Addiction Flashcards
(43 cards)
Opioids:
Tolerance?
W/drawal?
Lethality of w/drawal syndrome?
Opioids readily produce tolerance (including to apnea).
Withdrawal symptoms are most unpleasant but are NOT considered to be lethal.
Their Sx may start 6-12 hrs after last dose of short-acting Fentanyl or 3-4 days after last dose of Methadone.
Opioids - Sx of w/drawal?
Drug craving, hyperalgesia, nausea, abdominal cramps, insomnia, anxiety
Heroine - describe the time course of its effects
Intense euphoria lasting only a few minutes followed by hours of sedation.
B/c of its lipid solubility it has a much faster onset than Morphine.
How would heroine overdose kill someone?
Apnea (temporary cessation of breathing during sleep/sedation)
- usually tolerance develops to this, however overdose would be if they take impure heroine
What does “cross-tolerance” refer to?
When one substance may substitute for another in preventing the withdrawal syndrome of the
first substance
What types of drugs are included in CNS depressants?
Ethanol, Benzodiazepines, Barbiturates, & obsolete nighttime sedatives such as methaqualone
CNS Depressants - is the w/drawal syndrome fatal?
Yes, b/c it includes status epilepticus. Additional Sx include craving, irritability, insomnia, tachycardia, hypertension, and hallucinations.
Tolerance develops at different rates to the sedating and apneic doses in which type of drugs?
CNS depressants
NOT opioids
Most specialists substitute a CNS depressant with a longer half-life than the abused substance during
the detoxification period.
For example, ethanol detoxification may include the administration of a __(a1)__, while detoxification from __(a2)__ abuse may be achieved by giving __(b)__ and tapering the dose over a period of weeks to months.
a1) benzodiazepine such as oxazepam
a2) Diazepam
b) phenobarbitol
**get that Benzos treat Ethanol addiction & Barbiturates treat Benzo addiction —> as long as half-life of treatment is longer than that of the substance they were addicted to
What is “Tachyphylaxis” & in what drug does this occur in?
The rapid development of tolerance, is common and is manifested as lessening of the effects after
each dose within a single drug-using session.
Happens w/ cocaine
Describe the w/drawal syndrome following prolonged cocaine use.
It is physiologically mild and consists of drug craving, sleepiness, dysphoria, depression, and bradycardia, and lasts a week or two after prolonged cocaine use.
Cocaine Addiction - Tx?
Management of cocaine addiction is largely supportive and psychotherapeutic; there is no known medication with efficacy in preventing cocaine use.
CNS stimulants are used appropriately in the Tx of what?
ADHD & Narcolepsy
Which of the CNS stimulants may cause hallucinations?
MDMA
Δ-9-THC is also called dronabinol (Marinol®) and is available in tablet form for the treatment of what?
Severe nausea & vomiting ass’d w/ cancer chemotherapy
What is N-arachidonylethanolamine (AKA anandamide)?
What are its receptors & where are they located?
It is an endogenous ligand that binds the same receptor as Δ-9-THC (Dronabinol).
These are G-protein coupled receptors present in high densities in the cerebral cortex, hippocampus, striatum, and cerebellum.
Binding to the receptors decreases GABA release, thus inhibiting its activity.
T or F?
Tolerance to the effects of a marijuana high develops rapidly after a few doses.
True
Describe the w/drawal symptoms of marijuana use.
Withdrawal symptoms are mild and consist of insomnia, restlessness, irritability, and nausea.
LSD, mescaline, and psilocybin affect many different receptor types, but their hallucinogenic effects may be due primarily to _____ at _____ receptors.
agonism at 5-HT2 receptors
This is noteworthy because the newer, atypical antipsychotic medications are primarily
antagonists at this same receptor.
Phencyclidine (used as a veterinary anesthetic) and Ketamine are _____ at the _____ receptor.
antagonists at the NMDA receptor
Describe the timeframe for the effects of serotinergic psychedelics.
The effects of the serotonergic psychedelic substances usually begin within an hour of oral ingestion and usually last for about 8 hr.
What symptoms may the serotinergic psychedelics cause other than hallucinations?
In addition to hallucinations, these medications often cause mood changes (euphoria or depression), and alterations in color and shape perception.
Sometimes there is intense anxiety and/or dysphoria, the so-called “bad trip.”
Rarely the psychedelic or psychotic effects will last for a few days.
Describe the w/drawal syndrome of the serotinergic psychedelics.
There is no w/drawal syndrome.
A few users of these medications will experience visual hallucinations (“flashbacks”) long after the last usage. This effect is thought to be due to permanent drug-induced changes in the visual cortex.
Describe the effects of Phencyclidine and Ketamine
The effects include emotional w/drawal & bizarre & unusual responses to environmental stimuli.
At higher doses, coma results although ventilation is usually preserved; recall that these are desirable effects for medications developed and used as anesthetic agents.
Recovery is often prolonged & accompanied by hallucinations and delirium.
