11. Tobacco, Vaping, MJ, CBD Flashcards

1
Q

What are the benefits of smoking Juul/vaping, compared to cigarettes?

A
  1. Cigarette smoke has thousands of chemicals and > 70 carcinogens; e-cigs have less chemicals (~80)
  2. Less damage to lungs
  3. Cheaper
  4. Tastes better
  5. Fingers don’t smell like smoke; stains disappear
  6. Whiter teetch
  7. Overall looks improve bc no damage to skin and hair
  8. Sense of smell/taste improves
  9. Social interactions increase bc vaping is not seen as dirty
  10. Dont need to go outside for a smoke break
  11. Helps ppl stop smoking cigs
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2
Q

What are reasons for vaping?

A
  1. Use by a family/friend
  2. Taste
  3. Belief that vaping is safer > tobacco products
  4. Curiosity
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3
Q

Why has vaping/Juuls become a concern?

A
  1. 19% of girls and 23% of boys in middle/HS use tobacco products: common to use both e-cigs and regular cigs; MC in older, non-hispanic white and hispanic
  2. Upward trend of e-cig use in 10th graders in US (68% of e-cig users use flavors):
  3. Students become addicted to nicotine, which can harm developing brain, which contintues to develop until ~ 25 YO.
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4
Q

Why are adolescents more vulnerable to doing drugs and becoming addicted?

A

In adolescents, the prefrontal CTX is still developing. It is responsible for executive function: causing ↑-risk taking, impulsivibity and novelty seeking behavior.

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5
Q

Physiologically, how does nictoine affect the brain?

A
  1. Nicotine (+) nAChR on neurons in VTA => ↑ DA release in pre-frontal CTX.
  2. Impairs neuroplasticity (ability of brain to change T/O persons life) => alters gene expression, cell structure, intracellular signialing, synpatic pruning, removing redundant connections), myelination
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6
Q

How does nicotine affect the prefrontal CTX?

A
  1. Causes long-term cognitive impairment, affecting both accuracy and impulse control.
  2. Adolescent smokers: ↓ prefrontal CTX activity => ↓ memory and ATN
  3. Behavioral disturbances later in life: substance abuse/mental health problems
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7
Q

Is vaping safer than smoking?

A

Perhaps it is safer than burned tobacco products, but vape still has harmful chemicals. Overall impact on health has not been determined: may have compounds not safe to ingest and vitamin E acetate

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8
Q

How does vaping damage the lungs?

A

Vitamin E acetate, a thickening agent used to dilutre THC oil causes acute toxic lung injury, within a few days to weeks => pneumonia patters in lungs => extensive lung damage requiring O2 and days on ventilatory and permenent damage in some.

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9
Q

What is DWW theory in the vaping health crisis?

A

Aerolizing oil lets them penetrate deep in the lungs, coating the surfaces and creating a thin layer of oil that soaks up toxins and particles from air we breathe in, based on oil-water partition coefficient => deposit of toxins that cause damage.

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10
Q

What are other theories of the sudden vaping crisis?

A
    1. Bad ingrediants (Vit E acetate)
    1. Contaminents in products
    1. Past cases were not detected as being due to vaping
    1. Home-made vape
    1. Chinese tarriffs made poor quality materials
    1. Slow regulations: FDA pushed back scheduled review until 2022
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11
Q

How have we moved to banning e-cigs?

A
    1. Fruit and mind flavored cartridges must be DQ, except for tank vaping systems.
    1. Tobacco purchase was raised from 18 => 22.
      *
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12
Q

What chemicals does medical marijuana have?

A

> 100 chemicals called cannabinoids. Main two are:

    1. THC (delta-9-tettrahydrocannabinol) => makes you “high”
    1. CBD (cannabidiol)
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13
Q

How is medical marijuana regulated?

A
  • Schedule 1 drug, making research with drug difficult because of need for permits. But;
  • Legal for medicinal purposes in 33 states/DC: need a written recommendation from a doctor, a qualifying condition + a medical card.
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14
Q

MOA of Marijuana?

What enzymes break down endocannabinoids?

A
  1. Post-synaptic neuron makes endocannabinoids by stimulai that cause ↑ in intracellular Ca2+ => (+) DAG-lipase => make anandamide (partial AGO) and 2-arachidonylglycerol (2-AG; full AGO)
  2. Go into synaptic space => bind to CB1-R on presynaptic neuron
  3. (-) AC
  4. Hyperpolarize presynaptic neuron due to less Ca2+ influx and K+ moves out
  5. Less NT release
  6. To stop endocannabinoids:
    1. FAAH (fatty acid amide hydrolase) in post-synaptic cell hydrolyzes anandamide
    2. MAG-lipase, in presynaptic cells, breaks down 2-AG.
  7. **CB2-R are found on immune cells and cause cytokine reelase. However, endocannibinoids have higher affinity for CB1R.
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15
Q

What effects are mediated by the CB1-R?

A
  • 1. Analgesia
  • 2. ↑ Appetite
  • 3. Relaxes muscles
  • 4. Hormonal action
  • 5. Psychoogical effects:
    • ​Affective: euphoria and laughter
    • Sensory: increased perception of external stimuli, own body
    • Somatic: feeling of floating/sinking in bed
    • Cognitive: altered perceptions in time/memory lapses
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16
Q

What is a synthetic THC approved by the FDA?

  • What receptor does it bind to?
  • Use?
  • Off-label use?
A
  • Dronabinol: orally-administered synthetic THC, that binds to has equal affinity for CB1R = CB2R, but high efficacy at CB1-R
    • Use: anorexia in AIDS patients, chemotherapy-induced N/V
      • Off label: moderate - severe obstructive sleep apnea
17
Q

What drug is approved ONLY for chemotherapy induced N/V?

A

Nabilone, a capsule.

18
Q

Why is cannabis better than synethesized cannabinoids, like Dronabinol or Nabilone?

A
  1. Less expensive
  2. Overall effect is different: “entourage effect”
19
Q

AE of Medical MJ

A
  • Most AE are minor
    • Affects judgement and coordination
    • Sedation, bloodshot eyes, depression, dizzy, tachycardia, hypOtension, hallucinations and dry mouth
  • Affects intelligence and mental fx in younger people, whose brains are still developing.
  • Addictive and “gateway drug”/
20
Q

What conditions is cannibis effective for?

A
  1. Chronic pain: esp neuropathic pain, RA, fibromyalgia, cancer pain
  2. N/V (Ondansetron = more effective)
  3. ↑ appetite in cancer or HIV/anorexic patients (Megestrol = more effective)
  4. Multiple sclerosis (spastiticty and pain and bladder fx)
  5. Anxiety and PTSD
  6. Sleep quality
21
Q

Cannabinis is effective for N/V and increasing appetitie in cancer/AIDS pts. However, what drugs work better?

A

N/V = Ondansetron

Increasing appetitite = Megastrol

22
Q

Does cannabinis work for Tourettes, Parkinsons or Alzheimers?

A
  1. Tourettes = limited benefit
  2. Parkinsons and Alzheimers = unclear
23
Q

Can cannabis be taken with opioids?

A

Yes, allowing us to give lower doses of opioids.

24
Q

What conditions does cannabis LACK efficacy?

A
    1. Acute pain
    1. Tremors in MS
    1. Huntingtons/ schizo/ depression
    1. Glaucoma
    1. Slowing growth of cancer cells
25
Q

CI of Cannabis

A
  1. Hx of psychosis
  2. Current/past substance abuse disorder
  3. CV/ respiratory disease
26
Q

Caution of using Cannabis (start LOW and go SLOW)

A
  1. < 25 YO
  2. Active mood disorder
  3. RF for CV disease
  4. Pt using high doses of alcohol /benzos
27
Q

What are the qualifying conditions for a Missouri Medical MJ card?

A
  1. Cancer
  2. Epilepsy
  3. Glaucoma
  4. Intractable migraines
  5. Chronic conditions that cause pain/muscle spasms: MS, Parkinsons, Tourettes
  6. Psych disorders: PTSD
  7. HIV/AIDS
28
Q

Getting a medical MJ card allows you to home-grow how much weed and under what conditions?

A
  • < flower plants; < in a vegetative state; < seedlings
29
Q

Why has FAAH (fatty acid amide hydrolase) of interest to pharmacetical manufactors?

A
  • FAAH inhibitors/inactivators have been developed because of their ability to ↑ the concentration of endocannabinoids.
  • Scottish W with a FAAH mutation: experiences little anxiety/fear, does not feel pain and heals quickly.
  • Many inhibitors made, no successful clinical trials: BIA 10-2474 caused severe AE in 5th pt and death of 6th.
30
Q

Legally, where does CBD (cannabidoil) stand?

A
  • Illegal to sell a s food, dietary supplement or animal feed
  • Hemp CBD was delisted as a scheduled substance and can be sold as a cosmetic ingredient.
    • ​FDA regulations still apply.
31
Q

What enantiomer of CBD is used?

A

(-) CBD enantiomer

32
Q

How is CBD administered?

Metabolism?

A
  • Generally, orally as a capsule or dissolved in sesame/olive oil: it has poor aqueous ability, making absorption in GI tract erractic. Because a significant 1st-pass metabolism => 6% oral bioavailability.
  • If inhaled, sublingual, intranasal: higher BA and peak concentration in blood in 5-10 min.
33
Q

How is CBD similar to THC?

A
  1. Rapidly distrubutes
  2. High volume of distribution
  3. Accumulates in fat tissue due to high lipophilicity.
34
Q

How is CBD different from THC?

A

The effects of CBD are very different from THC, often opposing.

  1. Inverse AGO and negative allosteric modulator of CB1/2 -R
  2. TRPV1, PPARy and 5HT-1A AGO
35
Q

CBD is metabolized in the _____ by ______ and _______

A

Liver by 7 CYPS, mainly CYP3A4 and 2C19.

36
Q

AE of CBD

A
  1. Well-tolerated:
    1. no psychoactive effects
    2. no potential for abuse: no reports of tolerance/withdrawal,
37
Q

CBD effects on

  • embryonic development
  • immune system
  • drug interaction?
A
  1. No effect on: embryonic development, wide range of physiological/biochemical parameters (unless at high doses),
  2. Unclear effects on immune system (high concentration = immune suppression but low doses = stimulate immune system)
  3. Potential for drug interactions, when CYP450 is inhibited
38
Q

What is the FDA-approved CBD and what recommendations are made?

A
  • Epidiolex, oral CBD that is a Schedule 5 drug approved for tx of r_are childhood epilepsy_ in ppl > 2YO
    • Use:
      1. Lennox-Gastuat syndrome (tonic seizure that occur in non-REM sleep)
      2. Dravet syndrome (myoclonic szrs triggered by warm baths)
    • Rec: look for liver toxicity and suidical ideation
39
Q

Other therapeutic uses of CBD

A
  1. Alzheimers (anti-inflamm actions)
  2. N/V
  3. Fragile X syndrome
  4. Skin diseases (NL unwanted skin growth, reduce excesive oils, reduce inflamm and infection)
  5. CBD tampons for menstrual pain