Final Exam Flashcards
Explain the history behind drug use and development
Drugs have been used since before recorded history as shown evidenced by early written records from China and Egypt which provide a glimpse into agent traditions of drug use.
Ancient Civilizations: healers existed historically in all traditions and cultures of ancient times.
- Greece: Theophrastus wrote a textbook on the therapeutics that included opium, obtained from the opium poppy (palaver somniferum). Serturner, A pharmacist in Germany, isolated crystals of morphine from opium and tested the pure substance on himself and three companions to discover its pain relieving capabilities. Opium contains two important substances which are 10% morphine and 0.5% codeine. The name morphine comes from Morpheus, god of dreams. It can relieve pain a very great intensity. Coding is also widely used for pain relief and does it constitute of Tylenol-3.
- Egypt: Egyptian history was recorded on papyri. One of these papyri, the Ebers Papyrus, why is a textbook of drug use for medical students containing many true observations, particularly on purgatives, which are drugs used to cause bowel movements. One of the drugs recommended was senna which is still used today.
- China: Shen Nung classified all drugs according to taste. For example, Ma Huang was classified as a medium drug widely used for coughs and influenza. And the modern error, ephedrine has been isolated from Ma Huang to treat asthma and produce a derivative for decongestion.
Poisons: The use of poisons has resulted in the discovery of drugs still used today. All substances are poisons, there’s none which is not a poison, the right dose differentiates a poison and a remedy.
- Curare: A plant-derived drug that was historically used by indigenous people in various regions of the Amazon rainforest. As a poison, arrows were dipped in curare to use as a poison for hunting as it acted upon voluntary muscles causing paralysis and eventually death by respiratory paralysis. As a drug it was used by anaesthetists during surgery for muscle relaxation. Newer derivatives are still used by anesthetists today
- Ergot: A poisonous fungus that grows on the heads of rye, particularly during wet seasons. In the middle ages, ergot was ground together with rye, finding its way into bread. This resulted in terrible epidemics that killed over 20,000 people in one region of Russia. As a poison, ergot targets the nervous system resulting in symptoms of mental frenzy, hallucinations, and convulsions. It affects the cardiovascular system by causing constriction of the blood vessels that lead to the fingers, toes, and limbs. In the reproductive system, it causes violent contractions of the uterus. In the early 16th century, midwives used this to hasten labor. However, if not used appropriately it can result in death. As a drug, the ergotamine derivative is useful in treating migraines by preventing the pulsation of blood vessels. Ergonovine was used to Hazenbirth, but now is used to arrest uterine bleeding after childbirth.
Religion: in ancient societies, traditional healers acted as both physicians and priests, resulting in therapy being heavily influenced by religion and magic. In most parts of the world, plants containing intoxicating substances were used by traditional healers to alter the state of consciousness and facilitate communication with their gods. An example of this is peyote from the peyote cactus which was widely used to achieve a mystical state linked to spiritual and realistic use. It contains a potent substance, mescaline, which causes hallucinations, a feeling of well-being, and distortion similar to LSD.
What are drugs? What are the two major categories of drugs?
A drug is any substance received by a biological system that is not received for nutritive purposes, and which influences the biological function of the organism, meaning that chemicals, biological agents, and herbal products are all considered drugs.
About 25% of drugs used today are derived from plant sources where the active substances are purified and potentially modified to be either more effective or less toxic.
Drugs acting on the brain: Drugs that act on the brain alter the normal chemical signalling in the brain.
-LSD: Albert Hoffman tried to synthesize improved pharmaceutical products based on components of ergot but instead synthesized LSD, similar in chemical structure. The discovery of the psychedelic effects of LSD supported the idea that mental illnesses might be due to the production of potent substances in the brain that could produce psychic disturbance. This research stopped in the 1970s and the drug was classified as a controlled substance. Recently, however, evidence indicates that derivatives of LSD might be effective in treating depression, anxiety, and addiction.
Drugs acting against infectious disease: an infectious disease is any disease caused by an organism such as bacteria, viruses, fungi, or parasites.
1900: Organoarsenicals - arsenic and organic molecules can be selectively bound to parasites. This idea was applied to infectious disease to cure syphilis.
1930: Silva Drugs - Synthetic drugs for the treatment of bacterial disease as anti-bacterial compounds.
1940: Penicillin - During the second world war, penicillin was used in therapy of gram-positive bacterial disease.
1950: Streptomycin - antibiotic for tuberculosis and gram-negative bacterial diseases.
What is the process to drug development?
1) Drug discovery: Basic drug research is done through identification of the target, where a target for a new potential drug such as a receptor is found and it’s binding compound is identified and studied to determine pharmacological effects at the molecular, cellular, organ, and animal level; and studying the target, where the binding compound shows promise as a lead compound and enters detailed studies for safety and efficacy.
2) Pre-clinical studies: after the target has been discovered and studied, drugs enter pre-clinical studies which are conducted prior to testing in humans in range from molecular to tissue and animal studies. Pre-clinical studies can be pharmacology studies, which determine the detailed mechanism of action of the new drug, or toxicology studies, which determine the potential risks or harmful effects of the drug. These studies look at acute toxicity, chronic toxicity, and effects of reproductive, carcinogenic, and mutagenic potential.
If a manufacturer wants to test a new drug on humans, three steps are required before they can proceed. This includes proof of safety and efficacy, which must be submitted, from several animal species, to the government regulatory agency in the particular country concerned (Canada - Health products and food branch, USA - FDA), methodology, where the methods of the proposed clinical trial of humans is required, and investigation, where the submission is evaluated by qualified scientists that can give permission to highly qualified investigators like clinical pharmacologists to begin investigation of the drug in humans.
3) Phase 1 clinical trial: carefully evaluate the absorption, distribution, illumination, and adverse effects of the new drug. These trials test one or two doses of the drug to determine the tolerability on a limited number of healthy volunteers (20 - 80). The efficacy of the drug is not assessed.
4) Phase 2 clinical trial: determination of whether the drug is effective in treating the condition for which it is recommended in a limited number of patients with the disease (100 - 500). They also pay careful attention to the safety of the drug.
5) Phase 3 clinical trial: often called a randomized controlled trial‘s (RCT), are the main studies for licensing and marketing of the drug. These studies determine how safe and effective the drug is compared to no treatment or the current recommended therapy. It is tested on a larger number of people to obtain information about the drug in a diverse population. They are also conducted at centres in many cities, as one centre usually does not have the required number or diversity of patients. These trials are the most expensive part of drug development costing upwards of 50 million dollars.
6) Health Canada’s Review: the manufacture will submit to the regulatory body a new drug application containing detailed results of clinical trials. The results are again reviewed by regulatory scientists and, if deemed effective and the toxicity is acceptable, it will be granted approval.
7) Manufacturing: Manufacturers come up with a drug name and a brand name for the drug because chemical names are too complex for general use. Generic names are given to drugs that show promise. Around the same time that that is done, the manufacturer will apply for a patent with a brand name for the drug giving the company exclusive rights to market the drug for 20 years. That 20 year life begins when the patent is filed during pre-clinical development phase, so the effective patent life is in the range of 10 to 12 years. After a patent on a drug expires, other manufacturers can make copies of the original brand-name drug and sell it under their own brand name. The original brand-name drug and any generic versions will all contain the identical active ingredient gradient in the same amount and dosage form. These regulations are in place to ensure that all market of drugs are as effective as the original brand-name drug and or bioequivalent which is achieved by studying comparative bioavailability between blood levels after administration of the original and new brand-name drugs to healthy volunteers under controlled conditions.
8) Post market surveillance (Phase 4 clinical trial): The dragon is carefully watched even after being put on the market. If unexpected changes are seen in patients, there are changes to the drug labels to add warnings or advice about how to take the drug.
What is the design of phase 3 clinical trials?
Please three clinical trials can be divided into three large stages:
1) Enrollment: the people the new drug is tested on have to carefully be defined. The target population is the group of patients for whom the drug is intended. The study population is a subset of the target population that meets all required criteria. Two factors influence who can be included in the study population. This includes inclusion/exclusion criteria, which find characteristics of the patients to be included in the study to determine who is eligible for the trial in order to illuminate variables other than the drug under study that may influence results well also representing the target population. Severity of disease is important to consider and other present diseases as well. However, comorbidities are often included to be representative of the target population. Consent is the other criteria. Before a person can participate, informed consent must be obtained where the patient signs a document written in non-scientific language that outlines the purpose, procedures, and all potential risks and benefits that may occur. These consent documents are reviewed by an independent institutional ethics review board and at any time, or participant can revoke their consent.
2) Treatment: Studies are conducted in a double blind manner where neither the investigator nor the study subject is aware of the treatment the subject is assigned to. This is done to avoid any bias that could occur if the subject believes the drug will work or if the investigator is expecting positive results. Patients recruited for study are assigned to experimental treatment groups or a control group. To ensure these groups are similar, patients are assigned by randomization which ensures that confounding variables are distributed equally between experimental and control groups, removing potential bias. The efficacy and safety of the experimental drug has to be compared to a controlled drug which can either be placebo or a gold standard drug. A placebo does not contain any active drug but has identical in appearance, color, taste, and administration. Placebos can be very efficient in sick and anxious patients. A gold standard drug is a drug acceptable by the medical community has the best available treatment for that disease at that time. If a gold standard drug is a variable, that is what the control group receives so that all patients are receiving some sort of treatment.
3) Results: to determine if the experimental treatment was more or less effective than the control, and outcome of the trial which measures how much the drug worked in each participant is measured and compared in a reliable and objective manner. Factors which can influence the interpretation of a clinical trial must be considered when analyzing results. These include compliance, where patient compliance is tested by having participants bring back orally administered drugs or checking that the nurse signed off on intravenous drugs, quality of life, where the impact on patient quality of life is assessed, and statistics, where the measured outcome is compared to the measured outcome for the control drug using statistics to determine whether the difference is real or by chance.
What are drug targets?
Drugs are designed to interact with a selected target in the body which is commonly a receptor, but there can be other targets in the body.
Receptors: A molecule or complex of molecules on the outside or inside of a cell that has a regulatory or functional role in the organism. Many copies of the same receptor exist on or within a single cell, and many of the same cell types exist in an organ that all work together. This means thousands of the same receptors are within an organism. Receptors are normally bound to an activated by endogenous ligands, which are substances found in the body such as hormones and neurotransmitters. The location of receptors determines where a drug will act and whether the response that results is beneficial or detrimental.
Chemical Reactions: Commonly used antacids neutralize stomach acid through a simple acid-base neutralization reaction.
Physical Chemical Forces: Cholestyramine works by chemically binding the bile acids in the gastrointestinal tract to prevent reabsorption and increase the elimination of bile salts that are used to make cholesterol.
Most drags mimic or block the effect of a ligand at a receptor to stimulate the receptor as an agonist, or block the response as an antagonist.
How is drug response considered?
The intensity of the pharmacological effects produced by a drug increases in proportion to the dose. This is called the dose response relationship, reduce is defined as the amount of drag taken. To compare the effects of two different drugs you must consider the quantity, frequency of use, user demographics, and environmental factors.
For a drug to achieve its desired response, many receptors need to be activated at once. At low doses, very little response is observed as not many receptors are activated. The dose of the drug increases more receptors are activated until the desired response is seen. This is where a threshold exists. Once the threshold is reached a small increase in does result in a large increase in response. The response will increase until reaching a maximal effect where increasing the amount of drug will have no increase in therapeutic response. These can be seen on a dose response-curve.
Define efficacy and potency
Efficacy: the maximum pharmacological response that can be produced by a specific drug in that biological system.
Potency: the dose of drug required to produce a response of a certain magnitude, usually 50% of the maximum response for that drug.
What is therapeutic range?
Therapeutic range is the range of doses that achieve the therapeutic effect by keeping the blood concentration above the minimum which produces the desired response, but below the concentration that produces a toxic response.
What must happen for a drug to reach its desired effect?
To produce its desired effect, a drug must reach the cellular site of action at the right concentration, exert it’s a fact, and then be removed from the body.
Define pharmacokinetics
Pharmacokinetics is a term that refers to the movement of a drug into, through, and out of the body.
What are the different routes of administration?
Topical: drugs are applied directly to a particular place on or in the body by administration on the skin, through the skin, or through inhalation. Drugs applied to the skin treat mild to moderate severity conditions such as eczema, acne, and infection. These drugs, applied for a local affect, can be absorbed and produce a systemic affect. Transdermal drug delivery is the application of a drug to the skin for absorption into the general circulation for a systemic effect. This method of delivery is convenient, delivers a steady drug supply for several days, and bypasses the enzymes of the stomach, intestine, or liver. Drugs administered by inhalation can be rapidly absorbed from the lungs for local and systemic effect. An advantage of inhalation is that the quantities of drugs are smaller than that required for a systemic effect, thus avoiding toxicity associated with oral administration. A disadvantage is that the method requires proper use by the patient.
Enteral: administration via the gastrointestinal tract either through the mouth or an artificial opening. This administration enters the blood through the gastrointestinal tract then is delivered to the liver where enzymes decrease the amount of active drug left to enter the general circulation. This is called the first pass effect. These can be administered by mouth which is commonly used, most convenient, least expensive, and non-invasive, but absorption is variable due to differences in intestinal motility and disease. They can also be administered into the rectum for a systematic or local effect in patients who are nauseated or vomiting. An advantage is that the digestive enzymes of the stomach are bypassed but a disadvantage is that there is only a limited number of medication available for rectal administration and absorption from the rectum mucosa is slow, incomplete, and variable. Sublingual and buccal administration bypasses enzymes of the stomach, intestines, and liver but not all drugs are adequately absorbed this way and if the drug is swallowed, it just behaves as if it were taken orally.
Parenteral: administration bypassing the gastrointestinal tract through intervenous, intramuscular injection, or subcutaneous injection. In intravenous administration, the drug is placed directly into the blood and has immediate effects for drugs that are poorly absorbed, provided that they can be made into a solution in purified water. It must also be considered that the response is irreversible and administration require significant human resources and sterility. In intramuscular administration, the drug is injected deep into a muscle where the volume of drug is limited to 2 to 3 mL in an adult. In subcutaneous administration, the drug is injected into the deepest layer of the skin allowing for the modification of drug preparation to control the timing of release of that drug from the injection site.
Why is there not always a good relationship between the dose of drug and the concentration of drug in the blood?
During absorption, not all of the drug ends up in the blood. This is because bioavailability differs between drugs.
Define bioavailability
Bio availability is defined as the fraction of an administered dose that reaches the systemic circulation in an active form.
What are the four processes involved in pharmacokinetics?
1) absorption: The movement of a drug from the site of administration into the blood. For a drug to be absorbed and distributed two sites of action, it must be able to cross biological membranes. This can be done by diffusion through aqueous pores across a concentration gradient, diffusion through lipids dissolving into the lipid membrane and passing down a concentration gradient, or active/carrier mediated transport where carrier membrane complexes grasp the molecule move through the membrane and release the molecule on the other side.
2) distribution: The movement of a drug from the blood to the side of action and other tissues. Most drugs reach all tissues and organs regardless of the target site of action. The concentration of a drug at the site of distribution is an equilibrium with its concentration in the blood. The rate at which drugs distribute in and out of a particular organ depend on the blood flow to that organ. After administration, drug distribution to the target site allows a response to occur. However, once the concentration begins to reach equilibrium, moving into other tissues and organs, the concentration at the active site begins to decrees and the effect of the drug has been terminated.
3) metabolism: also known as bio transformation, the conversion of a drug to a different chemical compound in order to eliminate it. The products of metabolism are called metabolites which are usually devoid of pharmacological action. To be eliminated from the body by the kidneys, a drug must be water soluble so most drugs are converted to more water soluble compounds. The liver is where most biotransformation reactions occur, but some metabolism occurs in the kidneys, intestines, lungs, skin, and most other organs.
- Phase 1: functional groups are added or unmasked on the drug to prepare it for the addition of a large water soluble molecule.
-Phase 2: Add a large water soluble moiety, usually glucuronic acid or sulfate, making the metabolite water soluble for excretion by the kidney.
4) excretion: includes moving the drug and it’s metabolites out of the body through all bodily fluids.
-kidney: The majority of drugs are eliminated by the kidney. Drugs of sufficient water solubility will be excreted in the urine while lipid soluble drugs can be reabsorbed back in blood.
-G.I. tract: Some drugs are excreted in faeces after undergoing biotransformation in the liver.
-lungs: Volatile or gaseous drugs can be excreted by the lungs.
-breast milk: Drugs are often found in the breastmilk of nursing parents which can expose nursing infants to a therapeutic or toxic dose of the drug.
-saliva and sweat: drugs can be found in saliva and sweat, often in the presence of drug misuse.
What is P450?
P450s are enzymes capable of biotransforming drugs. They are in most tissues, but are present in high concentrations in the liver. The cytochrome P450 family of enzymes biotransforms the vast majority of clinically used drugs.
Why is there variation of drug response?
As drugs undergo five events after administration including absorption, distribution, target interaction, metabolism, and excretion, there are many possible influences at any stage which can contribute to variability in the observed response among patients. Some examples include genetic factors, environmental factors, disease states, physiological states, and the presence of other drugs.
Genetic: variability exists in the receptors to which the drug binds and in the manner in which the body handles and eliminates drugs. The activity of enzymes involved in bio transformation can vary between individuals due to genes that encode for those enzymes. Some individuals are slow biotransformers and others are fast biotransformers.
Environmental: exposure to certain chemicals can increase enzymes in the liver responsible for biotransformation of drugs. This makes these people illuminate the drug more rapidly.
Other disease states: the presence of a disease state may alter the manner in which drugs are handled by the body.
Altered physiological states: as we age, we lose the reserve or redundancy in Nuro function and drugs have a greater affect than expected. Liver and kidney function also decrease with age reducing the rate at which elderly eliminate drugs. Another example is during pregnancy due to increased blood volume, cardiac output, and rate of renal excretion.
Other drugs present: when multiple drugs are taken together it is possible for one drug to change the biological effect of a second, leading to variability in drug response.
What are the adverse effects of drugs?
An adverse drug reaction is defined as any effect produced by a drug in a patient that is not the intended effect.
Extension of therapeutic effect: occurs when there is too much of the drug in the blood (overdose).
Unrelated to main drag action: drugs can cause effects that are unrelated to the intended action like causing nausea. These may or may not be expected.
Allergic reaction: this is mediated by the immune system from an antigen-antibody combination which provokes an adverse reaction in the patient. These can be very mild or very severe.
Withdrawal an addiction: unwanted physiological and psychological effects of the drug can occur.
Teratogenesis: when a drug produces defects in a developing fetus.
Adverse biotransformation reaction: occurs when a drug is converted to a chemically reactive metabolite that combine to tissue components and cause tissue or organ damage.
Why is it difficult to predict adverse drug reactions?
Rarity of occurrence: the toxic reaction may be rare, making it difficult to predict the adverse drug reaction.
Length of usage: toxic reaction my only appear after prolonged use.
Detect ability and animals: the toxic effect may not be detectible in animals and only appear once the drug is being tested in humans.
Time period specificity: the toxic affect maybe unique to a particular period in time.
What is the therapeutic index?
Therapeutic index tells you how safe the drug is relating the dose of the drag required to produce a beneficial effect to the dose required to produce an undesirable or adverse effect. The higher the therapeutic index the safer the drug. When a drug has a low therapeutic index, it is more likely that toxicities will be observed. It is calculated by dividing toxic dose 50 by effective dose 50.
What is toxic dose 50? What is effective dose 50?
TD50: dose of drug that is toxic in 50% of the population.
ED50: dose of drug that is effective in 50% of the population.
Discuss drug-drug interactions
A drug to drug interaction occurs when one drug changes the pharmacological effect of a second. These can occur at many points during the drugs journey through the body.
Absorption: add drag can increase intestinal movement, speeding the passage of a second drug through the intestine and decreasing contact of the second drug with the intestinal wall, thereby decreasing absorption.
Metabolism: a drug can block the inactivation of a second drug in the liver, increasing the blood level and pharmacological effect of the second drug.
Excretion: a drug can facilitate the expression of a second drug by the kidney, decreasing the blood level and pharmacological effect of the second drug.
Discuss drug-food interactions
Drag the food interactions involves interference of food with drugs taken concurrently.
Tyramine: found in well matured cheeses and a variety of other foods. It is capable of raising blood pressure and is broken in the liver by an enzyme known as MAO. One class of anti-depressant drugs are inhibitors of MAO, preventing tyramine from being broken down to inactive products. This causes the blood pressure raising effects of tyramine to be greatly intensified.
Grapefruit: alter the absorption of drugs by inhibiting enzymes that bio transform drugs, resulting in a greater amount of the active drug being absorbed. The higher blood levels of the drug can potentially lead to overdose.
What is the cerebral cortex?
The cerebral cortex, also known as the cerebrum, is the largest part of the brain and is very rich in neurons. The overall functions of the cerebral cortex are: sensory and motor coordination, mental processes, intelligence, memory, vision, judgment, thought, speech, emotions, and consciousness. The neurons in the cerebral cortex can be stimulated or depressed by drugs.
What is the limbic system?
The limbic system is a region of the brain that integrates memory, emotion, and reward. This area of the brain, together with the hypothalamus, controls emotion and behavior. The limbic system contains the dopaminergic reward centers, which are targets for commonly misused drugs and are associated with addiction.
Describe neurons
Neurons are the functional unit of the brain capable of generating and transmitting electrical signals. The brain contains about 90 billion neurons that differ from each other and shape and size. New neurons are generated continuously through neurogenesis and the connection between neurons is constantly reshape through neuroplasticity.
Dendrites: Short and can have highly complex branching patterns that function as receiving antenna for incoming information and except information through receptors located on the dendritic membranes. Upon receiving this information, and electric current is generated and directed down the neuron.
Cell Body: Also known as the soma, is the largest part of the neuron and contains the nucleus and surrounding cytoplasm. The cytoplasm contains abundant prepackaged neurotransmitters that can be secreted.
Axon: Single fibre that extends from the cell body and ends at the synapse. The axon continues to carry the incoming information away from the dendrites and cell body by way electrical impulses. This information is in passed onto subsequent neurons.
What is the synapse?
An electrical impulse Hass to be somehow communicated across the junction of one neuron to another to produce a further effect. The junction between two neurons is the synapse, and is the area where one neurons axon ends and another neurons dendrite or cell body begins.
What is synaptic transmission?
Synaptic transmission is the passage of a signal from one neuron to another. It can also be called neural transmission which is very rapid and usually chemical in nature, meaning a substance is quickly released that activates the next neuron. The chemicals that transmit a signal between two neurons are called neurotransmitters.
How are neurotransmitters removed from the synaptic cleft?
1) neurotransmitters, like norepinephrine, are taken back into the presynaptic neuron with transporters.
2) Neurotransmitters, like Acetylcholine, are broken down by enzymes.
3) Neurotransmitters, Like glutamine, are taken by glial cells.
What are the steps to synaptic transmission?
At the end of an axon an electrical impulse causes vesicles with neurotransmitters to fused with the presynaptic membrane, releasing neurotransmitters into the synaptic cleft. These neurotransmitters diffuse across the synaptic cleft and bind with the postsynaptic neuron receptors. Activation of receptors causes a change in the permeability of the postsynaptic membrane, allowing ions to move into the postsynaptic neuron, generating an action potential. This transmission continues through neurons until it reaches the target organ in order to cause and effect. The neurotransmitters in the synapse are terminated in one of three ways and the postsynaptic membrane can re-polarized before the next signal.
What are the neurotransmitters and receptors?
Glutamate: primary excitatory neurotransmitter in the CNS and is found in almost all neurons acting on a family of receptors called the glutamatergic receptors. Neurons that release glutamate, termed glutamtergic neurons are important for learning.
Catecholamines: dopamine and norepinephrine are catecholamines that are similar in structure. Dopaminergic pathways are involved in the control of hormonal systems, motor coordination, and motivation and reward. Alterations in dopamine mediated motivation and reward systems are involved in addiction. Norepinephrine can bind to a large number of receptor types, but the two main classes are alpha and beta. Activation of these receptors usually leads to excitation of the cell. This pathway is targeted by CNS stimulants.
GABA: gamma-amino butyric acid is the primary inhibitory neurotransmitter in the CNS. Neurons that release GABA and GABA receptors are found in high concentrations in the cerebral cortex and other areas. A number of CNS depressants enhance GABA receptor function.
Serotonin: in the CNS, hyperactivity of the serotonergic system is involved in anxiety, and hyperactivity has been implicated in depression. CNS stimulants act by increasing serotonin at the synapse.
Acetylcholine: produces an excitatory response in the CNS. Two types of cholinergic receptors include nicotinic receptors, which are found in certain regions of the brain and can be stimulated by acetylcholine or nicotine, or muscarinic receptors, Which are found in many regions of the brain and are involved in learning, memory, and cognitive function. Muscarinic receptors can be stimulated by acetylcholine or muscarine. Drugs that block the action of acetylcholine at these receptors produce amnesia. Lots of these culinergic Neurons is thought to be associated with Alzheimer’s disease.
Opioid peptides: three classes of endogenous opioid peptides exist which are enkephalins, endorphins, and dynorphin‘s. They have varying degrees of selectivity for the three opioid receptors mu, delta, and kappa. All opioids interact with these receptors.
How has historical use of chemicals contributed to the advancement of pharmacology?
Use of sulfa drugs led to the development of the first synthetic antibacterial compounds.
Phase 3 clinical trials can employ a placebo. What is a placebo?
A placebo is defined as an inert substance masquerading as a drug.
Drug A can only relieve pain of mild intensity. Drug B, on the other hand, relieves pain a very marked intensity. What can you conclude?
Drug B has greater efficacy than drug A.
 The ultra short duration of action of thiopental is due to what?
Redistribution of the drug from the brain to muscle and fat.
What should be considered when selecting the most appropriate dosage for a patient’s situation?
Differences in bioavailability need to be carefully considered.
Penicillin can combine with proteins to form antigens. And a small percentage of the population receiving penicillin experiences adverse effects. What is this adverse effect?
A drug allergy.
What is the primary excitatory neurotransmitter in the brain?
Glutamate
Describe chemical transmission.
Chemical transmission is due to the notion that most synaptic transmission is chemically mediated.
What is an SUD?
SUD, also known as substance use disorder, is defined and diagnosed by a number of criteria. A minimum of two criteria must be met to be classified as having a mild SUD. The more criteria met, the more severe the SUD.
What are the criteria of an SUD?
Social impairment: the individual fails to fulfil major roles and has persistent social or interpersonal problems where social, occupational, or recreational activities are given up or reduced.
Risky use: the individual may use the substance in physically hazardous situations or use the substance despite physiological or psychological problems.
Impaired control: The individual may have persistent craving for the substance
Withdrawal: The individual may experience a withdrawal syndrome after stopping use of the substance.
Tolerance: the individual may develop tolerance to the substance.
What is addiction?
Addiction is a state in which stopping or abruptly reducing the dose of a given drug produces non-physical symptoms.
What is the hypothesis used to explain addiction?
The dopamine hypothesis explains addiction through effect on reward systems and dopamine increase. It suggests that misused drugs increase dopamine in the reward systems of the brain. These dopaminergic systems are responsible for natural rewards and stimulus related rewards, so drugs associated with addiction caused exaggerated increase in dopamine, altering brain communication.
What are the three characteristics of addictive drugs?
Increase dopamine: substances that increase dopamine in the brain reward systems including CNS stimulants, opioids, alcohol, and cannabis.
Produce novelty: substances that produce a novel feeling including LSD, and ecstasy.
Reduce anxiety: substances that reduce anxiety including CNS depressants like benzodiazepines and barbiturates.
What is drug withdrawal?
Drug withdrawal is a physiological state produced by repeated administration of a drug that causes withdrawal syndrome when the drug is discontinued or the dose is decreased. The severity of withdrawal syndrome increases with the speed of drug withdrawal, as the biological processes that accommodate to the presence of the drug do not have time to reverse themselves.
Withdrawal symptoms are usually opposite to the effects of a drug. For stimulants, withdrawal symptoms include sleepiness, muscle pain, anxiety, tremors, low mood, suicidal ideation‘s, and cardiovascular problems. For opioids, withdrawal symptoms include sweating, muscle aches, agitation, diarrhea, abdominal cramping, and vomiting.
What is drug tolerance?
Drug tolerance is expressed as a shortened duration of action and decreased magnitude of effect. The extent and rate of tolerance is specific for each drug. Drug tolerance can also be reversible among drug discontinuation.
What is cross tolerance?
Cross tolerance occurs between pharmacologically similar drugs. It is the resistance or tolerance to one drug because of the resistance or tolerance to a pharmacologically similar drug.
What factors influence SUD?
Genetic factors: predispose an individual to SUD
Pre-existing disorders: individuals with major affective disorder, anxiety disorder, or schizophrenia are hire at risk for SUD
Environmental factors: environments can increase the likelihood of drug missuse and SUD. These include family dynamics, trauma, and social groups
Developmental factors: individuals are more vulnerable during certain developmental time frames like adolescence and early adulthood
What is harm reduction?
Harm reduction is an approach to prevent negative consequences of substances and improve health without judgement or discrimination. The goal is to decrease morbidity, mortality, lost productivity, apprehension of children, and criminal activity.
What is Misuse potential?
Misuse potential is the tendency of a drug to be misused. It varies from drug to drug, as well as from individual to individual.
Nature of the drug: pleasurable affects produced by a drug increase the probability that the drug will be taking again.
Route of administration: drugs administered by routes that give rapid absorption and a facts have a greater potential for misuse.
Amount of use: the greater the dose and frequency, the greater the potential for development of tolerance, withdrawal, and addiction.
Availability: the more widespread a drug, the more likely it will be misused.
Inherent harmfulness: if a drug is perceived to be a serious risk to life and health, it will not be used even if widely available.
Which class of drugs is thought to result in addiction but not withdrawal?
Hallucinogens
What are amphetamines?
Amphetamines are drugs of widespread missuse and are controlled substances. These include amphetamine, dextroamphetamine, and methamphetamine. They are synthetic organic compounds that are structurally similar to the neurotransmitters norepinephrine and dopamine. amphetamines can be synthesized readily, resulting in illicit manufacturing where the purity is variable and may contain side products of the chemical reaction, unreacted chemicals, and filler agents.
Methylphenidate (Ritalin): used to treat attention deficit hyperactivity disorder (ADHD)
MDMA (ecstasy): A derivative of methamphetamine that fosters the feeling of intimacy and empathy while improving intellectual capacities. It is neurotoxic, causing neuronal damage and death.
What are the effects of amphetamines?
Amphetamines affect the CNS by:
1) Decreased threshold for transmitting sensory input to the cerebral cortex, leading to CNS excitation.
2) A feeling of euphoria and reward.
3) Temperature regulation and feeding centre modifications leading to appetite suppression.
4) An increase in aggressive behaviour in mood swings.
Increased CNS excitation will lead to increased alertness, a feeling of power, reduced fatigue, and increased responsiveness. However, it also results in increased heart rate and blood pressure.
Short term effects: chest pain, heart attack, cardiovascular collapse, increased respiratory rate.
Long-term effects: chronic sleeping problems, poor appetite, anxiety, psychosis, aggressive behavior, abnormal cardiac rhythm, and elevated blood pressure.
Overdose: seizure, high fever, or stroke.
What are the therapeutic uses of amphetamines?
Amphetamines, like Methylphenidate, can help treat narcolepsy, a chronic sleep disorder, or ADHD, a disorder consisting of hyperactivity and difficulty controlling attention. Amphetamines improve attention and control, enhancing task completion and performance.
How are amphetamines most commonly taken?
Amphetamines are typically taken orally, injected, or are smoked. However, occasionally they are sniffed or snorted.
Discuss the potential for misuse and SUD of amphetamines.
The misuse potential is extremely high as amphetamines produce euphoria and water soluble salt forms allow for large doses that are readily injectable for a rapid response. The inherent harmfulness does not appear to be a deterrent to misuse.
Tolerance: develops to the euphoria and mood elevating effects, the anoretic effects, the cardiovascular and respiratory stimulatory effects, and the lethal effects of the drugs. However, it does not develop to therapeutic effects or drug induced psychosis.
Withdrawal: cessation of use results in mood depression that may be profound, prolonged sleep, appetite, lack of energy, and fatigue.
Addiction: amphetamines are self administered to produce euphoria and abrupt awakening. These effects act as rewards that give a craving sensation for the effects.
What is cocaine?
Cocaine is classified as a local anaesthetic and a CNS stimulant. It is one of the most popular recreational drugs as a narcotic. Cocaine is almost indistinguishable from amphetamine and it’s a cute effects and toxicity. It has a shorter duration of action, usually less than an hour, and is commonly sniffed or smoked.
How does cocaine act in the body?
Cocaine causes generalized CNS stimulation by inhibiting the active reuptake of dopamine and serotonin, increasing the concentration of these neurotransmitters in the synaptic cleft to increase the activation of postsynaptic neuron receptors.
What is the therapeutic use of cocaine?
Cocaine is used as a local anaesthetic for the mouth and throat, but is rarely used as there are better local anaesthetics that do not have associated potential for misuse and SUD.
What are the long-term effects of cocaine?
Toxic psychosis, paranoia, hallucinations, impaired sexual function, permanent brain damage, high blood pressure, irregular heart rhythm, and changes to nasal mucosa.
Discuss the potential for misuse and SUD of cocaine.
Cocaine has one of the highest misuse liabilities due to powerful euphoria which can be rapidly reached by injection or smoking the freebase. The inherent harmfulness does not appear to deter misuse.
Tolerance: develops toward the mood elevating affect but not the drug induced psychotic affect. Tolerance does not develop as readily to hallucinatory and behavioural effects of cocaine as compared to amphetamines.
Withdrawal: withdrawal symptoms are very similar to those associated with amphetamines.
Addiction: addiction can occur as the behavioural effects are usually perceived as pleasurable and rewarding.
What is the ADME of nicotine?
Nicotine is the ingredient in tobacco products responsible for smoking addiction.
1) Absorption: nicotine exists in smoke in small particles, and when inhaled, droplets are rapidly absorbed. Nicotine can be absorbed from the G.I. tract, oral mucosa, and across the skin. The dose is controlled by the depth of inhalation and frequency of smoking.
2) Distribution: nicotine is distributed through the body and rapidly gains access to the brain.
3) metabolism: nicotine is rapidly metabolized in the liver.
4) Excretion: metabolites are excreted in the urine. The half life is about two hours.
What is the mechanism of action for nicotine?
Nicotine stimulates nicotinic receptors at synapses to increase psychomotor activity, cognitive function, attention, and memory. In large doses, nicotine causes agitation, tremors, and seizures.
The effects in the CNS are mediated by the nicotinic receptor-mediated release of the CNS neurotransmitters dopamine and serotonin.
What are the therapeutic uses of nicotine?
The only therapeutic use of nicotine is in smoking cessation programs where nicotine is administered through chewing gum, transdermal patches, or buccal spray to maintain blood nicotine levels and satisfy the craving for a cigarette.
What are the short-term effects of smoking?
Regular smoker: mild euphoria, arousal, concentration, relaxation, increased heart rate, increased blood pressure, and suppressed appetite.
Non-regular smoker: dizziness, headache, nausea, vomiting, abdominal cramps, coughing, and gagging.
What are the long-term effects of smoking?
Tobacco smoke contains over 4000 compounds including nicotine, carbon monoxide, carcinogenic aromatic hydrocarbons, tars, and products of combustion. The long-term effects are related to these products of combustion and not nicotine itself.
Cardiovascular disease: higher risk of death due to cardiac causes from nicotine. Also: carbon monoxide reduces the capacity of red blood cells to carry oxygen, increasing the incidence of atherosclerosis and thrombi.
Lung disease: smokers syndrome is characterized by difficulty breathing, wheezing, chest pain, congested lungs, and lung infections. There is also increased risk of emphysema and other chronic obstructive lung diseases.
Cancer: 30% of all cancers are caused by cigarette smoke which increases the risk of lung, oral cavity, throat, bladder, and uterus cancers.
What are alternative effects of smoking?
Passive smoke increases risk of cardiovascular disease and cancer, specifically in children, increasing the incidence of bronchitis, pneumonia, asthma, and sudden infant death syndrome.
During pregnancy, smoking affects the developing foetus with a 2 to 3 fold increase in the incidence of the foetus being small or born preterm. This can be reversed if the pregnant woman stopped smoking early in pregnancy. Exposure to passive smoke also increases the chance of a low birthweight neonate due to decreased oxygen delivery to the fetus.
What is the potential for missuse and SUD for nicotine?
Tolerance: does not appear to a great extent as smokers continue to keep nicotine blood levels at a certain range (30-40ng/mL)
Withdrawal: involves symptoms such as irritability, restlessness, anxiety, insomnia, fatigue, and the inability to concentrate. This is felt in the morning when smokers are in a state of nicotine withdrawal.
Addiction: occurs and manifests as an extreme urge to smoke.
What is the pharmacology of caffeine?
Caffeine is found in tea, coffee, chocolate, and cola drinks. As well, it is found in over-the-counter stimulants, analgesics, and diuretics. The average cup of coffee contains 100 mg of caffeine, well energy drinks have over 300 mg of caffeine.
The lethal dose of caffeine Is equal to about 10 g of caffeine.
What is the ADME of caffeine?
Caffeine predominantly affects the CNS and cardiovascular system as a stimulant.
1) absorption: taken orally, caffeine is rapidly and completely absorbed. Blood levels are significant at 30 minutes and peak 2 hours after ingestion?
2) distribution: caffeine distributes to all parts of the body and freely crosses into the brain and placenta.
3) metabolism: genetics determine the rate at which we metabolize and excrete caffeine, which is why drinking coffee at night keeps some people awake but not others.
4) elimination: the half-life varies from 2.5 hours to 10 hours.
What is the mechanism of action of coffee?
100 to 250 mg of caffeine increases mental performance and motor activity while decreasing drowsiness and fatigue.
Without caffeine, Tennessee and receptors stimulate GABAergic neurons that inhibit dopamine release.
With caffeine, adenosine receptors are completely blocked in the brain causing an increase in dopamine release and stimulating the CNS.
What are the short term effects of caffeine?
CNS: mood elevation, reduced fatigue, clearer thought, nervousness, irritability, agitation, reduced sleep.
Cardiovascular: construction of cerebral blood vessels, increased peripheral blood flow, stimulated cardiac muscle with rapid and irregular heartbeats.
Respiration: stimulation of the respiratory rate and relaxation of bronchial smooth muscle.
What is the clinical use of caffeine?
Caffeine is used to stimulate breathing in pre-term newborns. This helps the immature brains and lungs remember how to breathe.
What are the long-term effects of caffeine?
Restlessness, nervousness, insomnia, increased urinary output, gastric upset, rambling speech, and rambling thought.
What are the effects of caffeine in special circumstances?
Smoking: cigarette smoke increases the metabolism of caffeine.
Pregnancy: large doses of caffeine increase the risk of stillbirth, decreased foetal growth rate, and slightly increase the chances of miscarriage. Metabolism of caffeine is slower in pregnant people, extending the duration of action by two times in the second trimester, and three times in the third trimester.
What is the potential for Misuse and SUD for caffeine?
Misuse: potential is low as caffeine is not a reinforcer due to only mild euphoria. Inherent harmfulness is very low.
SUD:
-Tolerance: some tolerance does develop
-Withdrawal: abrupt cessation will result in headache, fatigue, and drowsiness
-Addiction: mild addiction can occur
Why are amphetamines used in sports?
Amphetamines increase the feelings of euphoria, reward, increased respiration, insomnia, and psychoses. These effects increase endurance and speed, or cause appetite suppression which is helpful in sports that benefit from weight loss.
Why are anabolic steroids used in sports?
Anabolic steroids are used to increase muscle mass and strength with reduced androgenic affects and maintained anabolic affects.
Anti catabolic: reduced breakdown of protein allows athletes to maintain muscle mass
Anabolic: produce more protein to increase muscle mass
Motivation: aggressive behavior, known as roid rage, is beneficial for competitive sports.
Anabolic steroids have greater effects in individuals with lower basil circulating levels of testosterone. With low to moderate doses there are modest effects, While large doses yield significant increases in lean body mass, weight, and strength.
Anabolic steroids increase mood swings, develop severe acne, increase cardiovascular disease with low density Lipo proteins, alter liver function, and reduce testosterone by blocking the release of gonadotropin which can cause infertility, libido, and impotence. In females, there is an increase in body hair, lowered voice, enlarged clitoris, increased libido, and amenorrhea.
Why are benzodiazepines used in sports?
Benzodiazepines reduce stress and anxiety during competition but can also impair psychomotor coordination and focus at higher doses, so benefits are closely weighed with potential impairments in performance.
What is blood doping and erythropoietin?
Blood doping is the re-infusion of an athletes blood cells, well erythropoietin is a hormone that increases the amount of red blood cells produced in the body. Both methods increase oxygen carrying to increase sport performance.
Inappropriate use of erythropoietin can result in thrombotic events.
Blood doping is detected by measuring the age of red blood cells, well erythropoietin is detected in urine.
Why are diuretics used in sports?
Diuretics increase exccretion of salt and water through the kidneys in order to reduce body water and allow that athlete to compete in lower weight classes. These can also increase the speed of excretion of other band drugs to avoid detection.
Toxicities include excess electrolyte and water depletion.
Why were performance-enhancing drugs banned in sports?
Athlete protection: to protect athletes under pressure to perform well.
Unfair advantage: to make a level playing field between all competitors.
What are sedative hypnotic agents?
Sedative hypnotic agents are CNS depressants that produce different affects at particular doses.
Antianxiety: used for anxiety disorders like general anxiety disorder and obsessive compulsive disorder.
Sedation: used to relieve anxiety, decreased activity, moderate excitement, and calm the individual.
Hipnosis: produce drowsiness and aid in the onset and maintenance of sleep.
General anesthesia: induce a state of unconsciousness with the absence of pain sensation.
What are the mechanisms of action of sedative hypnotics?
Without: excitatory neurons release the neurotransmitter glutamate when excitatory inputs exceed inhibitory inputs.
With: inhibitory signals from GABA neurons increase with most sedated hypnotics, decreasing glutamate nerve firing.
GABA selectively opens chloride channels to allow chloride ions to flow into the cell when signalled to open. Chloride ions flow into the postsynaptic neuron, making it hard for the postsynaptic neuron to transmit incoming messages to other neurons. This depresses the CNS signalling.
What are benzodiazepines?
Benzodiazepines are taken as a capsule or tablet, but can be available for intravenous or intranasal use. They increase the frequency of the opening of the chloride channel. Therapeutic effects include relaxation, calmness, skeletal muscle relaxation, and anticonvulsant effects.
Benzodiazepines are the most commonly used drugs in overdose, following ingestion of enormous doses, rapid intervenous injection, or drug combination.
An antidote for benzodiazepines is flumazenil, a benzodiazepine receptor antagonist that blocks the effects of benzodiazepines.
What are the short-term effects of benzodiazepines?
CNS: drowsiness, lethargy, fatigue, and impairment of thinking or memory.
Breathing: respiratory depression is seen with rapid intervenous administration.
Motor coordination: impairment of motor coordination and driving.
What are the long-term effects of benzodiazepines?
Long-term effects very between individuals as some people can take large amounts for long periods without any major evidence of intoxication. Others demonstrate symptoms of chronic sedated hypnotic intoxication like impaired thinking, poor memory and judgment, disorientation, in coordination, and slurred speech.
What are the effects of Benzodiazepines in special populations?
Pregnant: benzodiazepines cross the placenta and distribute into the foetus resulting in risk for abnormalities. When breast-feeding, benzodiazepines are exposed to infants with therapeutic or toxic doses which can result in sedation or death.
Older adults: benzodiazepines produce cognitive disfunction and are metabolized more slowly which can lead to oversedation, falls, and injury.
What is the potential for misuse and SUD with benzodiazepines?
Misuse of benzodiazepines for recreation occurs typically with combination of alcohol in order to enhance CNS depression effects.
Misuse potential: weaker reinforcing properties than other drugs with a low inhernt harmfulness.
Tolerance: can develop to summative affects and impairment of coordination, the anxiolytic effect, or euphoric effects. However, the magnitude does not produce clinical concerns. Cross tolerance can occur with other sedative hypnotic drugs.
Withdrawal: mild but distinct withdrawal occurs with anxiety, headache, and insomnia. With chronic use, discontinuation causes agitation, paranoia, seizures, and delirium.
Addiction: may develop in some individuals but not all, depending on factors of genetics and the environment.
Discuss barbiturates.
Barbiturates are sedative hypnotics classified according to the duration of action. They can be long acting, 1 to 2 days, short acting, 3 to 8 hours, and ultra short acting, 20 minutes. They are an older class of drugs that has been replaced by safer and more effective sedative of hypnotics.
Route of administration: administered in different ways depending on what they’re used to treat. For epilepsy they are administered orally, for anesthesia, they are administered intravenously.
Mechanism of action: activation of barbiturate receptor increases the duration of the opening of the chloride channel, demonstrating the full spectrum of those dependent CNS depression.
Therapeutic use: In low doses, barbiturates result in tranquillity and relaxation, while also inducing sleep. Ultra short acting and short acting can be used to induce anaesthesia well long acting agents can be used as antiepileptics.
Lethality: Low therapeutic index and potential for Leith Aliti due to depression of respiration, especially when combined with alcohol. Lethal dose of barbiturates varies between individuals, no antidote exists, and death can occur from withdrawal.
What are the short term effects of barbiturate use?
Barbiturate suppress REM type sleep which is essential to wake up feeling well rested.
Short-term use induces a fax like mild euphoria, reduced interest, dizziness, impairment of motor coordination, intoxication, and a depressed cardiovascular system.
What are the long-term effects of Barbiturate use?
Long-term use of barbiturates is chronic inebriation where memory, judgment, and thinking are all impaired. Individuals also exhibit hostility and mood swings that include depression.
What is the potential for miss use and SUD of barbiturates?
Barbiturates are prescribed Less frequently but illicit use continues to be a problem.
Potential for misuse: Equal to or greater than alcohol due to the significant degree of reinforcement from pleasurable effects. Inherent harmfulness is very high due to risk of death from respiratory depression or withdrawal.
Tolerance: can develop, along with a high degree of cross tolerance between barbiturates and others sedatives.
Withdrawal: occurs after discontinuation of chronic use with tremors, anxiety, weakness, insomnia, and postural hypotension that can produce to seizures, delirium, visual hallucinations, and high body temperature. Barbiturates must be withdrawn slowly under medical supervision.
Addiction Colin can result from regular use, ear respective of the dose. Addiction includes the craving of the drug and a feeling of panic without adequate supply. Craving persists long after use.
What are benzodiazepine-like drugs?
Benzodiazepine like drugs are sedative hypnotics used to treat anxiety or difficulty sleeping. Zopiclone and zolpidem bind to GABA receptors and cause sedation. These drugs act similarly to benzodiazepine but disturb sleep patterns even less.

What is Buspirone?
Buspirone is an xanxiolytic as it does not act on the GABA receptor, but on a serotonin receptor. It is used in generalized anxiety states and has an advantage as it does not appear to have additive effects with other sedated hypnotic drugs. This drug is prescribed instead of benzodiazepine when the individual is already taking another CNS depressant drug.
What is alcohol?
Alcohol is one of the three most used non-medical drugs in Canada that produces more health problems and deaths than all illicit drugs combined. The reason for extensive use is it’s ready availability and the permissive attitudes of society.
What is the ADME of alcohol?
Alcohol is a CNS depressant that works by slowing down brain functioning and neural activity.
1) Absorption: ethanol is absorbed rapidly from the stomach, 20%, and the upper small intestine, 80%, with absorption rate affected by stomach emptying time, ethanol concentration in the G.I. tract, and the presence of food. To reach maximal blood alcohol concentration, the time is 30-90 minutes.
2) Distribution: ethanol distributes throughout total body water and right away Gaines access to the brain. It can also transfer a cross the placenta and distribute throughout a developing fetus.
3) Metabolism: ethanol is converted to acetyl aldehyde by ADH (rate limiting step); MEOS, Part of the cytochrome P450 system Call and contributes to the metabolism of ethanol at full capacity; acetyl aldehyde is converted to acetate by the enzyme ALDH; acetate is metabolized into carbon dioxide and water by tissues. Genetic variance exist, so some individuals rapidly convert alcohol to acetyl aldehyde as a protective agent against alcoholism from unpleasant side effects. Alcohol is metabolized at a constant rate, irrespective of blood alcohol concentration.
4) excretion: over 95% of ethanol is eliminated by bio transformation in the liver. The remaining 5% is excreted in the breath, urine, and sweat.
What are the medical uses of alcohol?
Alcohol sponge to treat fever, skin disinfectant, antidote for methanol poisoning, and hand sanitizer.
What is the mechanism of action of alcohol?
Alcohol affects a large number of membrane proteins by binding to the chloride ion channel and augmenting GABA mediated neuronal inhibition. Interaction of alcohol with chloride ion channels in reward areas explain the reinforcing effects of the drug.
What are the short term effects of alcohol?
Cardiovascular: Low doses create vasodilation, I’ll high doses depress the cardiovascular system altering the normal rhythm of the heart.
Stomach: low doses increase gastric secretion, while high doses irritate the lining of the stomach to cause inflammation and erosion that increases vomiting and abdominal pain or aggravates ulcers.
Liver: low doses have no adverse effects, well high doses inhibit glucose production and lead to hypoglycemia.
What are the adverse effects of binge drinking?
Memory loss, depression, irritability, oversedation, overdose from respiratory depression or coma
What are the long-term effects of alcohol use?
CNS: neurological and mental disorders occur such as alcoholic dementia, with a decrease in cognitive functioning from damaged axons and neurons in the brain.
Cardiovascular: alcoholic cardiomyopathy and increased incidence of hypertension and stroke.
Liver: alcoholic liver disease causes hospitalization and death, but can be reversible at early stages with abstinence.
What happens with alcohol and pregnancy?
Chronic use of high dose ethanol in pregnancy can produce tetragenic effects of the foetus that manifest postnatally as fetal alcohol spectrum disorder (FASD).
Discuss alcohol and drug interactions.
During drug therapy, ethanol leads to additive or synergistic effects of the CNS depression, and the inhibition of metabolism can occur.
Chronically drinking alcohol but abstaining before drug therapy can increase the activity of metabolizing enzymes in the liver, but only occurs without liver injury.
What is the potential for misuse and SUD for alcohol?
Potential for misuse: with significant reinforcing properties, miss use potential is moderate from the ease of availability and social acceptance. Inherent harmfulness is moderate as death can occur from high doses, and chronic ingestion can have long-term effects on health.
Tolerance: tolerance to chronic consumption occurs. Individuals can also develop tolerance to ethanol induced impairment performance if they repeat the task repeatedly under the influence.
Cross tolerance: with sedative hypnotics a higher dose of sedative hypnotic drug is required for the therapeutic affect. For general anesthetic’s, a higher dose of anaesthetic agent is required for surgical anaesthesia for someone with alcohol tolerance.
Withdrawal: produces compensatory excitation of the CNS with delirium tremens, convulsions,coma, and death.
Addiction: compulsive desire to seek, obtain, and drink ethanol exists as a powerful factor in chronic use.
