12. Drugs of Abuse Flashcards
What is abstinence syndrome?
Signs and symptoms that occur when a person dependent on a drug is withdrawing.
What is addiction?
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.
What is a controlled substance?
A drug that can be abused that is listed on the governmental “Schedules of Controlled Substances”.
What is dependence?
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.
What is a designer drug?
Synthetic derivative of a drug, with a slighltly modified structure, but no major change in pharmacodynamic action. These drugs circumvent Schedules of Controlled Drugs.
What is the difference between tolerance and sensitization?
- 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.
How does the dose-response curve shift for tolerance vs. sensitization?
- Sensitization = shift in DR-curve to the left.
- Tolerance = shift in DR- curve to the right.
What is withdrawal?
- 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.
Duration of symptoms of:
- Alcohol
- Tobacco
- MJ
- Alcohol = 1 hr/serving
- Tobacco = 20 minutes
- MJ = 2 - 4 hours
Duration of symptoms of:
- Inhalants
- Stimulants
- Depressants
- Inhalants: 5 minutes => 8 hours
- Stimulants: 5 minutes => 12 hours
- Depressants: 1 hour => 16 hours
Duration of symptoms of:
- Hallucinogens
- Narcotics
- PCP
- Hallucinogens: 5 minutes => 12 hours
- Narcotics: 4 hours => 24 hours
- PCP: 4 hours => 6 hours
What drug is the person using:
[Odor on breath; slurred speech and lack of coordination]
Alcohol
What drug is the person using:
[Odor on breath or clothes/ stained fingers or teeth]
Tobacco
What drug is the person using:
[Red eyes, odor on breath/clothes, eyelid/muscle tremors, ↑ appetite]
Marijuana
What drug is the person using:
[Jittery, talkative, runny nose or dry mouth]
Stimulants
What drug is the person using:
[Disoriented, drowsy, speech is uncoordinated slow and slurred]
Depressants
What drug is the person using:
[eurphoria, sleepy, droopy eyelids, soft/low voice]
Narcotics
What drug is the person using:
[Confused, aggressive, sweaty and repetitive]
PCP
What drug is the person using:
[Spacey hallucinations, paranoia, memory loss and uncoordinated]?
Hallucinogens
What depressants, stimulants**, **painkillers are commonly abused?
-
Depressants
- Alprazolam
- Zolpidem
- Zalepion
-
Stimulants
- Adderal
- Methylphenidate
-
Painkillers
- Fentanyl
- Hydrocodone
- Oxycodone
Signs of amphetamines, methylphenidate, and cocaine OD?
Agitation + HTN/Tachycardia + Delusions + Hallucinations + Hyperthermia
Sx of amphetamines, methylphenidate, and cocaine withdrawal?
Apathy, irritability, increased sleep, disorientation, depressed and CRASH
Signs of barbituate, benzo, and ethanol OD?
Druken behavior, dilated pupils, shallow respiration, coma and death
Signs of barbituate, benzo, and ethanol withdrawal?
Anxiety, insomnia, delirium, tremors, seizures and death
Signs of heroin and other strong opioids OD?
Constricted pupils, drowsiness, respiratory depression and coma
Opioid-R ANT used to treat [dependence and addiction]
- Naloxone (Narcan)
- Naltrexone
Synthetic opioid used to treat [dependence and addiction]
- Methadone
mu-opioid- R partial AGO used to treat [dependence and addiction]
Buprenorphine
Nicotinic-R Partial AGO used to treat [dependence and addiction]
Varenicline (Chantix)
Benzos used to treat [dependence and addiction]
- Oxazepam
- Lorazepam
NMDA-R ANT used to treat [dependence and addiction]
Acamprosate = alcoholism medication that ↓ desire to drink
Other drugs used to treat dependence and addiction
- Dronabinol/ Nabilone
- Ketamine
- Bupropion
- Nicotene (Nicorette, Nicoderm CQ)
What drugs are abused, but NOT addictive?
- LSD (lysergic acid diethylamine)
- Mescaline (Peyote)
- Psilocybin
- Phencyclidine (PCP, angel dust)
- Ketamine (special K)
Although not addictive, what long-term effects and PCP and LSD have?
- PCP = irreversible schizophrenia-like psychosis
- LSD = flashback of altered perception years after taking
Caffeine Uses
- Improves mental alterness
- By mouth/rectally, with painkillers + ergotamine to treat migraine HA.
- Treat HA after epidural anesthesia
- By mouth: asthma, ADHD, memory
- WL, T2DM
- Very high doses are used with ephedrine => alternative to illegal stimulants.
What is considered a “drink”?
1 drink = 0.6 oz (14 grams or 1.2 tablespoon) of pure alcohol.
- 12 oz beer (5% alcohol content)
- 8 oz of malt liquor (7%)
- 5 oz of wine (12%)
- 1.5 oz of 80-proof (40%)
What is “excessive drinking”?
- Binge drinking = M (5 or more drinks in 1 occasion); W (4 or more drinks in 1 occasion)
- Heavy drinking = M (15 or more/week); W (8 or more/week)
- Drinking under 21
- PG and drinking
Are heavy drinkers alcoholic or alocholic dependent?
no
Describe the biochemical steps in the metabolism of alcohol?
Alcohol/ethanol => [alcohol DH] => acetaldehyde => [acetaldehyde DH] => acetic acid => [O2] => CO2 + water and energy
Alcohol is metabolized via what type of kinetics?
- Rate-limiting factor?
- How is the t1/2 affected by dose?
-
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)
The typical 70kg adult can metabolize how much alcohol/hour?
7 - 10 g of alcohol/hr = 1 drink
What is responsible for biotransformation of ethanol and methanol?
- Alcohol DH
- Aldehyde DH
- MFOs (CYP450)
What should be done if a patient comes in with acute alcohol intoxication?
- Watch for respiratory depression and aspiration of vomit
- Give glucose to tx hypoglycemia/ketosis
- Give thiamine to protect against Wernicke-Korsakoff syndrome.
What should be done if a patient comes in with acute withdrawal syndrome?
- Can be life-threatening: major goal is to prevent seizures, delirium, arrhythmias
- Tx = benzos
What should be done if a patient comes in with alcohol dependence?
- Primary tx = Psychosocial therapy
- Depression or anxiety disorders co-exist and treating these can decrease relapse.
Drugs used to tx [acute alcohol withdrawal syndrome]
- Diazepam (Valium)
- Lorazepam (Ativan)
- Oxazepam
- Thiamine (vit B1)
Drugs used to [prevent alcohol abuse]
- Acamprosate
- Disulfiram (Antabuse)
- Naltrexone
Drugs used to tx [acute methanol/ethylene glycol poisoning]
- Ethanol = 1st line
- Fomepizole
Naltrexone
- Use
- MOA
-
Tx = Alcohol and opiate dependence
- Reduces alcohol craving and rate of relapse to drinking or alcohol dependence for short-term (12-weeks)
- If dependent on alcohol AND opioids => must be opioid free before starting because it can cause acute withdrawal syndrome
- MOA: Long-acting u-opioid-r ANT
Acamprosate
- Use
- MOA
- 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)
Disulfiram
- MOA
- Use
- Warnings
- MOA = irreversibly inhibits aldehyde DH
- Use = prevent alcohol abuse by causing extreme discomfort in pts who drink alcohol
- Warnings =
- do not give with any drugs that have alcohol (cough syrups, cold meds and mouthwashes)
- Pts must be HIGHLY motivated.
