DRE 7 Categories: CNS Depressants and Radiography

Relevance to Radiography

• Different drug types affect individuals differently.
• Drugs are categorized based on shared symptoms or effects.
• The Drug Recognition Expert (DRE) categorization relies on established medical facts.
• DREs classify drugs into seven categories relevant to radiography.
  • Central nervous system (CNS) depressants
  • CNS stimulants
  • Hallucinogens
  • Dissociative anesthetics
  • Narcotic analgesics
  • Inhalants

CNS Depressants

• CNS depressants slow brain and body functions.
• They affect the neurotransmitter gamma-aminobutyric acid (GABA).
• Side effects include drowsiness, relaxation, and decreased inhibition.
• They are used to treat:
  • Insomnia
  • Anxiety
  • Panic attacks
  • Stress
  • Sleep disorders
  • Pain
  • Seizures
• Three major types include:
  • Sedatives
  • Hypnotics
  • Tranquilizers

Alcohol as a CNS Depressant

• Alcohol is one of the most commonly used drugs worldwide.
• The degree alcohol affects the brain depends on consumption amount and speed.
• Initial positive effects can mask the fact that it acts as a CNS depressant.
• Alcohol may increase anxiety and stress, leading to anger, aggression, or depression.
• Alcohol affects drug pharmacokinetics through altered gastric emptying or liver metabolism.

Barbiturates as CNS Depressants

• Barbiturates, or "downers," treat anxiety, tension, and sleep disorders.
• Formerly considered safe, abuse, addiction, and overdose problems became evident.
• Even small doses can generate euphoria and relaxation, encouraging abuse.
• Common barbiturates include:
  • Butabarbital (Butisol Sodium)
  • Mephobarbital (Mebaral)
  • Phenobarbital (Luminal, Sezaby)
  • Secobarbital (Seconal Sodium (Pro))

Benzodiazepines as CNS Depressants

• Benzodiazepines, or "benzos," treat anxiety, sleep disorders, convulsions, and acute stress.
• They are effective for anxiety and insomnia due to sleep-inducing, sedative, and muscle-relaxing effects.
• Long-term or illicit use may lead to tolerance, addiction, and withdrawal.
• Common benzos include:
  • Diazepam (Ducene®, Valium®): Long-acting
  • Oxazepam (Alepam®, Murelax®): Short-acting
  • Nitrazepam (Alodorm®, Mogadon®): Intermediate-acting

Opioids

• Opioids are commonly prescribed pain relievers in the United States and worldwide.
• They are highly effective for pain but also very addictive and dangerous.
• Examples of extended-release and long-acting opioid products:
  • Morphine sulfate extended-release capsules (Avinza®)
  • Buprenorphine transdermal system (Butrans®)
  • Morphine sulfate extended-release capsules (Kadian®)
  • Morphine sulfate controlled-release tablets (MS Contin®)

Potential Side Effects of Opioids

• Common side effects include sleepiness, constipation, and nausea.
• Serious, life-threatening side effects include shallow breathing, slowed heart rate, and loss of consciousness.
• These symptoms could indicate an opioid overdose and require immediate medical attention.
• Sudden cessation can cause symptoms like jittery nerves or insomnia.
• Addiction is possible, with the brain and body believing the drug is necessary for survival.

Overdose on CNS Depressants

• Overdosing on CNS depressants is possible, leading to life-threatening conditions or death.
• Breathing often slows or stops, decreasing oxygen to the brain.
• Hypoxia can cause short/long-term mental effects, nervous system damage, coma, and permanent brain damage.

CNS Depressant Withdrawal

• Discontinuing these drugs can lead to withdrawal due to the impact on brain chemistry.
• Withdrawal can be severe and sudden.
• Symptoms usually begin 12-24 hours after the last dose and peak between 24-72 hours.
• Acute withdrawal symptoms fade after the initial period.
• Post-acute withdrawal symptoms (PAWS) may last up to 24 months.
• Common symptoms include:
  • Insomnia
  • Restlessness
  • Nausea
  • Vomiting
  • Body tremors
  • Seizures
  • Depression
  • Irritability
  • Muscular stiffness or pain
  • Memory issues
  • Hallucinations
  • Anxiety

CNS Stimulants

• Stimulants increase heart rate, blood pressure, and overall stimulation
• Stimulants increases alertness, attention, energy, and physical activity.
• Commonly used to treat:
  • Depression
  • Attention deficit hyperactivity disorder
  • Narcolepsy
• May also be used to help with weight loss in morbidly obese individuals

Examples of CNS Stimulants

• Amphetamine (Adzenys ER, Dyanavel XR, Evekeo)
• Armodafinil (Nuvigil)
• Atomoxetine (Strattera)
• Caffeine (NoDoz, Vivarin)
• Dextroamphetamine (Dexedrine spansule, ProCentra)
• Dextroamphetamine/Amphetamine combination (Adderall, Mydayis)
• Methamphetamine (Desoxyn)

Safety of CNS Stimulants

• CNS Stimulants have unpleasant side effects, including death.
• They are Widely abused and highly addictive.
• Withdrawal symptoms can be harsh.
• Misuse can cause severe paranoia, psychosis, depression, and suicidal thoughts.
• Misuse can lead to relationship issues, and an inability to maintain a job.

Hallucinogens

• Hallucinogens alter a person's awareness of surroundings, thoughts, and feelings.
• Generally split into Classic Hallucinogens (LSD) and Dissociative Drugs (PCP).
• LSD (D-lysergic acid diethylamide) is a mind-altering chemical from lysergic acid found in rye fungus
• PCP (Phencyclidine) was developed in the 1950s as an anaesthetic but is no longer used due to serious side effects.
• PCP is found in tablet, capsule, liquid and crystal powder forms.
• Hallucinogens Can cause users to feel out of control or disconnected from their body and environment and cause Hallucinations, or sensations and images that seem real though they are not.

Dissociative Anesthetics

• Dissociative anesthetics inhibit pain by cutting off or dissociating the brain's perception of pain and cause individuals to feel separated or detached from their body or physical environment.
• Ketamine - anesthetic used in surgery and veterinary medicine, causes amnesia and pain relief.
• PCP – (Phencyclidine PCP) has hallucinogenic and dissociative properties.
  • Users feel separated from the body
  • effect produces a trance-like state.
  • Also known as “angel dust”.
• Nitrous Oxide – produces mind dissociation from the body (a sense of floating), distorted perceptions and in rare cases, visual hallucination.
• Methoxetamine - derived with dissociative properties that lasts longer, but lower analgesic and aesthetic effects.
• Commonly used dissociatives are Ketamine, Methoxetamine and Nitrous Oxide.

Effects of Dissociatives

• There is no safe level of drug use as use of any drug always carries some risk and dissociatives affect everyone differently, based on:
  • Size, weight and health
  • Whether the person is used to taking it
  • Whether other drugs are taken around the same time
  • The amount taken
  • The strength of the drug (varies from batch to batch)
  • The environment (in which the drug is taken)
• Dissociatives have general depressant effects including drowsiness, slow ineffective breathing, pain relief, anesthesia, and loss of muscle control, as well as cognitive and memory impairment.
• Amnesia is a reported side effect with dissociatives affecting dopamine release and the opioid systems of the body causing euphoria.

Narcotic Analgesics

• Narcotic analgesics relieve pain, induce euphoria, and create mood changes.
• Best for short-term, intense discomfort from medical conditions or post-surgery pain.
• Usage should not exceed 3-4 months unless instructed otherwise.
• Common Narcotic Analgesic Drugs:
  • Hydromorphone (Dilaudid)
  • Oxycodone Hydrochloride (OxyContin)
  • Fentanyl Citrate (Actiq)
• May be as a single opioid like morphine or oxycodone.
• As a combination of an opioid with an over-the-counter pain medicine such as aspirin, acetaminophen, or ibuprofen.
• Roxicet and Percocet are oxycodone and acetaminophen.
• Lorcet, Vicodin and Lortab are hydrocodone and acetaminophen.
• Morphine by itself treats moderate to severe pain, similar to Oxycodone.

Taking Narcotics

• Narcotic pain medications treat acute pain and chronic pain involving the nervous system.
• Side effects include drowsiness and impaired judgment with precautions advised to not drive, operate heavy machinery, or drink alcohol.
• Withdrawal symptoms include cravings, yawning, insomnia, restlessness, mood swings, or diarrhea.
• Providers may recommend gradually lowering the dosage over time to prevent withdrawal symptoms.

Inhalants

• Includes a wide variety of breathable substances that produce mind-altering results and effects.
• Xenon-133 is used for performing V/Q scans.
• (V/Q) scan assesses ventilation/perfusion of the lungs.
• Radioactive xenon or technetium is breathed for few minutes.
• Gamma camera is placed close to the patient, and scans at different angles.