Egleton: Drug Abuse Flashcards
(72 cards)
1
Q
Cause of pleasure sensation
A
Mesolimbic tract
Dopamine
2
Q
Cause of craving
A
PFC
Hippocampus
3
Q
Cause of withdrawal
A
Hypothalamus
Brain stem
4
Q
Meds with Direct effect
A
Cocaine
Amphetamine
5
Q
Meds with Indirect effect (disinhibition)
A
Nicotine Alcohol Opioids Benzos Cannabinoids PCP
6
Q
Severity of addiction depends on what
A
Dose and Duration
7
Q
Opioids: MoA
A
Stimulate opioid receptors in mesolimbic reward circuit
Inhibit GABAergic transmission
Increased Nucleus accumbens Dopamine release
Induce Euphoria, then tranquility and drowsiness
8
Q
Opioids: overdose
A
Decreased respiratory rate Decreased bowel sound Constricted pupils Dereased tidal volume Depressed mental status
9
Q
Opioids: treatment
A
Ventilation
Naloxone (IV/IM)
10
Q
Opioids: maitenance
A
Methadone maintenance (gold standard) {reduce craving and withdrawal}
Buprenorphine (partial Mu agonist, Kappa antagonist) {induce withdrawal abstinence}
Naltrexone (antagonist) {prevent relapse}
11
Q
Opioids: withdrawal
A
Pupil dilation
Yawning
Increased bowel sounds
Hypotension (by diarrhea and vomiting){loss of volume}
Dysphoria, Restlessness Rhinorreha, Lacrimation Myalgias, Arthralgias Nausea, Vomiting, Abdominal cramping, Diarrhea Hypersensitivity to pain
12
Q
Oxycodone
A
Hillbilly heroin Delayed release formulation Longest actign pain reliever on market Cheap Combination with Acetaminophen> potential Liver problem
13
Q
Heroin
A
Diacetylmorphine metabolized to 6-monoacetylmorphine then Morphine
High BBB penetration
Effects by 6-monoacetylmorphine and Morphine
Urine test detects 6-monoacetylmorphine specific heroin metabolites
14
Q
Cheese heroin
A
Mixture of Black tar heroin and Tylenol PM
{liver damage!}
15
Q
Krokodil
A
The living dead
Russian addicts
Leaves scaly skin akin to crocodile’s
16
Q
Benzodiazepines {BDZ}
A
Generally safe in overdose {unless with Alcohol/ depressants}
Sedative/ cause CNS depression with normal vital sign
Antidote= Flumazenil
Abrupt withdrawal= Tremor, Anxiety, Perceptual disturbance, Dysphoria, Psychosis, Seiuzures
Treated with Diazepam (IV)
17
Q
Flunitrazepam
A
Roofie drug
Date rape drug (added to drinks)
18
Q
Barbituates
A
Sedative
Can lead to respiratory depression and death
No antidote
19
Q
Propofol
A
In anesthesia
Short power naps for Anesthesiologists
Short term effects: Mild euphoria, Hallucination, Disinhibition
Long term effects: Addiction
20
Q
Gamma-hydroxybutyrate
A
Sedative
Date rape drug (put into drinks)
CNS depressant, Increase release of endogenous opioids
ADR: Drowsiness, Dizziness, Nausea/ Vomiting
Toxicity: Amnesia, Seizures, Cardiopulmonary depression, Coma, Death
21
Q
Alcohol
A
Stimulate both GABA and Opioid transmission
Antidote= Naltrexone
Antabuse= Disulfiram
22
Q
Amphetamines
A
Directly increase levels of Dopamine in Nucleus accumbens
Metamphetamine is the most effective (BBB crossing)
Meth is better at it.
23
Q
Amphetamines: MoA
A
Increase neurotransmission in central NE, DA and 5-HT system by their release
Low dose: NE released more
Moderate dose: NE and DA released
High dose: NE, DA, 5-HT released
{NE>DA>5-HT}
Blockade of reuptake of NE, DA, 5-HT
Inhibition of MAO
24
Q
Meth
A
Increase attention, Concentration, Focus, Talkativeness
Good for ADHD
Increase vigilance, Wakefulness
Decrease fatigue, Appetite
Increased mood, Elation, Euphoria, Self confidence, Psychomotor stimulation
Popular in college campus
Oral, nasal, IV
Rapid onset, Prolonged symptoms
25
Meth: ADR
{Like Schizophrenia}
Acute: Restlessness, Anxiety, Insomnia, Agitation, Aggressiveness, High dose= Convulsions
Chronic: Paranoid schizophrenia-like state, Delusions, Hallucinations
CV: Palpitations, Arrhythmias, Hypertension, Anginal pain, Circulatory collapse
GI: Anorexia, Nausea/Vomiting, Abdominal cramps, Diarrhea
Others: Meth mites, Meth mouth, etc
Headaches, chills, sweating, Fulminant hyperthermnia, DIC, Rhabdomyoslysis, Renal failure, Hepataotoxicity
26
Meth: Tolerance
With chronic use
| Withdrawal symptoms of Mental depression, Fatigue, Hunger
27
Meth: Overdose
```
CNS stimulation (Agitation, Delirium, Acute psychosis)
Tachycardia
Hypertension
Dilated pupils
Diaphoresis
Hyperthermia
```
28
Meth overdose treatment, avoid what
Beta blockers
29
Meth overdose treatment: meds
```
Benzodiazepine (Lorazepam, Diazepam)
Antipsychotics (Chlorpromazine, Haloperidol, Droperidol, Ziprasidone)
Stabilize airways and CV function
Activated charcoal
Control seizure
Modify urine pH
```
30
Meth: Withdrwal
Mental depression
Fatigue
Ravenous hunger
31
MDMA:MoA
Amphetamine derivative
Indirect serotonergic agonist
{Increase 5-HT release, Block reuptakes}
32
MDMA: action
```
Prolonged effect up to 1wk
Sympathomimetic and Psychotomimetic
Increased Euphoria, Empathy
Enhances pleasure
Heightens sexuality
Expands consciousness
Positive change in self-image
```
33
MDMA toxicity
```
{Problem if dehydrated}
Narrow margin of safety
Cardiac arrhythmias
Hyperthermia
Convulsions
Rhabdomyolysis
renal failure
Fatalities
Psychosis
```
Depression (after long term use)
Chronic use= Hepatic damage
34
Cocaine: MoA
Blocks reuptake of NE, DA, 5-HT
Blocks Na channel
{Act as local anesthetics for eye/nasal surgeries}
Increase concentration of excitatory AA (Glutamate, Aspartate) in Nucleus accumbens
35
Cocaine: CNS stimulation
Increase mental awareness, Euphoria
Feeling of well being, Increaed self confidence
Hallucinations, Delusion, Pranoia
Reduction of fatigue
Restlessness, Irritability, Anxiety, Sleeplessness, Mood swings
36
Cause of cocaine craving
Chronic cocaine intake= DA depletion by breakdown
37
Cocaine: withdrawal
Fatigue, Depression, Sleep disturbance, Increased appetite
38
Cocaine metabolites
Active metabolite:
Cocaethylene (formed only in presence of alcohol via transesterifcication, 17%)
{Crosses BBB, block reuptake, as potent as cocaine}
Inactive metabolites:
Benzoylecgonine (spontaneous hydrolysis, 50%)
Ecgonine (plasma/ liver pseudocholinesterase 40-50%)
Norcocaine (liver P450 induced demethylation, 5%)
39
Cocaine: overdose toxicity
Cardiac failure (rapid elevation of blood pressure= stroke, irregular heartbeat, cardiac arrest}
Delirium, Violent behavior
Weak and irregular pulse
Tonic-clonic seizures
Malignamnt encephalopathy
40
Cocaine: treatment
Agitation: Benzodiazepine (Diazepam, Lorazepam}
Hypertension: Benzodiazepine, Phentolamine
MI: Aspirin, Nitroglycerin, Phentolamine
{No Beta blockers for Hypertension and MI}
Bromocriptine: DA agonist, reduces craving of drug?
41
Cocaine: prolonged use
Addiction and Physical dependence
| Malnutrition, Weight loss, Sexual problems, Mental confusion, Anxiety
42
Cocaine babies
Hyperactivity, tension, Muscle stiffness, Poor reflexes, Delayed motor development
43
Levamisole
Anthelminthic drug used by vets in Mexico
MAOI and COMT inhibitory action
Induce Neutropenia, Agranulocytosis
44
Crack
Free base form of Cocaine
| "Crack lips" due to hot pipe
45
Bath salts
Designer drugs
Metphedrone, MDPV, Methylone
{Cathionones= similar to Amphetamine}
46
Bath salts: MoA
Similar to Amphetamine {transporter inhibition}
Not as potent
Induce Feeling of empathy, Stimulation, Alertness, Euphoria, Mood lift, Appreciation of music/ Awareness of senses
47
Bath salts: ADR
Similar to Amphetamine's
48
Bath salts: treatment
```
{Similar to Amphetamine's}
Benzodiazepine (Lorazepam, Diazepam)
Antipsychotics (Chlorpromazine, Haloperidol, Droperidol, Ziprasidone)
Stabilize airways and CV function
Activated charcoal
Control seizure
Modify urine pH
```
49
Khat
East Africa, Arabian-Peninsula
From Catha edulis (flowering shrub's shoots/ leaves)
Cathinone= active chemical
Structurally similar to Amphetamine, similar potency
90 min of action
ADR/ Withdrawal same as Amphetamine's
50
Nicotine
```
From Nicotiana plant
Lipid soluble
Tertiary amine
Rapidly absorbed/ distributed
Cotinine= metabolite
Tars in cigarette smoke accelerates metabolism of other drug
```
Used for smoking cessation therapy
51
Nicotine: MoA
Activate Cholinergic nicotinic receptors (CNS, PNS)
Initially stimulate>then block receptor
Inhibit MAO= activate DA neurotransmission (dependence)
Stimulate NE/DA release
Promote mild euhpria
Increase Arousal and Concentration
Improve memory
Suppress appetite
52
Nicotine pharmacokinetics
```
Absorption: lung, GI, skin
Cross placental membrane
Secreted in milk
Metabolized in Lung/ Liver= Cotinine is the metabolite
Urinary excretion
```
53
Nicotine: ADR
Irritability, Tremors, GI cramps, Diarrhea, Increased HP and BP
54
Nicotine: Toxicity
Central respiratory paralysis
| Hypotension from Medullary paralysis
55
Nicotine: withdrawal
Irritation, Anxiety, Restlessness, Frustration, Difficulty concentrating, Headache, Insomnia
Peak 1-2 days after quitting
Decrease over weeks
56
Caffeine: Use
Treat idiopathic apnea of premature neonates {Caffeine citrate}
Acute Circulatory failure
Diuretics
Treat Spinal puncture headaches (Caffeine sodium benzoate}
Adjuvant for Analgesics
57
Caffeine: MoA
Methylxanthine
Translocation of extracellular Ca2+
Inhibit PDE> Increase cAMP, cGMP
Blockade of Adenosine receptors {induce wakefulness}
58
Caffeine: Effects
Decrease fatigue
Increase mental alertness
{100-200mg}
Increase anxiety and tremor (1.5g)
```
Increase spinal cord stimulation (2-5g)
Cardiac arrhythmias (Lethal dose= 10g)
```
59
Why are kids hyper on Halloween nights?
Dark chocolates got caffeine, yo!
60
Caffeine: other effects
Mild diuretics
Positive inotropic/ chronotropic effects at high dose
Increase secretion of gastric HCl
Insomnia, Anxiety, Agitation at moderate doses
Emesis and Convulsions at high doses
61
LSD (Lysergic acid diethylamide)
5-HT1/2 agonist
Hallucinations with brilliant color {Visual hallucination}
Mood alteration
62
LSD: ADR
```
Hyperreflexia
Nausea
Muscle weakness
Increased HP, BP
Mydriasis
Flashbacks (days-1yr)
```
Not drug of abuse
63
LSD: treatment
Haloperidol (block hallucinations {Neuroleptic therapy}
64
Ketamine and Phencyclidine (PCP)
Glutamate action antagonist
Anticholinergic
Cause dissociative anesthesia
65
Ketamine and Phencyclidine (PCP): ADR
```
Extremity numbness
Staggered gait
Slurred speech
Muscular rigidity
Increase BP/ HR
Nausea/Vomiting
Violent behaviors
Suicidal
Seizures
```
66
Hallucinogenic mushrooms
"Shroom"
Psilobycin, Psilocin
20min-6hr effects
Dilated pupils, Confusion, Vertigo
Exhilaration, Laughter, Hallucinations
Tachycardia, Hypertension
Nausea/ Vomiting
67
Hallucinogenic mushrooms: Treatment
Activated charcoal
| Diazepam
68
Peyote
By Apache, Navajo, and Plains Tribes
Used in Native American Church rituals, Legal for them
Peyote= small, spineless cactus
Contain Phenethylamine alkaloids (Mescaline)
Similar to LSD, but not as potent
69
Marijuana
THC (delta9-tetrahydrocannabinol) metabolized to 11-OH-delta9-THC
Receptors in Basal ganglia, Hippocampus, Cerebellum
Euphoria followed by Drowsiness/ Relaxation
Impairs short-term memory and mental activity
Visual hallucinations
Delusions
Increased HR
Munchies
Tolerance, Withdrawal Addiction possible
Lipophilic
70
Dronabinol
THC (Tetrahydrocannibinol)
Treat severe nausea and pain by AIDS/ Cancer
Appetite stimulant
"Medical marijuana"
Marijuana vs Hashish-Hash oil
Lipophilic
71
NBome
5HT2A agonist
Agitation, Hallucinations
Tachycardia, Hypertension
Treat with Benzodiazepine (IV)
Prolonged periods of aggressive behavior
72
Inhalants
Volatile solvents
Aerosols
Gases
Nitrites
Tend to have burned mouth{b/c of solvent on their mouth and high prevalence of smoking}
Axonopathies, Hepatotoxicity, Cardiotoxicity
Alcohol high
Euphoria, Delusion, Sedation, Hallucinations
