L40 Drugs of Abuse and Drug Dependence →↑↓

Question 1

Classification of Additive Drugs (1)

Answer 1

Stimulants
→ Cocaine
→ Amphetamines

→ Nicotine, e.g. tobacco addiction

Depressants
→ Alcohol, e.g. alcohol addiction
→ Benzodiazepines
→ Barbiturates

Hallucinogens
→ LSD (lysergic acid diethylamide)
→ Methylenedioxymethamphetamine (MDMA; Ecstasy)
→ Mescaline

Question 2

Mechanism, Contraindication, S/E of

Amphetamine (1)

Answer 2

→→AMPHETAMINE – a synthetic drug that stimulates nervous system (“uppers” or “speed”)

Triggers release and blocks reuptake of dopamine and norepinephrine

S/E
Nervousness, agitation, irritability confusion, paranoia, hostility Tolerance

Question 3

Mechanism, Contraindication, S/E of

Cocaine

Answer 3

Acts on the reward system by preventing the reuptake of dopamine, resulting in a buildup of dopamine in the synapse

Adverse effects
→ Anxiety: hypertension, tachycardia, sweating, and paranoia
→ Stimulation of the CNS followed by a period of mental depression
→ Addicts withdrawal
→ Seizures

Question 4

Mechanism, Contraindication, S/E of Nicotine

Answer 4

Mechanism of action
→ Low dose: ganglionic depolarization
→ High dose: ganglionic blockade

Adverse effects
→ Caner of the lungs, oral cavity, bladder, and pancreas
→ Obstructive lung disease
→ Coronary artery disease
→ Peripheral vascular disease

Question 5

Depressants Alcohol

Answer 5

MoA
→ Related to changes in membrane fluidity with changes in membrane protein functions, i.e. causing inhibitory
postsynapitc potential (IPSP)
→ Enhancing the effects of GABA on GABAA receptors
→ Inducing the release of endogenous opioids
→ Altering the levels of serotonin and dopamine

→Alcohol Dependence (1)
→ Anxiety
→ Agitation
→ Hallucination
→ Convulsion
→ Insomnia
→ Muscle tremor
→ Elevated BP, pulse and temperature
→ Sweating

Question 6

Synthetic Sedatives-Hypnotics Benzodiazepines

Answer 6

MAO:

positive modulators of the GABAA receptor-coupled chloride channels and increase response to GABA

Question 7

Mechanism, Contraindication, S/E of Lysergic acid diethylamide (LSD) Hallucinogens

Answer 7

MOA: agonist at 5-HT2 receptors
Adverse effects
→ Distressing anxiety
→ Fear of death
→ Nausea
→ Hyperreflexia
→ Tremor
→ Muscular weakness

Question 8

Mechanism, Contraindication, S/E of Ecstasy (MDMA)

Answer 8

MOA: an indirect serotonergic agonist, increasing the amount of serotonin released into the synapse. MDMA acts on the serotonin transporter and is transported into the nerve terminal, which promotes release of serotonin.

S/E
“Serotonin syndrome
”→ Cognitive and behavioral changes: disorientation, hallucinations,
dizziness
→ Autonomic dysfunction: tachycardia, hypertension, flushing,
salivation, hyperthermia
→ Neuromuscular effects: muscle rigidity
→ Disseminated intravascular coagulopathy (DIC), renal failure, acute
respiratory distress syndrome (ARDS)

Acute symptomatic hyponatremia with the syndrome of inappropriate anti-duretic hormone secretion

→ “Flashbacks”
→ Parkinsonism

Drug-drug interaction: with monoamine oxidase (MAO)
inhibitors, other antipsychotic drugs

Question 9

Mechanism, Contraindication, S/E of Dissociative Anesthetics (Ketamine)

Answer 9

MOA: acts by blocking activation of non-competitive N-methyl-D-aspartate (NMDA) receptors
→ a state of “dissociative anesthesia”
→ sensory loss, analgesia, amnesia but without actual loss of consciousness

Adverse Effects

⎼ Emergence reactions: common during recovery, include unpleasant dreams, confusion, hallucinations and irrational
behavior
→ “Out-of-body” state/experience: a psychological dissociation, “near death experience”
→“Flashback”
→Hyper- and hypotension, arrhythmias, brady- or tachycardia
→Respiratory suppression, apnoea
→ Long term effects: impaired memory, learning and attentional mechanisms; compulsive repeated use
→Drug-drug interactions: with other antipsychotic drugs

Question 10

Mechanism, Contraindication, S/E of Dissociative Anesthetics Phencyclidine (PCP)

Answer 10

MOA: works by blocking the NMDA glutamate receptor to cause a series of hallucinogenic effects including euphoria, suicidal impulses and aggressive behavior

Adverse effects
→ Loss of balance
→ Slurred speech or trouble talking
→ Delusion
→ Convulsion
→ Paranoia

Question 11

Mechanism, Contraindication, S/E of Cannabis Marijuana

Answer 11

Long-term effects
→ Decreased cognitive ability
→ Respiratory problems
→ Sterility / impotence
→ Psychosis

Tolerance and psychological dependence develop
→ Sleep disturbance
→ Loss of appetite, irritability
→ Tremor

Question 12

Narcotics Analgesics

Answer 12

Opioids
HEROIN
→Euphoria
→Mouth Dryness
→Slowed breathing
Codeine
Methadone
Used for eliminating an addicts desire for heroin