Medicinal Cannabis Flashcards
(29 cards)
Where are Cannabinoids produced?
- They are produced in trichomes
- Small, mushroom-like growths, throught to protect the plant from ultraviolet light, predators and dehydration
What are the 3 Types of Cannabis Plants?
What are they used for?
- Sativa
- Most common strain for all uses
- Indica
- Used to make hashish
- Ruderalis
- Used for cross-breeding
What are the diverse uses of cannabis plants?
- Material
- Outer layer of plant can be used to make fabrics
- Medicine and Intoxicants
- Trichomes produce medically useful substances
- Food and Cosmetics
- Hemp seeds - nuts and contain 30% oil and 25% protein
Which part of the plant is psychoactive?
- Δ9-THC is carboxylated and only marginally psychoactive
- With mild heat, THCA decarboxylates to form CO2 and Δ9-THC which is psychoactive
What are the components of the Endocannabinoid System?
- Cannabinoid receptors
- Endocannabinoids
- Enzymes involved in the synthesis and degradation of endocannabinoids
Where are CB1 and CB2 Cannabinoid receptors found?
- CB1: CNS, PNS and peripheral tissues
- CB2: Immune Cells
List 6 Types of Endogenous Cannabinoids found in human body?
- Anandamide
- 2-AG
- Noladin Ether
- NADA
- OAE
- LPI
What are 2 Compounds (Phytocannabinoids) in Medical Cannabis and what are their actions?
- Delta 9-trans tetrahydrocannabinol
- Most abundant psychoactive
- Partial agonist of CB1 and CB2 receptors
- Cannabidiol
- Most abundant non-psychoactive compound
- Low affinity to receptors
If THC < 0.3%?
If THC > 0.3%?
- If THC < 0.3%: HEMP
- If THC > 0.3%: MARIJUANA
Is the Oral Bioavailability of THC higher through oral or smoking?
Higher through smoking
When does THC cause a high?
10mcg/kg through smoking
What are the Delivery Routes of THC that requires it to be active?
- Oral
- Vaporisation
- Oral
- Sublingual
- Rectal
- Transdermal
- Aerosols
What are the 2 Natural Extracts of Cannabis made by GW Pharmaceuticals?
What is their content?
What are their roles?
- Sativex:
- THC and CBD in a 1.08:1.00 ratio
- Approved for spasticity from MS
- Epidiolex
- Highly purified extract of CBD as liquid
- Dravet syndrome in childhood epilepsy
What are the Short Term and Long Term Adverse effects of Cannabis?
What else can it cause?
What does it alter in children?
What is there an increase in?
What is there a risk of in long-term users?
- Short Term:
- Memory loss, impaired motor coordination, altered judgment paranoia and psychosis
- Long Term:
- Symptoms of Chronic Bronchitis and increased risk for chronic psychosis in people with a predisposition to these disorders
- Schizophrenia
- Alter brain development in children
- 2-3 fold increase in automobile accidents
- Risk of cancer in long term users
How many Marijuana users are addicted?
What are withdrawal symptoms?
- Up to 9% are addicted
- Withdrawal symptoms: irritability, sleeplessness, decreased appetite, anxiety and drug craving
Is Marijuana a gateway drug?
What is a gateway drug?
- Use of ‘hard drugs’ is often preceded by marijuana use - yes it is a gateway drug
- A gateway drug is the idea that drug experimentation and use tends to follow a sequential pattern of increasingly potent and/or dangerous substances
What is the problem with Street Cannabis?
- No quality control
- No standardised composition
- No prescribing information
- No high-quality studies of effectiveness or long-term safety
To approve a medicine, what 5 criteria must the FDA fulfill?
- The drug’s chemistry must be known and repoducible
- There must be adequate safety studies
- There must be adequate and well-controlled studies proving efficacy
- The drug must be accepted by well-qualified experts
- Scientific evidence must be widely available
In terms of the Availability and Supply of Medicinal Cannabis
Is it regulated as a medicine in Australia?
Are the rules the same everywhere?
What are the Access Pathways based on?
- Regulated as medicine in Australia
- Different rules in different states (SA is the path of least restriction)
- Access pathways based on the fact that cannabis products are:
- Unapproved/unregistered medicines
- Not been evaluated for safety or efficacy by TGA
- Not first line treatments
What Approvals do you need for Prescribing, Supply and Import?
- Commonwealth and relevant state approvals
- Hospital based approvals (IPU applications, DTC assessments)
Under Commonwealth Restrictions, What process must the treating Specialist Medical Practitioner follow?
- Identify an appropriate medicinal cannabis product considering the:
- Evidence for use
- Dosing regimen
- Formulation
- Obtain TGA approval
- Check with the sponsor that they agree to supply to product before making an application to the TGA and what costs are involved
List the Practitioners approved under the commonwealth’s
- Special Access Scheme - Category B
- Authorised Prescriber Scheme
- Clinical Trials Scheme
These are necessary until medicinal cannabis products are registered medicines in Australia
Practitioners Approved under the Commonwealth’s
What is the Special Access Scheme (SAS)?
- Provide for the importation and/or supply of an unapproved therapeutic good for a single patient, on a case-by-case basis
- Two Kinds:
- Cat A: seriously ill, death likely to occur - can use immediately
- Cat B: all patients who don’t fit Cat A - need to wait for approval before use - 5-7 working days
The TGA has approved SAS applications including:
- Chemotherapy induced nausea and vomiting
- Refractory paediatric epilepsy
- Palliative care indications
- Cancer pain
- Neuropathic pain
- Spasticity from neurological conditions
- Anorexia and wasting associated with chronic illness
