Flashcards in Drugs of Abuse Deck (55):
Family of Drugs that do not cause addition
concept: Whats going on in the brain to make a substance addictive
general rule: all addictive drugs activate the mesolimbic dopamine system (alters behavoiur...something to the cortex that i cant remember **FILL IN WED AM)
Name that substance.
intial presentaiton: tremor, n/v, sweating, agitation, anxiety --> hallucinations --> 24-48 hours later generalizes seizures ---> 48-72 hours delirum tremens :)
~*~Treat your OH addicted patient.
SHARK - flashback
Disulfiram - aldehyde dehydrogenase inhibitor - creates AVERSION
Natrexone - opioid antagonist - decreases CRAVING
Acamprosate - NMDA receptor antagonist - prevents relapse
Topiramide - Glutamate receptor facilitation - may reduced craivns **NOT FDA APPROVED
~*~Treat your Oh withdrawal patient
long acting benzos: diazepam and chlordiazepoxide *new, not in benzo lecture)
~*~ Treat your elderly or liver failure OH patient
lorazepam and oxazepam (error here or in other lecture; this lecture says intermediate acting; benzo lecture says oxazepam is short acting, be careful :) )
bc less dependent on hepatic metabolism
Just a refreshed, which benzodiazepines don't need to be P450'd at the liver?..... whats the relevance to OH withdrawal treatment?
since dont get metab by P450 are more gentle on elderly and liver failure :)
~*~*Name that drug ER doctor. tremors + anxiety + perceptual disturbances + dysphoria + psychosis + seizures
~*~Which drug(s) produce a withdrawal symptom that can be life threatening?!
How do you treat benzodiazepine withdrawal
if on short acting drug --> switched to a long acting drug
usually use DIAZEPAM and gradually taper the dose
SHARK: addiction is rare with what drugs
what schedule number of drug is cocaine classified as?
Name that drug
wellbeing and euphoria
tachycardia, hyperT, mydriasis ***, diaphoresis
Name that drug: dysphoria, depression, sleepiness, fatigue, craving, bradycardia = generally mild and tx not generally required
How to treat cocaine addition?
we cant help yet.
Schedule DEA ranking of amphetamies
1) increase release of catecholamines
2) weak inhibitors of MAO
3) possibly act as direct catecholaminergic agonists @ brain
Name that drug: increased alertness, decreased fatigue *depressed appetite* and insomnia + @ high doses - psychosis and convulsions + peripheral adrenergic symptoms
Treatment for narcolepsy
amphetamine and methylphenidate
SHARK: flashback. What parkinson drug is metabolized to amphetamines and shouldn't be taken later in the day
Name that drug: *increasd appetite*, sleepiness, exhaustion, mental depression
Describe how the rewarding effect of Nicotine comes about
full agonist at the nicotine receptor found @ ventral tegmental area on dopamine neurons
MOA of nicotine please
low dose - ganglionic stimulation
high dose - ganglionc blockade
**midterm I pharm
Effects of nicotine @ low dose
euphoria and relaxation
improves attention, learning, problem solving, reaction time
Effects of nicotine @ high dose
central respiratory paralysis, severe hypotension due to medullary paralysis
Name that drug: mild withdrawal, irritability and sleeplessness, relapse common, very addictive
Treat the nicotine addiction! drug style
SHARK: flashback to antidepressant lecture
a) Nicotine replacement thearpy
b) Sustained release Buproprion (from antidepressnat lecture -- NDRI; no sexual dysfunction, also second line for anxiety disorders, overdose can cause seizures)
c) varenicline - partial agonist at nicotine receptors in the CNS
Varenicline. MOA. Uses.
Varenicline - used for nicotine treatment addiction; partial agonist at nicotinic receptors in the CNS
I say mydriasis, you think?
cocaine intoxication -- increaesed NE at the eyeball
Name the most commonly abused opioids please.
Name the most commonly abused opioids in health professionals
Name the drug: strong tolerance and dependence, behavioural disruptions and incompatibility with a productive life
Name the drug: not life threatening; dysphoria, **lacrimation** **rhinorrhoea** and yawning **
~*~Describe how you could help a patient in opioid withdrawal
replace (usually short acting) abused opiod with a long acting opioid and slowly reduced the dose
METHADONE or BUPRENORPHINE
Clonidine and lofexidine - used for what detoxification and why?
opioid withdrawal - chronic opioid - intolerance on teh ANS - rebound firing of neuroms; noradrenergic storm results......
Naltrexone effect on detox from opioids
only used when paitents have high moticiation bc will not satisfy craving or relieve withdrawal symptoms (naltrexone also used for OH addiction)
MOA of Mary-do-you-wanna
delta9-tetrahydrocannabinol --> Gi @ CB1 (brain = effects) and CB2 (immune cells)
Effects of THC
euphoria --> drowsiness and relazation
affects short term memory and mental activity
others: appetite stimulation (amphetamine withdrawal too), xerostomia, visual hallucinations, delusions, enhancement of sensory activty
@ high doses - toxic psychosis (also see this at high doses of amphetamine)
Dronabinol = ?
used @ anorexia with weight loss in AIDs patients AND @ nasuea and vomiting with cancer chemo (second line)
To be continued
when i get hoem
Name the psychedelic agents
mescaline (LSD like)
psilocybin (LSD like)
Affects of psychedelic agents
affect thought, perception and mood
DO NOT cause psychomotor stim/depression
agonist effects at 5 HT2 receptors in CNS
Cxl presentation of LSD
combo of somatic and psychomimetic symptosm - usually due to SYMPATHOMIMETIC
* mydriasis (cocain also)
* increased body temperature
LSD addiction or withdrawal symndrome
not cause addiction
a dissociative anesthetic AND blocks reuptake of NE and DA and also causes choli and anticholi effects AND action at nicotinic and opoid receptors
What causes dissociatve effects of PCP?
due to actions of PCp as a NON COMPETITIVE ANTAG at NMDA receptors
Name that drug: violent or bizarre behaviour, confusion, mystagmus, tachycardia, hypertension, diaphoresis, miosis, anesthesia, analgesia; appear to be having a psychotic episode, ~*~PINPOINT pupils in an AGITATED patient~*~
Name that drug: empathpy and intimacy without impairment of intellectual capacities
causes release of biogenic amines; increases concentration fo 5HT (the 'im in love' neurotransmitter) the most
Name that drug: depression lasting several weeks
Name that drug: euphoria, analgesia then loss of consciousness
nitrous oxide intoxication
Name that drug: exhiliration and light headedness
volatile organic solvent intoxication - gas, paint thinner, lighter fluid, glue, degreaser
COmplications of volatile organic solvent use pelase