Biology of Addiction Flashcards
defined Schedule I - V drugs
- Schedule I: no accepted medical use
- Scehdule II: high potential for abuse / dependence
- Schedule III: moderate - low potential for abuse / dependence
- Schedule IV: low potential for abuse / dependence
- Schdeuld V: lower potential for abuse / dependence than IV
heroin is what schedule drug?
schedule I
marijauna is what schedule drug?
schedule I
methamphetamine is what schedule drug?
schedule II
methadone is what schedule drug?
schedule II
(is an opioid)
oxycodone is what schedule drug?
schedule II
(is an opioid)
methylphenidate is what schedule drug?
schedule II
(CNS stimulant)
xanax is what schedule drug?
schedule IV
(is a benzodiazepene)
ambien is what schedule drug?
schedule IV
(is a BZ like drug)
what are examples of schedule V drugs?
- anti-diarrheals
- anti-tussives
- certain analgesics
which professions have a higher risk for drug abuse?
physicians
dentists
what are behavioral and pharmacological indicators of drug abuse?
Behavioral Indicators
- Impaired control and function
- Social impairment’
- Risky use
- DUI, HIV, hepatitis C, meth effects
Pharmacological Indicators
- Tolerance
- Withdrawal
discuss the players in the reward circuit?
VTA releases dopamine via the mesolimbic projection to the nucleus accumbens
“VTA-to-NAc”
opiates
- MOA:
- AEs
- overdose treatment?
- addiction treatment?
- mu agonist
- AEs:
- constipation
- respiratory depression
- sedation
- addiction
- overdose treatment: competitive antagonists - naloxone, naltrexone
- addiction treatment: agonists - methadone, buprenorphine
heroin
- what kind of drug
- MOA / PK
- administration
- AE
- risk factors for addiction
- drug: schedule I opioid
- MOA/PK: hydrophobic mu eceptor angatonist → faster onset
- administration: injection, smoking [spoon often used]
- AE:
- social - crime, unemployment
- respiratory depression / constipation (opioid AEs)
- HIV, Hep-B & C - from sharing needles
- skin infections → heart lining & valve infection - from non-sterile needles
- risk factors: previous abuse of precription opioids - major*
skin popping
from subdermal use ot heroin, cocaine
bacterial colonization of tricuspid valve
IV heroin use
which drugs are used to treat opioid overdose?
opiod receptor antagonists
- naloxone
- naltrexone
which drugs are used to treat opiod addiction?
opiod agonists
- methadone - full mu receptor agonist
- buprenorphine - partial mu receptor agonist
what is suboxone?
why is it useful?
a combination of buprenorphine and nalaxone
effective & safe teatment for addiction, since buprenorphine is a mu agonist and nalaxone is an antagonist
what are the benefits of using buprenorphine as opposed to methadone in the treatment of opioid addiction?
is a partial agonist, therefore:
- less abuse potential
- lesser eventual withdrawal symptoms & craving
- safer - lesser risk of respiratory depression*
what is the treatment BZ withdrawal?
- put patients on long-duration BZs
- chlorodiazpoxide
- diazepam
- slowly taper dose
ethanol acts at what receptors?
to have what effects?
potentiates:
- GABAA → inc GABA
- VTA → inc ACh
- nucleus accumbens → inc DA
inhibits: NMDA, kainate → less glutamate
what are the elimination kinetics of ethanol?
what does this mean?
zero order kinetics
can eliminate one drink per hour
what is the “J-shaped curve” pertaining to alcohol consumption?
at certain small levels, consumption of alcohol may have benefits
- small levels: decreased risk for coronary disease
- high levels: increased risk for arrythmias
list the key treatments for alcohol addiction
what is the MOA for each?
- naltrexone - mu receptor antagonist
- acamprosate - GABA enhancement, glutamate inhibition
- disulfram - aldehydrate dehydrogenase inhibitor
what is acamprosate?
a therapy for alcohol addiction
what is disulfiram?
how does it work?
an alcohol addiction therapy
disrupts ethanol metabolism such that acetylaldehyde accumulates→ makes patient sick & want to throw up
stimulants
- include what drugs
- what schedule
- AEs
- drugs: amphetamines, methylphenidate, methamphetamine, cocaine
- schedule II
- AEs (at abuse levels)
- social - unemployment / crime
- physical
- meth mouth: tooth decay of buccal / interproximal surfaces of teeth
- psychosis
- skin infections
“meth mouth”
- presentation
- pathophysiology
- medical intervention
- presentation: specific pattern of tooth decay affecting:
- buccal surfaces
- interproximal surfaces - anterior teeth
- pathophysiology: multifactorial
- poor oral hygeine → bacterial overgrowth → acid production
- vasoconstriction from amphetamines → xerostemia
- medical intervention:
- take opportunity to educate on risks / rehabilitation programs
- postpone dental trx until abuse is controlled
outline proper dental intervention for a patient with “meth mouth”
- post-pone tx until abuse is controlled
-
if the pt has used methanphetamine within the last 24 hrs use LA without epinephrine*
- amphetamines + epi → SNS drive to CV system → cardiac events
