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Pharmacology II > Drug Abuse > Flashcards

Drug Abuse Flashcards

1
Q

Define: psychologic dependence

A

Perceived “need” or “craving” for a drug. This is the primary reason for relapse.

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2
Q

Define: physical dependence

A

Changes that have occurred in the body after repeated use of a drug that necessitates the continued administration of a drug to prevent a withdrawal syndrome. Physical dependence can exist without addiction.

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3
Q

Define: chemical dependency

A

A primary, chronic, progressive, relapsing disease process with genetic, psychosocial and environmental factors influencing its development and manifestations. Addiction is progressive in nature (experimental–>social use–>abuse–>addiction) and may include gateway drugs like nicotine and alcohol.

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4
Q

Define: withdrawal syndrome

A

Withdrawal syndrome results when physical dependences are not met and may range from mildly unpleasant to life-threatening. Withdrawal syndrome depends on a number of factors including the drug being used, dose and route of admin., concurrent use of other drugs, frequency and duration; age, sex, health and genetics of user

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5
Q

Define: addiction

A

Compulsive drug-seeking behavior where acquiring and using a drug becomes the most important activity in the user’s life. Users choose continued use despite serious medical/social consequences. With addiction, there is always psychological dependence.

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6
Q

Define: tolerance

A

With repeated dosing, the dose of the drug must be increased to produce the same effect. Psychoactive drugs produce “central” tolerance (functional or behavioral)–definite decrease in the response of brain tissue to constantly increasing amounts of the drug.

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7
Q

Define: enabling (with respect to drug abuse)

A

The behavior of others (e.g. family and friends) who are associated with the drug addict that results in continued drug abuse.

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8
Q

Define: abstinence

A

The state of being free from drugs (this is the goal of drug treatment programs)

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9
Q

Define: drug abuse

A

When drugs are used in a manner or amount inconsistent with medical or social patterns of a culture. This includes non-sanctioned use of controlled substances and use of legal drugs outside of the scope of sound medical practice

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10
Q

What are some key factors that increase the potential for drug abuse?

A

potency of the drug, quick/rapid onset of action, inexpensive, easy to obtain/distribute

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11
Q

Discuss common reasons for relapse following treatment for drug addiction.

A

Pyychological dependence is the primary reason for relapse (it is the perceived “need” or “craving” for a drug)

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12
Q

What are some precautionary measures that should be taken when treating patients with a history of chemical dependency?

A

NO opiates, benzodiazepines, or nitrous oxide as these could make a recovered patient with alcoholoism relapse (remember relapsing disease)

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13
Q

(T/F): When comparing drugs in the same group, the time required to produce physical dependence is SHORTEST with a RAPIDLY metabolized drug.

A

True: (and similarly LONGEST with a SLOWLY metabolized drug)

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14
Q

(T/F): The longer the half-life, the quicker a withdrawal occurs.

A

False. The time course of withdrawal reactions is related to the half-life of a drug: the shorter the half-life, the quicker the withdrawal occurs.

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15
Q

What drugs are most abused by dentists?

A

Alcohol, hydrocodone with acetaminophen, benzodiazepines, street drugs and nitrous oxide

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16
Q

Discuss cardiovascular considerations for treating children who abuse inhalants.

A

Products containing difluroethane are often used as inhalants and cause increased heart muscle sensitivity to epinephrine–>leading to sudden death (if treatment with epinephrine proceeds)

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17
Q

What are the main causes of death from abusing inhalants?

A

suffocation, respiratory depression, hepatotoxicity, sudden sniffing death

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18
Q

Describe some features of dextromethorphan (DXM)

A

Low dose DXM = antitussive (thus used in cough medications like Robitussin). High dose = hallucinogenic (thus kids abuse it “Robotripping”)

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19
Q

Name several examples of depressants

A

Ethanol (alcohol), Benzodiazepines (anti-anxiety drugs), Opioids, Barbiturates (sedative hypnotics/anti-convulsants), volatile solvents (glue/gas), inhalants, nitrous oxide.

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20
Q

What are some key examples of opioids?

A

heroin, methadone (Dolophine), morphine, oxycodone (Percodan=widely abused by dentists)

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21
Q

What is the most rapidly acting opiate?

A

Heroin

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22
Q

Identify consequences of IV opioid drug abuse.

A

IV injections may result in Hepatitis B, HIV infection and damaged heart valves (IV drug users require antibiotic premedication prior to receiving any dental treatment)

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23
Q

What are key signs of acute opioid overdose?

A

Fixed, pinpoint pupils (miosis), depressed respiration, hypotension, shock, slow or absent reflexes, drowsiness, coma

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24
Q

Which oxycodone and acetaminophen product has less binder and is easier to dissolve than many counterparts (red flag when patients request this)?

A

Roxicet

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25
Q

What is the driving factor for opioid abuse?

A

These drugs are abused because they produce complete satiation of all drives in the body (elevate mood, cause euphoria, relieve fear/pain/anxiety, produce feeling of peace, suppress hunger, etc.)

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26
Q

Identify important drugs used as antidotes to manage opiate overdose.

A

naloxone (Narcan) and methadone

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27
Q

What are some key features of naloxone (Narcan) as a treatment of opioid overdose/withdrawal?

A

It is used for acute narcotic overdose to reverse respiratory depression, pinpoint pupils and coma (in oral surgeon office emergency kit)

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28
Q

What are some key features of methadone as a treatment of opioid overdose/withdrawal?

A

It is a long-acting opioid that can replace heroin then be gradually withdrawn. It is a physiologically equivalent drug to heroin used during long-term rehabilitation programs.

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29
Q

What is a helpful treatment option for alcoholism?

A

disulfiram (Antabuse): this drug inhibits the metabolism of aldehyde dehydrogenase, which increases the serum levels of acetaldehyde.

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30
Q

What features of disulfiram (Antabuse) make it effective in treating alcoholism?

A

It increases serum levels of acetaldehyde. These high levels cause many effects including vomiting (also flusing, nausea, thirst, palpitations, chest pain, vertigo, headache). Taking this drug and drinking makes you vomit and deters the person from drinking.

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31
Q

What are some dental treatment considerations for patients who abuse alcohol?

A

Poor oral hygiene, bilateral enlarged parotid glands, liver failure, increased bleeding, ascites and difficulty metabolizing drugs (including local anesthetics)

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32
Q

What are oral complications of alcholism?

A

Glossitis, loss of tongue pailla, angular cheilitis, fungal infections, bleeding (from liver damage), oral cancer (squamous cell), leukoplakia and ulceration of lateral borders of the tongue (examine tongue carefully for precancerous lesions)

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33
Q

What are treatment options for alcohol overdose?

A

Ventilation support, fluids and electrolytes, Vitamin B6, glucose, sodium bicarbonate, magnesium

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34
Q

Discuss the pharmacology of alcohol, including alcohol abuse and withdrawal.

A

Zero-order kinetics. Most frequently abused drug. Rapidly and completely absorbed from the GI tract and oxidized in the liver to acetaldehyde (which is then metabolized to CO2 and H2O and excreted in lungs and urine)

35
Q

What is the only depressant that that causes dilation of pupils?

A

CNS depressants typically cause pinpoint pupils. ALCOHOL is the only depressant that causes dilation of pupils.

36
Q

What are signs of severe alcohol intoxication?

A

Seizures, coma, death

37
Q

Describe symptoms of withdrawal from alcohol.

A

Withdrawal occurs in stages and includes paranoid behavior/delusions, disorientation, gran mal seizures, DTs = delirium tremens = shaky tremor movements

38
Q

What are some chronic signs of alcoholism?

A

Liver damage/cirrhosis (watch problems with bleeding), oropharyngeal cancer, liver cancer, impotence, HTN, arrhythmias, etc.

39
Q

Name several examples of CNS stimulants.

A

*cocaine, *methamphetamine, amphetamines, caffeine, nicotine

40
Q

Describe the characteristic effects of overdose with CNS stimulants (like ecstasy).

A

HTN and stroke, hyperthermia, seizures, death

41
Q

What is an indication for methylphenidate (Ritalin)?

A

Treatment of ADHD-it blocks reuptake of dopaminergic neurons (avoid vasoconstrictors)

42
Q

What is an indication for dextroamphetamine (Dexadrine)?

A

treatment of ADHD-it blocks reuptake of dopamine and norepinephrine (avoid vasoconstrictors)

43
Q

What are the primary indications for dextromethamphetamine (Desoxyn)?

A

ADHD (when other stimulants have failed), narcolepsy (this is the primary use), obesity (short-term use: <6 weeks)

44
Q

What is a selective norepinephrine reuptake inhibitor that is NOT an amphetamine (used to treat ADHD)?

A

atomoxetine (Straterra)-sympathomimetic so use vasoconstrictors with caution

45
Q

Discuss the therapeutic indications of amphetamines.

A

diet pills, energy pills, and for treatment of ADHD

46
Q

Between methamphetamine and cocaine, which produces the longer duration of action?

A

Methampetamine

47
Q

What are some “desireable” effects of amphetamines?

A

sympathomimetic, euphoria, increased energy, alertness, self-confidence

48
Q

What are some characteristics of meth withdrawal?

A

Withdrawal often causes depression which is longer and deeper than that seen from cocaine withdrawal. Relapse is common and there are no comparable drugs to break the addiction like we have for heroin addicts (methadone, naloxone)

49
Q

What are the desired effects of Nicotine?

A

increased alertness, muscle relaxation, facilitation of concentration and memory, decreased appetite

50
Q

What are the harmful effects of Nicotine?

A

irritability, HTN, increased pulse rate, nausea and vomiting, dizziness, coronary artery disease, lung cancer, oral cancer

51
Q

Describe some features of tobacco cessation.

A

It requires behavioral modification (and the person must be ready to quit), people often rquire 5-8 attempts to quit and the use of support groups significantly improves chance for success.

52
Q

What are two forms of nicotine cessation therapy?

A

Nicotine replacement (patches, gum, lozenges) and buproprion (Zyban)

53
Q

What is the difference between Wellbutrin and Zyban?

A

bupropion (Wellbutrin) is indicated medically as an antidepressant. The other version of bupropion (Zyban) is indicated within dentists’ scope of practice for smoking cessation.

54
Q

What are some adverse reactions associated with use of bupropion (Wellbutrin, Zyban)?

A

It causes seizures as a side effect. When used at the same time with a nicotine patch, it causes emergent hypertension (check blood pressure)

55
Q

Discuss dangers of hallucinogens.

A

tolerance develops quickly, long-term use leads to mental disturbances (depression, panic disorders, schizophrenia)

56
Q

What are examples of hallucinogens?

A

Diethylamide (LSD), Phencyclidine (PCP), Mescaline (peyote) and Marijuana

57
Q

Discuss adverse reactions of hallucinogens.

A

Powerful CNS stimulants (adverse CNS effects, delusions, panic, paranoia), Sympathomimetics (adverse cardio effects, dilated pupils and abnormal muscle movement, and muscle rigidity

58
Q

What are two major psychoactive chemicals found in marijuana?

A

Delta-9-tetrahydrocannabinol (THC) and Cannabidionl (CBD)

59
Q

Discuss risks associated with marijuana use.

A

problems with memory and learning, distorted perception, difficulty in thinking and loss of coordination. There is also an increased risk for depression, increased for and earlier onset of schizophrenia and othery psychotic disorders.

60
Q

What are some oral complications of marijuana?

A

xerostomia, gingivitis, leukoplakia, hyperkeratinized tissues

61
Q

What are some complications of chronic marijuana use?

A

chronic bronchitis, precancerous changes in bronchioles

62
Q

Describe dronabinol (Marinol) and its indications for use.

A

synthetic version of THC, schedule III drug approved for nausea and vomiting from chemotherapy (antiemetic properties) and appetitie stimulation in patients with AIDS

63
Q

Discuss dangers of cocaine.

A

potent vasoconstrictor, produces profound sense of euphoria, and produces intense psychological dependency, but no tolerance or withdrawal

64
Q

Discuss adverse reactions of cocaine.

A

CNS stimulation, CV effects, pulmonary, metabolic and nasal complications, death

65
Q

What are the three primary club drugs?

A

Ecstasy, Ketamine, Gamma Hydroxy-Butyrate (GHB). Rohypnol is also considered a predatory drug “date rape” drug

66
Q

flunitrazepam: mechanism of action and description

A

flunitrazepam (Rohypnol) not approved for use in U.S., aka “date rape drug” produces muscle relaxation, amnesia, sedative hypnotic, can be lethal when mixed with alcohol or other depressants

67
Q

sodium oxybate (Xyrem): mechanism of action and description

A

euphoric, sedative, anabolic (body building), CNS depressant (part of the GHB gamma hydroxy-butyrate group)

68
Q

ketamine: mechanism of action and description

A

sedative hypnotic drug, analgesic and hallucinogenic, used as general anesthetic (also in veterinary medicine)

69
Q

Discuss how to manage patients with substance abuse problems who seek drugs from dental health professionals.

A

Be aware of drug “shoppers” and their characteristics, refuse to give meds w/o an examination, document, request photo ID, confirm phone and address, prescribe in limited amounts only, use NSAIDS as often as possible. Watch prescription pads, lock away all controlled substances out of operatories

70
Q

Skin lesions from “crank bugs” are the result of the symptom known as formication caused by use of which drug?

A

Methamphetamine

71
Q

What are some signs of substance abuse in patients addicted to narcotics?

A

Lethargy, drowsiness, euphoria, nausea, constipation, constricted pupils, slowed breathing

72
Q

What are some signs of substance abuse in patients addicted to tobacco?

A

Smelly hair, clothes, and breath; yellowing of teeth; coughs; increased asthma attacks; shortness of breath and poorer athletic performance. After only a few weeks, users of spit tobacco can develop cracked lips, white spots, sores, and bleeding in the mouth.

73
Q

What are some signs of substance abuse in patients addicted to hallucinogens?

A

Trance-like state, excitation, euphoria, increased pulse rate, insomnia, hallucinations

74
Q

What are some signs of substance abuse in patients addicted to alcohol?

A

Slurred speech, dilated pupils, impaired judgment and motor skills, incoordination, confusion, tremors, drowsiness, agitation, nystagmus, nausea and vomiting, respiratory ailments, depression

75
Q

What are some signs of substance abuse in patients addicted to depressants?

A

Drowsiness, confusion, incoordination, tremors, slurred speech, depressed pulse rate, shallow respiration, dilated pupils

76
Q

What are some signs of substance abuse in patients addicted to cocaine/crack cocaine?

A

nasal bleeding/necrosis, dilated pupils, HTN, localized gingival recession, bleeding and alveiolar bone necrosis in maxillary premolar area, Excitability, euphoria, talkativeness, anxiety, increased pulse rate, paranoia, agitation, hallucinations

77
Q

What are some signs of substance abuse in patients addicted to inhalants?

A

Slurred speech, incoordination, nausea, vomiting, slowed breathing

78
Q

What are some signs of substance abuse in patients addicted to marijuana?

A

Mood swings, euphoria, slow thinking and reflexes, dilated pupils, increased appetite, dryness of mouth, increased pulse rate, delusions, hallucinations

79
Q

What are clinical signs of methamphetamine use?

A

dilated pupils, HTN and tachycardia, anorexia, increased sweating (diaphoresis), moodiness, xerostomia, bruxism

80
Q

What are some signs of substance abuse in patients addicted to stimulants?

A

excitability, tremors, insomnia, sweating, dry mouth and lips, bad breath, dilated pupils, weight loss, paranoia, hallucinations

81
Q

What are some oral effects of meth?

A

poor oral hygiene from neglect, caries, periodontal infection, bruxism, xerostomia, tissue damage, oral ulcerations and infections and oral burns (if smoked or snorted)

82
Q

Which drugs are associated with causing the greatest number of medical problems?

A

Alcohol and tobacco-thse drugs cause more medical problems than all other drugs of abuse combined

83
Q

What are signs of acute overdose of CNS stimulants?

A

dilated pupils, HTN and tachycardia, extreme sweating, hyperthermia (leads to brain damage, seizures and even death), hyperactive behavior, tremors

Pharmacology II (13 decks)

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