2015 Apa dan mengapa dengan

NAPZA

dr.Datten Bangun, M.Sc., SpFK

Bagian Farmakologi dan Terapeutik,

Fakultas Kedokteran USU
MEDAN
 Introduction
• What is a drug?
• Traditionally, a drug is a therapeutic chemical
designed to have maximal benefits with minimal
risks of side effects or toxicity.
• What is a psychoactive drug?
• A drug that can change cognition, behavior and
emotions by changing the functioning of the brain.
Some psychoactive drugs:
• Caffeine, heroin, alcohol, Prozac
 Definitions
• Drug Use
Taking a psychoactive substance for non-medical
purposes, out of curiosity
Drug Abuse
– Drug use that leads to problems (e.g. loss of
effectiveness in society; behavioral psychopathology,
criminal acts)
Drug Dependence
– A maladaptive pattern of drug use leading to clinically-significant
impairment or distress, associated with difficulty in controlling
drug-taking behavior, withdrawal, and tolerance
– The state of needing a drug to function within ‘normal limits’
 Continuum of Drug Use

Experimental
Drug Use

Casual Intensive Compulsiv Addiction

Drug Drug Use e Drug Use
Use

Motivational Strength
Circumstantia
l Drug Use
Motivational
Toxicity

From Bozarth (1990); terms described on

the continuum were suggested by Jaffe
(1975).
 DSM-IV Criteria for Substance Dependence

A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as

manifested by three (or more) of the following, occurring at any time in the same 12 month period:

• Tolerance
• Withdrawal
• Substance taken in larger amounts or over a longer period than intended
• Persistent desire or unsuccessful efforts to cut down or control substance use
• Great deal of time spent in activities necessary to obtain substance, use
substance (e.g., chain smoking), or recover from effects
• Important social, occupational, or recreational activities given up or reduced
because of substance use
• Substance use continued despite knowledge of persistent or recurrent
physical or psychological problem likely to have been caused or exacerbated
by substance
 How are drugs classified?:
• According to the physiological effect they have
• Stimulants, speed up the central nervous
system(CNS).
• Depressants, slow down the CNS
• Psychoactive drugs alter feelings
• Narcotics, are powerful painkillers
• Designer drugs try to mimic narcotics or other
drugs:amphetamines, hallucinogens.
• Halucinogenics
 Major neurotransmitters;

• Dopamine-motors systems, pleasure/reward,

mental illness, craving
• Norepinephrine-arousal, stress, mental
illness learning, sleep
• epinephrine-sympathetic arousal
• Serotonin-sleep, dreaming, mental
illness,craving ,eating
• GABA,gamma-aminobutyric acid- relaxation
 Drug addiction
• Drug addiction is the compulsive use of a
substance, despite its negative or dangerous
effects, such as cocaine
 Drug dependence
1.Physical drug dependence means that a person needs a
drug to function normally. Abruptly stopping the drug
leads to withdrawal symptoms. A person may have a
physical dependence on a substance without having an
addiction. For example, certain blood pressure
medications do not cause addiction but they can cause
physical dependence
2.psychological dependence=ex.cocain
 Physical vs. Psychological Dependence
• Physical Dependence
– Withdrawal symptoms in the absence of the drug
– Tolerance to its effects with repeated use
Psychological Dependence
– “a relatively extreme, pathological state in which obtaining,
taking, and recovering from a drug represents a loss of
behavioral control over drug taking which occurs at the
expense of most other activities and despite adverse
consequences” (Altman et al)
– “a situation where drug procurement and administration
appear to govern the organism’s behavior, and where the drug
seems to dominate the organism’s motivational hierarchy”
(Bozarth)
Apa itu Napza ?= narkotik dan
Zat berbahaya.

Apa itu Narkoba?

Narkoba  Narkotik dan obat berbahaya

Narkotik  narkose  menidurkan
Berbahaya  - dapat mematikan dan
merusak otak dan tubuh
 What is drug abuse?
How do drugs of addiction
work?
Most drugs of abuse “mimic”

Kriteria Ketergantungan Obat:

---- DSM IV--------- Dept.Psikiatri
 Substances that can be abused
There are four characteristics of drugs that are
frequently abused:
1.The drug creates an altered state of
consciousness---- euphoria
2.Prolonged use of the drug creates a tolerance for
the drug
3.The desirable effect is quick
4.Withdrawal symptoms develop if the drug
is stopped after prolonged use.
“Administration of the agonist drug is a fast way
to treat withdrawal symptoms”
WHO ABUSE DRUGS?
Those who abuse drugs do so because
They are:
= bored
= pressured by their peers
= affluent and want to experiment
= seeking to escape reality
= feeling inadequate
= feeling ashamed and depressed
= seeking relief from conflicts

Don’t forget: Genetic factors==== jangan coba-coba,

You never know what genetic factors you have
Genetics

Gene/
Environment
Interaction

Environment
Implication:

Elucidation of the mechanism of

drug addiction will help to
understand other addictive and
motivational behaviors/disorders
 MOTOR FUNCTION

• Slowed gait

•Impaired balance

• Impairment correlates with damage

to dopamine system
Is There Recovery?

• Good News: After 2 years some

of the dopamine deficits are
recovering
• Bad News: Functional deficits
persist
• What does this mean???
 DEPENDENCE = Ketergantungan obat

1. Psychologic dependence
2. Physiologic dependence

ADDICTION  1 & 2

Bila obat distop, timbul gejala PUTUS OBAT atau

WITHDRAWAL SYNDROME  SAKAW
Drug habituation:

=less intens compared to drug addiction,

------ withdrawal produce only mild
discomfort.
Ex.:
= consumption of tea,tobacco,coffee,social
drinking
= physical dependence is absent
TOLERANCE : Effek semula tercapai setelah
dosis ditinggikan setelah
penggunaan berulang

PENYEBAB : 1. Metabolic tolerance

2. Behavioral tolerance
3. Functional tolerance
Jenis narkoba
- merangsang otak : - amfetamin *
(stimulans) - kokain
- nikotin *
- Khat

- menekan otak : - ganja **

(depressans) - penenang *
- alkohol **

- merangsang dan menekan:

- morfin *
- heroin / putaw **
* Banyak di Indonesia
 Cocaine – Background Info
• From the leaves of Erythroxylan coca
• Ancient use in S. America
– Religious, Social, Euphoriant, and Medicinal
• Active alkaloid 1st purified from the leaves in 1860 –
What we commonly know as Cocaine.
• E. coca contains about 0.5-1.0% cocaine
• Leaves are soaked in kerosene and gasoline and
mashed
• Cocaine extracted in the form of coca paste
• Paste approx 50-60% purity
 Cocaine Hydrochloride
• Paste is treated with numerous chemicals to
oxidize and purify the paste to form the water
soluble cocaine hydrochloride powder.
• Can be close to 100% pure
• Can be injected, inhaled as powder, or
ingested orally
• Cannot be smoked
 Pharmacokinetics
• Absorption (Cocaine HCl)
– Absorbed from all sites of application
• Mucous membranes, lungs, stomach
– Vasoconstrictor
• crosses mucosal membrane poorly
– Plasma levels peak 30-60 minutes
– Nasal Inhalation causes slow absorption which
allows for prolonged euphoric effect
 Pharmacokinetics
• IV injection
– Bypasses all barriers to absorption
– Total dosage goes into blood stream and
eventually the brain
• Smoking Cocaine Base
– Absorption is rapid and complete at the lungs
– Effects onset in seconds, peaks in 5 minutes and
lasts about 30 minutes
 Effects of Short Term Use
• Low dose, nontoxic physiological responses include
– Increased alertness
– Motor hyperactivity
– Tachycardia
– Pupillary dilation
– Increased glucose availability
– Shifts of blood flow from internal organs to
muscles
 Effects of Short Term Use
• Psychological Effects
– Immediate euporia
– Giddiness
– Enhanced self-consciousness
– Forceful boastfulness
• These last approx 30 min.
• Moderate euphoria lasts for 60-90 min
• A state of anxiety lasts for hours
• Thoughts race, rapid speech
• Sleep delayed
• Appetite suppressed
• A depressive state follows
 Effects of Short Term Use
• Effects in the CNS
– Depletion of Oxygen
– Cerebral Atrophy
– Seizures
– Others
• Numerous cardiovascular complications can
occur with prolonged or single use
 Toxic and Psychotic Effects of Long-
Term, High Dose Use
• Anxiety and sleep deprivation increase
• Hypervigilance
• Suspiciousness, paranoia, and persecutory
fears
• Toxic Paranoid Psychosis
– Altered perception of reality that can result in
aggressive or homicidal actions as a response to
imagined persecution
 Medical Complications
• Many cardiovascular effects
– Heart attacks
– Irregular heart rhythm
• Respiratory failure
• Seizures
 Tolerance and Sensitization
• Tolerance to the “high” often occurs due to
downregulation
• Sensitization of the anesthetic and convulsant
effects occurs
– Explains some deaths occurring after low doses
 Comorbidity
• Chronic cocaine use produces virtually every
psychiatric syndrome
• 300 abusers
• 56% met current criteria
• 73% met lifetime criteria
• Alcoholism and Heroin addiction extremely
high in cocaine users
 Treatment
• There is no consensus on a generally
accepted successful pharmacological
treatment.
• Three problems that complicate therapy
1. Intensity of the drug effect and reinforcing
action
2. Pronounced tendency toward relapse
3. Most addicts have a coexisting disorder
 Treatment
• Three areas of need for pharmacologic
intervention
1. Antiwithdrawal agents to restore the
dopaminergic tone of the limbic system
2. Anticraving agents that block limbic
dopaminergic receptors
3. Treatment of coexisting disorders
 Kelompok amfetamine
Ada bermacam-macam:
- exctacy = metilendioximetamfetamin –MDMA; Adam
- Eva = metilendioxiamfetamin
-sabu-sabu = metamfetamin
 Amphetamines - Background
• Used in WW II to fight fatigue and enhance
performance
• Widespread abuse began in 1940’s with
students and truck drivers to stay awake and
increase alertness
• Were used as appetite suppressants
 Merupakan simpatomimetik
=merangsang pengeluaran
dopamine dari ujung saraf
simpatis,sehingga:
=HR meningkat
= TD meningkat
====
sudden death due to
heart attack
==perlu check TD dulu???
 Pharmacological Effects
• Psychological Effects
– Euphoria
– Excitement
– Mood elevation
– Increased motor/speech activity
– Feeling of power
• More effects
– Task performance may improve
– Dexterity deteriorates
 Effek Amfetamin
 menimbulkan rasa tenang, happy, percaya diri,
berani, friendly, suka mencium /memeluk.
 tidak merasa capek, segar terus, tidak merasa
mengantuk
 tidak lapar, kenyang terus

Setelah 1 – 3 hari,  kecapekan,  tertidur

bangun

Kelaparan makan
Overdosis amfetamin / sabu-sabu /XTC

 jantung berdebar-bebar
 tekanan darah meningkat
 sesak nafas
 suhu badan --- malignant
hyperthermia  ke rumah sakit
Penggunaan khronis:
- menimbulkan ketergantungan .
- menimbulkan waham-waham curiga
--- positive symptoms dari:

Psikosa
Treatment pada intoxication: ---- simptomatis
= tachycardia----- β-adrenergic blockers
= gelisah --------- benzodiazepine
= demam----------- rendam di bathtub
 Pharmacological Effects
• Long Term evidence shows...
– Psychometric deficits
– Poor academic performance
– Behavioral problems
– Cognitive slowing
– General maladjustment
• The effects on this list are permanent.
 Dependence and Tolerance
• Use becomes compulsive
– Drug strongly effects areas of brain associated
with behavior reinforcement
– Physical dependence follows a classical
conditioning model
• Withdrawal occurs but not as dramatic as with
narcotics and barbiturates
– Symptoms opposite of drugs effects
 Dependence and Tolerance
• Tolerance develops rapidly
• Necessitates the need for markedly higher
doses
• Tolerance to the euphoriant effects develops
which causes prolonged binging
 ICE
• Freebase form of methamphetamine
• Extremely potent
• High is intense and long lasting
• Chronic use can result in serious psychiatric,
cardiovascular, metabolic and neuromuscular
changes
Efek ganja :
- tenang, rilek
- waktu terasa berjalan lambat  jadi
pemalas
- mengantuk kalau sendiri
- “mata merah”
- tertawa dengan keras / mendadak
Pemakaian khronis:
- motivasi hidup hilang
- efek “eskalasi”--- cepat mencari narkoba yang
lebih kuat
- selama penggunaan,cognitive berkurang
- mempermudah terjadi psikosa
- pada tikus  cacat pada janin
After you inhale marijuana smoke, its
chemicals zip throughout the body.
THC is a very potent chemical compared to
other psychoactive drugs.
Once in your bloodstream, THC typically
reaches the brain seconds after it is inhaled
and begins to go to work.

Marijuana users often describe the experience

of smoking the drug as initially relaxing and
mellow, creating a feeling of haziness and
light-headedness (although those feelings may
differ depending on the particular strain).
 Cannabis
The user's eyes may dilate, causing colors to
appear more intense, and other senses may
be enhanced. Disukai pemusik.?

Later, the user may have feelings of paranoia

and panic.
The interaction of the THC with the brain is
what causes these feelings
 Cannabis
• Cannabis is paradoxical in that it simultaneously
produces stimulating, sedating and mildly
psychedelic properties and both anxiolytic or
anxiogenic properties, depending on the individual
and circumstances of use.
• Depressant properties are more obvious in
occasional users, and stimulating properties are
more common in chronic users’
• Cannabis is commonly used to self-medicate
individuals with attention deficit hyperactivity
disorder, which has shown to improve symptoms
for individuals with ADHD in studies.
Yang harus diwaspadai oleh orang muda:
1. Mudah terangsang secara seksual tatkala
berkelompok
2. Selama penggunaan ganja, tingkat intelegensia
menurun.
3. Penggunaan khronis------- psikosa with
negative symptoms
 Opioid Receptor Classification
Receptor Prototypic drug Proposed actions
µ1 Most endogenous , naturally- Supraspinal analgesia
occurring or synthetic opioids
µ2 Morphine Respiratory depression
Cardiovascular effects
 Enkephalins Spinal analgesia

 Ketocyclazocine Spinal analgesia

and dynorphin Sedation, miosis
 N - allylnormetazocine Psycotomimetic effects
Efek dari morphine/heroin :
- hilang rasa takut Dipergunakan dibidang
- hilang rasa sakit medis
- menenangkan Disalah gunakan
- timbul rasa enak
Efek heroin pada penggunaan khronis:
- toleransi  dosis yang diperlukan makin
besar / tinggi.
- ketergantungan  psikis  “sugesti”
 fisik

Sakaw = sakit oleh karena putaw

Gejala sakaw (Withdrawal syndr)
Timbul setelah ± 6 jam penggunaan terakhir dengan
gejala sebagai berikut.
 Rasa sakit yang hebat diseluruh badan istimewa di
perut.
 Bulu roma berdiri (goose-flesh reflex)
 Air liur, ingus, air mata bercucuran flu-like
syndrome
Setelah beberapa jam, gejala ini menurun / menghilang,
NAMUN esoknya gejala ini muncul lagi tapi dengan
intensitas berkurang.

TIDAK ADA YANG MATI OLEH KARENA SAKAW.

 DAMPAK PENGGUNAAN PUTAW
I. AKUT
Overdosis heroin / morfin
 penekanan pernafasan  pernafasan
melambat.
 pupil mata mengecil pin-point pupil

 sianosis
Overdosis heroin  ke rumah sakit
II. KHRONIS :
- Medis : - ketergantungan obat
- hepatitis
- penyakit kelamin
- HIV / AIDS
- Legal : - polisi / hukum

-Sosial : - mengganggu ketertiban umum /

keamanan masyarakat sekitarnya.
Treatment of acute intoxication:
Acute intoxication bisa terjadi karena:
1. Overdosis
2. Upregulation process

Treatment:
= kerumah sakit ---- bantu pernafasan
= N-Allylnormorphine = Nalorphin
 INHALANTS
Inhalant abusers:
- high school
- young adults
- households
Substances used:
- airplane glue – Cap kepala kambing
= rubber cement
- aerosols ;
- hair spray; paint spray,deodorants,
- solvents:= polish remover
= paint remover
= paint thinner
= fuel gas,lighter
 Chemical contents of inhalants;

= toluene
= ethyl acetate
= trichrolethylene
= butane;propane
= acetone
= nitrous oxide
= amyl nitrite
= fluorocarbone
 CLUB DRUGS

• Ecstasy (methylenedioxymethamphetamine)
• GHB (Gamma-hydroxybutyrate)
• Rohypnol (Flunitrazepam – related to Valium, Xanax)
• Ketamine ( anesthetic for humans and animals,
injected, smoked)
• Methamphetamine
• LSD (Lysergic Acid Diethylamide 25)
 CLUB DRUGS
Ecstasy =MDMA
In 1900 as appetite suppressant.
Has effects of Stimulant and Hallucinogen, effects last
approx 3-6hrs.
Usual side effects (confusion, depression, sleep
problems, anxiety, paranoia, dehydration,
hypertension and heart or kidney failure) can last up
to 1 mo.
Significant increase in BP, heart rate, increased sense of
alertness and energy.
 CLUB DRUGS
• Rohypnol In the benzodiazepine family (valium,
xanax).
• Is tasteless and odorless, dissolves easily in
carbonated beverages.
• Effects are aggravated by concurrent use of alcohol.
“Even without alcohol, a dose of Rohypnol can
impair a victim for 8 to 12 hours.”.
• The drug causes profound “anterograde amnesia”;,
individuals may not remember events experienced
while under the influence. -----date-rape..
• One of the “street names” is the “forget-me-pill”,
and has/is used in many reported/unreported
sexual assaults. -----date-rape..
 What is “khat”
• The World Health Organization (WHO) lists khat
as a drug that creates “dependence” in people,
meaning it produces a continuing desire to keep
using it.
• Khat contains stimulants similar to
amphetamines
• In Somalia, civilian and military use of khat has
been blamed for fueling civil war, draining the
nation's economy, and undermining
international relief efforts.
Legal Status

- Cathinone- Schedule I Final Action 2/93

- Produces a euphoric effect similar to
amphetamine in that it stimulates the Central
nervous system
- Begins to degrade 48 hours after harvesting
- Proper handling can prolong potency

- Cathine- Schedule IV Final action 6/88

Produces a much less stimulant effect that
cathinone
Structural Similarities
Cathinone Cathine
O OH

NH2 NH2

Amphetamine Methamphetamine

NH2 NHCH3
 “Bath salts”?Khat
• “Bath salts” are usually ingested by
= sniffing or snorting it when in powder form.
=They can also be taken orally, smoked, or put into a solution and
injected into veins.
Reported Effects of Bath Salts Use
• Agitation
• Combative behavior
• Hallucinations
• Paranoia
• Confusion
• Anxiety
• Involuntary muscle movements
Khat
Kesimpulan :
1. Narkoba berbahaya karena dapat merusak
tubuh, otak dan jiwa.
2. Narkoba dapat mengganggu proses belajar
karena dapat menurunkan intelegensia
3. Narkoba dapat mengganggu hubungan anak
dengan orang tua dan masyarakat sekitar.
4. Narkoba dapat melibatkan diri dengan
Hukum / Polisi.

NARKOBA MERUSAK MASA DEPAN !!!