Droguri

Question 1

Dependenta

Answer 1

-dependenta psihica,fizica
-toleranta(farmacocinetica,faemacodinamica,invatata/conditionata)
-psihotoxicitatea

Question 2

Efect

Answer 2

-nicotina,cocaina,amfetamina-stimulant
-barbiturice,benzodiazepine,alcool-sedativ
-LSD,fenciclidina-halucinatii
-marijuana-modif disociative

Question 3

Nicotina-istoric

Answer 3

-la doze mici stim recep Nn
-la doze mari stim recep Nm
-la doze f mari bloc recep nicotinici

-ef prin stim ggl vegetativi si a medulosuprarenalei

Question 4

Nicotina intox acuta cu doze mari

Answer 4

-paralizie inerv vegetativa
-tremur
-convulsii
-paralizie ms striati
-colaps
-hipotensiune
-deces

Question 5

Nicotina dependenta

Answer 5

-apar ef asupra SNC in doar 7 sec
-la cronici-stim atentie si relax ms(stim neuroni dopaminergici din nucleu accumbens)
-poate afecta secr endogena de opioide si glucocort
-fumatul scade speranta vietii cu 5-8 ani( la cei fara boli cronice) si cu 15-22 ani ( la cei cu boli cronice)

Question 6

Nicotina-sdr abstinenta

Answer 6

-max la 2 sapt
-dur 3-6 sapt

Question 7

Nicotina trat

Answer 7

-de substitutie-6 luni
- ef benefice apare dupa 6 sapt
-la 12 luni de abstinenta ,doar 20% au recaderi
-cel mai ok sunt aerosoli presurizati dozati-inca nu sunt aprobate
-optim-ter de substit,ter comportamentala,ter anti craving

VARENCICLINA(agonist recep nicotinici)

Question 8

Alcool dehidrogenazA

Answer 8

-gastrica
-inhibata de aspirina
-metab gastrica a alcoolului e mai scazuta la femei

Question 9

Alcool efecte

Answer 9

1.CV
-aritmii
-cardiomiopat
-AVC hemoragic/ischemic
-HTA

2.Ms striati
-Scade forta de contr
-Miopatie scheletala

3.temperatura-o cresc,daca o scad risc moarte subita

4.digestiv
-creste secr acida gastric
-diaree(malabs)
-pancr acuta
-steatoza hep(cant medii)
-hepatita alcoolica,ciroza hep alcoolica(cant mari)

Altele
-inh vasopresina(ef diuretic)
-hipovitaminoze
-hipoMg
-hipoCa
-osteoporoza
-disfunctii sex

Question 10

Alcool doze

Answer 10

-20-30g/zi ef protectiv
-40-60g/zi-risc crescut

-80mg/dl intox acuta
-400mg/dl letal

Question 11

Alcool indicatii

Answer 11

-inj in nv/ggl simpatici-nevralgie trigemen,carcinom inoperabil
-inj paravert/epidural-durere lomb inop
-sistemic-intox cu alcool metilic,etilenglicol

Question 12

Dependenta cronica de alcool

Answer 12

-poate da ciroza
-sdr KORSAKOFF(afect memorie pt evenim noi)-reversibil dupa cateva lunil abstinenta

Question 13

Trat intox acuta alcool

Answer 13

-risc de hipoglic(se da Glu)
-daca avem vars,risc aspiratie(intubare)
-sedative,antipsihotice(daca e agresiv)

Question 14

Trat dependenta cronica

Answer 14

-rehidrat
-reech hidro electrolitica
-vitamine
-benzodiazepine
-anticonvulsivante

Question 15

Medicamente trat alcool

Answer 15

-NALTREXONA(antag opioid)-se da 3 luni,trb abstinenta 5-7 zile inainte,scade ef placute ale alcoolului

-NALMEFEN(scade motivatia de a bea,scade cant ingerata)-hepatotox mai mica decat primul

-ACAMPROSAT(normalizeaza transmitere neuronala in consum cronica)
-TOPIRAMAT(scade niv dopamina )

-carbamazepina-creste dispozitia
-ondansetron-amelioreaza dependenta fizica

Question 16

Marijuana

Answer 16

-form din THC (ef psihotrop)si CBD(potenteaza ef THC)
-in fum-61 canabinoizi
-SNC-clonati recep pt canabinoizi cu ligand endogen-anandamida
-recep gasiti in special in cortex,cerebel,corpi striati,hipocamo
-pe langa ca creste ef cognitive,atentir memorie
-mai are si alte ef-antivomitiv,anticonvulsivant,miorelax,scade pres intraoc
-ef teratogen
-daca consuma copiii-pot face coma

Question 17

Marijuana trat pt dependenta cronica

Answer 17

-dronabinol
-buspirol
-litiu
-timostabilizatoare
-antidepresive

Question 18

Substante inhalatorii folosite ca droguri

Answer 18

-fenciclidina-anestezic de uz veterinar(act pe recep pe aminoacizi excitatorii)-dg pe baza anamnezei si analiza suc gastric
-da coma 5-7 zile
-nu avem antidot,acidifiere urina(semn ca se elimina)

-GHT(gamahidroxibutirat)-ecstasy lichid

Question 19

Opioide -exemple

Answer 19

-opium,codeina,morfina
-semisintetice-heroina,hidromorfona
-sintetice-fentanil,tramadal,petidina

Question 20

Alcaloizi in opiu

Answer 20

-fenantrenici(codeina,morfina)-dau abuz
-benzilizochinolonici(papaverina)-efecte periferice

Question 21

Opioide intox acuta

Answer 21

Naloxona iv

Question 22

Sindrom abstinenta opioide

Answer 22

-apare la 10h de la oprire consum
-max la 36-48h
-simot dispar cam dupa 5 zile

Question 23

Durata de act opioide

Answer 23

-scurta(heroina,morfina)
-lunga(metadona)

Question 24

Trat dependenta opioide

Answer 24

-se trece de la subst cu elib rapida la cele cu elib lunga(metadona cu elib sustinuta)
-daca avem hipertonie simpatica-se da clonidina
-NALTREXONA(antag opioid)

Question 25

Heroina

Answer 25

-diacetil morfina -ef ce dureaza 3-5h -pac isi adm de 2-4 ori pe zi -sdr de abstinenta tine aprox 5-6 luni

Question 26

Heroina trat dependenta

Answer 26

-se tece pe morfona initial 20-30 g dupa se scade cu 20%/zi treptat -in caz de dependenta fizica majora se asoc cu naltrexona -pt hipertonia simpatica-clonidina(adm transdermica da hipotens),lofexidina(mai rar hipotens) -pt scadere craving-burprenorfina(agonist partial de opioizi)-sublingual sau inj(+naloxona) Dupa detox dam Naltrexona de tip depot+psihoter

Question 27

Psihostimulante-util benefice

Answer 27

-ADHD -oboseala -depresie usoara -narcolepsie -cocaina e fol ca anestezic in ORL

Question 28

Psihostimulante mec act

Answer 28

-inh recaptare serotonina si catecolaminte -act pe recaptare dopamina -creste dopamina in zone critice -inh sist transport specific transmembranar

Question 29

Cocaina

Answer 29

-T1/2 de 5 min -se doreste adm la 10-30 min -euforia depinde de cant ei in corpi striati -se gaseste in urina pana la 72h(10 zile la util cronici)

Question 30

Psihostimulante supradozare trat

Answer 30

1.agitaie -benzodiazepine(diazepam) -barbiturice cu dur scurta de act(ciclobarbital) -pt manif psihotice-clordelazin sau alt neuroleptic cu potenta mare AVEM GRIJA LA HALOPERIDOL sau alt neuroleptic-hipertermie,diskinezii,convulsii 2.TAD>110-alfa cu beta bloc(IMPREUNA DOAr!!),BCC,vasodil -se prefera nitroprusiat iv 3.convulsii cu diazepam sau barbiturixe 4.hipertermia prin metode fizice 5.rabdomioliza-alcalinizare urina +manitol/furosemid IN CAZURI SEVERE-curarizare cu PANCIRONIU sau adm de DANTROLEN

Question 31

Sdr de abstinenta cocaina

Answer 31

-faza de crash-imd dupa oprire -sdr de abstinenta propriu zis pana la 3 sapt -faza de excitatie-simptome asemanatoare,dar diminuate(1-3 luni)

Question 32

Trat dependenta cronica psihostimulante

Answer 32

Pt reducere craving -antidepr triciclice-au ef adv(TOPIRAMAT,BACLOFEN) -agonisti dopaminergici -inh selectivi recaptare serotonina -carbamazepina -partial agonisti opioizi(burprenorfina)

Question 33

Cofeina

Answer 33

-creste NA,dopamina -traverseaza BHE -antag recep adenozina -inh fosfodiesteraze