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NMSK Exam 1 > 12. Drugs of Abuse > Flashcards

12. Drugs of Abuse Flashcards

1
Q

What is abstinence syndrome?

A

Signs and symptoms that occur when a person dependent on a drug is withdrawing.

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2
Q

What is addiction?

A

Previously called psychological dependence; Compulsive drug-using behavior in which a person uses the drug for personal satisfaction, even though they know the health risks.

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3
Q

What is a controlled substance?

A

A drug that can be abused that is listed on the governmental “Schedules of Controlled Substances”.

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4
Q

What is dependence?

A

Previously called physical/physiologic dependence: a state of sign and symptoms that occur when a chronic drug user stops taking drug or when the dose is abruptly lowered.

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5
Q

What is a designer drug?

A

Synthetic derivative of a drug, with a slighltly modified structure, but no major change in pharmacodynamic action. These drugs circumvent Schedules of Controlled Drugs.

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6
Q

What is the difference between tolerance and sensitization?

A
  • Tolerance = ↓ response to a drug, necessitating larger doses to acheive the same effect. This can occur due to: ↑ disposition of the drug (metabolic toleranance), an ability to compensate for the effects of a drug (behavioral tolerance) or changes in the receptor/effector system (functional tolerance)
  • Sensitization = ↑ in response with as you keep giving the same dose of drug.
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7
Q

How does the dose-response curve shift for tolerance vs. sensitization?

A
  • Sensitization = shift in DR-curve to the left.
  • Tolerance = shift in DR- curve to the right.
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8
Q

What is withdrawal?

A
  • Adaptive changes that become fully apparent when drug exposure is stops: the CNS is trying to become re-adapated to the absence of the drug.
  • EVIDENCE of physical dependence.
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9
Q

Duration of symptoms of:

  1. Alcohol
  2. Tobacco
  3. MJ
A
  1. Alcohol = 1 hr/serving
  2. Tobacco = 20 minutes
  3. MJ = 2 - 4 hours
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10
Q

Duration of symptoms of:

  1. Inhalants
  2. Stimulants
  3. Depressants
A
  1. Inhalants: 5 minutes => 8 hours
  2. Stimulants: 5 minutes => 12 hours
  3. Depressants: 1 hour => 16 hours
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11
Q

Duration of symptoms of:

  1. Hallucinogens
  2. Narcotics
  3. PCP
A
  1. Hallucinogens: 5 minutes => 12 hours
  2. Narcotics: 4 hours => 24 hours
  3. PCP: 4 hours => 6 hours
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12
Q

What drug is the person using:

[Odor on breath; slurred speech and lack of coordination]

A

Alcohol

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13
Q

What drug is the person using:

[Odor on breath or clothes/ stained fingers or teeth]

A

Tobacco

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14
Q

What drug is the person using:

[Red eyes, odor on breath/clothes, eyelid/muscle tremors, ↑ appetite]

A

Marijuana

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15
Q

What drug is the person using:

[Jittery, talkative, runny nose or dry mouth]

A

Stimulants

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16
Q

What drug is the person using:

[Disoriented, drowsy, speech is uncoordinated slow and slurred]

A

Depressants

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17
Q

What drug is the person using:

[eurphoria, sleepy, droopy eyelids, soft/low voice]

A

Narcotics

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18
Q

What drug is the person using:

[Confused, aggressive, sweaty and repetitive]

A

PCP

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19
Q

What drug is the person using:

[Spacey hallucinations, paranoia, memory loss and uncoordinated]?

A

Hallucinogens

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20
Q

What depressants, stimulants**, **painkillers are commonly abused?

A
  1. Depressants
    1. Alprazolam
    2. Zolpidem
    3. Zalepion
  2. Stimulants
    1. Adderal
    2. Methylphenidate
  3. Painkillers
    1. Fentanyl
    2. Hydrocodone
    3. Oxycodone
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21
Q

Signs of amphetamines, methylphenidate, and cocaine OD?

A

Agitation + HTN/Tachycardia + Delusions + Hallucinations + Hyperthermia

22
Q

Sx of amphetamines, methylphenidate, and cocaine withdrawal?

A

Apathy, irritability, increased sleep, disorientation, depressed and CRASH

23
Q

Signs of barbituate, benzo, and ethanol OD?

A

Druken behavior, dilated pupils, shallow respiration, coma and death

24
Q

Signs of barbituate, benzo, and ethanol withdrawal?

A

Anxiety, insomnia, delirium, tremors, seizures and death

25
Q

Signs of heroin and other strong opioids OD?

A

Constricted pupils, drowsiness, respiratory depression and coma

26
Q

Opioid-R ANT used to treat [dependence and addiction]

A
  1. Naloxone (Narcan)
  2. Naltrexone
27
Q

Synthetic opioid used to treat [dependence and addiction]

A
  1. Methadone
28
Q

mu-opioid- R partial AGO used to treat [dependence and addiction]

A

Buprenorphine

29
Q

Nicotinic-R Partial AGO used to treat [dependence and addiction]

A

Varenicline (Chantix)

30
Q

Benzos used to treat [dependence and addiction]

A
  1. Oxazepam
  2. Lorazepam
31
Q

NMDA-R ANT used to treat [dependence and addiction]

A

Acamprosate = alcoholism medication that ↓ desire to drink

32
Q

Other drugs used to treat dependence and addiction

A
  1. Dronabinol/ Nabilone
  2. Ketamine
  3. Bupropion
  4. Nicotene (Nicorette, Nicoderm CQ)
33
Q

What drugs are abused, but NOT addictive?

A
  1. LSD (lysergic acid diethylamine)
  2. Mescaline (Peyote)
  3. Psilocybin
  4. Phencyclidine (PCP, angel dust)
  5. Ketamine (special K)
34
Q

Although not addictive, what long-term effects and PCP and LSD have?

A
  1. PCP = irreversible schizophrenia-like psychosis
  2. LSD = flashback of altered perception years after taking
35
Q

Caffeine Uses

A
  1. Improves mental alterness
  2. By mouth/rectally, with painkillers + ergotamine to treat migraine HA.
  3. Treat HA after epidural anesthesia
  4. By mouth: asthma, ADHD, memory
  5. WL, T2DM
  6. Very high doses are used with ephedrine => alternative to illegal stimulants.
36
Q

What is considered a “drink”?

A

1 drink = 0.6 oz (14 grams or 1.2 tablespoon) of pure alcohol.

  1. 12 oz beer (5% alcohol content)
  2. 8 oz of malt liquor (7%)
  3. 5 oz of wine (12%)
  4. 1.5 oz of 80-proof (40%)
37
Q

What is “excessive drinking”?

A
  1. Binge drinking = M (5 or more drinks in 1 occasion); W (4 or more drinks in 1 occasion)
  2. Heavy drinking = M (15 or more/week); W (8 or more/week)
  3. Drinking under 21
  4. PG and drinking
38
Q

Are heavy drinkers alcoholic or alocholic dependent?

A

no

39
Q

Describe the biochemical steps in the metabolism of alcohol?

A

Alcohol/ethanol => [alcohol DH] => acetaldehyde => [acetaldehyde DH] => acetic acid => [O2] => CO2 + water and energy

40
Q

Alcohol is metabolized via what type of kinetics?

  • Rate-limiting factor?
  • How is the t1/2 affected by dose?
A
  • Zero-order kinetics; (rate is constant and independent of concentration or amount); undergoes extensive 1st pass metabolism by stomach and liver alcohol DH (ADH)
    • Rate-limiting factor: biological system
    • t1/2: ↑ with dose (not a true t1/2)
41
Q

The typical 70kg adult can metabolize how much alcohol/hour?

A

7 - 10 g of alcohol/hr = 1 drink

42
Q

What is responsible for biotransformation of ethanol and methanol?

A
  1. Alcohol DH
  2. Aldehyde DH
  3. MFOs (CYP450)
43
Q

What should be done if a patient comes in with acute alcohol intoxication?

A
  1. Watch for respiratory depression and aspiration of vomit
  2. Give glucose to tx hypoglycemia/ketosis
  3. Give thiamine to protect against Wernicke-Korsakoff syndrome.
44
Q

What should be done if a patient comes in with acute withdrawal syndrome?

A
  • Can be life-threatening: major goal is to prevent seizures, delirium, arrhythmias
  • Tx = benzos
45
Q

What should be done if a patient comes in with alcohol dependence?

A
  • Primary tx = Psychosocial therapy
  • Depression or anxiety disorders co-exist and treating these can decrease relapse.
46
Q

Drugs used to tx [acute alcohol withdrawal syndrome]

A
  1. Diazepam (Valium)
  2. Lorazepam (Ativan)
  3. Oxazepam
  4. Thiamine (vit B1)
47
Q

Drugs used to [prevent alcohol abuse]

A
  1. Acamprosate
  2. Disulfiram (Antabuse)
  3. Naltrexone
48
Q

Drugs used to tx [acute methanol/ethylene glycol poisoning]

A
  1. Ethanol = 1st line
  2. Fomepizole
49
Q

Naltrexone

  • Use
  • MOA
A
  1. Tx = Alcohol and opiate dependence
    1. ​Reduces alcohol craving and rate of relapse to drinking or alcohol dependence for short-term (12-weeks)
    2. If dependent on alcohol AND opioids => must be opioid free before starting because it can cause acute withdrawal syndrome
  2. MOA: Long-acting u-opioid-r ANT
50
Q

Acamprosate

  • Use
  • MOA
A
  • MOA = weak NMDA receptor ANT and GABA AGO (also affects, 5HT, noradrenergic and DA system
  • Reduces short term and long-term relapse rate (more than 6 months)
51
Q

Disulfiram

  • MOA
  • Use
  • Warnings
A
  • MOA = irreversibly inhibits aldehyde DH
  • Use = prevent alcohol abuse by causing extreme discomfort in pts who drink alcohol
  • Warnings =
  1. do not give with any drugs that have alcohol (cough syrups, cold meds and mouthwashes)
  2. Pts must be HIGHLY motivated.

NMSK Exam 1 (22 decks)

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