Drugs of Abuse

Question 1

Alcohol

Answer 1

1. CNS depressant
2. Will cause physiological and physical dependence
3. Side Effects
4. Drug int
   - Naltrexone- to reduce cravings
   - Acomprosate- improves abstinence rate and dec. amount of alcohol consumed while drinking
   - SSRI- tx accompanying depression in WD
   - Buproprion= reduce cravings and tx depression
6. Adverse
   - WD can be life threatening- seizures, delirium tremens

Question 2

Opioids

Answer 2

1. CNS Depressant
3. Side Effects:
   - produce euphoria, reduce anxiety
   - Tolerance with chronic use (receptor desensitization)
4. Drug interactions:
   - Cross tolerance between opiates
5. WD sx: restlessness, cravings, fever, chills, perspiration, piloerection, lacrimation, nausea, vomiting, mydraisis
   Drug tx for wd: naltrexone,
   **methadone (prevents wd sx, and absorbed more slowly- does not produce high),
   bupreorphine combined with naloxone for maintence therapy

Question 3

Ampetamines (Adderal), methylphenidate (Ritalin)

Answer 3

1. CNS stimulant, used for narcolespy, ADHD, obesity
2. Mimics the actions of DA and NE in the periphery, may inhibit DA uptake and inhibit VMAT (promotes release of DA from the presynaptic terminals)
3. Side Effects:
   - Alertness, reduced fatigue, inc. energy, decreased appetite
   - may cause severe anxiety, insomnia, and irritability
   - at high doses psychosis may occur, and stereotypic behavior
4. 5.

Question 4

Methampetamine

Answer 4

1. CNS stimulant
2. Can be smoked, IV, physical tolerance occurs rapidly (need more to get high), cravings occur during abstinence
3. Side effects
   - Neurotoxic: persistent damage to dopaminergic and seratoninergic neurons
   - dental problems: rotting teeth
   - death due to cardiotoxicity
   - Formication
   -
4. Used with alcohol to decrease the alcohol depression effect
5. WD SX: inc. appetite, dec. energy, inc need for sleep, severe depression, suicidal behavior, paranoia

Question 5

Cocaine

Answer 5

1. CNS stimulant- used medically in the past as a anesthetic and vasoconstrictor
2. Inhibits uptake of DA, IV or smoked, psychological dependence
3. Side Effects
   - euphoria (DA in NAc)
   - powerful bursts of energy
   - sympathicomemetic: inc HR and respirations and BP, dec appetite, dilates pupils, perspiration, and pallor
   - Produces chronic changes: nasal congestion, perforated septum, irritability, insomnia, paranoia, hallucinations, formication
   - Lethal Effects: ventricular tachy, vfib, inc in BP resulting in cerebral hemorrhage, seizures
   - Fetal toxicity: placental detachment, premature labour, still births, SGA, retarded growth
5. WD: profound depression, severe headaches, irritability, sleep disturbance

Question 6

Nictotine

Answer 6

1. CNS stimulate
2. Activates nicotinic receptors in the CNS (seratonin and DA release) and periphery, physiologic and psychologic dependence
3. Side Effects
   - periphery effects: Inc. blood pressure and heart rate (inc epi release, and inc. tone of GI tract)
   - CNS: reinforcement and antidepressant actions - DA release may activate endogenous opioid pathways
   - Memory and learning mediated thru nicotinic receptors
5. WD sx: cravings, irritability, anxiety, anger, difficulty concentrating, restlessness, impatience, inc appetite, insomnia
   tx wd sx: buproprion will reduce the craving for nicotine

Question 7

MDMA (ecstasy)

Answer 7

1. CNS stimulant - Effects the 5HT system
2. Inc. serotonin levels in the brain (blocks SERT, stimulates release), tablet, snorted, smoked
3. Side Effects
   - Neurotoxic effect due to SERT inhibition
   - Feelings of peacefulness, acceptance, empathy, etc.
   - lasts 4-6 hrs
   - inc HR and BP
4. NONE
5. Adverse Effects: confusion, depression, teeth clenching, anxiety, muscle tension
   fatalities: due to dehydration, hyperthermia, and kidney failure

Question 8

Marijauna (THC, HASHISH)

Answer 8

1. 2 Stimulates presynaptic cannaboid receptor to alter NT release, inhibits release of glutamate and achetylcholine -
   - High lipid solubility, long half life, endogenous ligand
2. Side Effects:
   - impairs memory and learning (glutamate and ach inhib)
   - Pleasant feelings, well being, introspection, tranquility, rapid mood changes, altered perceptions, increased appetite, antiemetic
   - ability to perform complex tasks, and short term memory is impaired.
3. NONE
4. WD sx: restlessness, irritability, mild agitation, craving, insomnia
   Medical uses: Antiemetic, reduces muscle spasms and pain, appetite enhancement for AIDs pts.
5. Adverse effects: Amotivational syndrome
   - acute depression, panic attacks and mild paranoia at high levels
   - bronchial irritation and inflammation (smoking)

Question 9

LSD/Mescaline/Psilocybin

Answer 9

1. Hallucinogens
2. Binds to 5HT2 receptor, no effect in the mesolimbic DA (no dependence)
3. Effects
   - Profound CNS effects with minimal peripheral actions
   - euphoria (without causing dependence)
   - visual hallucinations, overlap of sensory impressions
   - altered perceptions (time, self, emotion, etc.)
   - Labile mood- varies from elation to depression and fear
4. Mescaline: less potent than LSD
   Psilocybin: mushrooms

Question 10

Ketamine (Special K)

Answer 10

1. General anesthetic in children and animals
2. Ketamine targets the NMDA/glutamate system, odorless, and colourless (rohypnol)
3. High doses cause delirium and amnesia

Question 11

GHB

Answer 11

1. Targets the GABA system, increases inhibition
3. Effects
   - Prevents memory storage- amnesia

Question 12

Nitrous Oxide (Abuse)

Answer 12

1. Rapid short pleasurable effect
2. OD: unconciousness and Death
3. Chronic use: peripheral neuropathy
   DENTISTS

Question 13

Amyl and Butyl Nitrite

Answer 13

1. smooth muscle relaxant (butt holes)
2. hypotension and reflex tachycardia
3. fast acting, light headedness, blurred vision, headache, nausea, inc. intra-ocular pressure,
4. relaxes anal sphincter (allows for improved butt hole penetration), dilation of genital bv/enhances sexual pleasure (improved penetration of everything)