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B&B Week 8 Flashcards > Lecture 54: Prescription Drug Abuse > Flashcards

Lecture 54: Prescription Drug Abuse Flashcards

1
Q

What is the most commonly abused sedative?

A

Benzodiazepines

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2
Q

What are benzodiazepines?

A

Enhance GABA at GABA receptor to induce sedation, anti-anxiety, anti convulsant
Example: Xanax

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3
Q

What are types of benzodiazepines?

A 
High potency:
i. short half life
	Alprazolam (Xanax)
	Lorazepam (Ativan)
	Triazolam (Halcion)
ii. Long half-life
	Clonazepam (Klonopin)
Low potency
i. Short half-life
	oxazepam (serax)
	temazepam (Restoril
ii. Long half-life
	Librium
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4
Q

What benzos are most addictive?

A

High potency, short half life

Example: Xanax (alprazolam)

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5
Q

What is valium?

A

A low potency, long acting benzodiazepine

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6
Q

What is the MOA of benzodiazepines?

A

Binds to GABA-A receptor and increases overall conductance of inhibitory channels
-BZ POTENTIATE effects of GABA and do NOT activate receptors by themselves
DISINHIBITS dopamine by inhibiting interneuron in ventral tegmental area
-interneuron controls dopaminergic VTA projection, so inhibiting this guy by benzos leads to disinhibition and euphoria feeling
-nicotine and alcohol act at same channels

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7
Q

What else binds GABA-A receptors besides benzos?

A

Alcohol

Barbiturates

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8
Q

What are the three substances that bind to GABA-A receptors? Significance?

A
  1. Benzos
  2. Barbiturates
  3. Alcohol
    The three accounts for the cross tolerance of the sedatives
    -allows one to use benzos for alcohol withdrawal treatment
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9
Q

What happens over time when benzos are continually bound to GABA-A? Significance?

A

Compensatory changes in GABA-A receptor in presence of benzos renders them less efficient resulting in tolerance or less effect with the same dose
This compensatory change leads to withdrawal symptoms…when off benzos, GABA-A receptor does not function as well leading to agitation, etc.

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10
Q

What does BZ withdrawal look like?

A 
Due to the fact that  it is harder to activate GABA receptor so you get more monoamine release and you get
1. Anxiety
2. Agitation
3. Increased sensitivity to lights, sound
4. paresthesias, strange sensations
5. Muscle cramps
6. Myoclonic jerks
7. Insomnia
8. Dizziness
9. Seizures, delirium
Similar to alcohol withdrawal but the TIME OF ONSET is different
Short half-life drugs = 2-3 days
Long half life drugs = 4-7 days
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11
Q

How long do you have to take benzos to see withdrawal results?

A

4 months

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12
Q

In what patients are benzos most indicated for?

A

Non drug abusing patients
Extremely useful but can lead to DEPENDENCE and WITHDRAWAL
-also has street value

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13
Q

When are benzos abused?

A

Abused by opiate patients who take benzos to AUGMENT euphoria or treat withdrawal

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14
Q

What are BZ used for?

A
  1. Treat anxiety
  2. Promote sleep
  3. alleviate alcohol withdrawal
  4. Treat seizures
  5. Perioperative amnesia
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15
Q

What are the downsides of prescribing benzodiazepine?

A

After four months, BZ leads to dependence
Easily sold…have street value
So DON’T PRESCRIBE shit load of benzos

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16
Q

What BZ has the least street value?

A

Oxazepam

17
Q

What are examples of stimulants?

A
  1. Amphetamines
  2. Diet pills
    Example: Phentermine
  3. Methylphenidate
    -used in California
18
Q

What are sources of narcotics?

A

HOARDERS…parents who hoard pain meds and kids who take them
Genuine pain patients that sell their medications
Deceived and dishonest physicians
Internet
The world is AWASH in opiates

19
Q

What is the ideal medication?

A
  1. stops withdrawal
  2. reduces craving
  3. blocks the high from abuse
    Example: Methadone
    Naltrexone
    Buprenorphine
20
Q

How do you treat opiate withdrawal and opiate abuse?

A
  1. methadone
  2. naltrexone
  3. Buprenorphine
    Ideal medications
21
Q

What is Percocet?

A

Contains a combination of Acetaminophen and oxycodone

So it is opioid pain reliever

22
Q

What is the suburban slide?

A

Start with Percocet and oxycondone
Progresses heroin use
-snorting
-IV

23
Q

How many 12th graders use pain relievers?

A

10% !!!!!!

24
Q

What is pseudo-addiction?

A 
Focus on obtaining opioids for pain relief
Looks like addiction
	-manipulation
	-doctor shopping
	-multiple ED visits
But it disappears with adequate meds
25
Q

What do you need to do with methadone to prevent high associated with opiates?

A

Give patient enough methadone so that you have TOLERANCE and there is less euphoria

26
Q

How do we deter opiate addiction?

A
  1. combining opioids with naloxone
  2. Physical barriers
  3. decrease ease with which drug can be taken
  4. educate the public
  5. make opioids less abusable

B&B Week 8 Flashcards (12 decks)

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