Lecture 55: Stimulants like Cocaine Flashcards
What are the different types of stimulants?
- Cocaine
- Methamphetamine
- Dextroamphetamine
- Methylphenidate
- MDMA
What is sensitization in cocaine?
The longer someone uses cocaine, the stronger the craving gets (although euphoria decreases)
Hypothetical MOA: Glutamate/AMPA receptors
-increase in number of things that remind you of cocaine
What happens to the frontal lobe in cocaine use?
Decrease activity in frontal lobe in chronic cocaine
Means less ability to make responsible choices
-increase gambling impulse
What is drug salience?
The increased frequency of some shit reminding cocaine user of cocaine
What are the key characteristics of cocaine dependence?
- Chronic illness
- Long-term FLEXIBLE treatment needed
- difficult to treat
- most patients do not get clean as outpatients
- less than half are clean 6 months after treatment
What are the different methods of treatment for cocaine dependence?
- Individual drug counseling (most effective)
- former drug users to avoid people, places and things that remind them of drug use
- Group drug counseling
- CBT
- better sustained effects than contingency management
- Supportive/experessive therapy
- Voucher treatment (contingency management)
What is voucher treatment?
Contingency management
Vouchers = immediate reward for abstinence
Outcompetes the immediate reward from cocaine
Are there any effective medications for treatment of cocaine?
No Possible medications = 1. Topiramate (relapse prevention) GABA agonist 2. Disulfiram (relapse prevention) 3. Cocaine vaccine 9relapse prevention) General concepts: use drugs that are analogous to methadone treatment for opioid addiction
What is disulfiram?
Blocks dopamine beta hydroxylase Copper chelater…so any enzyme that uses copper will get fucked INCREASES dopamine DECREASES norepinephrine Blocks plasma esterases Dopamine/cocaine levels raised NE levels reduced Also inhibits acetaldehyde dehydrogenase to incrase acetaldehyde levels and decrease euphoria associated with alcohol
What is the MOA of topiramate?
Glutamate ANTAGONIST -blcoks AMPA/Kainate receptors GABAergic -increases transmission at GABA A receptors -increase brain GABA levels
What is significance of Topiramate?
Generic and is not going to be ever approved with FDA
Decreases heavy drinking
Kranzler thinks topiramate works best…but you have to increase dosage slowly
Patients want to deal with side effects because this shit actually works?
Makes carbonated drinks taste turrible
Also shown by Kampman to decrease cocaine use and in a trial now
What is the MOA for cocaine vaccine (TACD)?
TACD binds to cocaine in blood and PREVENTS that motherfucker from diffusing through the BBB
- produces cocaine specific antibodies
- antibodies adhere to cocaine and prevent them from crossing BBB
- phase 3 trial ongoing
Is there a cocaine withdrawal symptom?
No PHYSICAL symptoms
so at first this was seen as safer than opioids
Mental symptoms include craving and delayed depression
What are the effects of cocaine?
- Euphoria
- Pressured speech
- Racing thoughts
- Grandiosity
- Increased HR and BP
- Decreased appetite
- Anxiety and delusions
What is the most common combination used with cocaine?
Alcohol + cocaine = reduces axiety
Cocaine and heroine = enhances positive effects of both drugs
