[216B] Drug Use and Abuse Flashcards
The theory behind addictive personalities is that there is a genetic link to decreased activity in the _________ _____ ____ (part of the brain), resulting in decreased _____ ____.
Ventromedial prefrontal cortex.
Impulse control.
T/F: addiction is a disease.
True :0
List 3 drug classes considered “downers”.
- Opioids.
- Sedative hypnotics.
- Benzodiazepines.
List 3 desired effects of downers abuse.
- Altered mood.
- Relaxation (euphoria).
- Uninhibited behaviour.
What are the names of the 3 opioid receptors?
- Mu.
- Kappa.
- Delta.
Opioids provide pain relief by inhibiting:
Substance P.
Which opioid receptor does morphine bind to?
Kappa.
When opioids bind to Kappa receptors, they stimulate ______ release, which is why _____ is a common side effect.
Histamine release.
Itching.
List 8 things we should assess for when treating a pt on opioids.
- Pain relief efficacy.
- CNS (altered LOC, dizziness, seizures).
- Orthostatic hypoTN (d/t peripheral vasodilation).
- Respirations (d/t CNS depression).
- Itching (d/t mast cell stimulation/histamine release).
- Nausea (d/t decreased peristalsis + substance P binding in chemoreceptor trigger zone).
- Constipation (d/t decreased peristalsis).
- Urinary retention (d/t mu receptor antagonism).
We should hold opioids if RR is less than
12
Opioids are pregnancy category __, which means:
D - should not be given to pregnant pts.
Drugs causing ______ [neurotransmitter] release are likely to be addictive because it is responsible for our sense of:
Dopamine.
Pleasure/reward pathway.
T/F: usually, ODs are caused by one drug.
False D: usually mixes of multiple drugs
Why do we see such a high number of fentanyl ODs?
Often laced into other street drugs (cos it’s cheap).
Fentanyl is ___x more potent than morphine.
100
Do we use carfentanyl for therapeutic purposes?
No D:
What is the tx for opioid OD?
Naloxone (Narcan).
T/F: only one dose of naloxone is required to reverse an opioid OD.
False :| naloxone’s half-life is shorter than most opioids, so to be safe, we should give repeated doses or start a continuous IV infusion.
What is the therapeutic use for ketamine?
Conscious sedation (anesthetic).
List 3 effects of ketamine.
- Sedation.
- Amnesia.
- Respiratory depression.
How is ketamine abused?
Date rape drug.
PCP (phencyclidine) was originally developed for:
anesthesia.
Why is PCP not used in clinical settings?
Too lipophilic, potent & addictive.
T/F: PCP can cause an excitation phase and a sedation phase.
True: excitation first, then sedation (dose dependent).
What are the 2 active ingredients in mushrooms?
- Psilocin.
2. Psilocyb.
Mushrooms have ________ effects.
Hallucinogenic.
List 3 categories of substances that would be considered mixed effect.
- Cannabinoids.
- Alcohol (ETOH).
- Nicotine.
List 3 desired effects of mixed-effect substances.
- Altered mood.
- Relaxation.
- Un-inhibition of behaviour.
Which mixed effect substance has a 2% risk of psychosis? What is a long-term consequence of this?
Cannabinoids: may cause mental illness (ex: schizophrenia).
List 2 therapeutic uses for cannabinoids.
- Nausea.
2. Complex pain.
What are 2 notable active ingredients in cannabinoids?
- THC (tetrahydrocannabinol).
2. CBD (cannabidiol).
What receptors do cannabinoids bind to? Where are these found?
CB1 & CB2.
CNS & PNS.
Which 3 neurotransmitters do cannabinoids increase?
- Dopamine.
- Serotonin.
- Anandamide.
Where does anandamide act? What can this result in?
Amygdala.
Memory loss.
CBD ______ the adrenergic NS, resulting in a ______ effect.
Antagonizes.
Calming.
THC acts on the adrenergic NS to make you feel:
Alert, focused, agitated.
What happens when you take both CBD & THC?
They compete at receptors and balance each other out.
What is THC resin? What will it cause (2)?
Superconcentrated THC.
Causes voltatile VS changes (BP, HR) & CNS effects (hallucinations/seizures).
Which 3 neurotransmitters does alcohol increase?
- Ach.
- Serotonin.
- GABA.
List 5 ADME characteristics of alcohol.
- Absorbed via stomach.
- Readily crosses BBB.
- Uses Vit B during metabolism.
- Zero order kinetics.
- Liver toxicity/disease: cirrhosis.
What do we call alcohol withdrawal syndrome?
Delirium tremens.
What is the primary tx for an alcohol OD? What is its MoA?
Metadoxine: increases metabolism (converts it to use first order kinetics).
List 2 adjunct txs for alcohol ODs. Why are they helpful?
- Anxiolytics (ex: benzos): tx anxiety (ex: restlessness, irritability).
- Vitamins (replacement for depletion d/t metabolism).
Nicotine is a (2):
cholinomimetic & adrenergic.
Why is vape juice testing awful?
It’s based on ingestion and not inhalation.
Nicotine affects adolescent brain development, especially the parts responsible for (3):
- Intelligence.
- Language.
- Memory.
List 2 ways we can obtain a toxicology sample.
- Serum (blood draw).
2. Urine.
List 2 drugs classes that would be considered “uppers”.
- CNS stimulants.
2. Psychoactive stimulants (ex: ecstasy).
List 3 desired effects of uppers abuse.
- Altered mood.
- Excitation (euphoria).
- Uninhibited behaviour.
Uppers increase these 3 neurotransmitters:
- NE.
- Serotonin.
- Dopamine.
Uppers will increase these 4 physiological processes:
- BP.
- HR.
- Vasoconstriction.
- Metabolic rate.
CNS stimulants include these 2 drug classes:
- Sympathomimetics.
2. Amphetamines.
List 1 therapeutic use for stimulants.
Tx ADHD (ex: concerta).
List 2 stimulant street drugs.
- Cocaine.
2. Crystal meth.
List 2 ways crystal meth differs from concerta (ADHD tx) and is therefore more dangerous.
- Higher dose.
2. Usually injected (concerta is usually PO) = much higher bioavailability.
Cocaine + alcohol is called _____ and has an increased ______ [PK characteristic].
“Cocaethylene”.
Increased half-life.
List 2 psychoactive stimulant street drugs.
- LSD (acid).
2. Ecstasy (MDMA).
List 4 broad effects of addiction.
- Impaired CNS synapses.
- Malnutrition (electrolyte & vitamin deficiencies).
- Infections (d/t needle sharing/contact with body fluids).
- Socioeconomic decline.
List 8 s&s of impaired CNS synapses.
- Poor memory & IQ decline with use.
- Hallucinations.
- Paranoias.
- Seizures.
- Altered personality.
- Impulsive behaviours.
- Violence.
- Depression.
List some adrenergic-like symptoms associated with withdrawals.
Anxiety, restlessness, tremors, insomnia.
GI distress (nausea, cramping).
Fever, diaphoresis, tachycardia.
Headaches.
List 4 tx for withdrawals.
- CBT/counselling.
- Weaning protocols.
- Milder opioids: buprenorphine, suboxone, methodone (satisfies cravings without the “downing” effect).
- Adjunct tx: antidepressants, anxiolytics.
