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401 - Toxicology, Drug Abuse, Pharmacology > 31: CNS Stimulants > Flashcards

31: CNS Stimulants Flashcards

1
Q

rank the top 3 forms of stimulants people prefer

A

meth > crack > cocaine

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2
Q

list 3 reasons for stimulant use

A

There is no single drug user experience
Increased energy, wakefulness
Euphoria, pleasure
Focus and attention, productivity
Performance enhancement
Confidence
Sexual desire and longevity
Acceptance, stigma suppression, decreased inhibition
Weight management, appetite suppression

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3
Q

list 4 types of stimulants

A

cocaine, meth, caffeine, prescription stimulants

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4
Q

CV risks of stimulants include

A

elevated HR/ BP, chest pain, heart attack, risk of stroke

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5
Q

CNS risk of stimulants include

A

anxiety, hallucinations, paranoia

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6
Q

overall bodily risks of stimulants include

A

elevated body temp, weight loss, sleep deprivation, STBBI, wounds, bacterial infections (risk based on injection route, parasitosis and compulsive scratching/ picking)

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7
Q

cocaine is typically cut with

A

usually cut with cornstarch, talc, anaesthetic (popular b/c same effect), dextrose, etc

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8
Q

what is free base cocaine

A

HCL group removed = rock form that can be smoked

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9
Q

crack cocaine was developed as

A

an alternative to free base cocaine due to dangerous manufacturing technique of free base

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10
Q

cocaine powder routes

A

snorting, PO, INJ

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11
Q

describe the onset and duration of free base vs powder cocaine

A

free base = Faster onset, more intense high, shorter lasting (5-10min)
powder = Slower onset, longer lasting (20-60min)

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12
Q

what is the MOA of cocaine

A

blocks NE, DA, 5HT reuptake

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13
Q

half life of cocaine

A

50 min

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14
Q

cocaine itnx enzymes

A

CYP2D6 (strong), substrate of 3A4 (major)

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15
Q

reinforcing effects of cocaine include

A

alertness, energy, decreased need for sleep, appetite suppression, intense feeling of euphoria

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16
Q

2 therapeutic uses of cocaine

A

topical anaesthetic, nose bleeds (vasoconstriction)

17
Q

sx of acute cocaine intoxication

A

Alertness, restlessness
Euphoria
Insomnia
Irritability, aggression
Anxiety, paranoia, hypervigilance
Increased BP, HR, RR
Sweating, chills
N/V

18
Q

sx of chronic cocaine use

A

Nasal sx (congestion, nose bleeds, deviated septum)
Stroke
Reduced blood flow to brain
Memory impairment, reduced attention
Depression, mood swings
Hallucinations, delusions
Arrhythmias, MI
Impotence
Urinary retention
Anorexia
Suppressed immunity (highly dependent on dose + frequency used)

19
Q

describe the cocaine withdrawal process

A

Day 1-4 (crash): fatigue, nightmares, increased sleep, depression, increased appetite
Weeks 2-12: low drive, boredom, decreased interest in activities, cravings

20
Q

meth is often made in ____________ using __________________

A

Often made in home and mobile labs using ephedrine or pseudoephedrine and solvents

21
Q

meth MOA

A

blocks reuptake and enhances release of DA, NE, 5HT in synapses

22
Q

meth half life

A

12hrs

23
Q

meth reinforcing effects include

A

alertness, ambition, energy, ↓ need for sleep, weight loss/ appetite suppression

24
Q

meth acute intoxication sx

A

Alertness, euphoria, confusion, irritability, aggression, anxiety, paranoia, ↑ BP/HR/RR, tremors, ↓ food/ fluid intake, urinary retention

25
Q

meth chronic use sx

A

Mouth sores, skin lesions, HPTN, stroke
Dental decay: meth = acidic = breaks down enamel, causes dry mouth and ↑ temp = dehydration and ↑ bad bacteria, ↓ self care
↓ cognition and psychosis: may be acute and resolve on d/c in some, may be chronic in others

26
Q

what is overamping

A

nonfatal OD

27
Q

overamping tx

A

May require more formal support such as in patient hospitalisation with psychiatry
if just regular overuse = can use BZDs

28
Q

stimulant psychosis is
1. common
2. uncommon
3. only common with cocaine use
4. none of the above

A

1

29
Q

what are predictors of more persistent psychosis

A

length of meth use, severity of psychotic sx, whether pt experienced sustained depressive sx as part of withdrawal

30
Q

physical sx of overamping include

A

N/V, passing out (but still breathing), chest pain, high temp/ sweating profusely, fast HR, HPTN, irregular breathing or SOB, tremors, jerking, rigidity, stroke, severe HA, teeth grinding, insomnia

31
Q

psychological sx of overamping include

A

Extreme anxiety, panic, paranoia, hallucinations, hypervigilance, aggressiveness, restlessness or irritability
Agitation: hyperresponsiveness, racing thoughts, emotional tension, motor/ visual hyperactivity, difficulty communicating feelings, can’t remain still or calm
Enhanced sensory awareness potentiates all above sx

32
Q

3 hallmark sx of meth withdrawal

A

↓ mood, ↑ sleep, ↑ appetite

33
Q

describe tx for meth withdrawal

A

No meds currently approved for tx stimulant intoxication or overamping
Trials using prescribed stimulants to manage cravings

Contingency management: reinforces positive behaviours based on operant conditioning principles- offers incentives for goals achieved

Supportive tx: standard of care = psychiatric tx to decrease use/ abstain

34
Q

why do contingency managements for meth withdrawal have low uptake

A

High cost (replenish incentives)
Practical concerns: requires high fidelity to protocol to get full benefit
Philosophical concerns: may seem like gambling or reinforcing people for not doing drugs

35
Q

describe motivational interviewing as a supportive tx to meth withdrawal

A

what benefits do you get from meth use? How can we find these benefits from something else + how can we help you find + support these other activities?

36
Q

list 2 ways of harm reduction

A

Safe sex education (condoms, PrEP)
Safer equipment (pipes, smoking supplies, syringes, injection equipment)
Nutrition, hydration
Deescalation
Greater inclusivity with supervised consumption sites- currently no inhalation spaces in AB
Take home naloxone kits

401 - Toxicology, Drug Abuse, Pharmacology (32 decks)

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