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Flashcards in Exam 3 Substance Abuse Deck (24)
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1

HEROIN AND OTHER OPIOIDS

What are the subjective/behavioral effects?

  • Initially patients get a “kick” or “rush” that lasts about 45 seconds that consists of pleasure, relaxation, warmth, and thirst. The next experience is a prolonged sense of euphoria “that all is well with the world”. This second response is the main reason for abuse.  
  • Note: first-time users may feel nausea and vomiting and a profound sense of dysphoria; prolonged use due to peer pressure is the main reason people progress to the enjoyable feeling caused by opioid use. 

2

HEROIN

  • Heroin – crosses the blood-brain barrier easily because it has high lipid solubility → effects are immediate and intense (this is what sets it apart from other opioids) 
  • Administered (from most used to least): Intravenous injection (7-8 second onset), smoking (slower, peaks 10-15 min later), and nasal inhalation/sniffing or “snorting”. 
  • Note: when given orally or subcutaneously instead of IV, it acts like morphine and other opioids

3

MEPERIDINE

  • Meperidine – aka Demerol. May see more in nurse and physician abusers. Like heroin, highly effective when taken PO and does not have the warning sign of multiple injection sites, also less pupillary constriction. Also does not affect smooth muscle function, making constipation and urinary retention less problematic than other opioids

4

OXYCODONE

  • Oxycodone – given in medical setting as a controlled-release tablet that is designed to slowly release steady levels of oxycodone. Abusers crush the pill and then
  • Snort it or mix it with water to be injected, which gets absorbed immediately and raising blood levels dangerously high
  • Risk of respiratory depression and death is greatest in people who have not developed tolerance to opioids

5

HEROIN AND OTHER OPIOIDS

S&S

ACUTE TOXICITY

  • Classic triad of symptoms: respiratory depression, coma, and pinpoint pupils. Treat with Naloxone (Narcan), an opioid antagonist: titrate carefully or else you can put them straight from overdose straight into withdrawal, noooOOOoo! Readministered every few hours because of short half-life

6

HEROIN AND OTHER OPIOIDS

 

SEQUELAE OF COMPULSVIE USE

  • Actually has few direct detrimental effects. Many indirect hazards. Largely revolve around lifestyle of the opioid user, esp the impurities that come from street drugs and the non-sterile needles being shared, suffer from high rates of death from secondary infections and emboli from impure drugs

7

HEROIN AND OTHER OPIOIDS

Describe the use of methadone for substitution and for long-term management

 

  • Methadone is a long-acting oral opioid most common for easing withdrawal
  • Methadone substitutes for the drug the addict is on
  • Opioids display cross-dependance with one another
  • Patient is stabilized on Methadone
  • The process takes about 10 days 
  • Methadone must be matched closely to the existing degree of physical dependence 
  • For long-term management, larger doses are given progressively until a high dose of (120 mg/day) is achieved. This allows a high tolerance, which than no subjective effects are experienced. 
  • Cross-tolerance among opioids exists — so once tolerance for Methadone is achieved, pa

8

BARBITURATES

What are the effects?

CNS depression: ranges from mild sedation, to coma, to death (so get the dosage right!)

9

BARBITURATES

What is the issue with tolerance? 

Why is it dangerous with this particular drug?

  • Tolerance develops for some effects, not all. Progressively larger doses are needed to produce the desired effect, but little tolerance develops for respiratory depression. Basically, if you want to therapeutic effect, you’ll have to increase the dose as tolerance builds, but the amount it takes for you to not die from respiratory arrest stays the same since tolerance doesn’t develop for that. This is unlike something like opioids, where both increase as you take more. 

10

BARBITURATES

other drugs that have cross-tolerance with barbiturates?

Other CNS depressants: alcohol, benzos, general anesthetics. But NOT opioids

11

S and S

BARBITURATES

 

Respiratory depression, coma, pinpoint pupils: the triad of symptoms

12

BENZODIAZEPINES

How do they differ from barbiturates?

  • Benzos are usually more antianxiety and some sleeping pills but they can also control seizures and work to relax muscles as in diazepam or valium.
  • Barbiturates are hypnotics/sedatives but are also used for sleeping pills and anticonvulsants.
  • Barbiturates can be used to treat seizures but benzos also raise the seizure threshold which means they make it harder to have a seizure

13

COCAINE

How is it administered?

  • Usually, intranasally. “snorted” where it is absorbed by the nasal mucosa into the bloodstream. Very few (5%) administer IV. It CANNOT be smoked because it is unstable at high temperatures. The base form of cocaine can be administered through smoking, called “freebasing”, which delivers large amounts of cocaine to the lungs where it is rapidly absorbed. 

14

COCAINE

What are the subjective effects?

  • Euphoric high, dopamine feedback loop stimulation. IV and freebasing have the strongest effects, snorting less intense. The good effects quickly fade within minutes and get replaced with dysphoria. In order to regain the euphoria, users may repeat doses in short intervals, called “binging”. This can lead to quick addiction. 

15

COCAINE

What are the symptoms and treatment for acute toxicity?

  • Mild overdose produces agitation, dizziness, tremor, and blurred vision. Severe overdose can produce hyperpyrexia (super high body temperatures), convulsions, ventricular dysrhythmias, and hemorrhagic stroke. Users may get a coronary artery spasm, which can result in  secondary angina pectoris and MI ): 
  • Psychologically, users may experience severe anxiety, paranoid ideation, and hallucinations. Symptoms last about 1-2 hours because of cocaine’s short half-life. 
  • Treat symptoms since cocaine has not specific antidote. IV diazepam or lorazepam can reduce anxiety and seizures. Diazepam can also help with HTN and dysrhythmias. IV nitroprusside can help severe HTN. Dysrhythmias with prolonged QT intervals may respond to hypertonic sodium bicarbonate. Can prevent thrombus and MI with aspirin, beta blockers might help or make the dysrhythmia worse. 

16

AMPHETAMINES

What are the subjective and behavioral effects?

  • Can increase wakefulness and alertness, reduce fatigue, elevate mood, and augment self-confidence and initiative. Euphoria, talkativeness, and increased motor activity are likely. Can stimulate respiration, suppress appetite and perception of pain. 

17

AMPHETAMINES

 

How do amphetamines affect the CNS and cardiovascular system?

  • Stimulates the medullary respiratory center and increases respiration. Effects hypothalamic feeding center to decrease appetite. Cardiovascular effects occur secondary to release of NE from sympathetic neurons → effects of NE so increased HR, atrioventricular conduction, and force of contraction. In excess, can cause dysrhythmias. May lead to HTN. 

18

AMPHETAMINES

What are the symptoms of withdrawal?

  • Dysphoria and a strong sense of craving. Fatigue, prolonged sleep, excessive eating, and depression (which is the common reason for resuming drug use). 

19

MARIJUANA

What are the subjective and behavioral effects?

Three main subjective effects: euphoria, sedation, and hallucinations (no other drug produces all three). Low doses (it’s pleasantly lit) – euphoria, relaxation, gaiety and a heightened sense of humor, increased sensitivity to visual and auditory stimuli, enhanced sense of touch/taste/smell, increased appetite and ability to appreciate flavor of food, and distortion of time perception (short periods seems longer than they are). Moderate doses (it’s lit, but not as nice) – short-term memory loss, decreased capacity to do multi step tasks, slowed reaction time and motor impairment, altered judgement and decision making, temporal disintegration (can’t tell what’s past, present, or future), depersonalization, and decreased ability to perceive others emotions. High doses (lit, but not worth it) – hallucinations, delusions, and paranoia, intense anxiety, dissociative state where user feels “outside of their body”. EXTREMELY high doses can produce a state resembling toxic psychosis and can persist for weeks. 

Note: all users are not equally vulnerable to adverse effects. Some can have none, some can have all at even moderate doses. 

20

MARIJUANA

What is the effect of chronic use?

 

Behavioral phenomenon known as amotivational syndrome, characterized by apathy, dullness, poor grooming, reduced interest in achievement, and disinterest in the pursuit of conventional goals.

21

MARIJUANA

What are the cardiovascular, respiratory, reproductive, and CNS effects?

  • Cardiovascular – increase HR by 20 to 50 beats. Pretreat with beta blocker can reduce this effect. Causes orthostatic hypotension and reddening of conjunctiva (from vasodilation). 
  • Respiratory – acute use results in bronchodilation, but in chronic smoking use, airway constriction occurs. Can also lead to development of bronchitis, sinusitis, and asthma. 
  • Reproductive – In males, decrease spermatogenesis and testosterone levels. In females, reduces levels of follicle-stimulating hormone, luteinizing hormone, and prolactin. Alters development to babies in utero – present with trembling, altered responses to visual stimuli, high pitched cry. Preschoolers struggle with memory and sustained attention activities. 

22

MARIJUANA

 

What are therapeutic uses for THC?

Suppression of emesis, appetite stimulation, relief of neuropathic pain, glaucoma, multiple sclerosis

23

MDMA (ECSTASY) 

How is it administered?

  • This drug is a stimulant that alters mood and perception (awareness of surrounding objects and conditions).  It is administered usually as a capsule or tablet, sometimes a liquid or powder form.  
  • This drug increases…
    • Dopamine
      • causes a surge in euphoria and increased energy/activity
    • Norepinephrine 
      • increases heart rate and blood pressure, which are particularly risky for people with heart and blood vessel problems
    • Serotonin
      • affects mood, appetite, sleep, and other functions. It also triggers hormones that affect sexual arousal and trust. The release of large amounts of serotonin likely causes the emotional closeness, elevated mood, and empathy felt by those who use MDMA.

24

MDMA (ECSTASY)

What are the adverse effects?

 

  • Nausea, muscle cramping, involuntary teeth clenching, blurred vision, chills, sweating
  • Over the course of the week following moderate use of the drug, a person may experience:
    • Irritability, impulsiveness and aggression, depression, sleep problems, anxiety, memory and attention problems, decreased appetite, decreased interest in and pleasure from sex