[216B] Drug Use and Abuse

Question 1

The theory behind addictive personalities is that there is a genetic link to decreased activity in the _________ _____ ____ (part of the brain), resulting in decreased _____ ____.

Answer 1

Ventromedial prefrontal cortex.

Impulse control.

Question 2

T/F: addiction is a disease.

Answer 2

True :0

Question 3

List 3 drug classes considered “downers”.

Answer 3

1. Opioids.
2. Sedative hypnotics.
3. Benzodiazepines.

Question 4

List 3 desired effects of downers abuse.

Answer 4

1. Altered mood.
2. Relaxation (euphoria).
3. Uninhibited behaviour.

Question 5

What are the names of the 3 opioid receptors?

Answer 5

1. Mu.
2. Kappa.
3. Delta.

Question 6

Opioids provide pain relief by inhibiting:

Answer 6

Substance P.

Question 7

Which opioid receptor does morphine bind to?

Answer 7

Kappa.

Question 8

When opioids bind to Kappa receptors, they stimulate ______ release, which is why _____ is a common side effect.

Answer 8

Histamine release.

Itching.

Question 9

List 8 things we should assess for when treating a pt on opioids.

Answer 9

1. Pain relief efficacy.
2. CNS (altered LOC, dizziness, seizures).
3. Orthostatic hypoTN (d/t peripheral vasodilation).
4. Respirations (d/t CNS depression).
5. Itching (d/t mast cell stimulation/histamine release).
6. Nausea (d/t decreased peristalsis + substance P binding in chemoreceptor trigger zone).
7. Constipation (d/t decreased peristalsis).
8. Urinary retention (d/t mu receptor antagonism).

Question 10

We should hold opioids if RR is less than

Answer 10

12

Question 11

Opioids are pregnancy category __, which means:

Answer 11

D - should not be given to pregnant pts.

Question 12

Drugs causing ______ [neurotransmitter] release are likely to be addictive because it is responsible for our sense of:

Answer 12

Dopamine.

Pleasure/reward pathway.

Question 13

T/F: usually, ODs are caused by one drug.

Answer 13

False D: usually mixes of multiple drugs

Question 14

Why do we see such a high number of fentanyl ODs?

Answer 14

Often laced into other street drugs (cos it’s cheap).

Question 15

Fentanyl is ___x more potent than morphine.

Answer 15

100

Question 16

Do we use carfentanyl for therapeutic purposes?

Answer 16

No D:

Question 17

What is the tx for opioid OD?

Answer 17

Naloxone (Narcan).

Question 18

T/F: only one dose of naloxone is required to reverse an opioid OD.

Answer 18

False :| naloxone’s half-life is shorter than most opioids, so to be safe, we should give repeated doses or start a continuous IV infusion.

Question 19

What is the therapeutic use for ketamine?

Answer 19

Conscious sedation (anesthetic).

Question 20

List 3 effects of ketamine.

Answer 20

1. Sedation.
2. Amnesia.
3. Respiratory depression.

Question 21

How is ketamine abused?

Answer 21

Date rape drug.

Question 22

PCP (phencyclidine) was originally developed for:

Answer 22

anesthesia.

Question 23

Why is PCP not used in clinical settings?

Answer 23

Too lipophilic, potent & addictive.

Question 24

T/F: PCP can cause an excitation phase and a sedation phase.

Answer 24

True: excitation first, then sedation (dose dependent).

Question 25

What are the 2 active ingredients in mushrooms?

Answer 25

1. Psilocin. | 2. Psilocyb.

Question 26

Mushrooms have ________ effects.

Answer 26

Hallucinogenic.

Question 27

List 3 categories of substances that would be considered mixed effect.

Answer 27

1. Cannabinoids. 2. Alcohol (ETOH). 3. Nicotine.

Question 28

List 3 desired effects of mixed-effect substances.

Answer 28

1. Altered mood. 2. Relaxation. 3. Un-inhibition of behaviour.

Question 29

Which mixed effect substance has a 2% risk of psychosis? What is a long-term consequence of this?

Answer 29

Cannabinoids: may cause mental illness (ex: schizophrenia).

Question 30

List 2 therapeutic uses for cannabinoids.

Answer 30

1. Nausea. | 2. Complex pain.

Question 31

What are 2 notable active ingredients in cannabinoids?

Answer 31

1. THC (tetrahydrocannabinol). | 2. CBD (cannabidiol).

Question 32

What receptors do cannabinoids bind to? Where are these found?

Answer 32

CB1 & CB2. | CNS & PNS.

Question 33

Which 3 neurotransmitters do cannabinoids increase?

Answer 33

1. Dopamine. 2. Serotonin. 3. Anandamide.

Question 34

Where does anandamide act? What can this result in?

Answer 34

Amygdala. | Memory loss.

Question 35

CBD ______ the adrenergic NS, resulting in a ______ effect.

Answer 35

Antagonizes. | Calming.

Question 36

THC acts on the adrenergic NS to make you feel:

Answer 36

Alert, focused, agitated.

Question 37

What happens when you take both CBD & THC?

Answer 37

They compete at receptors and balance each other out.

Question 38

What is THC resin? What will it cause (2)?

Answer 38

Superconcentrated THC. | Causes voltatile VS changes (BP, HR) & CNS effects (hallucinations/seizures).

Question 39

Which 3 neurotransmitters does alcohol increase?

Answer 39

1. Ach. 2. Serotonin. 3. GABA.

Question 40

List 5 ADME characteristics of alcohol.

Answer 40

1. Absorbed via stomach. 2. Readily crosses BBB. 3. Uses Vit B during metabolism. 4. Zero order kinetics. 5. Liver toxicity/disease: cirrhosis.

Question 41

What do we call alcohol withdrawal syndrome?

Answer 41

Delirium tremens.

Question 42

What is the primary tx for an alcohol OD? What is its MoA?

Answer 42

Metadoxine: increases metabolism (converts it to use first order kinetics).

Question 43

List 2 adjunct txs for alcohol ODs. Why are they helpful?

Answer 43

1. Anxiolytics (ex: benzos): tx anxiety (ex: restlessness, irritability). 2. Vitamins (replacement for depletion d/t metabolism).

Question 44

Nicotine is a (2):

Answer 44

cholinomimetic & adrenergic.

Question 45

Why is vape juice testing awful?

Answer 45

It's based on ingestion and not inhalation.

Question 46

Nicotine affects adolescent brain development, especially the parts responsible for (3):

Answer 46

1. Intelligence. 2. Language. 3. Memory.

Question 47

List 2 ways we can obtain a toxicology sample.

Answer 47

1. Serum (blood draw). | 2. Urine.

Question 48

List 2 drugs classes that would be considered "uppers".

Answer 48

1. CNS stimulants. | 2. Psychoactive stimulants (ex: ecstasy).

Question 49

List 3 desired effects of uppers abuse.

Answer 49

1. Altered mood. 2. Excitation (euphoria). 3. Uninhibited behaviour.

Question 50

Uppers increase these 3 neurotransmitters:

Answer 50

1. NE. 2. Serotonin. 3. Dopamine.

Question 51

Uppers will increase these 4 physiological processes:

Answer 51

1. BP. 2. HR. 3. Vasoconstriction. 4. Metabolic rate.

Question 52

CNS stimulants include these 2 drug classes:

Answer 52

1. Sympathomimetics. | 2. Amphetamines.

Question 53

List 1 therapeutic use for stimulants.

Answer 53

Tx ADHD (ex: concerta).

Question 54

List 2 stimulant street drugs.

Answer 54

1. Cocaine. | 2. Crystal meth.

Question 55

List 2 ways crystal meth differs from concerta (ADHD tx) and is therefore more dangerous.

Answer 55

1. Higher dose. | 2. Usually injected (concerta is usually PO) = much higher bioavailability.

Question 56

Cocaine + alcohol is called _____ and has an increased ______ [PK characteristic].

Answer 56

"Cocaethylene". | Increased half-life.

Question 57

List 2 psychoactive stimulant street drugs.

Answer 57

1. LSD (acid). | 2. Ecstasy (MDMA).

Question 58

List 4 broad effects of addiction.

Answer 58

1. Impaired CNS synapses. 2. Malnutrition (electrolyte & vitamin deficiencies). 3. Infections (d/t needle sharing/contact with body fluids). 4. Socioeconomic decline.

Question 59

List 8 s&s of impaired CNS synapses.

Answer 59

1. Poor memory & IQ decline with use. 2. Hallucinations. 3. Paranoias. 4. Seizures. 5. Altered personality. 6. Impulsive behaviours. 7. Violence. 8. Depression.

Question 60

List some adrenergic-like symptoms associated with withdrawals.

Answer 60

Anxiety, restlessness, tremors, insomnia. GI distress (nausea, cramping). Fever, diaphoresis, tachycardia. Headaches.

Question 61

List 4 tx for withdrawals.

Answer 61

1. CBT/counselling. 2. Weaning protocols. 3. Milder opioids: buprenorphine, suboxone, methodone (satisfies cravings without the "downing" effect). 4. Adjunct tx: antidepressants, anxiolytics.