Cocaine and Stimulants Flashcards
What are the 2 determinants that drive drug epidemics?
Low perceived risk.
High supply.
What’s different about crack cocaine?
Chloride removed, acts as weak base…
Can be vaporized at relatively low temperatures -> smoked.
Does blocking dopamine receptors work for cocaine addiction / OD? Why / why not?
No. There’s no naltrexone/naloxone for cocaine.
Other neurotransmitters, such as glutamate, GABA, dynorphin/enkephalin are also involved.
Why is cocaine + EtOH more common than what you would expect by chance?
Reduces anxiety from cocaine.
Cocaethylene metabolite formed is psychoactive.
What is actually measured in the urine in drug tests for cocaine?
Benzoylecgonine - a metabolite.
2 most severe CNS toxicities of cocaine?
Seizures, strokes.
4 cardiac complications of cocaine use?
Angina
Myocardial infarction
Cardiomyopathy
Myocarditis
Why can cocaine cause a perforated nasal symptom?
Chronic vasoconstriction -> necrosis.
What happens in long-term sensitization to cocaine?
Same amount of drug produces greater craving afterward, correlated with increased dopamine in the brain. (though the euphoria experienced actually decreases).
Mechanism of long-term sensitization?
Upregulation of NMDA and AMPA receptors in the dopaminergic neurons of the VTA.
Part of brain most affected in chronic cocaine use?
Frontal lobes -> poor judgment / increased impulsivity.
Is addiction more driven by need for high, withdrawal symptoms, or by craving?
By craving.
Does short-term rehab work well?
Nope.
What’s one effective short-term treatment for cocaine addiction?
“Contingency Management”: Reward abstinence with vouchers for stuff.
(gains don’t last, though)
What treatment for cocaine addiction is longer-lasting?
CBT - but it’s still not great.
3 possible medications that could be used for cocaine addiction?
Topiramate
Disulfiram
Cocaine vaccine.
How would Topiramate help cocaine addiction?
Maybe by blocking AMPA/Kainate receptors in the VTA.
And increasing GABA signaling.
(it’s an anticonvulsant)
What’s the MoA of disulfiram? What enzymes does it target?
Chelates copper, which targets…
Dopamine beta hydroxylase (DA -> NE)
Plasma esterases (cocaine breakdown)
How might disulfiram help cocaine addiction?
Increased dopamine and decreased NE might cause cocaine not to have as much effect?
Might cause cocaine to cause more paranoia?
Problem with disulfiram for cocaine addiction?
Because it inhibits plasma esterases, cocaine can reach dangerously high concentrations when taken.
Idea behind a cocaine vaccine? Has it worked?
IgG neutralizing cocaine will keep in from crossing the BBB.
Proof-of-principle has been demonstrated, but the vaccine isn’t very immunogenic.
