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Adv Pharm > Chapter 35: Substance Use Disorders IV > Flashcards

Chapter 35: Substance Use Disorders IV Flashcards

1
Q

major drugs of abuse

A

Opioids​

Psychostimulants​

Depressants​

Psychedelics​

Dissociative drugs​

Anabolic steroids​

Miscellaneous drugs of abuse​

Marijuana​

d-Lysergic acid diethylamide (LSD)

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2
Q

Heroin, Oxycodone, and ​
Other Opioids

A

Major drugs of abuse: Heroin, oxycodone, meperidine​

Most opioids are Schedule II need DEA to scribe ​
In Ohio need OAARS​

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3
Q

heroin pattern of abuse

A

Greatest use among 18- to 25-year-olds​

All segments of society​

First exposure usually social or for pain management

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4
Q

subjective and behavioral effects of heroin

A

Moments after IV injection: Sensations of pleasure, relaxation, warmth, and thirst​

Followed by euphoria​

Initial use causes nausea and vomiting

Initially may also cause an overall sense of dysphoria

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5
Q

heroin preferred drugs and routes of admin

A

Opioid of choice for street use​

High lipid solubility​

IV route preferred, but also smoking, nasal inhalation

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6
Q

oxy

A

Opioid similar to morphine​

Intended as controlled-release drug [OxyContin]​

Abusers crush tablet​

Snort powder or dissolve in water for IV​

Entire dose absorbed immediately with high risk of death

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7
Q

Meperidine

A

Nurses and health care providers who abuse opioids often select meperidine​

Highly effective in oral route (unlike injections, leaves no sign)​

Minimal effect on smooth muscle: Fewer problems with constipation and urinary retention

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8
Q

opioid tolerance

A

develops for resp depression, euphoria, nausea

does not develop for meiosis and constipation

cross tolerance to other opioids -not to CNS depressants

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9
Q

opioid physical dependence

A

Long-term use​

Abstinence syndrome​

Acute phase (10 days) and second phase (months)

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10
Q

opioid acute toxicity

A

Triad of symptoms​
Respiratory depression​
Coma​
Pinpoint pupils​

Treatment​
Naloxone [Narcan]: Careful titration

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11
Q

Opioid Detoxification: Clonidine-assisted withdrawal​

A

Centrally acting alpha2-adrenergic agonist

Most effective against symptoms related to autonomic hyperactivity (nausea, vomiting, diarrhea)​

Provides modest relief from muscle aches, restlessness, anxiety, and insomnia​

Does not diminish opioid craving

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12
Q

opioid detox withdrawa;

A

Rapid withdrawal​

Ultrarapid withdrawal​
Administration of naloxone or naltrexone: Immediate withdrawal​
Withdrawal process accelerated​
Ultrarapid procedure: General anesthesia or heavy sedation with IV midazolam [Versed]​
In both procedures, clonidine may be added to ease symptoms​
No more effective than standard withdrawal techniques​
Considerably more expensive​

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13
Q

opioid detox sub

A

Methadone substitution ​
Long-acting oral opioid​
Most commonly used agent​
Approximately 10 days​

Buprenorphine​ -suboxone

Substituted for opioid the addict is physically dependent on​

Prevents symptoms of withdrawal

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14
Q

Drugs for Long-Term Opioid Addiction Management

A

Three groups of medications​
Opioid agonists, opioid agonist-antagonists, and opioid antagonists​

Methadone​
Maintenance and suppressive therapy​

Buprenorphine​
Maintenance therapy and detox facilitation​

Naltrexone​
Discourages renewed opioid abuse

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15
Q

Sequelae of Compulsive ​
Opioid Use

A

Few direct detrimental effects​

Individuals on methadone maintenance can be successful socially and at work​

Indirect hazards: Septicemia, cellulitis, abscesses, endocarditis, tuberculosis, hepatitis C, HIV, and foreign body emboli​

Accidental overdose

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16
Q

general CNS depressants

A

Barbiturates, benzodiazepines, alcohol, and other agents​

Benzodiazepines have unique properties

17
Q

Barbiturates

A

Depressant effects are dose dependent​
Mild sedation to sleep to coma and death​

Subjective effects similar to those of alcohol​

Agents with short to intermediate duration of action have highest abuse incidence and are Schedule II​
Amobarbital, pentobarbital, and secobarbital

Tolerance​

Physical dependence​

Withdrawal​

Acute toxicity​

Maintain respiration and remove drug​
Naloxone: Reverses opioid poisoning but is not effective against barbiturate poisoning

18
Q

Benzodiazepines

A

Benzodiazepines (Schedule IV)​
Much safer than barbiturates​
Overdose rare when taken alone and orally​
Risk increased with IV or with other depressants​

Tolerance​

Physical dependence and withdrawal techniques​

Acute toxicity​

Flumazenil [Romazicon] -reversal

19
Q

Psychostimulants

A

CNS stimulants (Schedule II) with a high potential for abuse​
Methamphetamines​
Cocaine​

Can stimulate the heart, blood vessels, and other structures under sympathetic control

20
Q

Cocaine

A

Extracted from leaves of coca plant​

CNS effect similar to that of amphetamines​

Two forms used by abusers:​
Cocaine​
“Crack”​

Can produce local anesthesia, vasoconstriction, and cardiac stimulation

Tolerance, dependency, and withdrawal​

Treatment of cocaine addition​
Anticocaine vaccine ​
Disulfiram [Antabuse]

21
Q

coke acute tox

A

Mild overdose: Agitation, dizziness, tremor, blurred vision​

Severe overdose: Hyperpyrexia, convulsions, ventricular dysrhythmias, hemorrhagic stroke, angina pectoris, myocardial infarction ​

Treatment: Intravenous diazepam or lorazepam, nitroprusside, hypertonic sodium bicarbonate, aspirin, external cooling

22
Q

coke chronic tox

A

Intranasally: Atrophy of the nasal mucosa and loss of sense of smell​

Extreme cases: Necrosis and perforation of the nasal septum​

Injury to the lungs can occur from smoking cocaine base​

Use during pregnancy

23
Q

coke admin

A

Cocaine hydrochloride ​
White powder​
Diluted for sale​
Taken intranasally​

Cocaine base: Commonly called “crack”​
Heated for use​
Taken by IV injection

24
Q

Methamphetamines

A

In abuse, usually taken orally, snorted, smoked, or IV​

Also called “ice” or “crystal meth”​
Form of dextroamphetamine​
Smoked, snorted, or inserted into rectum​

Effects​
Arousal, euphoria, sense of increased physical strength and mental capacity​
Hallucinations, psychotic state, sympathomimetic actions

25
Q

meth adverse CV effects

A

Hypertension​

Angina pectoris​

Dysrhythmias​

Cerebral and systemic vasculitis and renal failure, stroke​

Vasoconstriction can be relieved with an alpha-adrenergic blocker (e.g., phentolamine)​

Cardiac stimulation can be reduced with a mixed alpha and beta blocker (e.g., labetalol)​

26
Q

other meth effects

A

Significant weight loss​

Fetal effects​

“Meth mouth”

27
Q

meth Tolerance, dependency, and withdrawal

A

Treatment: Cognitive behavioral therapy, matrix model, bupropion [Wellbutrin, Zyban], modafinil [Provigil, Alertec], and Ibudilast

28
Q

Marijuana

A

Cannabis sativa (hemp) ​
Marijuana and hashish are derivatives​
Common names: “Grass,” “weed,” “pot” ​

Most commonly used illicit drug in the United States, although it is now legal in some states

29
Q

Marijuana

A

Psychoactive substance ​
Delta-9-tetrahydrocannabinol (THC)​

Routes​
Smoking -60% of THC content is absorbed; effects begin in minutes and peak within 20 to 30 minutes​

Oral​ -Most of THC is inactivated by first-pass effect

Effects​
Low to moderate dose​
High dose​
Long-term use​
Schizophrenia​

Cardiovascular​
Dose-related increase in heart rate​

Respiratory​
Acute: Bronchodilation​
Chronic: Airway constriction

Reproduction​
Males and females affected​

Altered brain structure​
Hippocampal volume left hemisphere​

Tolerance and dependence

30
Q

Therapeutic Use of Marijuana

A

Approved uses for cannabinoids​

Unapproved uses for cannabinoids​

Medical research on marijuana​

Legal status of medical marijuana​

Synthetic marijuana

Comparison of marijuana with alcohol​
Aggressive behavior is rare with marijuana use​
Less loss of judgment with marijuana​
Increased appetite with marijuana: Fewer problems with nutritional deficiencies​
Marijuana produces increased toxic psychosis, dissociative phenomena, and paranoia, more so than alcohol does

31
Q

Psychedelics​ lsd

A

d-Lysergic acid diethylamide (LSD)​

Acts on the brain’s serotonin receptors​

Routes: Oral, IV, smoked​

Alters the following (as otherwise occurs only in dreams):​
Thinking​
Feelings​
Perception ​
Relationship to environment

32
Q

other psychedelics

A

Salvia: Causes dream-like state of unreality​

Mescaline​
From peyote cactus​

Psilocybin ​

Psilocin​

Dimethyltryptamine

33
Q

Dissociative Drugs pcp

A

Original use: Surgical anesthetics​

Recreational use: Distort sight and sound and produce dissociation​

Act in the cerebral cortex and limbic system ​

PCP easily synthesized/manufactured by amateurs ​

Routes: Oral, intranasal, IV, smoking

Effects​
Low to moderate doses, high doses​

Toxicity

34
Q

ketamine

A

Similar to PCP in structure, mechanism, and effects​

Shorter duration of effects

35
Q

Dextromethorphan

A

Over-the-counter (OTC) cough suppressant ​
Low dose for antitussive: No psychologic effects​
Doses 5 to 10 times higher: Produces euphoria, disorientation, paranoia, altered sense of time, and hallucinations​

Also used in combination cold products​

Highly abused by adolescents and teenagers

36
Q

3,4-Methylenedioxymethamphetamine

A

Common names: MDMA, ecstasy​

Complex drug with stimulant and psychedelic properties​

Structurally related to methamphetamine (stimulant) and mescaline (hallucinogen)​
Low doses: Mild LSD-like psychologic effects​
Higher doses: Amphetamine-like effects ​

Promotes release of neurotransmitters​

Usually taken orally; also snorted, injected, or taken by rectal suppository

Adverse effects​
Can injure serotonergic neurons, stimulate the heart, and dangerously raise body temperature​

Neurologic effects​
Seizures, spasmodic jerking, jaw clenching, teeth grinding​
Confusion, anxiety, paranoia, panic

37
Q

Inhalants

A

Term can refer to many drugs; common characteristic is administration by inhalation​
Anesthetics​
Volatile nitrites​
Organic solvents

38
Q

Anabolic Steroids

A

Androgens​

Taken to enhance athletic performance​

Increase muscle mass and strength​

Massive doses often used have high risk for adverse effects​

Most are classified as Schedule III drugs

Adv Pharm (76 decks)

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