Mary Jane

Question 1

In the State of Oklahoma, there are no ____ for obtaining a license

Answer 1

Qualifying conditions

Question 2

The terpenoids give marijuana its distinctive odor and the ____ are responsible for most of the pharmacological effects. The biologically active compounds are found in highest amounts in _____

Answer 2

cannabinoids

flowers of the unfertilized female plant

Question 3

The most potent compound that produces the majority of the psychotropic effects is ____.

Another compound that has significant pharmacological effects is ____

The amounts of the various cannabinoids vary depending on ____

Answer 3

Delta9-tetrahydrocannabinoid (THC)

cannabidiol (CBD), however CBD has no psychotropic effects.

the cultivar

Question 4

Three cannabinoids are approved by the FDA

Answer 4

Dronabinol, Cannabidiol, and Nabilone

Question 5

Dronabinol

Answer 5

Marinol - CIII
Syndros - CII

Synthetic THC

FDA approved for anorexia in patient with AIDS and N/V associated with chemo who failed conventional anyiemetics

Question 6

Nabilone

Answer 6

Cesamet
C-II

Synthetic analog of THC

FDA approved for tx of N/V in patients doing chemo

Question 7

Cannabidiol

Answer 7

Epidiolex

extract of C. sativa
Oral is FDA approved for tx of Lennox-Gastaut and Dravet syndrome in patients 2 years and older

Question 8

Nabiximols (Sativex®, THC & CBD) Approved in EU and Canada, not U.S.

1:1 combination of THC and CBD. Approved for ____, spasticity,
cover active bladder caused my multiple sclerosis

Answer 8

Neuropathic pain

Question 9

Routes of Admin

inhalation

Answer 9

Smoking, inhaling

oils may contain up to 75% THC

peak plasma level in 3-10 min, cleared in 3 hours, and avoids 1st pass metabolism

Question 10

Routes of Admin

Topical

Answer 10

very lipophilic

must be formulated with a carrier to penetrate the skin

Question 11

Routes of Admin

Rectal

Answer 11

Avoids 1st pass

more bioavailable than oral

onset - 10 min

Question 12

Routes of Admin

Oral

Answer 12

onset = 30-120 min

duration 5-8 hours

significant 1st pass and bioavailability is low (6%)

Hard to titrate dose of edibles

Question 13

Distribution

Cannabinoids distribute to ______ first followed by _____.

Chronic use of cannabinoids may cause accumulation in ____.

Release from fat can cause ….

Answer 13

vascularized tissues
less vascularized tissues.

adipose tissue.

persistent levels of cannabinoids in the plasma for weeks.

Question 14

Biotransformation

THC and CBD are metabolized by _____ followed by ____.

The metabolites are eliminated in the urine and feces.

THC can …

Answer 14

several cytochrome P450 enzymes (CP3A4, CYP2C9 and CYP2C19)

glucuronidation.

cross the placenta.

Question 15

MOA: Endocannabinoids – endogenous cannabinoids

Endocannabinoids are ____ synthesized in the nerve cell body.

Anandamide: _____

Answer 15

retrograde neurotransmitter

Anandamide: 2-arachidonylglycerol (2-AG)

Question 16

Endocannabinoids are synthesized on demand in the neuron cell body from membrane lipids and then diffuse out of the neuron. The synthesis is activated by _______

The endocannabinoids are _____ neurotransmitters.

The diffuse back across the synapse and bind to receptors on the ____

The actions of the endocannabinoids are terminated by ___

Answer 16

elevated cytosolic Ca++ concentrations.

retrograde

presynaptic nerve terminal

reuptake.

Question 17

Receptors:

CB1 - neuronal receptors - inhibit _____

CB2 receptors – in periphery primarily on ___

Answer 17

presynaptic voltage-gated Ca+2 channels.

immunological cells

CB1 - CNA
CB2 - immune

Question 18

Function:

Function - Activation of CB1 receptors on the presynaptic nerve terminal…

Answer 18

inhibits neurotransmitter release (presynaptic inhibition).

Question 19

Endocannabinoids affect…

Answer 19

motor activity, motivation, perception, cognition, short term memory, learning and pain processing.

Question 20

Delta9-THC binds to____and is considered a _____.

CDB does not bind to ____. Multiple mechanisms of action have been suggested, but none have been proven. It’s mechanism of action is still being studied

Answer 20

CB1 and CB2 receptors partial agonist.

either CB1 or CB2 receptors

Question 21

Psychotropic Effects

THC decreases ___ and produces a ____sensation.

decreased ____ and impaired ___ and __ skills.

The user’s appetite for ____ is enhanced.

Answer 21

Decreases anxiety
mild euphoric sensation.

decreased short-term memory
impaired perception and motor skills.

sweet and fatty food

Question 22

Prolonged use of cannabis and THC can lead to a…

Answer 22

down regulation of the CB1 receptors and produce tolerance to the psychotropic effects.

Question 23

High blood levels of THC can produce …

Answer 23

panic attacks, paranoid thoughts and hallucinations.

Question 24

THC is not a

Answer 24

Hallucinogen

Question 25

Conclusive or substantial evidence for effectiveness of cannabis/cannabinoids a. Treatment of _____ b. ______ c. Improving patient-reported _______

Answer 25

a. chronic pain in adults (cannabis) b. Antiemetics in tx of chemo-induced N/V (oral cannabinoids) c. multiple sclerosis spasticity symptoms (oral cannabinoids)

Question 26

Moderate evidence for effectiveness of cannabis or cannabinoids a. Improving short-term ____ outcomes in individuals with ...

Answer 26

sleep outcomes obstructive sleep apnea syndrome, fibromyalgia, chronic pain, and multiple sclerosis (cannabinoids, primarily nabiximols

Question 27

Risks of Acute and Chronic use of Cannabinoids Substantial evidence: Moderate evidence: Moderate evidence in cessation: Moderate evidence of NO association: No evidence:

Answer 27

Substantial: worse resp sx and more freq bronchitis Moderate: improved airway dynamics w/acute use but not chronic Moderate: cessation of smoking and improved resp sx Moderate: NO evidence of lung cancer and head/neck cancer No evidence: esophageal cancer, prostate cancer, bladder cancer, etc.