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Abuse.Anesthetics Flashcards

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1
Q

physiological dependence

A

neuroadaptations-abnml behavior and physical sxs if withdrawn

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2
Q

psychological dependence

A

dysphoria and intense craving following withdrawal

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3
Q

withdrawal

A

adverse reactions caused by discontinuation of drug

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4
Q

tolerance

A

more drug is required to produce effect

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5
Q

pharmacokinetic tolerance

A

increased metabolism

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6
Q

pharmacodynamic tolerance

A

receptor downregulation

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7
Q

learned tolerance

A

adaptation to the degree of intoxication

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8
Q

conditioned tolerance

A

adaption to setting/environment

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9
Q

acute tolerance

A

may occur when a drug is used repeatedly over a short period of time

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10
Q

cross tolerance

A

one drug produces tolerance to another

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11
Q

sensitization

A

increase of responsiveness after repeated use

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12
Q

does sensitization cause dose-response curve L or R?

A

left

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13
Q

addiction definition

A

drug taken to alleviate craving/dysphoria

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14
Q

person is physiological dependendt, are they addicted?

A

not necessarily

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15
Q

properties of abused drugs

A

euphoria
easy to use
potency, purity
rapid onset/short action

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16
Q

reward pathway

A

VTA–>NAc–>prefrontal cortex

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17
Q

pharmacotherpaies for nicotine addiction

A

nicotine replacement therapy
buproprion
varenicline
all w/ behavioral tx

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18
Q

uses of amphetamines

A

narcolepsy

ADHD

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19
Q

amphetamine NT effect

A

increase release of DA–reverses DA transport throught DAT

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20
Q

peripheral effects of amphetamines

A

increased BP

cardiotoxicity

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21
Q

methamphetamine

A

may produce psychosis
rapid psychological and physical dependence
withdrawal

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22
Q

most life-threatening withdrawal

A

alcohol

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23
Q

mechanism of cocaine

A

inhibits DA reuptake

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24
Q

medical use of cocaine

A

local anesthetic

vasoconstrictor

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25
cocaine dependence
physical and psychological
26
peripheral effects of cocaine
``` tachycardia vasoconstriction HTN bronchodilation hyperpyrexia ```
27
effects of chronic cocaine use
reduction in overall brain activity nasal issues cocaine bugs
28
cocaine overdose
vtach/fib stroke seizures
29
tx for cocaine addiction
bromocriptine-decrease craving
30
nicotine MOA
activates nicotinic receptors in CNS and periphery, increasing serotonin, DA
31
nicotine dependence
psych and phsical
32
pharmokinetics of nicotine
induces CYP450s
33
MDMA MOA
increases 5HT activity by blocking reuptake and stiulating 5HT receptors
34
SE of MDMA
hyperthermia dehydration kidney failure
35
short term effects of MDMA
during: elevated mood (increased 5HT) after: depression-like, irritability (decreased 5HT)
36
marijuana dependence
psychological possible | no physical
37
marijuana MOA
stimulates presynaptic CB1 receptors to inhibit transmitter (ACh) release
38
SE of maijuana
``` amotivational syndrome cannabinoid hyperemesis (cyclic vomiting syndrome) ```
39
synthetic "cannabinoid" agonists
bath salts
40
LSD MOA
acts on 5-HT receptors in the brain
41
what is synesthesia associated with?
LSD
42
peripheral effects of LSD
increased BP/HR flushing dilated pupils
43
angel duust
PCP
44
PCP MOa
NMDA receptor antagonist
45
ketamine MOA
NMDA receptor antagonist
46
GHB MOA
GABA receptor weak agonist
47
analgesia aaccompanied aggression
PCP and ketamine
48
effects of PCP
psychosis--treat with haldol
49
used as date rape drugs
ketamine | GHB
50
general dissociative anesthetics
PCP ketamine GHB
51
inhalants MOA
unknown
52
peripheral neuropathy
nitrous oxide
53
amyl and butyl nitrite
SMM relaxants
54
dilated pupils
LSD
55
non-reactive pupils
PCP ketamine GHB
56
infiltration anesthesia
injection directly into tissue without consideration of cutaneous nerves
57
drugs used for infustion anesthesia
procaine lidocaine bupivicane
58
advantages and disadvantages of infusion anesthesia
a: anesthesia w/o sirupting normal function d: large amounts necessary
59
field block
subq injection that anesthetizes distal to injection
60
nerve block
injection around individual nerves or nerve plexuses
61
drugs used for spinal anesthesia
lidocaine bupivicaine tetracaine
62
physiological properties of esters
shorter duration of action | increased degree of systemic toxicity
63
what form must the anesthetic be in to cross the membrane?
non-ionized | ionized to bind to receptor
64
what kind of base or acid are anesthetics?
weak base | EXCEPT benzocaine
65
how is benzocaine used?
topical only
66
what things can decrease the effect of a local anesthetic?
inflammation (infection) | acidification
67
why might you add bicarbonate to an anesthetic?
increase level of non-ionized LA=increased membrane transport=shortened onset of action
68
MOA of local anesthetics
block Na channels and inhibit neuronal firing and the propagation action potentials
69
what state are Na channels when local anesthetics bind?
activated or inactivated | not resting
70
how do increases in calcium or potassium affect local anesthetics?
calcium: decreased effect potassium: enhanced effect
71
what determines potency of local anesthetics?
lipid solubility
72
what determines the duration of action of local anesthetics?
lipid solubility degree of protein binding site of location
73
short acting local anesthetics
procaine
74
intermediate acting local anesthetics
lidocaine | mepivicaine
75
long acting local anesthetics
bupivicaine ropivicaine tetracaine
76
what are toxic effects of local anesthetics dependent on?
half life
77
how do vasoconstrictors affect local anesthetics?
reduce diffusion
78
what are esters metabolized by?
butyrycholinesterase in plasma
79
what are amides metabolized by?
liver CYPs
80
local anesthetics: myelinated vs unmyelinated nerves
m: affected before unm. | larger and more myelinated=less sensitive
81
conduction velocity
the greater the velocity of the action potential the faster the onset and the less sensitive the nerve
82
firing frequency
increased firing rate the more sensitive the nerve
83
sensory or motor fibers more sensitive?
sensory
84
main SE of local anesthetics
``` CNS PNS CV hypersensitivty localized toxicity ```
85
amides or esters more likely to cause allergic rxn?
esters
86
CV SE of local anesthetics
arrhythmias | vasodilation--hypoTN
87
prilocaine uniqu
methemoglobinemia | highest rate of clearance
88
how can you reverse toxicity of lipid-soluble drugs?
administraiton of lipids
89
worst drug for CV SE
bupivicaine
90
procaine drug interactions
metabolic product PABA inhibits culfonamides
91
how do we measure potency of local anesthetics?
compared to procaine
92
procaine general
short acting | infiltration, diagnostic
93
tetracaine general
long but slow duration | ophtho, spinal
94
benzocaine general
topical--pruritus
95
lidocaine general
intermediate | infiltration, epidural
96
risk with lidocaine
TNS--no spinal anesthesia
97
ropivicaine general
long acting enantiomer of bupivicaine peripheral, epidural
98
ropivicaine vs bupivicaine
ropivicaine: less CV toxicity | less lipid soluble
99
prilocaine general
intermediate | dentistry
100
prilocaine CI
CVD | respiratory dz
101
etidocaine general
long duration | affects motor nerves
102
articaine general
amide-type but has ester group | dental
103
SE of articaine
persistent paresthesias
104
dibucaine general
used to test for butyrycholinesterase deficiency
105
who has low butyrycholinesterase levels?
elderly pregnant children parturition
106
baclofen MOA
GABAa agonist--hyperpolarize neurons--inhibit excitatory NTs
107
baclofen use
chronic spasticity
108
route of baclofen
oral | intrathecal pump
109
SE of baclofen
drowsy mm weakness increase seizures in epilepsy
110
diazepam use for muscle relaxant
local muscle trauma adjunct in chronic *sedation
111
tizanidine MOA
clonidine analogue | alpha2 agonist
112
tizanidine use
chronic due to SC injury | acute mm spasms
113
SE of tizanidine
hypotension sedatopm mm weakness, falls-elderly
114
cyclobenazaprine MOA
sedative at level of brainstem w/ cholinergic activity
115
cyclobenazaprine use
temporary- trauma/sprain
116
SE of cyclobenazaprine
confusion | transient visual hallucinations
117
carisoprodol MOA
metabolized to meprobamate | sedating
118
carisoprodol issues
short-term tx for anxiety--abuse potential
119
SE of carisoprodol
chronic=induction of hepatic microsomal enzymes
120
dantrolene MOA
direct action on the muscle- interferes with release of Ca2+
121
dantrolene use
``` malignant hyperthermia (general anesthetics) neuroleptic malignant syndrome (antipsychotics) ```
122
botulinum toxin MOA
blocks release of ACh

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