Drugs of Abuse - Cannabis Flashcards

1
Q

Outline the reward pathway

A
  • Dopaminergic neurones that originate in the ventral tegmental area and project down to the nucleus accumbens in the ventral striatum
  • Dopamine secretion at the nucleus accumbens in the ventral striatum causes the euphoria
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2
Q

1) Mention the 4 different routes of administration of these drugs of abuse and outline the path they take
2) Which one of these is the fastest route and why?

A
  1. Nasal (snorting)
  2. Oral
  3. Inhalation (smoking)
  4. Intravenous (injecting)
  • Inhalation has the fastest route to the brain
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3
Q

What are the 4 classifications of the drugs of abuse and give examples

A
  1. Depressants - alcohol, benzodiazepams, barbiturates
  2. Stimulants - cocaine, amphetamine, methamphetamine
  3. Narcotics / painkillers - opiates e.g. heroin
  4. Miscellaneous - cannabis, ecstasy
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4
Q

What are the 2 main cannabinoids found in cannabis and which one is more potent?

A
  1. Cannabidiol
  2. Delta9 - THC - MOST POTENT
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5
Q

Cannabidiol is believed to have a ….. ….. from the ….. ….. of Delta9 - THC

A

Cannabidiol is believed to have a protective effect from the negative effects of Delta9 - THC

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6
Q

Which one of these cannabinoids - cannabidiol or delta9 - THC is the harmful cannabinoid?

A
  • Delta9-cannabidiol
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7
Q

Why is there low and slow absorption if you intake a drug using oral administration?

A
  • Low absorption due to first pass metabolism by the liver
  • Slow due to the time it takes for it to pass through the digestive tract and enter the circulation in order for it to reach the brain
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8
Q

Why don’t you get complete absorption with the inhalational (smoking) route of drug administration?

A
  • Because not all of the smoke will reach far down enough into the lungs and lots of it is breathed out
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9
Q

1) Where does cannabis accumulate and why?
2) In what form does it accumulate in these tissues?

A

1)

  • In poorly perfused tissues
  • In fatty tissues - as it is very lipophilic

2)

  • As fatty acid conjugates of 11-OH-THC - a metabolite of delta9-THC which is even more potent
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10
Q

What is the metabolite of cannabis which is even more potent than the most potent cannabinoid prior to metabolism?

A
  • 11-OH-THC is a metabolite which is even more potent than delta9-THC which is the most potent cannabinoid
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11
Q

Give 2 ways that cannabis can persist in the system

A
  1. Enterohepatic cycling
  2. Bio-accumulation of fatty acid conjugates of 11-OH-THC in fatty tissue and poorly perfused tissue
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12
Q

Why do chronic cannabis users get more high than non-chronic users?

A
  • Because of the stores of the very very potent 11-OH-THC metabolite which bio-accumulates in fatty tissue and in the poorly perfused tissues
  • It even accumulates in the fatty tissue of the brain
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13
Q

What is the most prevalent endogenous cannabinoid?

A
  • Endogenous anandamide
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14
Q

What are the 2 types of cannabinoid receptors and where are they located?

What type of receptors are these cannabinoid receptors?

A

1)

  1. CB1 receptors - in brain areas
  2. CB2 receptors - in peripheral immune cells

2)

  • Gi-protein coupled - and negatively coupled to adenylate cyclase
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15
Q

Explain the mechanism for how endogenous cannabinoids or even exogenous cannabinoids can cause euphoria

A
  • Anandamide (endogenous cannabinoid) or the exogenous cannabinoids e.g. delta9-THC can bind CB1 receptors, particularly on GABAergic neurones in the brain which have many CB1 receptors
  • These CB1 receptors are negatively coupled with adenylate cyclase, thereby depressing the function of these GABAergic neurones
  • Therefore less inhibition of the dopaminergic neurones which would otherwise be greatly inhibited by the GABAergic neurones
  • So more active dopaminergic neurones in the reward pathway - remember this originates in the ventral tegmentum and terminates in the nucleus accumbens within the ventral striatum
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16
Q

Explain the pathophysiology behind how chronic cannnabis use can lead to psychosis / schizophrenia

A
  • Hypoactivity of the anterior cingulate cortex
  • Which otherwise adjusts behaviour in response to performance monitoring in order to avoid losses
17
Q

How does cannabis increase appetite?

A
  1. Presynaptic inhibition of GABA increases MCH firing rate in the lateral hypothalamus to increase appetite
  2. Increased orexin production in the lateral hypothalamus
18
Q

What impact does cannabis have on the immune system?

A
  • It binds CB2 receptors
  • Inhibits immune function
  • IMMUNOSUPRESSANT
19
Q

Why does cannabis use cause bloodshot eyes?

A
  • Causes vasodilation in conjunctiva
20
Q

Give 5 negative side-effects of cannabis use

A
  1. Psychosis
  2. Schizophrenia
  3. Increased appetite
  4. Impaired memory
  5. Psychomotor problems - impact on cerebral cortex
21
Q

Why is cannabis use not fatal, whereas alcohol and heroin use can be?

A
  • Alcohol and heroin can involve the medulla which is an important area most notably because it contains the cardio-respiratory centre
  • However there are very few CB1 receptors in the medulla, so cannabis has little effect on the medulla, meaning it is not fatal
22
Q

In what cases can CB receptors be upregulated, and of these when can it be:

1) Positive
2) Negative

A

1)

  • Stroke
  • Pain
  • MS

2)

  • CONTRIBUTE TO THE FOLLOWING PATHOLOGIES
  • Obesity
  • Infertility
23
Q

What are the enzymes that break down endogenous cannabinoids called?

A
  • Fatty acid amide hydrolase inhibitors
24
Q

Give 3 cannabinoid agonists and for each mention which cannabinoids they are agonists for and then what they are useful in treating / what they are NOTE 2 of them can be grouped together

A
  1. Dronabinol / Nabilone - delta9-THC agonist
  • Anti-nausea for chemotherapy patients
  • Stimulate appetite in AIDs or cachectic patients
  1. Sativex - CBD / delta9-THC agonist
    * Analgaesic
25
Q

Give one cannabinoid antagonist, what it was used for and why it was eventually pulled from use - what side effect did it have?

A
  • Rimonabant
  • Anti-obesity agent - becuase remember that CB is upregulated in and contributes to obesity
  • Pulled because it caused depression and suicide!