases.

 Cigarettes sold in underdeveloped countries tend to have

higher tar content and are less likely to be filtered,
potentially increasing vulnerability to tobacco-related
disease in these regions

31
 Tobacco ctd
 Smoke contains several carcinogenic products that bind to
DNA and cause many genetic mutations. There are over 19
known chemical carcinogens in cigarette.
 Tobacco also contains nicotine , which is a highly addictive
psychoactive chemical.
 When tobacco is smoked, nicotine causes physical and
psychological dependency
 Tobacco use is a significant factor in miscarriages among
pregnant smokers, it contributes to a number of other threats
to the health of the fetus such as premature births and low
birth weight and increases by 1.4 to 3 times the chance for
sudden infant death syndrome.

32
 Tobacco ctd
 Impotence is approximately 85 percent higher in male
smokers compared to non-smokers, and is a key factor
causing erectile dysfunction.

33
 Nicotine
 Nicotine is an alkaloid found in the nightshade family of
plants (solanaceae) that constitutes approximately 0.6–3.0%
of the dry weight of tobacco with biosynthesis taking place
in the roots and accumulation occurring in the leaves.
 It functions as an antiherbivore chemical with particular
specificity to insects; therefore nicotine was widely used as
an insecticide in the past, and currently nicotine analogs such
as imidacloprid continue to be widely used.
 In low concentrations (an average cigarette yields about
1 mg of absorbed nicotine), the substance acts as a stimulant
in mammals and is the main factor responsible for the
dependence-forming properties of tobacco smoking.

34
 Nicotine ctd
Psychoactive effects
 Nicotine's mood -altering effects are different by report: in
particular it is both a stimulant and a relaxant.

 First causing a release of glucose from the liver and

epinephrine (adrenaline) from the adrenal medulla, it causes
stimulation.

 Users report feelings of relaxation, sharpness, calmness, and

alertness. Like any stimulant, it may very rarely cause the often
catastrophically uncomfortable neuropsychiatric effect of
akathisia.

35
 Nicotine ctd
 By reducing the appetite and raising the metabolism, some
smokers may lose wait as a consequence.
 When a cigarette is smoked, nicotine-rich blood passes from
the lungs to the brain within seven seconds and immediately
stimulates the release of many chemical messengers
including acetylcholine, norepinephrine, epinephrine,
vasopressin, arginine, dopamine, autocrine agents, and beta-
endorphine.
 This release of neurotransmitters and hormones is
responsible for most of nicotine's effects. Nicotine appears to
enhance concentration and memory due to the increase of
acetylcholine.

36
 Nicotine ctd
 It also appears to enhance alertness due to the increases of
acetylcholine and norepinephrine. Arousal is increased by
the increase of norepinephrine.

 Pains is reduced by the increases of acetylcholine and beta-

endorphin. Anxiety is reduced by the increase of beta-
endorphin.

 Nicotine also extends the duration of positive effects of

dopamine and increases sensitivity in brain reward systems.

37
 Nicotine ctd
 Research suggests that, when smokers wish to achieve a
stimulating effect, they take short quick puffs, which
produce a low level of blood nicotine. This stimulates
nerve transmission.
 When they wish to relax, they take deep puffs, which
produce a high level of blood nicotine, which depresses the
passage of nerve impulses , producing a mild sedative
effect.
 At low doses, nicotine potently enhances the actions of
norepinephrine and dopamine in the brain, causing a drug
effect typical of those of psychostimulants. At higher doses,
nicotine enhances the effect of serotonin and opiate
activity, producing a calming, pain- killing effect.
38
 Nicotine ctd
 Nicotine is unique in comparison to most drugs, as its profile
changes from stimulant to sedative / pain killer in increasing
dosages and use.

 Technically, nicotine is not significantly addictive, as

nicotine administered alone does not produce significant
reinforcing properties. However, after coadministration with
an MAOI, such as those found in tobacco, nicotine produces
significant behavioral sensitization, a measure of addiction
potential. This is similar in effect to amphetamine.

39
 Nicotine ctd
Nicotine withdrawal
 Symptoms can include craving cigarettes, becoming
irritable, intense headaches and increased blood pressure.
Persons who have smoked a higher number of cigarettes or
for a longer period of time are more likely to experience
these symptoms, although almost all people who try to
‘kick the habit’ suffer some form of withdrawal symptoms
from the drug.
 When regular smokers quit, they often have strong cravings
when they are placed in situations associated in their minds
with smoking (e.g., leaving home in the morning, on a
coffee break, etc.).
40
 Nicotine ctd
 The most common symptoms of nicotine withdrawal are
impaired concentration, irritability, tension, disturbed sleep
or drowsiness, intense longing for a cigarette/nicotine,
headaches, and an increased appetite leading to weight gain

 Sometimes people can experience nicotine withdrawal

when cutting down to light cigarettes or cutting down the
number smoked.

41
 Nicotine ctd
Management of nicotine dependence
Many medications, including nicotine replacement therapy
and non-nicotine medications, have been approved as safe
and effective in treating tobacco dependence. Any of these
medications, combined with behavioral changes, can
increase the chances of quitting.
Nicotine replacement products
 Nicotine gum (Nicorette, others)
 Nicotine lozenge (Commit, Nicorette mini lozenge).
 Nicotine nasal spray (Nicotrol)
 Nicotine inhaler (Nicotrol).

42
 Nicotine ctd
Non-nicotine medications
Bupropion
It is an antidepressant drug and increases levels of
dopamine and norepinephrine. Bupropion may be
prescribed along with a nicotine patch.

Varenicline
This medication acts on the brain's nicotine receptors,
decreasing withdrawal symptoms and reducing the
feelings of pleasure you get from smoking.

43
 Nicotine ctd
Nortriptyline
This tricyclic antidepressant has been shown to help smokers
stop. It acts by increasing the levels of the brain
neurotransmitter norepinephrine. It is used as a second line
medication to treat tobacco dependence. Side effects may
include dry mouth.

Clonidine
This drug is approved for use in treating high blood pressure,
but may be used as a second line medication for tobacco
dependence if other medications haven't helped. Its usefulness is
limited because of side effects such as drowsiness and sedation.

44
 Nicotine ctd
 Counseling, support groups and smoking cessation
programs
Combining medications with behavioral counseling
provides the best chance for long-term success in quitting
tobacco use. Medications help to cope with withdrawal
symptoms, while behavioral treatments help to develop the
skills needed to stay away from tobacco over the long run.
The more time you spend with a counselor, the better your
treatment results will be.

45
 CANNABIS

46
 Cannabis ctd
 It is derived from Cannabis sativa which is an annual
herbaceous plant in the cannabaceae family.

 Humans have cultivated this herb throughout recorded history

as a source of industrial fibre, seed oil, food, recreation,
spiritual enlightenment.

 Each part of the plant is harvested differently, depending on

the purpose of its use. The flowers (and to a lesser extent the
leaves, stems, and seeds) contain psychoactive and
physiologically active chemical compounds known as
cannabinoids.

47
 Cannabis ctd
Acute symptoms
 Within minutes, smoking marijuana produces a dreamy
state of consciousness in which ideas seem disconnected,
unanticipated, and free-flowing.

 Time, color, and spatial perceptions may be altered. In

general, intoxication consists of a feeling of euphoria and
relaxation (a high). These effects last 4 to 6 h after
inhalation.

48
 Cannabis ctd
Anxiety, panic reactions, and paranoia have occurred, particularly
in naive users. Marijuana may exacerbate or even precipitate
psychotic symptoms in schizophrenics, even those being treated
with antipsychotics.

Physical effects are mild in most patients. Tachycardia, conjunctival

injection, and dry mouth occur regularly. Concentration, sense of
time, fine coordination, depth perception, tracking, and reaction
time can be impaired for up to 24 h—all hazardous in certain
situations (eg, driving, operating heavy equipment).

Appetite often increases.

49
 Cannabis ctd
Chronic effects
High-dose smokers develop pulmonary symptoms
(episodes of acute bronchitis, wheezing, coughing, and
increased phlegm), and pulmonary function may be altered,
manifested as large airway changes.

50
 Cannabis ctd
Withdrawal
 Cessation after 2 to 3 wk of frequent, heavy use can cause
a mild withdrawal syndrome, which typically begins about
12 h after the last use. Symptoms consist of insomnia,
irritability, depression, nausea, and anorexia; symptoms
peak at 2 to 3 days and last up to 7 days.

51
 COCAINE

52
 Cocaine ctd
 For over a thousand years south american indigenous
peoples have chewed the leaves of Erythroxylon coca, a
plant that contains vital nutrients as well as numerous
alkaloids, including cocaine.
 The coca leaf was, and still is, chewed almost universally
by some indegineous communities. The remains of coca
leaves have been found with ancient Peruvian mummies,
and pottery from the time period depicts humans with
bulged cheeks
 Cocaine is an alkaloid that is obtained from the leaves of
the coca plant

53
 Cocaine ctd
 It is a stimulant of the central nervous system, an appetite
suppressant and a topical anaesthetic

Pharmacological effects
 Cocaine is a powerful nervous system stimulant. Its effects
can last from 15–30 minutes to an hour, depending upon the
method of ingestion.
 Cocaine increases alertness, feelings of well-being and
euphoria, energy and motor activity, feelings of competence
and sexuality. Athletic performance may be enhanced in
sports where sustained attention and endurance is required.

54
 Cocaine ctd
 Anxiety, paranoia and restlessness are also frequent. With
excessive dosage, tremors, convulsions and increased body
temperature are observed.

 Occasional cocaine use does not typically lead to severe or even

minor physical or social problems.

 With excessive or prolonged use, the drug can cause itching,

tarchycardia, hallucinations and paranoid delusions.

 Overdoses cause tarchyarrythmias and a marked elevation of

blood pressure, which can be life-threatening.

55
 Cocaine ctd
 Physical side effects from chronic smoking of cocaine
include hemoptysis, bronchospasm, pruritus, fever, diffuse
alveolar infiltrates without effusions, pulmonary and
systemic eosinophilia, chest pain, lung trauma, sore throat,
asthma, hoarse voice, dyspnoea (shortness of breath), and an
aching, flu-like syndrome.

 A common but untrue belief is that the smoking of cocaine

chemically breaks down tooth enamel and causes tooth
decay. However, cocaine does often cause involuntary tooth
grinding, known as bruxism, which can deteriorate tooth
enamel and lead to gingivitis.

56
 Cocaine ctd
Chronic intranasal usage can degrade the cartilage separating the
nostrils (the septum naesi), leading eventually to its complete
disappearance. Due to the absorption of the cocaine from cocaine
hydrochloride, the remaining hydrochloride forms a dilute hydrochloric
acid

Cocaine may also greatly increase this risk of developing lupus,

goodpatures disease, vasculitis, glomerulonephritis, steven-Johnson
syndrome and other diseases. It can also cause a wide array of kidney
diseases and renal failure.

Cocaine abuse doubles both the risks of hemorrhagic and ischemic

strokes, as well as increases the risk of other infarctions, such as
myocardial infarction.

57
 Cocaine ctd
Routes of administration
 Oral (chewing)
 Insufflation (sniffing)
 Inhalation
 Injection

58
 Cocaine ctd
Withdrawal symptoms
When the drug is discontinued immediately, the user will
experience, paranoia, depression, exhaustion, anxiety, itching,
mood swings, irritability, fatigue, insomnia, an intense craving for
more cocaine, and in some cases nausea and vomiting.

Some cocaine users experience schizophrenia, crawling sensation

on the skin. These symptoms can last for weeks or, in some cases,
months.
 Even after most withdrawal symptoms dissipate most users feel
the need to continue using the drug; this feeling can last for years.
About 30-40% of cocaine addicts will turn to other substances such
as medication and alcohol after giving up cocaine

59
 Caffeine

60
 Caffeine ctd
 Caffeine is a bitter, white crystalline xanthine alkaloid that
acts as a stimulant drug. Caffeine is found in varying
quantities in the seeds, leaves, and fruit of some plants,
where it acts as a natural pesticide that paralyzes and kills
certain insects feeding on the plants.

 It is most commonly consumed by humans in infusions

extracted from the bean of the coffee plant and the leaves of
the tea bushes, as well as from various foods and drinks
containing products derived from the kola nut. Other sources
include yerba mat’e guarana berries, guavusa and the
yaupon holly.

61
 Caffeine ctd
 In humans, caffeine acts as a central nervous system
stimulant, temporarily warding off drowsiness and
restoring alertness.

 It is the world's most widely consumed psychoactive drug,

but, unlike many other psychoactive substances, it is legal
and unregulated in nearly all parts of the world.

 Beverages containing caffeine, such as coffee, tea, soft

drinks and energy drinks enjoy great popularity; in North
America, 90% of adults consume caffeine daily.

62
 Caffeine ctd
Pharmacologic effects
Stimulant effects
Caffeine is a central nervous system and metabolic stimulant,
and is used both recreationally and medically to reduce physical
fatigue and to restore alertness when drowsiness occurs.

It produces increased wakefulness, faster and clearer flow of

thought, increased focus, and better general body coordination.
The amount of caffeine necessary to produce effects varies
from person to person, depending on body size and degree of
tolerance. Effects begin less than an hour after consumption,
and a moderate dose usually wears off in about five hours.

63
 Caffeine ctd
 Caffeine has a number of effects on sleep, but does not affect
all people in the same way. It improves performance during
sleep deprivation but may lead to subsequent insomnia.

 In shift workers it leads to fewer mistakes caused by tiredness.

In athletics, moderate doses of caffeine can improve sprint,
endurance and team sports performance, but the improvements
are not usually very large. High doses of caffeine, however,
can impair athletic performance by interfering with
coordination. Evidence shows that, contrary to common
advice, caffeine may be helpful at high altitude

64
 Caffeine ctd
Physical effects
 Consumption of large amounts of caffeine — usually more
than 500 mg per day — especially over extended periods of
time, can lead to a condition known as caffeinism.

 Caffeinism usually combines caffeine dependency with a

wide range of unpleasant physical and mental conditions
including nervousness, irritability, restlessness, insomnia,
headaches, and heart palpitations.

65
 Caffeine ctd
Psychological
 In moderate doses it may reduce symptoms of depression
and lower suicide risk . High doses may trigger anxiety and
rarely mania and psychosis.

 Caffeine can have both positive and negative effects on

anxiety disorders depending on the dose. At high doses,
typically greater than 300 mg, it can both cause and worsen
anxiety. At low doses it may reduce symptoms of anxiety.

66
 Caffeine ctd
 Caffeine withdrawal, on the other hand, can cause an
increase in anxiety level. In moderate doses caffeine
typically does not affect learning or memory. It does
however improve cognitive function in people who are
fatigued, due to its effect on alertness
Caffeine intoxication
 The symptoms of caffeine intoxication are like overdoses
of other stimulants. It may include restlessness, fidgeting,
anxiety, excitement, insomnia, flushing of the face,
increased urination, gastrointestinal disturbance, muscle
twitching, a rambling flow of thought and speech,
irritability, irregular or rapid heart beat, and psychomotor
agitation.
67
 Caffeine ctd
 In cases of much larger overdoses, mania, depression,
lapses in judgment, disorientation, delusions,
hallucinations, or psychosis may occur, and rhabdomylosis
(breakdown of skeletal muscle tissue) can be provoked
 Extreme overdose can result in death.

68
 Amphetamine

69
 Amphetamine ctd
 Amphetamine is a psychostimulant of the phenyethylene
class which produces increased wakefulness and focus in
association with decreased fatigue and appetite

 The drug is also used recreationally and as a performance

enhancer.

70
 Amphetamine ctd
Effects
Physical effects
Physical effects of amphetamine can include hyperactivity,
dilated pupils, vasoconstriction, blood shot eyes, flushing,
restlessness, dry mouth, bruxism, headache, tarchycardia,
bradycardia, tarchypnea, hypertension, hypotension, fever,
daphoresis, diarrhea, constipation, blurred vision, aphasia,
dizziness, twitching, insomnia, numbness, palpitations,
arrythmias, tremors, dry/itchy skin, acne, pallor,
convulsions, and with chronic and high doses seizure,
stroke, coma, heart attack and death.

71
 Amphetamine ctd
Psychological effects
Psychological effects can include euphoria, anxiety,
increased libido, alertness, concentration, energy, self
esteem, self-confidence, sociability, irritability, aggression,
psychosomatic disorder, psychomotor agitation,
grandiosity, repetitive and obsessive behaviors, paranoia
and psychosis

72
 Amphetamine ctd
Withdrawal effects
 Withdrawal symptoms of amphetamine primarily consist of
mental fatigue, mental depression and increased appetite.

 Symptoms may last for days with occasional use and weeks
or months with chronic use, with severity dependent on the
length of time and the amount of amphetamine used.

 Withdrawal symptoms may also include anxiety, agitation,

excessive sleep, vivid or lucid dreams, deep REM sleep and
suicidal ideation

73