lecture 81 Flashcards
svensson -- pharmacology of psychostimulant misuse
what is the definition of a psychostimulant?
agents that activate the CNS resulting in alterness, excitation, and elevated mood
what is the mesolimbic DA system?
the key dopaminergic pathway that transports DA from the VTA to the NAcc and amygdala
what is addiction liability?
likelihood that a person using the drug will become addicted
what is the addiction liability of common substances?
tobacco (nicotine) > heroin > cocaine > alcohol > cannabis
what is sympathomimetic toxidrome?
a constellation of signs and symptoms indicative of ingestions of a psychostimulant
what are the characteristics of cocaine?
psychostimulant first isolated from cocoa leaves in 1857
primarily an inhibitor of DA transporter, preventing reuptake of DA released into the synaptic clef
what are the characteristics of nicotine?
the most addictive substance in current use
activates nicotinic acetylcholinergic receptors
not metabolized by AChe so has longer duration of effects
at least 12 different subunits
membrane penetrable at physiological pH (weak base)
what are the characteristics of ecstasy (MDMA) and meth?
psychostimulants that primarily release endogenous DA by pushing DA out from vesicles (leaving more DA in the synaptic cleft)
also induces revere transport function
what are cathinones?
derivatives of the Khat plant that displays similar activity to meth
commonly known as bath salts
what are the primary clinical effects of psychostimulants?
delirium, tremors
anxiety, paranoia, hallucinations, delusions, repetitive behavior
profuse dental decay
tachycardia, HTN/vasospasm
diaphoresis
what is the effect of chronic psychostimulant use?
down regulation of DA receptors in the CNS dopaminergic system
likely accounts for experiencing withdrawal system after sudden d/c
will return to baseline after a period of abstinence
what are the symptoms associated with low dose psychostimulants?
enhance wakefullness and vigilance
what are the results of increasing doses of psychostimulants?
aggression
euphoria
psychosis
why is sudafed kept behind the counter?
readily converted to meth via reducing hydrogen
phenylephrine cannot do this thus not being regulated
what are the hallmarks of sympathomimetic syndrome?
M - mydriasis
A - agitation, arrhythmia, angina
T - tachycardia
H - HTN, hyperthermia
S - seizures, sweating
where does cocaine act on?
DAT > SERT > NERT
should stimulants be used with the goal of cognitive enhancement?
not well supported by research (ppl stay on task longer, but dont perform any better than control)
off-label use
can progress to stimulant use disorder
how should sympathomimetic toxidrome be treated?
sedation with benzos
avoid BB due to unopposed alpha agonist
