9 Drugs of Abuse Flashcards
Flesh-eating “zombie” drug that kills you from the inside out
Krocodil (Desomorphine)
Abnormal behavior and physical symptoms (withdrawal) occur if drug is withdrawn
Physiological dependence
Results from NEUROADAPTATIONS (something changes in the brain)
Dysphoria and intense craving following withdrawal of drug
Psychological dependence
Occurs with or without physical dependence
Adverse reactions caused by d/c of a drug
Withdrawal
Based on physical neuroadaptations of brain
Release of dynorphin and GABA in the nucleus accumbens
Dose/response curve shifted to the right
Tolerance - more drug is required to produce effect
Dose/response curve shifted to the left
Sensitization - increase of responsiveness after repeated use (need less to get high)
What type of tolerance:
Genetic lack of sensitivity
Innate
What type of tolerance:
Increased metabolism
Pharmacokinetic
What type of tolerance:
Receptor downregulation
Pharmacodynamic
What type of tolerance:
Adaptation to the degree of intoxication
Learned
What type of tolerance:
Adaptation to setting/environment
Conditioned
What type of tolerance:
May occur when a drug is used repeatedly over a short period of time
Acute
What type of tolerance:
One drug produces tolerance to another
Cross
What is the definition of addiction?
Compulsive, relapsing drug use in spite of adverse consequences
Neural plasticity alters brain function, drug taken to alleviate craving/dysphoria
Typically psychological in nature but physiological dependence is usually present
Development of addiction depends on …
The individual, the drug, and the environment
What is Oniomania?
Addiction to shopping
What are some common properties of abused drugs?
Cause euphoria
Easy to use
Potency and Purity - effect with small dose
Rapid onset/short action
What is the reward pathway?
Mesolimbic dopamine pathway
VTA —> NAc —> Prefrontal cortex
Reinforcement/reward, motivation pathways get hijacked by drug use
Drugs for alcohol addiction
Naltrexone
Acamprosate
Disulfiram
Topiramate
Drugs for Opioid addiction
Methadone
Buprenorphine
Naltrexone
Naloxone
Drugs for Nicotine addiction
Nicotine Replacement Therapy (NRT)
Bupropion (Zyban)
Varenicline (Chantix)
Combined with CBT
Miscellaneous drug for addition
Bromocriptine
MOA for amphetamines
Increased release of DA by REVERSING DA TRANSPORT through the DAT
Used for Narcolepsy and ADHD
Ex: Adderall, Ritalin (methylphenidate)
CNS effects of Amphetamines
Alertness, euphoria, excitement
Appetite suppression
Aggression, paranoia, delusions
Peripheral - increased BP and Cardiac toxicity (Pulmonary edema and HF)
Methamphetamine (ICE, crystal meth) have the same MOA as amphetamines but may produce…
Amphetamine psychosis
Chronic use may cause permanent damange to noradrenergic and serotonergic neurons —> long-term personality changes
Adverse effects of meth
Weight loss, pale skin, body odor, hyperthermia, dental problems, “meth bugs”, seizures, organ damage, stroke, heart attack
Rapid physical and psychological dependence
Craving in abstinence is intense
Withdrawal may be severe and last a long time
Which drug has the most life-threatening withdrawal?
Alcohol
MOA for Cocaine
Inhibits DA reuptake
DAT (coke)-blocker
vs. amphetamines that cause release of DA from DAT
Effects of cocaine
Craving can be severe —> physical and psychological dependence
CNS stimulation—> alertness, euphoria, anxiety, hyperactivity
Peripheral effects: tachycardia, vasoconstriction, HTN, bronchodilation, hyperpyrexia
Cocaine has been used medically for…
Local anesthesia
Vasoconstrictor
What is crack cocaine?
Allows for inhalation rather than typically intranasal administration
Very fast onset but wears off faster
Also called “freebasing” b/c it is separated from HCl (it’s a free base…)
Led to “crack lung” and “crack babies”
Effects of chronic cocaine use
Reduction in overall brain activity
Anxiety, insomnia, paranoia, hallucinations, repetitive behaviors
“Cocaine bugs”
Nasal congestion and perforated nasal septum
Intense physiological dependence
Severe withdrawal (more than meth but less than alcohol)
Cocaine overdose
Ventricular tachycardia and fibrillation
Stroke or cerebral hemorrhage
Seizures
All because your body is being flooded by DA
How to treat cocaine addiction
Detox and withdrawal Abstinence Long-term support systems 12-step programs Avoid environmental cues BROMOCRIPTINE decreases cravings by keeping DA at moderate, normal level
MOA for nicotine
Activates nicotinic receptors in the CNS/periphery —> increased serotonin and DA release
CNS effects of nicotine
Mild euphoria, increased arousal, appetite suppression
Intense psychological/physical dependence
Nicotine ______ CYP450s
Induces
Treatment for nicotine addiction
NRT
Bupropion (Zyban)
Varenicline (Chantix)
CBT
MOA for Ecstasy
MDMA - 3,4-Methylenedioxymethamphetamine
Increases 5HT activity by blocking reuptake and stimulating 5HT receptors
Produces feelings of peacefulness, empathy, closeness, and trust
May be followed by confusion, depression, anxiety, paranoia
Adverse effects of MDMA
Increased BP/HR
Hyperthermia, dehydration, kidney failures —> fatalities
Persistent memory loss
MOA of Marijuana
Delta-9-tetrahydrocannabinol is the active ingredient
Stimulates presynaptic CB1 receptors to inhibit transmitter (ACh) release
Produces state of euphoria, well being, altered sense of time, difficulty concentrating, introspection, tranquility
What kind of dependence do you get with marijuana?
No physical dependence but psychological dependence possible (no brain changes)
Adverse effects of marijuana
Anxiety, decreased memory, impaired cognition Amotivational syndrome Cannabinol hyperemesis - cyclic vomiting Bronchial irritation, risk of cancer Decreased ovulation and sperm production Low birth weight and fetal malformations
What do we need to know about synthetic cannabinoid agonists?
1/9 HS seniors have used them
Psychoactive effects - paranoia, hallucinations, mood swings, aggression and violent outbursts
Elevated HR and BP
Not tested for human effects, not regulated
High rate of ER visits
MOA for LSD, mescaline, psilocybin
Act on 5HT receptors in the brain
LSD = Lysergic acid diethylamide
Mescaline = peyote
Psilocybin = magic mushrooms
What is the main side effect of LSD?
Synesthesia - one sensory modality assumes the characteristics of another (colors can be heart or sounds smelled)
Why don’t LSD, mescaline, or psilocybin cause dependence?
Because they don’t stimulate DA pathways
Which drugs of abuse are NMDA receptor antagonists?
PCP
Ketamine
Which drug of abuse is a GABA receptor weak agonist
GHB
How do you treat PCP?
Haloperidol
Non-reactive pupils
Red flag for PCP
Why do dumb ass kids huff inhalants?
Produces sense of euphoria
Cheap and easy to get (don’t have access to better drugs)
Inhalant that can cause peripheral neuropathy with chronic use
Nitrous Oxide
Think of a dentist dropping his tools
