Biology of Addiction

Question 1

defined Schedule I - V drugs

Answer 1

• 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

Question 2

heroin is what schedule drug?

Answer 2

schedule I

Question 3

marijauna is what schedule drug?

Answer 3

schedule I

Question 4

methamphetamine is what schedule drug?

Answer 4

schedule II

Question 5

methadone is what schedule drug?

Answer 5

schedule II

(is an opioid)

Question 6

oxycodone is what schedule drug?

Answer 6

schedule II

(is an opioid)

Question 7

methylphenidate is what schedule drug?

Answer 7

schedule II

(CNS stimulant)

Question 8

xanax is what schedule drug?

Answer 8

schedule IV

(is a benzodiazepene)

Question 9

ambien is what schedule drug?

Answer 9

schedule IV

(is a BZ like drug)

Question 10

what are examples of schedule V drugs?

Answer 10

• anti-diarrheals
• anti-tussives
• certain analgesics

Question 11

which professions have a higher risk for drug abuse?

Answer 11

physicians

dentists

Question 12

what are behavioral and pharmacological indicators of drug abuse?

Answer 12

Behavioral Indicators

• Impaired control and function
• Social impairment’
• Risky use
• DUI, HIV, hepatitis C, meth effects

Pharmacological Indicators

• Tolerance
• Withdrawal

Question 13

discuss the players in the reward circuit?

Answer 13

VTA releases dopamine via the mesolimbic projection to the nucleus accumbens

“VTA-to-NAc”

Question 14

opiates

• MOA:
• AEs
• overdose treatment?
• addiction treatment?

Answer 14

• mu agonist
• AEs:
  
  • constipation
  • respiratory depression
  • sedation
  • addiction
• overdose treatment: competitive antagonists - naloxone, naltrexone
• addiction treatment: agonists - methadone, buprenorphine

Question 15

heroin

• what kind of drug
• MOA / PK
• administration
• AE
• risk factors for addiction

Answer 15

• 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*

Question 16

Answer 16

skin popping

from subdermal use ot heroin, cocaine

Question 17

Answer 17

bacterial colonization of tricuspid valve

IV heroin use

Question 18

which drugs are used to treat opioid overdose?

Answer 18

opiod receptor antagonists

• naloxone
• naltrexone

Question 19

which drugs are used to treat opiod addiction?

Answer 19

opiod agonists

• methadone - full mu receptor agonist
• buprenorphine - partial mu receptor agonist

Question 20

what is suboxone?

why is it useful?

Answer 20

a combination of buprenorphine and nalaxone

effective & safe teatment for addiction, since buprenorphine is a mu agonist and nalaxone is an antagonist

Question 21

what are the benefits of using buprenorphine as opposed to methadone in the treatment of opioid addiction?

Answer 21

is a partial agonist, therefore:

• less abuse potential
• lesser eventual withdrawal symptoms & craving
• safer - lesser risk of respiratory depression*

Question 22

what is the treatment BZ withdrawal?

Answer 22

1. put patients on long-duration BZs
   
   • chlorodiazpoxide
   • diazepam
2. slowly taper dose

Question 23

ethanol acts at what receptors?

to have what effects?

Answer 23

potentiates:

• GABA_A → inc GABA
• VTA → inc ACh
• nucleus accumbens → inc DA

inhibits: NMDA, kainate → less glutamate

Question 24

what are the elimination kinetics of ethanol?

what does this mean?

Answer 24

zero order kinetics

can eliminate one drink per hour

Question 25

what is the “J-shaped curve” pertaining to alcohol consumption?

Answer 25

at certain small levels, consumption of alcohol may have benefits

• small levels: decreased risk for coronary disease
• high levels: increased risk for arrythmias

Question 26

list the key treatments for alcohol addiction

what is the MOA for each?

Answer 26

• naltrexone - mu receptor antagonist
• acamprosate - GABA enhancement, glutamate inhibition
• disulfram - aldehydrate dehydrogenase inhibitor

Question 27

what is acamprosate?

Answer 27

a therapy for alcohol addiction

Question 28

what is disulfiram?

how does it work?

Answer 28

an alcohol addiction therapy

disrupts ethanol metabolism such that acetylaldehyde accumulates→ makes patient sick & want to throw up

Question 29

stimulants

• include what drugs
• what schedule
• AEs

Answer 29

• 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

Question 30

“meth mouth”

• presentation
• pathophysiology
• medical intervention

Answer 30

• presentation: specific pattern of tooth decay affecting:
  
  • buccal surfaces
  • interproximal surfaces - anterior teeth
• pathophysiology: multifactorial
  
  1. poor oral hygeine → bacterial overgrowth → acid production
  2. vasoconstriction from amphetamines → xerostemia
• medical intervention:
  
  • take opportunity to educate on risks / rehabilitation programs
  • postpone dental trx until abuse is controlled

Question 31

outline proper dental intervention for a patient with “meth mouth”

Answer 31

• 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