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Pharmacology > Drug abuse and dependence > Flashcards

Drug abuse and dependence Flashcards

1
Q

What professionals are required for the management of drug abuse and dependence?

A

Social scientists

Psychologists

Pharmacologists

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2
Q

Why is drug dependence important?

A

It is a global burden with high social cost

100 million people affected

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3
Q

What is substance dependence?

A

A state in which an organism functions normally only in the presence of a drug

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4
Q

Symptoms of psychological dependence

A

Craving

Compulsive seeking behaviour

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5
Q

Symptoms of physical dependence

A

Withdrawal upon cessation of drug use

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6
Q

Examples of harm caused by recreational drug use

A

Overdose

Direct physical damage

Inappropriate behaviour

Drift into criminal subculture

Self-neglect

Spread of disease

Exposure to unknown substance

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7
Q

Example of direct physical damage caused by drug use

A

Liver cirrhosis

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8
Q

Example of inappropriate behaviour caused by drug use

A

Driving while drunk

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9
Q

Why do drug abusers often show self-neglect?

A

They’re pleasure comes solely from a drug

So there is no need to find pleasure anywhere else

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10
Q

How do drug users get exposed to unknown substances?

A

Drugs are often laced with dangerous impurities

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11
Q

Characteristics of drug dependence

A

Psychological dependence - craving, compulsive drug-seeking behaviour

Physical dependence - tolerance associated with withdrawal syndrome

Tolerance - the need to increase dose to maintain the desired effect

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12
Q

What is the Misuse of Drugs Act?

A

Drugs are categorised A-C reflecting their addictive and harmful power

Their unauthorised possession is a criminal offence

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13
Q

Examples of class A drugs

A

Heroin

Cocaine

LSD

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14
Q

Examples of class B drugs

A

Amphetamine

Cannabis

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15
Q

Examples of class C drugs

A

Tranquilisers

Some pain killers

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16
Q

Length of criminal offence for each class of drug

A

Class A
Possession: 7 years
Dealing: up to life

Class B
Possession: 5 years
Dealing : 14 years

Class C
Possession: 2 years
Dealing: 14 years

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17
Q

What happened under prohibition in 1910-1930

A

Alcohol was banned

This lead to a rise in gang, crimes and cirrhosis

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18
Q

What did a rat study show about addiction?

A

Persistence in drug-seeking behaviour - forget to eat and only push the lever

Resistance to punishment - push the lever even when this is coupled with electrical shock

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19
Q

Where in the brain is the rewards system found?

A

Mesolimbic and mesocortical parts

Midbrain-forebrain bundle formed by dopaminergic neurons

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20
Q

What happens normally in the midbrain-forebrain bundle?

A

Dopaminergic neurons release dopamine from their synaptic terminus, leading to pleasure

A modulatory system controls this pathway through negative feedback

They do this through the release of dynorphins, pre-synaptic inhibitory modulators of dopaminergic neurons

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21
Q

What happens in the brain following drug addiction?

A

The pleasure system is constantly activated

Along with dopamine and dynorphin, Delta-fos-b (TF) is also released with the stimulation of pleasure center

The build up of delta-fosb transcription factors inhibit the dynorphin production and therefore causes the pleasure pathway to become overactivated

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22
Q

Why is the brain of an addict changed?

A

Plasticity of the brain

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23
Q

What mechanisms induce tolerance to a drug?

A

Increase in enzyme production of pathway that is inhibited

Downregulation of receptors

Receptor desensitisation

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24
Q

Classes of drugs abused for their central effects

A

Opioids

Stimulants

Anxiolytics

Depressants

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25
Q

Where is cocaine derived from?

A

Erythroxylon coca plant

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26
Q

Mechanism of action of cocaine

A

Inhibits reuptake of dopamine by neurons through dopamine transporter inhibition

Inhibits sodium channels

27
Q

Mechanism of action of ethanol

A

Activates GABA-gated chloride channels

Enhances chloride influx

Causing hyperpolarization

Also inhibits NMDA receptors and voltage gated Ca2+ channels

28
Q

How does ethanol stimulate the reward center?

A

Inhibition of the inhibitory input

29
Q

Symptoms of ethanol abstinence

A

Tremors

Nausea

Sweating

Hallucinations

Aggressiveness

30
Q

Unwanted effects of ethanol use

A

Motor incoordination

Feminisation of men due to reduced testosterone levels

Dementia

Liver disease

Fetal alcohol syndrome

31
Q

Mechanism of action of nicotine

A

Desensitisation of central nicotinic acetylcholine receptors

Long term use = large increase in the number of nicotinic receptors in the CNS

32
Q

How is tolerance observed in nicotine addiction?

A

Normally tolerance is correlated with a decrease in receptor density

Paradoxical increase in receptor number is likely because of the high proportion of receptors being in the desensitised state

33
Q

What are three ways to treat alcoholism?

A

Opioid antagonists such as Naloxone

Aversion therapy

Behavioural aspects of the addiction

34
Q

Describe aversion therapy

A

Disulfiram is used to make the alcohol taste badly

Inhibits one of the metabolic mechanisms using aldehyde dehydrogenase

Acetylaldehyde builds up as a response and causes a toxic bad feeling

35
Q

Why do alcoholics most often die?

A

Vitamin B1 deficiency due to malnutrition

Which leads to encephalopathy and coma

36
Q

Where are cannabinoids found?

A

Derived from cannabis sativa

Endocannabinoids are found naturally in the body

37
Q

What are the two active component of cannabinoids?

A

Tetrahydrocannabinol

Cannabidiol

38
Q

Components of the endocannabinoid system

A

Endogenous THC-like substances

At least two types of receptors

Enzymes that synthesize ECs

Systems that transport ECs into and out of cells

Enzymes that degrade ECs

39
Q

What is the effect of the endocannabinoid system in the body?

A

Endocannabinoids are involved in many physiological functions and pathological states involving most of the systems of the body

40
Q

Which receptors does THC interact with?

A

CB1

CB2

41
Q

Which receptors does CBD interact with?

A

CB1

CB2

Weakly*

42
Q

Where are CB1 receptors found?

A

Neurons

43
Q

Where are CB2 receptors found?

A

Immune system

C-fibres

44
Q

How are endocannabinoids made?

A

By demand

Through enzymatic cleavage of membrane lipid precursors

45
Q

What is the effect of endocannabinoids on pre-synaptic neurons?

A

Endocannabinoids are made in the post-synaptic neuron and act on the pre-synaptic neuron to inhibit the release of the neurotransmitter

46
Q

Which type of neurons do endocannabinoids act on?

A

GABAergic

Glutamatergic

47
Q

How do endocannabinoids affect the inflammatory cells?

A

Autocrine mediators

Inhibits the production of inflammatory mediators via CB receptors

48
Q

What is the main endogenous cannabinoid?

A

Anandamide

It is an arachidonic acid derivative

49
Q

What type of receptors are CB receptors?

A

G-protein coupled

Gi

50
Q

Main sites of function of CB1 receptors

A

Association regions of the cerebral cortex

Hippocampus

Cerebellum

Hypothalamus

51
Q

Which cells primarily express CB2 receptors?

A

Leukocytes

52
Q

Effects of the CB1 receptor

A

Higher brain function

Increases appetite

Inhibits nausea and vomiting

Modulate muscle contraction

53
Q

Effects of the CB2 receptor

A

Inhibition of macrophages

Inhibition of T cell activation

54
Q

Difference between THC and CBD

A

THC binds strongly to CB receptors

CBD has weak interactions, does not cause euphoria and reduces anxiety probably by activation of 5HT1A receptors

55
Q

Medical uses of THC and CBD

A

Patients with multiple sclerosis-related muscle spasticity

Adults with vomiting or nausea caused by chemotherapy

Children and adults with rare, severe, untreated forms of epilepsy

56
Q

Main unwanted effect of Cannabinoids

A

Increase schizophrenia rates in children

57
Q

Diseases targeted by CB1 agonists

A

MS

PD

Cancer

Chemotherapy-induced nausea

Glaucoma

58
Q

Diseases targeted by CB1 antagonists

A

Obesity

Alcoholism

Smoking

59
Q

Diseases targeted by CB2 agonists

A

Inflammatory conditions

60
Q

5 main categories of drugs

A

Cannabinoids - relaxation, euphoria

Opioids - euphoria

Hallucinogens - altered perception

Depressants - release of inhibition, sedation

Stimulants - increased alertness

61
Q

Examples of depressants

A

Ethanol

Benzodiazepine

62
Q

Examples of stimulants

A

Amphetamines

Cocaine

Nicotine

63
Q

Examples of hallucinogens

A

LSD

Psilocybin

64
Q

Why are opioids particulalry dangerous?

A

High addiction rates due to causing both euphoria and depressant action

Pharmacology (13 decks)

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