12. Drugs of Abuse

Question 1

What is abstinence syndrome?

Answer 1

Signs and symptoms that occur when a person dependent on a drug is withdrawing.

Question 2

What is addiction?

Answer 2

Previously called psychological dependence; Compulsive drug-using behavior in which a person uses the drug for personal satisfaction, even though they know the health risks.

Question 3

What is a controlled substance?

Answer 3

A drug that can be abused that is listed on the governmental “Schedules of Controlled Substances”.

Question 4

What is dependence?

Answer 4

Previously called physical/physiologic dependence: a state of sign and symptoms that occur when a chronic drug user stops taking drug or when the dose is abruptly lowered.

Question 5

What is a designer drug?

Answer 5

Synthetic derivative of a drug, with a slighltly modified structure, but no major change in pharmacodynamic action. These drugs circumvent Schedules of Controlled Drugs.

Question 6

What is the difference between tolerance and sensitization?

Answer 6

• Tolerance = ↓ response to a drug, necessitating larger doses to acheive the same effect. This can occur due to: ↑ disposition of the drug (metabolic toleranance), an ability to compensate for the effects of a drug (behavioral tolerance) or changes in the receptor/effector system (functional tolerance)
• Sensitization = ↑ in response with as you keep giving the same dose of drug.

Question 7

How does the dose-response curve shift for tolerance vs. sensitization?

Answer 7

• Sensitization = shift in DR-curve to the left.
• Tolerance = shift in DR- curve to the right.

Question 8

What is withdrawal?

Answer 8

• Adaptive changes that become fully apparent when drug exposure is stops: the CNS is trying to become re-adapated to the absence of the drug.
• EVIDENCE of physical dependence.

Question 9

Duration of symptoms of:

1. Alcohol
2. Tobacco
3. MJ

Answer 9

1. Alcohol = 1 hr/serving
2. Tobacco = 20 minutes
3. MJ = 2 - 4 hours

Question 10

Duration of symptoms of:

1. Inhalants
2. Stimulants
3. Depressants

Answer 10

1. Inhalants: 5 minutes => 8 hours
2. Stimulants: 5 minutes => 12 hours
3. Depressants: 1 hour => 16 hours

Question 11

Duration of symptoms of:

1. Hallucinogens
2. Narcotics
3. PCP

Answer 11

1. Hallucinogens: 5 minutes => 12 hours
2. Narcotics: 4 hours => 24 hours
3. PCP: 4 hours => 6 hours

Question 12

What drug is the person using:

[Odor on breath; slurred speech and lack of coordination]

Answer 12

Alcohol

Question 13

What drug is the person using:

[Odor on breath or clothes/ stained fingers or teeth]

Answer 13

Tobacco

Question 14

What drug is the person using:

[Red eyes, odor on breath/clothes, eyelid/muscle tremors, ↑ appetite]

Answer 14

Marijuana

Question 15

What drug is the person using:

[Jittery, talkative, runny nose or dry mouth]

Answer 15

Stimulants

Question 16

What drug is the person using:

[Disoriented, drowsy, speech is uncoordinated slow and slurred]

Answer 16

Depressants

Question 17

What drug is the person using:

[eurphoria, sleepy, droopy eyelids, soft/low voice]

Answer 17

Narcotics

Question 18

What drug is the person using:

[Confused, aggressive, sweaty and repetitive]

Answer 18

PCP

Question 19

What drug is the person using:

[Spacey hallucinations, paranoia, memory loss and uncoordinated]?

Answer 19

Hallucinogens

Question 20

What depressants, stimulants**, **painkillers are commonly abused?

Answer 20

1. Depressants
   
   1. Alprazolam
   2. Zolpidem
   3. Zalepion
2. Stimulants
   
   1. Adderal
   2. Methylphenidate
3. Painkillers
   
   1. Fentanyl
   2. Hydrocodone
   3. Oxycodone

Question 21

Signs of amphetamines, methylphenidate, and cocaine OD?

Answer 21

Agitation + HTN/Tachycardia + Delusions + Hallucinations + Hyperthermia

Question 22

Sx of amphetamines, methylphenidate, and cocaine withdrawal?

Answer 22

Apathy, irritability, increased sleep, disorientation, depressed and CRASH

Question 23

Signs of barbituate, benzo, and ethanol OD?

Answer 23

Druken behavior, dilated pupils, shallow respiration, coma and death

Question 24

Signs of barbituate, benzo, and ethanol withdrawal?

Answer 24

Anxiety, insomnia, delirium, tremors, seizures and death

Question 25

Signs of **_heroin_** and **other _strong opioids_ _OD_**?

Answer 25

**Constricted pupils**, **drowsiness**, **respiratory depression** and **coma**

Question 26

**Opioid-R ANT** used to treat **[dependence** and **addiction**]

Answer 26

1. **Naloxone** (Narcan) 2. **Naltrexone**

Question 27

**Synthetic opioid** used to treat [**dependence** and **addiction**]

Answer 27

1. **Methadone**

Question 28

**mu-opioid- R partial AGO** used to treat [**dependence** and **addiction**]

Answer 28

**Buprenorphine**

Question 29

**Nicotinic-R _Partial_ AGO** used to treat [**dependence** and **addiction**]

Answer 29

**Varenicline (Chantix)**

Question 30

**Benzos** used to treat [**dependence** and **addiction**]

Answer 30

1. **Oxazepam** 2. **Lorazepam**

Question 31

**NMDA-R ANT** used to treat [**dependence** and **addiction**]

Answer 31

**Acamprosate** = alcoholism medication that ↓ desire to drink

Question 32

Other drugs used to treat **dependence** and **addiction**

Answer 32

1. **Dronabinol/ Nabilone** 2. **Ketamine** 3. **Bupropion** 4. **Nicotene** (Nicorette, Nicoderm CQ)

Question 33

What drugs are **abused**, but **NOT addictive?**

Answer 33

1. **LSD** (lysergic acid diethylamine) 2. **Mescaline** (Peyote) 3. **Psilocybin** 4. **Phencyclidine** (PCP, angel dust) 5. **Ketamine** (special K)

Question 34

Although not addictive, what **long-term effects** and **PCP** and **LSD** have?

Answer 34

1. **PCP** = irreversible schizophrenia-like psychosis 2. **LSD** = flashback of altered perception years after taking

Question 35

**Caffeine** Uses

Answer 35

1. **Improves mental alterness** 2. By mouth/rectally, with painkillers + ergotamine to **treat migraine HA.** 3. **Treat HA after epidural anesthesia** 4. **By mouth:** asthma, ADHD, memory 5. **_WL, T2DM_** 6. Very high doses are used with ephedrine =\> **alternative to illegal stimulants.**

Question 36

What is considered a "drink"?

Answer 36

1 drink = **0.6 oz** (**14 grams** or **1.2 tablespoon**) of pure alcohol. 1. **12 oz beer** (5% alcohol content) 2. **8 oz of malt liquor** (7%) 3. **5 oz of wine** (12%) 4. **1.5 oz of 80-proof** (40%)

Question 37

What is "**excessive drinking"**?

Answer 37

1. **Binge drinking** = M (5 or more drinks in 1 occasion); W (4 or more drinks in 1 occasion) 2. **Heavy drinking** = M (15 or more/week); W (8 or more/week) 3. **Drinking under 21** 4. **PG and drinking**

Question 38

Are **heavy drinkers** alcoholic or alocholic dependent?

Answer 38

**no**

Question 39

Describe the biochemical steps in the metabolism of **alcohol**?

Answer 39

Alcohol/ethanol =\> **[alcohol DH]** =\> acetaldehyde =\> [**acetaldehyde DH**] =\> acetic acid =\> [**O2**] =\> CO2 + water and energy

Question 40

**Alcohol** is metabolized via what type of kinetics? * _Rate-limiting factor_? * How is the _t1/2_ affected by dose?

Answer 40

* **Zero-order kinetics**; (_rate_ is _constant_ and _independent_ _of concentration_ or amount); undergoes extensive 1st pass metabolism by stomach and liver alcohol DH (ADH) * **Rate-limiting factor:** biological system * **t1/2:** ↑ with dose (not a true t1/2)

Question 41

The typical **70kg** adult can metabolize how much alcohol/hour?

Answer 41

7 - 10 g of alcohol/hr = **1 drink**

Question 42

What is responsible for biotransformation of **ethanol** and **methanol**?

Answer 42

1. **Alcohol DH** 2. **Aldehyde DH** 3. **MFOs (CYP450)**

Question 43

What should be done if a patient comes in with **_acute alcohol intoxication?_**

Answer 43

1. Watch for **respiratory depression** and **aspiration of vomit** 2. Give **glucose** to tx hypoglycemia/ketosis 3. Give **thiamine** to protect against Wernicke-Korsakoff syndrome.

Question 44

What should be done if a patient comes in with **_acute withdrawal syndrome_**?

Answer 44

* **Can be life-threatening:** major goal is to prevent seizures, delirium, arrhythmias * Tx = **benzos**

Question 45

What should be done if a patient comes in with **alcohol dependence?**

Answer 45

* **Primary tx** = Psychosocial therapy * Depression or anxiety disorders co-exist and treating these can decrease relapse.

Question 46

Drugs used to tx [**acute alcohol withdrawal syndrome]**

Answer 46

1. **Diazepam** (Valium) 2. **Lorazepam** (Ativan) 3. **Oxazepam** 4. **Thiamine** (vit B1)

Question 47

Drugs used to [**prevent alcohol abuse]**

Answer 47

1. **Acamprosate** 2. **Disulfiram (Antabuse)** 3. **Naltrexone**

Question 48

Drugs used to tx **[acute methanol/ethylene glycol poisoning]**

Answer 48

1. **Ethanol** = 1st line 2. **Fomepizole**

Question 49

**_Naltrexone_** * Use * MOA

Answer 49

1. **Tx = Alcohol** and **opiate** **dependence** 1. **​**Reduces alcohol craving and rate of relapse to drinking or alcohol dependence for short-term (12-weeks) 2. If dependent on alcohol AND opioids =\> must be opioid free before starting because it can cause acute withdrawal syndrome 2. **MOA**: Long-acting u-opioid-r ANT

Question 50

**_Acamprosate_** * Use * MOA

Answer 50

* **MOA** = weak NMDA receptor ANT and GABA AGO (also affects, 5HT, noradrenergic and DA system * Reduces short term and long-term relapse rate (more than 6 months)

Question 51

**_Disulfiram_** * MOA * Use * Warnings

Answer 51

* MOA = irreversibly inhibits aldehyde DH * Use = prevent alcohol abuse by causing extreme discomfort in pts who drink alcohol * Warnings = 1. do not give with any drugs that have alcohol (cough syrups, cold meds and mouthwashes) 2. Pts must be HIGHLY motivated.