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Neuro exam 2 > Drug abuse 2 > Flashcards

Drug abuse 2 Flashcards

1
Q

MDMA (3,4-methylenedioxymethamphetamine)

A
  • Designer drug “Ecstasy”; “Adam”; “XTC”, “E”
  • Amphetamine derivative
  • Popular club / rave drug especially in Europe
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2
Q

MDMA (3,4-methylenedioxymethamphetamine): MOA

A

• Indirect serotonergic agonist

o ↑ release of 5-HT; Blocks reuptake of 5-HT

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3
Q

MDMA (3,4-methylenedioxymethamphetamine): actions

A 
Actions:
• Can have prolonged effect up to 1 week
• Sympathomimetic and psychotomimetic
• Increased euphoria, emphathy
• Enhances pleasure, Heightens sexuality, Expands consciousness,
positive change in self-image
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4
Q

MDMA Tox

A 
• Narrow margin of safety
• Cardiac arrhythmias
• Hyperthermia
• Convulsions
• Rhabdomyolysis
• Renal failure
• Fatalities may occur
• Chronic use may cause hepatic damage
Psychiatric effects:
• Psychosis
• Depression (after long term use)
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5
Q

Cocaine

A
  • Derived from Erythroxylon coca plant

* Very effective pleasure enhancer

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6
Q

Cocaine: Mechanism

A

Blocks reuptake of NE, DA, 5-HT

Binds transporter and reduces capacity to transport NE, DA, 5-HT

Blocks Na+ channel

Slows/blocks nerve conduction

Acts as a local anesthetic by altering the recovery of the neuronal Na+ channels

Increases the concentration of the excitatory amino acids glutamate and aspartate
in the brain, particularly in the nucleus accumbens

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7
Q

Cocaine: CNS

stimulation

A

Cortex and brainstem are targets of cocaine
↑ mental awareness, euphoria
Feeling of well- being, increased self confidence
Can produce hallucinations, delusions, paranoia
Reduction of fatigue
With regular use, feelings of restlessness, irritability, anxiety, sleeplessness, mood
swings
Prolongation of DA effects in limbic system → Euphoria
Chronic cocaine intake → DA depletion → Triggers craving for cocaine

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8
Q

Cocaine: Sympathetic

A

Potentiates action of NE
“Fight or flight” syndrome
Tachycardia, hypertension, papillary dilation, peripheral vasoconstriction

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9
Q

Cocaine: Withdrawal

A

l Fatigue, Depression, Sleep disturbances, Increased appetite

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10
Q

Cocaine: Metabolites

A

benzoylecgonine - spontaneous hydrolysis ~50%

Ecgonine - plasma / liver pseudocholinesterase 40-50% for cocaine use

Norcocaine - Liver P450 induced n-demythylation ~5%

Cocaethylene
Formed only in presence of alcohol via a transesterification ~17%
Crosses BBB
Active metabolite, blocking reuptake
As potent as cocaine
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11
Q

Cocaine Tox (OD)

A

• Delirium, violent behavior
• Pulse may be weak, irregular rapid
• Tonic-clonic seizures can be induced
• Malignant encephalopathy
• Cardiac failure: rapid elevation of blood
pressure which can lead to stroke, irregular
heartbeat, cardiac arrest

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12
Q

Cocaine Treatment

A 
Agitation
• Benzodiazepine (diazepam / lorazepam)
Hypertension
• Benzodiazepine (sedation)
• Phentolamine
• NO BETA BLOCKERS
MI
• Aspirin
• Nitroglycerin
• Phentolamine
• NO BETA BLOCKERS
• Bromocriptine used during withdrawal to reduce craving of drug

– DA receptor agonist; effectiveness not firm

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13
Q

Cocaine Prolonged use

A 
• Addiction and Physical dependency common
• Continued use may result in adverse
conditions:
– Malnutrition
– Weight loss
– Sexual problems
– Mental confusion
– Anxiety
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14
Q

Cocaine Babies

A
  • Hyperactivity
  • Tension
  • Muscle stiffness
  • Poor reflexes
  • Delayed motor development
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15
Q

How pure is your cocaine?

A

Found in 78% of seizures in 2011.
• Anthelminthic drug used by vets in Mexico
• Has some MAOI and COMT inhibitory action
• “more bang for your Buck” believed to be a player in the death of DJ
AM.
• can induce neutropenia and agranulocytosis

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16
Q

Crack

A
  • Free base form of cocaine
  • Rocks are smoked in crack pipe
  • “Crack lips” due to hot pipe
  • Cocaine frequently mixed with other drugs
17
Q

Bath salts

A

• Ivory wave, White lightning, Charlie, Cloud 9
• Designer drugs available legally in some states
can be a combination of
– mephedrone, MDPV, and methylone
• Cathionones, similar in structure to amphetamine

18
Q

Bath salts: Mechanism:

A

• similar transporter inhibition properties as the amphetamines though not as
potent.

19
Q

Bath salts: Induce:

A

– Feelings of empathy (openness, love, closeness, sociability, well-being
– Stimulation / alertness
– Euphoria / mood lift / appreciation of music; and, awareness of senses.

20
Q

Bath salts: Adverse Effect:

A

– Similar to amphetamine
– You will see on average 4 patients per month on your emergency medicine
rotation, probably more
• Clinically treat similar to methamphetamine

21
Q

Khat

A

Catha edulis, is a flowering shrub native to East
Africa and the Arabian-Peninsula, Khat refers to
the shoots and leaves

• Most commonly abused amongst African immigrants
• Chewed and stored in cheek to release juices (much like chewing tobacco)
• Active chemical is cathinone (similar to bath salts)
• Structurally similar to amphetamine and about as potent
o Very similar effects to amphetamine with about a 90 min time of
action
o Side effects and withdrawal same as amphetamines

22
Q

Nicotine

A 
• Principal alkaloid of plants
of genus Nicotiana
• Lipid, soluble tertiary
amine
– Rapidly absorbed, distributed
– Metabolite: cotinine
– Tars in cigarette smoke
accelerates metabolism of
nicotine and other drugs

Cigarettes accelerate metabolism of certain drugs

23
Q

Nicotine: Uses

A

Smoking cessation therapy

Nicotine nasal spray (Nicotrol NS)
Nicotine Inhaler (Nicotrol Inhaler)
E Cigarretes

24
Q

Nicotine: MoA

A

• Activates cholinergic nicotinic receptors (CNS, PNS)
• Nicotine initially stimulates, then blocks the receptor
• Inhibits MAO → Activate DA neurotransmission →dependence?
• Stimulates release of NE and DA
• This promotes
– Mild euphoria
– ↑ arousal, concentration
– Improved memory
• Appetite suppression

25
Q

Nicotine: Pharmacokinetics

A 
• Absorption via oral mucosa of lung, GI
mucosa, skin
• Crosses placental membrane
• Secreted in milk of lactating women
• Metabolism in lung, liver
– Cotinine major metabolite
• Urinary excretion
26
Q

Nicotine: Adverse Effects

A
  • Irritability
  • Tremors
  • Intestinal cramps/diarrhea
  • Increased heart rate
  • Increased blood pressure
27
Q

Nicotine Toxicity and withdrawl

A

Toxicity
• Central respiratory paralysis
• Severe hypotension caused by medullary paralysis

Withdrawal
• Peak 1-2 days after quitting and then decreases over a period of weeks
– Irritability
– Anxiety
– Restlessness, frustration
– Difficulty concentrating
– Headache
– Insomnia
28
Q

Caffeine: Clinical Uses

A

• Treatment of idiopathic apnea of prematurity (caffeine citrate)
Neonates.
• Emergency stimulant in acute circulatory failure; diuretic; treatment of
spinal puncture headaches (caffeine sodium benzoate) Adults.
• Adjuvant for analgesics
– Has some mild analgesic properties
• Do not interchange the caffeine citrate salt formulation with the
caffeine sodium benzoate formulation

Other Uses
• Most widely consumed stimulant in world

29
Q

Caffeine: Source and MoA

A 
• Methylxanthine
• Source: coffee, tea, cola drinks, chocolate
candy, cocoa, chewing gum
• Mechanism of action
– Translocation of extracellular calcium
– ↑ cAMP, cGMP via inhibition of PDE
– blockade of adenosine receptors
30
Q

Caffeine as a Stimulant: • Effects

A 
– ↓ fatigue
– ↑mental alertness → via stimulation of
cortex
– ↑ anxiety
– ↑ tremors
– ↑spinal cord stimulation (2-5 g
caffeine)
– Lethal dose: cardiac arrhythmias (100
cups of coffee, 10 g)
31
Q

Caffeine as a StimulantOther Effects

A

– Mild diuretic action
– At high doses: positive inotropic/chronotropic effects
on heart
– ↑secretion of gastric HCl
Moderate doses: insomnia, anxiety, agitation
– High doses: emesis, convulsions

32
Q

Lysergic acid diethylamide (LSD)

A 
• Agonist at 5-HT1 and 5-HT2
• Hallucinations with brilliant colors and mood
alteration occurs
• Adverse effects: hyperreflexia, nausea, muscle
weakness; Increased BP, HR, mydriasis
• Flashbacks (days to 1 yr)
• Not considered a drug of abuse
• Neuroleptic therapy with drugs such as
Haloperidol block hallucinations
33
Q

Ketamine and Phencyclidine (PCP, “Angel dust”)

A 
Antagonizes glutamate action
• Anticholinergic activity
• Dissociative anesthesia (insensitivity to pain without loss of
consciousness), (PCP, an analog of ketamine
– Extremity numbness
– Staggered gait
– Slurred speech
– Muscular rigidity
– Blood pressure, heart rate increase
– Nausea/vomiting
– Violent behaviours/suicidal
– Seizures
34
Q

Hallucinogenic Mushrooms

A 
• Street names: Shrooms,caps, divine flesh, magic mushrooms
• Psilobycin, Psilocin
• 20 min – 6 hr
– Dilated pupils, confusion, vertigo
– Exhilaration, laughter, hallucinations
– Tachycardia, hypertension
– Nausea, Vomiting
• Treatment: Activated charcoal, diazepam
35
Q

Use of hallucinogens in Religion

A

Native American Church: Practiced predominantly by Apache, Navajo and Plains Tribes.
• Involves the use of Peyote in ceremonies
– small, spineless cactus(Lophophora williamsii) found in the southwestern US and
northern Mexico.
– Contains a number of phenethylamine alkaloids, of which the principal one is mescaline
• Ingested as dried buttons, which are the round fleshy tops of the cactus. Or as a powder and
prepared as a tea.
• Mescaline produces effects similar to LSD, but is not as potent.
• Peyote may be used legally in the US by members of the Native American Church, it is
otherwise restricted under the US Controlled Substances Act.

36
Q

Marijuana

A
  • Δ9-tetrahydrocannabinol (THC) metabolized to 11-OH-Δ9-THC
  • Euphoria followed by drowsiness/relaxation
  • Receptors found in basal ganglia, hippocampus, cerebellum
  • Impairs short-term memory and mental activity
  • Visual hallucinations, delusions
  • ↑Increased heart rate
  • “munchies”
  • Tolerance, withdrawal, addiction possible
  • Highly lipophilic
37
Q

Tetrahydrocannabinol (THC)

A

• Dronabinol:
– Used to treat severe nausea and pain caused by
some diseases such as AIDS and cancer as well as
an appetite stimulant “Medical Marijuana”
• Marijuana (dried plant material) vs. Hashish
(exuded resinous material from plant)-Hash
oil (liquid extract from plant material)
LIPOPHILIC

38
Q

NBome

A

New Kid on the block, deaths reported in WV
• W.Va. man charged with wife’s drug death
• Dec. 06, 2013 @ 07:34 AM
The Associated Press
CHARLESTON, W.Va. (AP) — A West Virginia man has been charged with first-degree murder for
allegedly providing a synthetic hallucinogenic drug to his wife that led to her death.
According to the Charleston Gazette, a court affidavit reveals that 35-year-old Todd Anthony Honaker of
Left Hand believed he was buying LSD, but instead gave his wife an experimental drug. Honaker told
police his wife, Renee, took a dose of the drug and began convulsing. The Roane County woman died
March 1.
An autopsy determined that Honaker’s wife died from abusing a synthetic hallucinogen known as 25b- NBOMe.
• 5HT2A agonist
• Agitation and hallucinations
• Tachycardia and hypertension
• May require physical restraints and treatment with intravenous benzodiazepine.
• Prolonged periods of aggressive behavior.

39
Q

Inhalants

A

Volatile Solvents
paint thinner
nail polish remover
spray paint

Aerosols
deodorant
hair products
cooking products

Gases
refrigerants
Nitrous Oxide

Nitrites
“poppers”

Neuro exam 2 (35 decks)

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