5.8 Pharmacology Of Psychostimulant Misuse Flashcards

1
Q

What do psychostimulants do to the CNS?

A

Activate the CNS resulting in alertness, excitation, and elevated mood

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2
Q

What is the MOA of nicotine?

A
  • Nicotine activates nicotinic acetylcholinergic receptor
  • Na enters cell, K exits the cell —> action potential
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3
Q

What determines how many molecules of Ach bind to receptor (in the MOA of nicotine)?

A

Heterogeneity of subunits

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4
Q

What may influence physiological response of nicotine?

A

Variation in receptor composition at different sites

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5
Q

What are the similarities between nicotine and ACh?

A
  • Charged amino groups
  • Hydrogen bond acceptor groups
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6
Q

When is nicotine membrane penetrable?

A

At physiological pH (weak base)

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7
Q

Is nicotine degraded by acetylcholinesterase?

A

No

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8
Q

What does partial agonist therapy cause?

A

Causes release of dopamine

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9
Q

What is a danger of partial agonist therapy?

A

Highly addictive

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10
Q

Nicotine replacement therapy is relatively ineffective alone. What increases the quit rate success?

A

Varenicline is a partial agonist that increases quit rate success

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11
Q

What is the MOA of cocaine?

A
  • Antagonist of amine transporters: DAT, SERT, NERT
  • Prevents DA uptake
  • Increases DA concentration
  • Increase duration of DA action
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12
Q

What is the order of preference for amine transporter antagonism of cocaine?

A

DAT >= SERT > NERT

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13
Q

What is the MOA of methamphetamine, ecstasy (XTC), and bath salts?

A

Compete for reuptake
- Resemble endogenous DA, NE
- Block DA reuptake
- Push out DA from vesicles
- Increase extra-vesicular DA
- Reverse transport (gradient)
Activate trace amine-associated receptor (TAAR1)
- Phosphorylates DAT
- Induces reverse transport fxn

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14
Q

What are neurological effects of meth abuse?

A

Delirium, tremor

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15
Q

What are psych effects of meth abuse?

A

Anxiety, paranoia, hallucinations, delusions

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16
Q

What are ENT effects of meth abuse?

A

Poor oral hygiene which all lead to profuse dental decay

17
Q

What are CV effects of meth abuse?

A

Tachycardia, hypertension/vasospasm

18
Q

What is the pulmonary effect of meth abuse?

A

Pulmonary hypertension

19
Q

What are GI effects of meth abuse?

A

Nausea, vomiting, diarrhea

20
Q

What is renal effect of meth abuse?

A

Acute kidney injury

21
Q

What are musculoskeletal effects of meth abuse?

A

Rigidity, rhabdomyolysis

22
Q

What are the effects of meth abuse on the skin?

A

Diaphoresis, soft tissue infection/abscesses in injecting

23
Q

What is believed to mediate withdrawal symptoms?

A

Receptor downregulation

24
Q

What receptors change similarly interacting with antidepressant therapy to DA receptor interacting with meth?

A

NE and 5HT receptors

25
Q

Is DA downregulation evidence of a broken brain?

A

No

26
Q

Can low dose psychostimulant improve performance?

A

Yes, but dosing and potency matter

27
Q

There is an increasing use of stimulants w the goal of cognitive enhancement. This is an off-label use. Is this supported?

A

This off-label use is not well supported by research and can progress to stimulant use disorder

28
Q

What is the mnemonic for sympathomimetic toxidrome?

A

MATHS:
- M: mydriasis
- A: agitation, arrhythmia, angina
- T: tachycardia
- H: htn, hyperthermia
- S: seizures, sweating

29
Q

How is sympathomimetic toxidrome managed?

A
  • Tx agitation, HTN, seizures w benzos
  • Avoid pure BBs due to unopposed alpha agonism
30
Q

In sympathomimetic toxidrome, what does HTN usually respond to?

A

Usually responds to sedation

31
Q

In sympathomimetic toxidrome, what does hyperthermia denote?

A

Hyperthermia denotes a poor prognosis

32
Q

In sympathomimetic toxidrome, what symptoms are often seen?

A

Aggression and paranoia