Drugs of Abuse

Question 1

Substance Use Disorder Criteria

Answer 1

Problematic pattern of substance use within a 12 month period by two or more symptoms that cause impairment in functioning

Question 2

Marijuana pharmacokinetics

Answer 2

Rapidly metabolized by liver to 11-OH-THC (active)
Then metabolized to 9-nor-COOH-THC (inactive)
Excreted in urine and feces, detectable for many days
Smoked reaches brain in 15-30 seconds (3-5 times more potent smoked than ingested)
Oral onset is 30 minutes
Duration of action 1-6 hours

Question 3

What receptor does THC bind?

Answer 3

CB1 receptor: in cerebellum, hippocampus and basal ganglia; low in hypothalamus
CB2 receptor: peripheral tissue
Inhibits transmitter release

Question 4

Endocanibinoids

Answer 4

Endogenous ligands for CB1 receptor
Arachidonylglycerol
Anandamide

Question 5

CV effects of marijuana

Answer 5

Tachycardia
Orthostatic hypotension
Exacerbate angina

Question 6

Pulmonary effects of marijuana

Answer 6

Bronchodilation
Lung irritant – bronchoconstriction
Decrease alveolar macrophage activity
Decrease in ciliary functino

Question 7

Repro effects of marijuana

Answer 7

Lowers testosterone levels and sperm counts
LHRH release is decreased (decreases FSH and LH)
Prolactin release is decreased in females, greater incidence of abnormal menstrual cycles
Hazard to marginally fertile

Question 8

Psychopathological effects of marijuana

Answer 8

Acute anxiety reaction 
Transient paranoid feelings
Exacerbation of schizophrenia 
Diffuse cut brain syndrome with high doses (clouding of consciousness and memory, perceptual and sleep disorders) 
Amotivational syndrome

Question 9

Does tolerance and dependence occur with marijuana use?

Answer 9

Yes - cessation of marijuana can lead to restlessness, irritability, agitation, sleep difficulties, decreased appetite and nausea, cravings

Question 10

Therapeutic uses of marijuana

Answer 10

Control nausea
AIDS wasting syndrome
Pain treatment and cancer pain

Question 11

What is synthetic marijuana?

Answer 11

Has THC-like CB1 agonist activity

Question 12

NMDA antagonists
Hallucinogens
Sympathomimetic effects (tachycardia, hypertension, potentiation of catecholeamines)
Tolerance developed

Answer 12

PCP

Ketamine

Question 13

Treatment for PCP intoxication

Answer 13

Benzodiazepines

Rapid-acting antipsychotic

Question 14

Sensory effects through 5-HT2 receptors (agonist/partial agonist)
Sympathomimetic - tachycardia, increased BP, psychomotor stimulation
Altered perception, lability of mood, impaired judgement

Answer 14

LSD

Question 15

LSD toxicity

Answer 15

Acute - hallucinations, anxiety, panic and depersonalization, <24 hours, quiet environment, BDZs for sedation
Flashbacks
Neurotoxicity - 5HT damage associated with phenethylamine type drugs like MDMA

Question 16

Induces feelings of well-being and connection, altered time perception
Psychomotor stimulation, restlessness, bruxism, anorexia, sweating, tremor

Answer 16

Ecstasy (MDMA)

Question 17

Found in the brain, precursor and metabolite of GABA
Primarily a depressant - induces a state of relaxation and tranquility
Interacts with ethanol

Answer 17

Gamma hydroxybutyrate (GHB)

Question 18

Smoked herb
Short duration of action (20-45 minutes), dream-like experience with open and close eyed visuals, dissociation at high doses with fear, panic and perspiration
Kappa opioid agonist

Answer 18

Salvia Divinorum

Question 19

Treatment for Delirium tremens

Answer 19

Benzodiazepines

Question 20

Treatment for opioid intoxication

Answer 20

Naloxone, Naltrexone

Question 21

Treatment for opioid withdrawal

Answer 21

Long term support
Methadone
Buprenorphine
Clonidine

Question 22

Treatment for benzodiazepine intoxication

Answer 22

Flumazenil

Question 23

Treatment for cocaine intoxication

Answer 23

Benzodiazepines

Question 24

Treatment for nicotine withdrawal

Answer 24

Nicotine patch, gum, lozenges
Buproprion
Varenicline

Question 25

Treatment for PCP intoxication

Answer 25

Benzodiazepines, rapid acting antipsychotic

Question 26

Treatment for heroin addiction

Answer 26

Methadone
Naloxone + buprenorphine
Naltrexone

Question 27

Long-acting oral opiate; used for heroin detoxification or long-term maintenance

Answer 27

Methadone

Question 28

Partial agonist; long acting with fewer withdrawal symptoms than methadone.

Answer 28

Naloxone + buprenorphine

Question 29

Long-acting opiod antagonist used for relapse prevention once detoxified

Answer 29

Naltrexone

Question 30

Treatment for alcoholism

Answer 30

Disulfarim - to condition the patient to abstain from alcohol use
Naltrexone
Acamprosate
Supportive care - AA and peer support groups