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D&T II Exam 2 > Drugs of Abuse > Flashcards

Drugs of Abuse Flashcards

1
Q

Why are certain drugs addictive?

A

Mesolimbic dopamine
promotes pleasure sensation

Either directly or indirectly increase DA levels within the nucleus accumbens

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2
Q

Opioids Used:

A

Prescription: morphine, hydrocodone, oxycodone, methadone, tramadol, fentanyl

Street: Heroin, Opium, Krokodil

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3
Q

Opioids

A

Mechanism: stimulate opioid receptor to inhibit GABA, initially increase DA release from nucleus accumbens
Effects: Euphoria, Tranquility

OD: depressed mental status, decreased respiration, decreased bowel sounds, constricted pupils

Tx: Ventilation, IV/IM Naloxone
Maintenance:
1. Methadone which has a half life =24-36 hours, relieves craving and withdrawal, taper the doses, can be abused!
2. Buprenorphine - partial mu agonist, kappa antagonist, can induce withdrawal, taper to wean
3. Naltrexone - antagonist, used for prevention of relapse

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4
Q

Opioid Withdrawal

A

PE: pupil dilation, yawning, increased bowel sounds, hypotension

Complains of: Dysphoria and restlessness (clonidine) rhinorrhea and lacrimation
Myalgia and arthralgia (NSAIDs)
Nausea, vomiting, diarrhea (Loperamide)

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5
Q

Oxycodone

A

Delayed release formulation, acts for 12 hours, crush the pills then swallow, snort, or inject
Cheap can be combined with other drugs

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6
Q

Heroin

A

Diacetylmorphine to 6 monoacetylmorphine to morphine

Diacetyl and 6mono penetrate BBB

Rarely pure
Cheese Heroin: Mix of Black Tar and Tylenol PM

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7
Q

Krokodil

A

desomorphine, very potent, short half life, synthesized from codeine in kitchen

causes scaling of the skin

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8
Q

Sedatives Used:

A

Prescription: Benzodiazepines, Barbiturates, Propofol, GHB
Street: Alcohol

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9
Q

Sedatives

A

Work by increasing GABA signaling or promoting endogenous opioid signaling

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10
Q

Benzodiazepines

A

Generally safe in overdose unless coupled with another depressant
OD causes respiratory depression that can be treated with Flumazenil

Withdrawal: tremors, anxiety, perceptual disturbances, dysphoria, psychosis, and seizures
Tx with IV diazepam

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11
Q

Flunitrazepam

A

Roofie, date rape

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12
Q

Barbiturates

A

OD can lead to respiratory depression and death

No antidote

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13
Q

Propofol

A

Standard component of balanced anesthesia
abused by anesthesiologists for short “power naps”
recovery leads to short term mild euphoria, hallucinations, and disinhibition, long term addiction

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14
Q

Gamma-hydroxybutyrate

A

Date Rape, CNS depressant, put in drinks
Side Effects: Drowsiness, Dizziness, Nausea, Vomiting
Toxicity: amnesia, seizures, cardiopulm depression, coma, death

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15
Q

Alcohol

A

effect on both GABA and opioid transmission
Naltrexone can prevent opioid stimulation
Disulfiram
Causes: emotional/motor instability, confusion, stupor/sedation, anesthesia/coma, death

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16
Q

Stimulants Used:

A

Prescription: Amphetamines, Methylphenidate
Street: Cocaine, Crack, Methamphetamine, Bath Salts, Khat

17
Q

Amphetamines

A

Directly increase levels of DA in nucleus accumbens
Increase neurotransmission in central NE, DA, and 5HT systems (low doses - NE, moderate doses - NE and DA, High doses - NE, DA, 5HT)
Blockade of reuptake of NE, DA, 5HT, Inhibition of MAO
Effects: increased attention, concentration, focus, talkativeness; increased vigilance, wakefulness; decreased fatigue and appetite; increased mood, elation, euphoria, confidence

Adverse Effects: Restlessness, anxiety, insomnia, agitation, convulsions, hypertension, palpitations, anorexia, nausea, vomiting, diarrhea, headache, chills, DIC, delusions, hallucinations
(Basically can be a drug induced schizophrenia)

Most abused drug on college campuses

18
Q

Meth

A

PO, Nasally, IV
Rapid onset, prolonged symptoms
Addicts lose weight
Signs of Abuse:
Meth Mites - phantom itch leading to scratching
Meth mouth - reduced blood flow to gums and poor dental hygiene

19
Q

Amphetamine OD and withdrawal

A

OD: CNS stimulation, tachycardia, hypertension (avoid beta blockers), dilated pupils, diaphoresis, hyperthermia
Tx of OD: Benzos, Chlorpromazine, Haloperidol, Droperidol, Ziprasidone
ABCs, activated charcoal, seizure control

Withdrawal: Mental depression, fatigue, hunger

20
Q

MDMA (Ecstasy)

A

Amphetamine derivative
Indirect serotonergic agonist by increasing release of 5HT and blocking reuptake
Actions: prolonged effect, increased euphoria and empathy, enhances pleasure, heightens sexuality, positive self image
may lead to psychosis and depression

Toxicity: narrow margin of safety, cardiac arrhythmias, hyperthermia, convulsions, rhabdomyolysis, renal and liver failure, death

21
Q

Cocaine

A

derived from Erythroxylan coca
Mechanism: blocks reuptake of NE, DA, and 5HT, blocks Na+ channel
Effects: increased mental awareness, euphoria, confidence, “well-being” ; produce hallucinations, delusions, paranoia, reduce fatigue, restlessness, irritability, anxiety, sleeplessness, mood swing
potentiates NE so fight or flight, tachycardia, hypertension, pupillary dilation, vasoconstriction

Withdrawal: fatigue, depression, sleep disturbance, increase appetite
Tx of withdrawal: Bromocriptine

Usually found combined with levamisole (an antineoplastic)

22
Q

Cocaine metabolites

A

Benzoylecgonine: spontaneous hydrolysis

Ecgonine: plasma pseudocholinesterase

Norcocaine: Liver P450 induced n-demethylation

Cocaethylene: formed only in presence of alcohol, cross BBB

23
Q

Cocaine Toxicity

A

delirium, violent, weak and irregular pulse, tonic-clonic seizures, malignant encephalopathy
Cardiac failure: rapid elevation of BP causing stroke or cardiac arrest

Treat per symptom
Tx of Agitation: Benzo (diazepam/lorazepam)
Tx of HTN: benzo, phentolamine, NO BETA BLOCKER
Tx of MI: Aspirin, Nitroglycerin, Phentolamine, NO BETA BLOCKER

Prolonged use leads to addiction and physical dependence, malnutrition, weight loss, sex problems, mental confusion, anxiety

24
Q

Cocaine Babies

A

hyperactivity, tension, muscle stiffness, poor reflexes, delayed motor development

25
Q

Crack

A

free base form of cocaine, smock rocks in a crack pipe

“crack lips” from hot pipe

26
Q

Bath Salts

A

combination of ephedrine, MDPV, and methylone
Similar transporter inhibition as amphetamines, not as potent
Effects: feelings of empathy, stimulation, alertness, euphoria, mood lift, appreciation
Adverse Effects: similar to amphetamines

27
Q

Khat

A

Catha edulis, east Africa and Arabian Peninsula, is the shoots and leaves

Abused among African immigrants, chewed and stored in cheek

Active chemical: cathinone

Actions and Side effects: similar to amphetamines

28
Q

Nicotine

A

Principal alkaloid of Nicotiana
Lipid soluble, tertiary amine
rapidly absorbed
Metabolite: cotinine
accelerates metabolism of other drugs
Mechanism: activates cholinergic nicotinic receptors, initially stimulates then blocks, inhibits MAO, stimulates release of NE and DA
Causes: mild euphoria, increased arousal, concentration, and memory; decreased appetite

Absorbed via oral mucosa of lung, GI mucosa, and skin
Crosses placenta, secreted in milk
Metabolized in lung and liver, excreted in urine

Side Effects: irritability, tremor, cramps or diarrhea, increased HR, increased BP

Toxicity: Central respiratory paralysis and severe hypotension from medially paralysis

29
Q

Nicotine Withdrawal

A

1-2 days after quitting then decreases over weeks

Irritability, anxiety, restlessness, frustration, difficulty concentrating, headache, insomnia

30
Q

Caffeine

A

Tx of idiopathic apnea of prematurity in neonates, Tx of acute circulatory failure, diuretic, spinal puncture headaches in adults
Adjuvant for analgesia
Methylxanthine from coffee, tea, soda, chocolate, gum
Mechanism: translocation of extracellular calcium, increased cAMP, cGMP via inhibition of PDE, blockade of adenosine receptors

Effects:
at 1-2 cups (100-200 mg) decreased fatigue, increased mental alertness
at 12-15 cups (1.5g) increased anxiety and tremors
diuretic, positive inotropic and chronotropic, increase gastric HCL, insomnia, anxiety, agitation, emesis, or convulsions

31
Q

Hallucinogens Used:

A

Prescription: Ketamine

Street: LSD, ecstasy, ketamine, mescaline, peyote, ayahuasca, cannabis, inhalants, NBome

32
Q

Lysergic Acid Diethylamide (LSD)

A

agonist at 5HT1 and 5HT2
visual hallucinations with bright colors and mood alteration
Side effects: hyperreflexia, nausea, muscle weakness, increased BP and HR, mydriasis
Haloperidol blocks hallucinations

33
Q

Ketamine and PCP

A

antagonizes glutamate, anticholinergic
Side effects: dissociative anesthesia, extremity numbness, staggered gait, slurred speech, muscle rigidity, increase BP and HR, nausea, vomiting, violent, seizures

34
Q

Hallucinogenic Mushrooms

A

Psilobycin, Psilocin
20 min- 6 hours
Causes: dilated pupils, confusion, vertigo, exhilaration, laughter, hallucinations, tachycardia, hypertension, nausea, vomiting

Tx: activated charcoal and Diazepam

35
Q

Use of Hallucinogens in Religion

A

Native American (Apache, Navajo, and Plains Tribes)

use peyote in ceremonies, part of a cactus, contains phenethylamine alkaloids (mescaline)
similar effects to LSD not as potent though

36
Q

Marijuana

A

THC, highly lipophilic
causes euphoria, drowsiness, relaxation
receptors in basal ganglia, hippocampus, and cerebellum
impairs short term memory and mental activity
Visual hallucinations and delusions
increased HR, munchies
Tolerance, Withdrawal and Addiction possible

“Medical Marijuana” Dronabinol, used for severe nausea and pain from aids and cancer

37
Q

NBome

A

5HT2a agonist
causes: agitation and hallucinations, tachycardia, hypertension, aggression
Tx: Benzos

D&T II Exam 2 (7 decks)

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