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pharm II: opioids, drugs of abuse, genomics > drugs of abuse > Flashcards

drugs of abuse Flashcards

1
Q

T/F: the use of illicit substances increases the risk for adverse consequences and drug interactions during anesthesia

A

TRUE

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2
Q

_______________ = psychological dependence

A

addiction

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3
Q

definition of addiction

A

compulsive drug use despite negative consequences

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4
Q

T/F: dependence equals addiction

A

false; dependence occurs with chronic exposure

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5
Q

which normally comes first, dependence or addiction?

A

dependence

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6
Q

___________________ is the primary target of addictive drugs

A

mesolimbic dopaminergic system

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7
Q

the mesolimbic pathway connects the _________________ (in the midbrain) to the _____________________

A

ventral tegmental area; nucleus accumbens

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8
Q

_________________ is where dopamine producing neurons are housed, and where large amounts of dopamine are released to the nucleus accumens and prefrontal cortex

A

ventral tegmental area (in the midbrain)

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9
Q

systemic administration of drugs of abuse –> the release of ____________

A

dopamine

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10
Q

the mesolimbic pathway is aka the ___________________

A

reward pathway

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11
Q

as a general rule, addictive drugs activate the __________________________

A

mesolimbic dopamine system

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12
Q

class of addictive substance is determined by _____________________

A

receptor

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13
Q

what are the three receptor types that addictive substances can act on to activate the mesolimbic dopamine system

A
  1. GCPR
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14
Q

which addictive drugs activate the mesolimbic dopaminergic system through GCPR ?

A
  1. opioids
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15
Q

what are the two way that addictive substances activate the mesolimbic dopaminergic system through GCPR

A
  1. target GABA neurons of the ventral tegmental area (VTA)
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16
Q

_________________ target Mu opioid receptors (MOR) on GABA neurons in the VTA; MORs are expressed on the ___________________ of these cells and the somatodendritic compartment on the ____________________ cells

A

opioids; presynaptic; postsynaptic

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17
Q

what is the major addictive mechanism of opioids on the presynaptic terminal of GABA neurons

A

G-protein (beta-gamma) inhibition of VG Ca channels (inhibiting the inhibitor –> excitation of dopamine neuron)

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18
Q

in dendrites mu opioid receptors activate _______________ channels –> _____________

A

K+; hyperpolarization (making it harder to respond to another stimulus)

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19
Q

together the pre and postysynaptic mechanisms of the Mu opioid receptors in the VTA –> ______________________

A

removal of inhibition of dopamine by GABA neurons

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20
Q

THC and other cannabinoids cause increased dopamine through _______synaptic inhibition of the _____________ receptor –> inhibition of ______________

A

pre; CBR1; GABA

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21
Q

Gama-hydroxybutyric acid (GHB) targets the ________________ receptors, which are located on both cell types; however, ______________ neurons are more sensitive to GHB than _______________

A

GABAb; GABA; dopaminergic

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22
Q

GHB will increases ______________ –> hyperpolarization of the GABA neuron

A

Cl

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23
Q

what is the clincial use of GHB

A

administered to pts with narcolepsy for high quality sleep

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24
Q

which addictive drugs work on ionotropic receptors to increase the release of dopamine

A
  1. nicotine
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25
Q

addictive drugs that work through ionotropic receptors work on _________________ neurons to increase release of ________________

A

dopaminergic & GABA; dopamine

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26
Q

which addictive substances –> addiction through primary actions on the dopamine transporter?

A
  1. cocaine
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27
Q

MOA of addiction from cocaine and amphetamines

A
  1. block the dopamine transporter –> blocking dopamine reuptake
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28
Q

T/F: cocaine and amphetamines effect the transporters of dopamine only

A

false; they affect dopamine primarily; but also other monoamines (NE and serotonin) issues with increased SNS when actively intoxicated with cocaine

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29
Q

hasish is __________x more potent than weed

A

3

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30
Q

benefits of cannabinoids

A
  1. increased appetite
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31
Q

___________________ is a FDA approved cannabinoid agonist in the US

A

dronabinol

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32
Q

________________ = older commercial THC analog recently reintroduced in the US for the management of chronic pain

A

nabilone

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33
Q

overall addictive potential of marijuana

A

2 (on 0-5 scale)

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34
Q

what is the psychoactive substance in cannabinoids

A

tetrahydrocannabinol (THC)

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35
Q

THC leads to _________________ with chronic use; but has a low risk for _______________

A

dependence; addiction

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36
Q

onset of smoking cannabinoids _____________; peak ______________

A

within minutes; 1-2 hours

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37
Q

_____________________ leads to euphoria, relaxation, feelings of well being, grandiosity, and an altered passage of time

A

cannabinoids

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38
Q

dose dependent perception changes of cannabinoids

A
  1. visual distortions
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39
Q

very high doses of cannabinoids can cause what rare effects

A
  1. visual hallucinations
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40
Q

withdrawal symptoms from cannabinoids would onset within ________________ hours from last use

A

24-72

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41
Q

withdrawal symptoms from cannabinoids

A
  1. restlessness
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42
Q

who is the MOST at risk for heroine use

A

18-25 year old caucasians in large metropolitan areas

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43
Q

heroine has an addiction score of ______________ on a 0-5 scale

A

4

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44
Q

_________________ is a semi-synthetic opioid agonist

A

heroine

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45
Q

metabolism of heroine

A

rapidly metabolized via biotransformation into mu-opioid agonist 6-monoacetylmorphine and morphine

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46
Q

smoking heroine has a _________________ delivery and ___________ bioavailability

A

rapid; low

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47
Q

tolerance of heroine leads to death from __________________

A

respiratory depression

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48
Q

heroine will cause a rush of ________________ followed by ______________ hours of sedation

A

euphoria; 2-4

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49
Q

IV dose of heroine:

A

5-10 mg

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50
Q

IV onset of heroine

A

3-5 seconds

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51
Q

smoking dose of heroin

A

15-25 mg

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52
Q

onset of heroin if smoked

A

5-15 seconds

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53
Q

IM/SubQ onset of heroin

A

5-10 min

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54
Q

insufflating (snorting) onset of heroin

A

2-10 min

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55
Q

PO onset of heroin

A

60-90 min

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56
Q

what is the typical dose of Lysergic Acid Diethylamide-25 (LSD)

A

20-30 mcg

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57
Q

LSD is what class of drug

A

ergot alkaloid

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58
Q

what is the MOA of LSD

A
  1. increases glutamate release in the cortex
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59
Q

onset of LSD

A

30 min

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60
Q

DOA of LSD

A

6-12 hours

61
Q

T/F: LSD induces tolerance

A

TRUE

62
Q

T/F: LSD stimulates dopamine release

A

FALSE

63
Q

_______________ is psychotomimetic and neurotoxic, meaning it mimics the sx of psychosis

A

LSD

64
Q

addiction score of LSD on a 0-5 scale

A

0

65
Q

psychomimetic and neurotoxic sx of LSD

A
  1. depersonalization
66
Q

somatic symptoms of LSD

A
  1. dizziness
67
Q

MOA of amphetamines

A

inhibits vesicular transporters ability to store dopamine in the presynaptic terminal –> increase release of synaptic dopamine

68
Q

route of methamphetamines

A

PO, IV, inhale, insufflate

69
Q

onset of methamphetamines is route dependent, so onset ranges from ________ - _______

A

instant; 30 min

70
Q

DOA of methamphetamines

A

4-8 hours

71
Q

metabolism of methamphetamines

A

liver

72
Q

excretion of methamphetamines

A

kidney

73
Q

methamphetamines are __________________ via NMDA receptor _______________

A

neurotoxic; antagonism

74
Q

methamphetamines indirect increased release of dopamine causes what s/sx

A
  1. euphoria
75
Q

methamphetamines indirect release of NE causes what s/sx

A
  1. increased arousal
76
Q

methamphetamines indirect release of serotonin would cause what s/sx

A
  1. hallucinations
77
Q

withdrawal sx from methamphetamines

A
  1. dysphoria
78
Q

bruxism is common with chronic _______________ users

A

methamphetamine

79
Q

methamphetamines have an addictive score of _____________ on 0-5 scale

A

5

80
Q

amphetamine pyschosis s/sx

A
  1. paranoia
81
Q

onset of smoking cocaine

A

6-8 seconds

82
Q

duration of action of smoking cocaine

A

20 min

83
Q

IV onset of cocaine

A

15 seconds

84
Q

Nasal onset of cocaine

A

5 min

85
Q

duration of action of IV cocaine

A

30-60 min

86
Q

duration of action of nasal cocaine

A

90 min

87
Q

________________ = water soluble salt stimulant of the SNS that is highly addictive

A

cocaine

88
Q

cycle experienced with cocaine use

A
  1. euphoria
89
Q

effects that may occur with chronic use of cocaine

A
  1. loss of appetite
90
Q

s/sx of OD of cocaine

A
  1. hyperthermia
91
Q

uses of cocaine in clinical medicine

A
  1. local anesthetic
92
Q

when you become sensitized to small doses of cocaine this describes __________________

A

reverse tolerance

93
Q

withdrawal s/sx of cocaine

A
  1. dysphoria
94
Q

metabolism of cocaine

A
  1. 90% metabolized by plasma cholinesterases (to inactive metabolites)
95
Q

1/2 life of cocaine

A

30-90 min

96
Q

cocaine metabolites are detected in urine testing up to __________ days after single use

A

6

97
Q

urine test can detect urine cocaine metabolites ________________ days after high dose or long term use

A

10-20

98
Q

central MOA of cocaine

A
  1. blocks reuptake of dopamine, 5-HT, and NE
99
Q

peripheral MOA of cocaine

A

inhibits voltage gated sodium channels

100
Q

what is a “speedball”

A

IV cocaine mixed with heroine

101
Q

_________________ will foster the feelings of intimacy and empathy without impairing intellectual capacity

A

MDMA

102
Q

MOA of MDMA

A

reverses monoamine transporters: 5-HT

103
Q

onset of MDMA

A

30 min

104
Q

DOA of MDMA

A

3-5 hours

105
Q

you can have intracellular decrease of 5-HT for _____________ hours after 1 dose of MDMA

A

24

106
Q

acute adverse effects of MDMA

A
  1. hyperthermia
107
Q

using MDMA with other serotonin agonists will cause what s/sx

A
  1. mental status change
108
Q

s/sx of withdrawal from MDMA

A
  1. depression lasting possibly serveral weeks
109
Q

abuse of _________________ often causes pts to water board –> water intoxication which can cause hyponatremia, seizure, and death

A

MDMA

110
Q

complications of IV drug abuse

A
  1. local infections/dificulty with access
111
Q

complications of inhalational drug abuse

A
  1. cilia depletion
112
Q

evidence of IV drug abuse (physical assessment)

A
  1. track marks
113
Q

pupillary response with amphetamine use

A

mydriasis

114
Q

pupillary reponse with opioid use

A

miosis

115
Q

pupillary response with PCP abuse

A

nystagmus

116
Q

lymphadenopathy can be a sign of _____________ drug abuse

A

IV

117
Q

nasal perforation is a sign of ____________ abuse

A

cocaine

118
Q

______________ abusers tend to be malnourished, while ____________ abusers tend to be well nourished

A

amphetamine; opioids

119
Q

goals in management of pt who has a substance abuse d/o

A
  1. adequate pain control
120
Q

recommendations for managing the substance abuse pt to meet anesthetic management goasl

A
  1. ketamine infusion
121
Q

if you have a patient present for elective surgery and you think they are under the influence of illicit drug what should you do

A

cancel/delay until further patient evaluation can be performed

122
Q

acute drug abuse –> elevated heart rates. what drugs should be avoided

A
  1. ketamine
123
Q

issues/risks with anesthetic management in a heroin abuser

A
  1. PUD
124
Q

anesthetic management recommendations for pt who abuses heroin

A
  1. regional
125
Q

issues/risks of anesthetic management in methamphetamine abuser

A
  1. rhabdomyolysis
126
Q

recommendations for anesthetic management of pts who abuse methamphetamines

A
  1. avoid neuraxial
127
Q

issues/risks in anesthesia management in the pt who abuses cocaine

A
  1. increased SNS activity
128
Q

recommendations for anesthetic management in the pt who abuses cocaine

A
  1. avoid long acting BB
129
Q

anesthetic management for the pt who abuses MDMA

A
  1. beware of sympathomimetics (2/2 increased SNS)
130
Q

acute use of marijuana is _______________ to anesthetic agents

A

additive

131
Q

T/F: cannabinoids have a cross tolerance to anesthetic agents

A

TRUE

132
Q

what are the 3 humoral systems used to manage hemodynamics?

A
  1. SNS
133
Q

which SNS receptor is Gq coupled

A

alpha 1 (postsynaptic)

134
Q

which SNS receptor is Gi coupled

A

alpha 2 (presynaptic)

135
Q

alpha 1 receptor is Gq coupled meaning it activates ______________; causing _________ –> _______ + _______

A

phospholipase C; PIP2; IP3; DAG

136
Q

alpha 2 receptor is Gi coupled meaning it inhibits _____________ –> inhibition of _______________

A

adenylyl cyclase; cAMP

137
Q

B1 and B2 receptors are ______________ coupled meaning they activate ________ –> ___________

A

Gs; adenyl cyclase; cAMP

138
Q

effects of alpha 1 stimulation

A
  1. vasoconstriction
139
Q

effects of alpha 2 stimulation

A
  1. inhibits insulin release in the pancrease
140
Q

effects of B1 stimulation

A
    • chronotropy, dromotropy, and ionotropy
141
Q

effects of B2 stimulation

A
  1. bronchodilation
142
Q

what is the primary NT from postganglionic SNS nerve?

A

NE

143
Q

the adrenal medulla releases 80% ________ and 20% __________

A

epi; NE

144
Q

________________ is the final product in the synthesis of natural catecholamines

A

epi

145
Q

describe the steps of SNS production of catecholamines

A
  1. tyrosine into SNS nerve
146
Q

what is the rate limiting step for NE synthesis

A

tyrosine to L-dopa via tyrosine hydroxylase

147
Q

__________% of NE is transported back into the nerve terminal via reuptake transport system

A

90

148
Q

metabolism of NE that occurs in the cytoplasm of the axon is done via __________

A

MAO

149
Q

metabolism of NE that occurs in the nerve junction is done via ____________

A

COMT

pharm II: opioids, drugs of abuse, genomics (4 decks)

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