Drugs of Abuse

Question 1

What are the sedatives (aka CNS depressants)?

Answer 1

Alcohol, benzodiazepines, barbiturates, opioids

Question 2

Alochol, benzodiazepines, barbiturates: MOA

Answer 2

Potentiate GABA recpetor.

Question 3

Opioids: MOA

Answer 3

Exert effects at
opioid receptors,
such as the μ
receptor.

Question 4

Alcohol Intoxication: Symptoms/Complications

Answer 4

Ataxia and incoordination, loquacity and
slurred speech, euphoria, impaired attention,
irritability, mood changes, sedation. Can get
Wernicke-Korsakoff syndrome and alcoholic
nephropathy; depletion of NAD+ and
accumulation of TCA metabolites causes liver
degeneration (cirrhosis).
Fetal alcohol syndrome: Low birth weight,
microcephaly, upturned nose, smooth philtrum,
intellectual disability, heart defects.

Question 5

Alcohol: Withdrawal Sx

Answer 5

Altered perceptions,
delirium tremens
(usually 48-96h after
last drink), insomnia,
irritability, seizures,
tremor, HTN,
tachycardia, nausea,
sweating. Withdrawal
is potentially FATAL.

Delerium tremens is a
medical emergency
that involves sudden
and severe mental
nervous system
changes.

Question 6

Alcohol, benzodiazepines, barbiturates: Treatment of overdose

Answer 6

TAPERED
benzodiazepine
withdrawal.

Question 7

Alcohol: Metabolism

Answer 7

ETOH metabolism:
conv. To acetaldehyde
by Alcohol DH.
Acetaldehyde then conv
to acetate by
Acetaldehyde DH. EtOH
at higher or chronic
doses also undergoes
oxidation by P450
(CYP2E1).
Accumulation of
acetaldehyde ->
hangover. BAC is
amount EtOH in blood
(0.08 = legal limit)

Question 8

Benzodiazepines and barbiturates intoxication: Sx

Answer 8

Similar to alcohol, with hypotension and
respiratory depression.

Reminder of alcohol withdrawal sx: Ataxia and incoordination, loquacity and
slurred speech, euphoria, impaired attention,
irritability, mood changes, sedation.

Question 9

Benzodiazepines and barbiturates: withdrawal sx

Answer 9

As for alcohol, but no
tremor, nausea or
sweating.

W/ muscle
cramps + twitching.

Withdrawal from alcohol OR benzodiazepines is
potentially FATAL.

Barbiturate withdrawal=Not fatal.

Question 10

Opioid Intoxication: Sx

Answer 10

Motor slowness, slurred speech, apathy,
euphoria or dysphoria, impaired attention,
sedation, miosis.

Question 11

Opioids: Withdrawal Sx

Answer 11

As for EtOH, but no tremor.

W/ muscle
aches, PLUS fever,
mydriasis, diarrhea,
yawning + piloerection.

Question 12

What are the stimulants?

Answer 12

Cocain, amphetamines, caffeine, nicotine

Question 13

Cocaine: MOA

Answer 13

Inhibits neuronal
reuptake of NE
and dopamine

Question 14

Amphetamines: MOA

Answer 14

Increases synaptic
concentrations of
NE and dopamine

Question 15

Caffeine: MOA

Answer 15

Indirectly
enhances DA
neurotransmission
by blocking
adenosine R’s

Question 16

Nicotine: MOA

Answer 16

Activates
cholinergic
nicotinic R’s in
CNS and PNS

Question 17

Cocaine Intoxication: Sx

Answer 17

Tactile hallucinations of bugs crawling on skin,

mydriasis

Question 18

Amphetamines Intoxication: Sx

Answer 18

BEHAVIORAL: grandiosity, euphoria,
hypervigilance, paranoia, agitation.
AUTONOMIC: HTN, tachycardia, chills, mydriasis, nausea, vomiting, nystagmus,
sweating

Question 19

Cocaine and amphetamines: Withdrawal sx

Answer 19

Increased appetite,
bradycardia,
depression/dysphoria, drowsiness/fatigue

Question 20

Cocaine and amphetamines: Overdose treatment

Answer 20

Supportive care.
Lorazepam for
agitation, cardiac
monitoring and support,
haloperidol for
psychosis

Question 21

Caffeine: Withdrawal Sx

Answer 21

Anxiety, depression,
impaired
concentration, HA,
malaise

Question 22

Nicotine: Withdrawal Sx

Answer 22

Increased appetite, bradycardia,
dysphoria, anxiety,
irritability, restless

Question 23

What are the hallucinogens?

Answer 23

PCP, LSD, marijuana

Question 24

PCP: MOA

Answer 24

Blocks NMDA

receptor.

Question 25

LSD: MOA

Answer 25

Acts via serotonin R’s in neocortex, limbic system and brain stem.

Question 26

PCP: Intoxication Sx

Answer 26

``` PSYCHOTIC Sx: Hallucinations and delusions with associated euphoria and violent behavior. NEUROLOGICAL Sx: Rigidity and nystagmus. AUTONOMIC: Miosis and tachycardia and sweating. ```

Question 27

LSD: Intoxication Sx

Answer 27

PSYCHOTIC Sx: Hallucinations and delusions. NEUROLOGICAL Sx: Ataxia and tremor. AUTONOMIC: Mydriasis, tachycardia, sweating.

Question 28

PCP and LSD: Overdose Treatment

Answer 28

``` Supportive care. Lorazepam for agitation, haloperidol for psychosis, minimize sensory input. ```

Question 29

Marijuana: MOA

Answer 29

``` Active agent is tetrahydrocanna binol (THC), inhibits adenyl cyclase + cAMP ```

Question 30

Marijuana: Intoxication Sx

Answer 30

Rapid speech, conjunctivitis, hallucinations (at high doses), jocularity, HTN, tachycardia, increased appetite, tightness in chest, euphoria and sensory intensification, dry mouth. Can cause fetal malformations.

Question 31

Maijuana: Withdrawal Sx

Answer 31

``` Irritability, mild agitation, mild agitation, sleep disturbances, nausea, stomach cramps. ```

Question 32

Marijuana: Overdose Treatment

Answer 32

``` Can potentially treat agitation with lorazepam. Treatment of other withdrawal Sx are unnecessary. ```

Question 33

Naloxone is used for?

Answer 33

Tx: Opioid dependence

Question 34

Naltrexone is used for?

Answer 34

Tx: Opioid and alcohol dependence MOA:Opioid antagonist (blocks μ receptors) Naltrexone affects endogenous opioid system pathways that cause reinforcement of alcohol addiction.

Question 35

Disulfiram is used for?

Answer 35

Tx: Alcohol abuse Inhibits aldehyde dehydrogenase Accumulation of acetaldehyde causes sweating, palpitations, dizziness, nausea. This is prescribed to help people abstain from alcohol use.

Question 36

Buprenorphine is used for?

Answer 36

Tx: Opioid dependence