Chapter 35: Substance Use Disorders IV

Question 1

major drugs of abuse

Answer 1

Opioids​

Psychostimulants​

Depressants​

Psychedelics​

Dissociative drugs​

Anabolic steroids​

Miscellaneous drugs of abuse​

Marijuana​

d-Lysergic acid diethylamide (LSD)

Question 2

Heroin, Oxycodone, and ​
Other Opioids

Answer 2

Major drugs of abuse: Heroin, oxycodone, meperidine​

Most opioids are Schedule II need DEA to scribe ​
In Ohio need OAARS​

Question 3

heroin pattern of abuse

Answer 3

Greatest use among 18- to 25-year-olds​

All segments of society​

First exposure usually social or for pain management

Question 4

subjective and behavioral effects of heroin

Answer 4

Moments after IV injection: Sensations of pleasure, relaxation, warmth, and thirst​

Followed by euphoria​

Initial use causes nausea and vomiting

Initially may also cause an overall sense of dysphoria

Question 5

heroin preferred drugs and routes of admin

Answer 5

Opioid of choice for street use​

High lipid solubility​

IV route preferred, but also smoking, nasal inhalation

Question 6

oxy

Answer 6

Opioid similar to morphine​

Intended as controlled-release drug [OxyContin]​

Abusers crush tablet​

Snort powder or dissolve in water for IV​

Entire dose absorbed immediately with high risk of death

Question 7

Meperidine

Answer 7

Nurses and health care providers who abuse opioids often select meperidine​

Highly effective in oral route (unlike injections, leaves no sign)​

Minimal effect on smooth muscle: Fewer problems with constipation and urinary retention

Question 8

opioid tolerance

Answer 8

develops for resp depression, euphoria, nausea

does not develop for meiosis and constipation

cross tolerance to other opioids -not to CNS depressants

Question 9

opioid physical dependence

Answer 9

Long-term use​

Abstinence syndrome​

Acute phase (10 days) and second phase (months)

Question 10

opioid acute toxicity

Answer 10

Triad of symptoms​
Respiratory depression​
Coma​
Pinpoint pupils​

Treatment​
Naloxone [Narcan]: Careful titration

Question 11

Opioid Detoxification: Clonidine-assisted withdrawal​

Answer 11

Centrally acting alpha2-adrenergic agonist

Most effective against symptoms related to autonomic hyperactivity (nausea, vomiting, diarrhea)​

Provides modest relief from muscle aches, restlessness, anxiety, and insomnia​

Does not diminish opioid craving

Question 12

opioid detox withdrawa;

Answer 12

Rapid withdrawal​

Ultrarapid withdrawal​
Administration of naloxone or naltrexone: Immediate withdrawal​
Withdrawal process accelerated​
Ultrarapid procedure: General anesthesia or heavy sedation with IV midazolam [Versed]​
In both procedures, clonidine may be added to ease symptoms​
No more effective than standard withdrawal techniques​
Considerably more expensive​

Question 13

opioid detox sub

Answer 13

Methadone substitution ​
Long-acting oral opioid​
Most commonly used agent​
Approximately 10 days​

Buprenorphine​ -suboxone

Substituted for opioid the addict is physically dependent on​

Prevents symptoms of withdrawal

Question 14

Drugs for Long-Term Opioid Addiction Management

Answer 14

Three groups of medications​
Opioid agonists, opioid agonist-antagonists, and opioid antagonists​

Methadone​
Maintenance and suppressive therapy​

Buprenorphine​
Maintenance therapy and detox facilitation​

Naltrexone​
Discourages renewed opioid abuse

Question 15

Sequelae of Compulsive ​
Opioid Use

Answer 15

Few direct detrimental effects​

Individuals on methadone maintenance can be successful socially and at work​

Indirect hazards: Septicemia, cellulitis, abscesses, endocarditis, tuberculosis, hepatitis C, HIV, and foreign body emboli​

Accidental overdose

Question 16

general CNS depressants

Answer 16

Barbiturates, benzodiazepines, alcohol, and other agents​

Benzodiazepines have unique properties

Question 17

Barbiturates

Answer 17

Depressant effects are dose dependent​
Mild sedation to sleep to coma and death​

Subjective effects similar to those of alcohol​

Agents with short to intermediate duration of action have highest abuse incidence and are Schedule II​
Amobarbital, pentobarbital, and secobarbital

Tolerance​

Physical dependence​

Withdrawal​

Acute toxicity​

Maintain respiration and remove drug​
Naloxone: Reverses opioid poisoning but is not effective against barbiturate poisoning

Question 18

Benzodiazepines

Answer 18

Benzodiazepines (Schedule IV)​
Much safer than barbiturates​
Overdose rare when taken alone and orally​
Risk increased with IV or with other depressants​

Tolerance​

Physical dependence and withdrawal techniques​

Acute toxicity​

Flumazenil [Romazicon] -reversal

Question 19

Psychostimulants

Answer 19

CNS stimulants (Schedule II) with a high potential for abuse​
Methamphetamines​
Cocaine​

Can stimulate the heart, blood vessels, and other structures under sympathetic control

Question 20

Cocaine

Answer 20

Extracted from leaves of coca plant​

CNS effect similar to that of amphetamines​

Two forms used by abusers:​
Cocaine​
“Crack”​

Can produce local anesthesia, vasoconstriction, and cardiac stimulation

Tolerance, dependency, and withdrawal​

Treatment of cocaine addition​
Anticocaine vaccine ​
Disulfiram [Antabuse]

Question 21

coke acute tox

Answer 21

Mild overdose: Agitation, dizziness, tremor, blurred vision​

Severe overdose: Hyperpyrexia, convulsions, ventricular dysrhythmias, hemorrhagic stroke, angina pectoris, myocardial infarction ​

Treatment: Intravenous diazepam or lorazepam, nitroprusside, hypertonic sodium bicarbonate, aspirin, external cooling

Question 22

coke chronic tox

Answer 22

Intranasally: Atrophy of the nasal mucosa and loss of sense of smell​

Extreme cases: Necrosis and perforation of the nasal septum​

Injury to the lungs can occur from smoking cocaine base​

Use during pregnancy

Question 23

coke admin

Answer 23

Cocaine hydrochloride ​
White powder​
Diluted for sale​
Taken intranasally​

Cocaine base: Commonly called “crack”​
Heated for use​
Taken by IV injection

Question 24

Methamphetamines

Answer 24

In abuse, usually taken orally, snorted, smoked, or IV​

Also called “ice” or “crystal meth”​
Form of dextroamphetamine​
Smoked, snorted, or inserted into rectum​

Effects​
Arousal, euphoria, sense of increased physical strength and mental capacity​
Hallucinations, psychotic state, sympathomimetic actions

Question 25

meth adverse CV effects

Answer 25

Hypertension​ Angina pectoris​ Dysrhythmias​ Cerebral and systemic vasculitis and renal failure, stroke​ Vasoconstriction can be relieved with an alpha-adrenergic blocker (e.g., phentolamine)​ Cardiac stimulation can be reduced with a mixed alpha and beta blocker (e.g., labetalol)​

Question 26

other meth effects

Answer 26

Significant weight loss​ Fetal effects​ “Meth mouth”

Question 27

meth Tolerance, dependency, and withdrawal

Answer 27

Treatment: Cognitive behavioral therapy, matrix model, bupropion [Wellbutrin, Zyban], modafinil [Provigil, Alertec], and Ibudilast

Question 28

Marijuana

Answer 28

Cannabis sativa (hemp) ​ Marijuana and hashish are derivatives​ Common names: “Grass,” “weed,” “pot” ​ Most commonly used illicit drug in the United States, although it is now legal in some states

Question 29

Marijuana

Answer 29

Psychoactive substance ​ Delta-9-tetrahydrocannabinol (THC)​ Routes​ Smoking -60% of THC content is absorbed; effects begin in minutes and peak within 20 to 30 minutes​ Oral​ -Most of THC is inactivated by first-pass effect Effects​ Low to moderate dose​ High dose​ Long-term use​ Schizophrenia​ Cardiovascular​ Dose-related increase in heart rate​ Respiratory​ Acute: Bronchodilation​ Chronic: Airway constriction Reproduction​ Males and females affected​ Altered brain structure​ Hippocampal volume left hemisphere​ Tolerance and dependence

Question 30

Therapeutic Use of Marijuana

Answer 30

Approved uses for cannabinoids​ Unapproved uses for cannabinoids​ Medical research on marijuana​ Legal status of medical marijuana​ Synthetic marijuana Comparison of marijuana with alcohol​ Aggressive behavior is rare with marijuana use​ Less loss of judgment with marijuana​ Increased appetite with marijuana: Fewer problems with nutritional deficiencies​ Marijuana produces increased toxic psychosis, dissociative phenomena, and paranoia, more so than alcohol does

Question 31

Psychedelics​ lsd

Answer 31

d-Lysergic acid diethylamide (LSD)​ Acts on the brain’s serotonin receptors​ Routes: Oral, IV, smoked​ Alters the following (as otherwise occurs only in dreams):​ Thinking​ Feelings​ Perception ​ Relationship to environment

Question 32

other psychedelics

Answer 32

Salvia: Causes dream-like state of unreality​ Mescaline​ From peyote cactus​ Psilocybin ​ Psilocin​ Dimethyltryptamine

Question 33

Dissociative Drugs pcp

Answer 33

Original use: Surgical anesthetics​ Recreational use: Distort sight and sound and produce dissociation​ Act in the cerebral cortex and limbic system ​ PCP easily synthesized/manufactured by amateurs ​ Routes: Oral, intranasal, IV, smoking Effects​ Low to moderate doses, high doses​ Toxicity

Question 34

ketamine

Answer 34

Similar to PCP in structure, mechanism, and effects​ Shorter duration of effects

Question 35

Dextromethorphan

Answer 35

Over-the-counter (OTC) cough suppressant ​ Low dose for antitussive: No psychologic effects​ Doses 5 to 10 times higher: Produces euphoria, disorientation, paranoia, altered sense of time, and hallucinations​ Also used in combination cold products​ Highly abused by adolescents and teenagers

Question 36

3,4-Methylenedioxymethamphetamine

Answer 36

Common names: MDMA, ecstasy​ Complex drug with stimulant and psychedelic properties​ Structurally related to methamphetamine (stimulant) and mescaline (hallucinogen)​ Low doses: Mild LSD-like psychologic effects​ Higher doses: Amphetamine-like effects ​ Promotes release of neurotransmitters​ Usually taken orally; also snorted, injected, or taken by rectal suppository Adverse effects​ Can injure serotonergic neurons, stimulate the heart, and dangerously raise body temperature​ Neurologic effects​ Seizures, spasmodic jerking, jaw clenching, teeth grinding​ Confusion, anxiety, paranoia, panic

Question 37

Inhalants

Answer 37

Term can refer to many drugs; common characteristic is administration by inhalation​ Anesthetics​ Volatile nitrites​ Organic solvents

Question 38

Anabolic Steroids

Answer 38

Androgens​ Taken to enhance athletic performance​ Increase muscle mass and strength​ Massive doses often used have high risk for adverse effects​ Most are classified as Schedule III drugs