Environment and the Brain 4 Flashcards
1
Q
Fill the gaps relating to morphine. (4)
Morphine is an ……………………… drug.
It acts via the ………………………. receptor, and has a range of clinical effects, including …………………. and ……………………
A
opiate
u (mu)
analgesia
antitussive
2
Q
Describe the clinical antitussive effects of opiates. (2)
A
antitussive means to stop coughing
codeine used to be sold to inhibit the cough reflex
3
Q
Give three major side effects of opiate drugs when used in clinical practice. (3)
A
- Euphoria/dysphoria
- Constipation (40% on oral preparation)
- Respiratory depression
4
Q
Which property or side effect of morphine/opiates make them a candidate for a drug of abuse? (1)
A
Euphoric properties
5
Q
Give two issues with opiates being used as a drug of abuse. (2)
A
- Tolerance
- Dependence
6
Q
What is meant by ‘tolerance’ when referring to drugs of abuse such as morphine? (1)
A
The dose needs to be increased to get the same effect
7
Q
Briefly, what cellular/molecular mechanism causes morphine tolerance in chronic users? (1)
A
GPCRs become desensitised
8
Q
Briefly, what cellular/molecular mechanism causes morphine dependence in chronic users? (1)
A
Drug increases dopamine levels
9
Q
Where in the world is there a major opioid crisis? (1)
A
USA
10
Q
Where in the world does cannabis trafficking and use affect and cause problems the most? (1)
A
All regions worldwide
11
Q
Describe the main drug problems faced in North America and Canada. (3)
i.e. which drugs cause problems?
A
- High levels of opioid use and overdose
- Increasing use of methamphetamines
- High levels of cocaine use
12
Q
Describe the main drug problems faced in South America. (4)
i.e. which drug/s cause problems and how?
A
Main issues are with cocaine:
- use
- production
- trafficking
13
Q
Which two types of drugs seem to be the most widely-used drugs of abuse worldwide? (2)
A
Cannabis
Opioids
14
Q
Which type of drug (of abuse) seems to account for the most drug-related deaths worldwide? (1)
A
Opioids
15
Q
Which two types of drug (of abuse) are responsible for the highest levels of drug-related medical treatment worldwide? (2)
A
- Opioids
- Cannabis
16
Q
True or false? Explain your answer if appropriate. (1)
Opioid abuse is a very Western problem, with negligible levels elsewhere in the world.
A
True - highest levels in North America and Canada
17
Q
What is the main consequence of opioid use in the USA? (1)
A
Increased deaths due to overdoses
18
Q
Give two factors regarding opioid prescription and production which contribute to the increased opioid use and deaths currently seen in USA. (2)
A
- Escalation in use of prescription opioids
- Increased production of synthetic opioids
19
Q
Describe the trend in the total number of deaths involving prescription opioids among all ages in the US between 1999 and 2021. (1)
A
Number showed a large increase, and may be more stable at this increased number in the last few years
20
Q
Describe the trend in the number of deaths involving prescription opioids without any other opioids among all ages in the US between 1999 and 2021. (1)
A
Trend increased at first, but has shown quite a large decrease in the last few years (from about 2011 onwards)
21
Q
Describe the trend in the number of deaths involving prescription opioids in combination with synthetic opioids among all ages in the US between 1999 and 2021. (1)
A
Sharp increase from about 2013 onwards (numbers are rising)
22
Q
What is currently the major driver of the opioid crisis in the USA? (1)
a) commonly prescribed opioid drugs
b) synthetic, non-prescription opioids
A
b) synthetic, non-prescription opioids
23
Q
Compare the relative potencies of commonly prescribed opioid drugs, and synthetic non-prescribed opioid drugs. (1)
A
Synthetic non-prescribed drugs tend to have a much higher potency than prescribed opioids.
24
Q
Describe an advantage and a disadvantage of people with an opioid addiction using synthetic non-prescribed opioids rather than prescribed opioids. (2)
A
ADVANTAGE:
- Much higher potency so they can be used in lower doses for people who have developed tolerance
DISADVANTAGE:
- Higher potency means it may be easier to overdose on synthetic opioids
25
Name three general routes/types of impact of opioids on the environment. (3)
Give a short description of each one.
- Cultivation and production (effects on the environment from producing and transporting opioids)
- Drug use (effects on the environment from the use of opioids)
- Drug responses (impact of wide-scale responses and policies relating to drug use)
26
Describe a route of how opioids and their metabolites may contaminate wastewater. (4)
- Drugs consumed and partially metabolised in the body
- Drugs and metabolised excreted in waste
- Excreted substances enter sewer
- Wastewater treatment plants only remove part of the substances
27
Describe two general consequences of opioids and their metabolites contaminating wastewater. (2)
- In contaminated aquatic environments, substances may affect fish and other organisms
- Substances can reach humans through consumption of water or fish
28
Describe how drug responses and policies may affect the environment. (3)
May introduce alternative development methods
Which may result in deforestation/reforestation
and higher or lower carbon footprint
29
Describe five potential consequences on the environment from cultivation and production of opioids. (5)
- Energy use may increase/decrease
- Deforestation resulting in biodiversity loss
- Soil pollution/depletion leading to effects on the food chain
- Water pollution/depletion leading to effects on the food chain
- Air pollution
30
Describe how synthetic drug production waste may contaminate the environment. (2)
- Solid/liquid waste from labs may directly contaminate environment
- Fumes from transportation of waste contaminate air
31
Give the six stages of opioid (specifically morphine) production which may have a negative impact on the environment. (6)
- Poppy farming
- Bulk morphine/opioid production
- Mixing
- Filling
- Sterilisation
- Packaging
32
Which stage of morphine production releases the most greenhouse gases (CO2)? (1)
Which stage releases the least? (1)
MOST:
- Packaging
LEAST:
- Poppy farming
33
True or false? Explain your answer if appropriate. (1)
Although all stages of opioid production can have an impact on the environment, the initial stages, including poppy farming and manufacture of bulk morphine, have the largest environmental impacts.
False - poppy farming and bulk manufacture had the lowest impacts
Final stages such as processing and packaging had by far the largest impacts on the environment
34
Give three specific examples of ways that production of opioids can have negative impacts on the environment. (3)
- Use of fertilisers/pesticides during poppy farming
- CO2 release from transport and machinery
- Waste drugs or other chemicals being discarded
35
Describe the potential consequences on the environment from opioid use. (3)
Opioid use can pollute water,
and can also pollute soil.
And these can have effects on the food chain.
36
Fill the gaps relating to opioid use and the environment. (1)
........................... is a valuable information source used for public health purposes to monitor trends in drug use. This method has been used for over a decade.
Wastewater
37
Currently, the European Monitoring Centre for Drugs and Drug Addiction, Australian Criminal Intelligence Commission, and New Zealand Police all fund programs to use wastewater to look at drug use.
Describe a recent advance in these programs which provides benefit when looking at drug use in a region. (2)
Programs have incorporated emerging drugs
and this can provide a snapshot of new substance use.
38
Describe why it is difficult to detect newer synthetic opioids in wastewater, when monitoring drug use in a community. (1)
How is this difficulty overcome? (1)
New synthetic opioids have high potency so are only used in low doses - concentrations in wastewater are likely to be very small.
This is overcome with new methods which can detect trace levels down to 0.01ng/L, or about 2ng/L without sample preconcentration.
39
Complete the sentence relating to the monitoring of opioid use by testing wastewater in a community. (3)
Expanding routine monitoring of wastewater to include synthetic and natural opioids in the population can allow harm minimisation strategies to be employed, such as .................................. and ...............................
It can also be a cost-effective way to evaluate ........................................
HINT: answers are all phrases
warnings to drug users
checking of potency and danger of drugs being produced
ongoing opioid response interventions
40
Apart from testing drugs and monitoring drug use within a population, give another way that testing wastewater has been used in the past to monitor/improve human health. (1)
Describe how widespread this intervention/testing was. (1)
Areas monitored for outbreak and spread of SARS-CoV-2 during Covid-19.
Programs covered 74% of population in UK, >80% in New Zealand, and 1745 sampling sites (up to 133 million people) in US.
41
Describe how testing wastewater for the SARS-CoV-9 virus was able to give an indication of disease and spread within a population. (3)
People who have Covid-19 shed virus when going to toilet and blowing nose.
Virus fragments then enter sewer system through sinks, drains, and toilets.
Sewage then tested for Covid-19 RNA.
42
Describe a piece of evidence supporting the fact that testing wastewater for drugs is able to detect increased levels of drug use within a population and the drug's impact on the environment. (3)
- Testing wastewater downstream of music festivals after the event
- Water analysis shows high concentrations of drugs after festivals
- And this proves that drugs do get into wastewater, and can be used to monitor use, and can also affect the environment
43
Monitoring of water downstream of music festivals provides evidence that synthetic drugs are able to contaminate wastewater and have harmful impacts on the environment.
Give two reasons why music festivals are ideal for monitoring the effects of drugs on the environment. (2)
- Lots of people all using drugs (so high concentrations thought to be getting into water)
- in the same place and at the same time
44
Monitoring of water downstream of music festivals provides evidence that synthetic drugs are able to contaminate wastewater and have harmful impacts on the environment.
Which drug is usually tested after music festivals, and may have the largest impact on the environment from use at music festivals? (1)
MDMA
45
A study/report in the USA spiked soil and water with a known concentration of fentanyl, and then monitored samples for drug levels over several weeks.
Describe and explain/conclude the findings in relation to fentanyl in soil and water. (3)
Fentanyl was fully recovered from water samples
for at least 7 weeks.
Which indicates that fentanyl is relatively stable (does not break down) and persistent in water and moist soils.
46
In general, is it more common to find synthetic opioids, semi-synthetic opioids, or natural opioids in wastewater? (1)
Describe a reason or confounding factor for this. (1)
More common to find synthetic opioids
however this could be because there are more synthetic opioids on the market than any other groups.
47
True or false? Explain your answer if appropriate. (1)
In a study looking at drug use, several opioids were detected in raw wastewater and surface water, however treated wastewater was free of any opioids.
False - treated wastewater still contained several opioids
48
True or false? Explain your answer if appropriate. (1)
There is shown to be significant variability in the efficacy of removal of opioids from wastewater between different countries.
True
49
Which specific opioid was the most common drug found in wastewater effluents around the world - pretty much being found in treated wastewater of all countries? (1)
Morphine and its metabolites (such as codeine)
50
Describe the relationship between heroin and morphine. (1)
Heroin is metabolised and converted to morphine in the body
51
Briefly describe a method that we could use to determine the efficacy of water treatment at removing drugs such as opioids from wastewater. (2)
- Measure concentration of drug in influent (before water treatment)
- Measure concentration of drug in effluent (after water treatment)
52
A study aiming to determine the efficacy of water treatments at removing opioids from wastewater measured the influent and effluent concentrations of the target opioids.
In wastewater, which drug was detected at the highest levels, and in most samples? (1)
EDDP (a metabolite of methadone)
53
A study aiming to determine the efficacy of water treatments at removing opioids from wastewater measured the influent and effluent concentrations of the target opioids.
They also measured the amounts of drugs found in surface water, which does not get treated but runs straight into rivers and oceans.
In surface water, which drug was detected at the highest levels, and in most samples? (1)
Tramadol
54
A study aiming to determine the efficacy of water treatments at removing opioids from wastewater measured the influent and effluent concentrations of the target opioids.
Give two drugs that were found in relatively few samples of wastewater, as well as surface water, in this study. (2)
- Heroin
- Fentanyl
55
A study aiming to determine the efficacy of water treatments at removing opioids from wastewater measured the influent and effluent concentrations of the target opioids.
Concentrations of heroin were relatively low, despite it potentially being commonly used.
Suggest a reason for this. (2)
Heroin is metabolised and converted to morphine
therefore there would be a larger detection of morphine and a lower detection of heroin.
56
A study aiming to determine the efficacy of water treatments at removing opioids from wastewater measured the influent and effluent concentrations of the target opioids.
Norbuprenorphine and fentanyl concentrations were higher in the effluent than the influent.
Suggest why this may be. (3)
- Water treatment may actually alter conjugation of certain molecules
- Which results in these drugs being PRODUCED during water treatment
- So increased concentrations are seen in the effluent
57
A study aiming to determine the efficacy of water treatments at removing opioids from wastewater measured the influent and effluent concentrations of the target opioids.
When influent and effluent concentrations are measured, give a conclusion that can be drawn regarding the efficacy of water treatment at removing drugs from wastewater, and explain how you came to this conclusion. (4)
- Water treatment is not sufficient to remove drugs from wastewater
- And sometimes even increases drug concentrations
- Because effluent is not that much lower than influent
- And sometimes effluent is actually higher than influent
58
Fill the gaps regarding opioids in surface water. (4)
Opioids are often detected in surface water. ..................... and its metabolites are the most abundant, with ..................., ..........................., and ........................ metabolites also detected.
Tramadol
morphine
codeine
methadone
59
Fill the gaps relating to opioids in tap water. (1)
Multiple opioids have been detected in tap water. The most common detected are ......................... and its metabolites.
methadone
60
Give two ways in which humans might be exposed to opioids in wastewater and surface water. (2)
Wastewater becomes tap water, which has been shown to contain opioids, and may be consumed by humans.
Fish are exposed to surface water, and may then be consumed by humans.
61
Describe a piece of evidence which supports the theory that drugs such as opioids, which contaminate wastewater, can get into human food such as fish. (1)
Contaminants of emerging concern (drugs) were found in transplanted mussels collected in 2012/2013 from locations near urbanised areas around Washington.
62
In 2012/2013, it was found that contaminants of emerging concern were found in transplanted mussels collected from locations near urbanised areas around Washington.
Researchers identified over 200 pharmaceuticals, including trace amounts of which two classes of therapeutic drugs? (2)
Antidepressants
Antibiotics
63
In 2012/2013, it was found that contaminants of emerging concern were found in transplanted mussels collected from locations near urbanised areas around Washington.
Why are mussels particularly good for conducting these types of experiments where we try to identify water contaminants? (2)
- Wide geographic distribution
- Ability to bio-accumulate pharmaceuticals from surrounding water
64
In 2012/2013, it was found that contaminants of emerging concern were found in transplanted mussels collected from locations near urbanised areas around Washington.
One reason why mussels are so good for assessing contamination of water is their ability to bio-accumulate pharmaceuticals from surrounding water.
How does this bio-accumulation occur? (3)
- Mussels filter feed (take in everything found in water)
- Unlike finfish, mussels poorly filter out or metabolise pharmaceuticals, including opioids
- So they effectively build up anthropogenic contaminants in their tissues
65
In 2012/2013, it was found that contaminants of emerging concern were found in transplanted mussels collected from locations near urbanised areas around Washington.
Which opioid drug was found to be present in mussels? (1)
How common was it to find this drug in mussels? (1)
i.e. in how many locations was this drug found in mussels?
Oxycodone
3 out of 18 locations tested showed oxycodone in mussels
66
In 2012/2013, it was found that contaminants of emerging concern were found in transplanted mussels collected from locations near urbanised areas around Washington.
Traces of oxycodone were found in 3 of 18 test sites.
Describe how dangerous this is thought to be to human health. (1)
'The likelihood of pharmacological effects on humans of oxycodone from consuming contaminated shellfish appears negligible.'
67
In 2012/2013, it was found that contaminants of emerging concern were found in transplanted mussels collected from locations near urbanised areas around Washington.
Traces of oxycodone were found in 3 of 18 test sites, however the risk to human health is thought to be negligible.
Give two reasons why risk to humans is not high. (2)
- Mussels in this study were collected near urbanised areas for research purposes, and not from commercial shellfish beds, which are considered to be pharmaceutically clean
- The amount of oxycodone in mussels is so small as to not cause a significant risk
68
In 2012/2013, it was found that contaminants of emerging concern were found in transplanted mussels collected from locations near urbanised areas around Washington.
A more recent study compared oxycodone concentrations in water with concentrations in mussels to assess bioaccumulation by mussels.
How did they quantify this? (1)
i.e. what did they calculate to show the account of bioaccumulation by mussels?
Mean bioaccumulation factor
69
True or false? Explain your answer if appropriate. (1)
In a study assessing bioaccumulation of oxycodone in water by mussels, the highest concentration in mussels was 1.5ng/g wet weight.
For a person to ingest 10mg of oxycodone, an average adult dose, they would need to consume 6,700kg of mussel meat, or about 466,660 mussels.
True - the potential dose of opioids from contaminated shellfish would be extremely low
70
True or false? Explain your answer if appropriate. (1)
Despite it being stated that risk to human health from oxycodone-contaminated mussels is 'negligible', there have been several case reports of adverse events from the consumption of shellfish contaminated with opioids.
False - there are no known case reports of adverse events
71
Give an ideal animal model, which is able to show the impact of opioid-contaminated water on fish, as well as determining effects and mechanisms on human disease. (1)
Zebrafish
72
In one study investigating the effects of opioids on wildlife, fathead minnows were exposed to tramadol.
They examined the uptake of tramadol from water into the blood and brain, and they also examined the metabolism of tramadol.
What did they find regarding how easily plasma concentrations of the drug could be predicted? (1)
What does this suggest about the effect of tramadol on wildlife? (1)
Plasma concentrations could be predicted reasonably accurately based on lipophilicity of drug and pH of water
Uptake of the drug from contaminated water occurs in a dose-dependent mechanism - higher concentration in water means more will get into plasma
73
In one study investigating the effects of opioids on wildlife, fathead minnows were exposed to tramadol.
They examined the uptake of tramadol from water into the blood and brain, and they also examined the metabolism of tramadol.
What did they find when they compared the concentrations of tramadol and its main metabolites in plasma vs brain? (1)
Concentrations were higher in the brain than in plasma
74
In one study investigating the effects of opioids on wildlife, fathead minnows were exposed to tramadol.
They examined the uptake of tramadol from water into the blood and brain, and they also examined the metabolism of tramadol.
Give two findings of the study that suggest that the observations seen in fish may also apply to mammals. (2)
What can you conclude from these findings? (1)
- Brain and plasma concentration ratios were within the range of values reported in mammalian species
- Fish metabolised the pro-drug tramadol into O-desmethyl tramadol and N-desmethyltramadol in a similar manner to that of mammals
We can conclude that fish likely uptake and metabolise tramadol in the same way as mammals, so we can accurately apply findings in fish to how tramadol would affect mammals.
75
In one study investigating the effects of opioids on wildlife, fathead minnows were exposed to tramadol.
They examined the uptake of tramadol from water into the blood and brain, and they also examined the metabolism of tramadol.
The study found that the pro-drug tramadol was metabolised into which two products? (2)
State whether each of these metabolites is active or inactive.
O-desmethyl tramadol (highly active metabolite)
N-desmethyl tramadol (inactive metabolite)
76
One study on drugs and the environment aimed to assess the effects of naproxen sodium on early life stages in fish, and also to assess the mixture of naproxen sodium and tramadol hydrochloride.
Two tests with the common carp (Cyprinus carpio) were performed for 32 days.
They found that subchronic exposure to naproxen and also to naproxen+tramadol had strong effects on early life stages and biomarkers such as... (6)
- Hatching
- Developmental rate
- Morphology
- Histopathology
- Mortality (with naproxen+tramadol)
- Oxidative stress
77
One study on drugs and the environment aimed to assess the effects of naproxen sodium on early life stages in fish, and also to assess the mixture of naproxen sodium and tramadol hydrochloride.
Two tests with the common carp (Cyprinus carpio) were performed for 32 days, which found significant adverse effects on early life stages and oxidative stress biomarkers.
What could we conclude from this study? (1)
Naproxen and tramadol in water have significant adverse effects on fish, and these effects could also occur in humans if the fish were to be consumed.
78
One study looking at drugs and the environment aimed to study the effects of exposure of Japanese medaka (Oryzias latipes) to codeine and fentanyl over their life cycle.
How did codeine affect reproduction in these fish at 100, 1000, and 25000 ng/L? (3)
HINT: all concentrations had same effect
- Reduced number of eggs produced
- Reduced number of mature oocytes observed histologically in ovaries
- Altered concentrations of hormones in hypothalamic-pituitary-gonadal axis (including reduced 12b-estradiol in females)
79
One study looking at drugs and the environment aimed to study the effects of exposure of Japanese medaka (Oryzias latipes) to codeine and fentanyl over their life cycle.
How did fentanyl affect reproduction in these fish at 5, 25, and 1000ng/L? (1)
No effect on reproduction or hormones at the concentrations tested
80
One study looking at drugs and the environment aimed to study the effects of exposure of Japanese medaka (Oryzias latipes) to codeine and fentanyl over their life cycle.
Describe how this study is relevant to the real world. (2)
Monitoring of surface waters in Southern Ontario, Canada, downstream of wastewater treatment plants
showed that the test concentrations of fentanyl and codeine were environmentally relevant.
81
Give two reduction strategies that have been put in place to reduce the impact of drugs on the environment. (2)
- Education to reduce clinical waste from hospital and people (eg. flushing unwanted drugs down toilet)
- Drug return programs (Take back, Mail back)
82
Describe a study which aimed to reduce the impact of drugs on the environment by giving patients other ways to dispose of leftover drugs. (5)
- Found that 41% of gynaecological surgical patients had leftover opioid pills
- Carbon drug deactivation bag neutralises opioid medication and can be safely discarded in rubbish
- Patients were educated about pain management goals and disposal bag
- Some places also now give an option to mail unused mediation back for free (so drugs can be disposed of effectively)
- Providing easier ways to discard drugs has been shown to improve toxicity to the environment
