Drug Abuse/ Drugs of Abuse Flashcards
What is a drug related leading cause of death in WV?
Methadone OD– possible assn. with genetic polymorphisms
Which state has # 1 rate of drug OD deaths?
WV
Which dopaminergic pathway mediates the pleasure response to drug use?
Mesolimbic pathway– increases DA when take drug, decreases baseline DA over time
Which parts of the brain mediate the “craving” element of drug addiction?
- PFC
- Hippocampus
- Hypothalamus* –withdrawal/ negative effects of abuse
Why have prescription drugs become so popular in contrast to street drugs?
Drugs abusers have false perception that they are safer
Which drugs of abuse are important to keep in the differential when diagnosing psychotic patients?
- LSD
- amphetamines also cause psychosis! think meth mites
- cocaine
Opioids: MOA Therapeutic use/ Effects of abuse Presentation of OD 4 factors that complicate OD
Stimulate u/K/D receptors in mesolimbic pathway
Tx: pain
Abuse: euphoria/ dysphoria/ tranquility
OD: Decreased resp. rate, bowel sounds, miosis
Worse OD: hypothermia, coma, seizure, head injury
Emergent treatment of opioid OD:
3 things to do
- Ventilation
- IV/ IM naloxone
- Naloxone bolus if pt does not begin breathing
Three drugs to maintain patients after acute Opioid OD
- Methadone (gold standard)
- Long t 1/2
- No K effect - Buprenorphine (24 HRS OFF OPIOIDS)
- Better binding u and K without activation–will displace and cause acute withdrawal in patient not actively withdrawing - Naltrexone
- PO agonist; prevents relapse
Physical signs of opioid withdrawal (3)
Patient complaints + Drugs to treat them (3)
Signs: 1. Mydriasis 2. ^ bowel sounds (Diarrhea) 3. Hypotension (low blood volume) Complaints: 1. Dysphoria/ restlessness (clonidine) 2. Myalgia/arthralgia/hyperalgesia (NSAIDS, Acetaminophen) 3. N/V/D (Loperamide)
Oxycodone:
Drug class
Metabolism
ROA (Abuse)
Opioid
Longest t1/2 (12 hrs, longest pain reliever on market)
ROA: Swallow, snort, IV
What are two massive complications associated with oxycocone abuse?
- Hepatotoxicity due to combination with acetaminophen
2. Hep C
Heroine:
Drug class
Bioavailability
Largest danger asstd with use*
Opioid
- Best opioid at crossing BBB (>morphine!)
- Often cut with dangerous materials like tylenol PM “cheese”–> hepatotoxic
2 MOAs for all sedatives:
^ GABA signaling
^ endogenous opioid signaling
When are BDZ dangerous in overdose
Combination with other sedatives like ETOH–> respiratory depression
*DO NOT cause resp depression without adjunct sedative
Antidote for BDZ OD?
FLUMAZENIL–use in severe OD cases only, otherwise supportive care
How do we treat abrupt BDZ withdrawal?
What are 5 sx?
IV Diazepam
- Tremor/ anxiety
- perceptual disturbance
- dysphoria
- psychosis
- Seizures
Which BDZ is a date rape drug? Why is it used for this purpose?
FLUNITRAZEPAM–causes amnesia
Why are barbiturates exceptionally dangerous
Independently cause resp depression and death in OD
NO ANTIDOTE
Propopfol:
Therapeutic use
Primary means of abuse
Addictive potential?
- Standard clinical anesthesia for surgery
- Abused by anesthesiologists to take power naps (use not monitored)
- addictive if used long term
Gamma-Hydroxybuterate (GHB, GBH)
- MOA
- Use
Date rape drug
- Causes increase then decrease in DA + ^ release endogenous opioids
- Depresses CNS + Causes amnesia in toxic doses
ETOH:
MOA
^ GABA, ^ Opioid transmission
Two drugs used to treat Alcoholism
- Naltrexone– inhibits opioid stimulation
2. Disulfiram–Increase acetylaldehyde; ^ hangover
Amphetamines:
MOA (3)
How do MOAs differ with dose?
Stimulate CNS: 1. ^ NE, ^DA, ^5HT--- dose dependent 2. Block reuptake ^ NE, ^DA, ^5HT 3. MAOi Dose Dependent effects: Low dose: ^ NE Moderate Dose: ^ NE, ^DA High Dose: ^ NE, ^DA, ^5HT NE --> DA --> 5 HT (DA--nucleus accumbens septi!)
Which Amphetamine is most effective at crossing BBB?
Methamphetamine–highly effective for this reason
Acute effects of amphetamine use and therapeutic application
^ attention, concentration, focus, talkativeness (school)
^ vigilance, wakefulness (truckers)
^ mood, elation, euphoria, self confidence (recreation)
Decrease appetite*
Tx: ADHD
Most abused drug on college campuses?
Amphetamines– specifically methylphenidate (ritalin)
With which psychological disorder might amphetamine abuse be confused and why?
Schizophrenia: chronic use causes paranoia, delusions, hallucinations
(Severe) Adverse effects of amphetamine use on cardio and GI? (2)
- circulatory collapse
2. Anorexia (n/v/d + abdominal cramps)
Two important signs that a patient is on meth and what causes them
- meth mites (phantom itch)
2. meth mouth (low blood flow to gums + neglect hygiene)
Describe to which effects patients develop tolerance with amphetamine use and why this is dangerous
Tolerance develops to mood elevation + euphoria effects faster than toxic CNS effects (convulsions)–> patients take more drug to get pleasure effects,
- Three symptoms of amphetamine withdrawal
- mental depression
- fatigue
- ravenous hunger
How does an amphetamine OD present?
What are three important signs?
Sympathomimetic (CNS stim.)
- Dilated Pupils*
- Tachy–DO NOT GIVE B-BLOCKER!
- HTN
With which drugs can we treat amphetamine OD? (2)
- BDZ = first line
2. Admin antipsychotic if pt does not respond
4 important actions to take in treating amphetamine OD
- ABC’s
- Admin activated charcoal (absorb leftovers)
- Control for seizure
- Modify urine pH (^ excretion)
MDMA:
MOA
Effects
Biggest danger when taking this drug?
^ 5HT release, Blocks 5HT reuptake
^ Euphoria, empathy, pleasure, sexuality “ecstasy”
BIGGEST RISK = DEHYDRATION esp in night clubs (compounds all toxic effects); low margin of safety
Cocaine:
MOA
Therapeutic Use
Effects (abuse)
-Block reuptake NE, DA, 5HT, Na+ Channels
Tx: Nasal/ eye surgery local anesthetic (Na+ channels)
-Effects (abuse): ^ mental awareness, euphoria, self confidence–similar to amphetamine
Describe the prolonged effects of cocaine use on the limbic system
Euphoria–> chronic drug intake–> DA depletion–> Cravings
–*Drug decreases endogenous DA production and causes Anhedonia; abusers have HIGHER threshold for pleasure
2 Most common drugs that cause psychosis?
#1: Meth #2: Cocaine
How does Cocaine effect sympathetic NS?
Potentiates NE: fight or flight syndrome
Cocaethylene: what is it?
- -Active Cocaine metabolite formed when cocaine is taken with ETOH; crosses BBB and is equipotent to cocaine
- -NOTE: All other metabolites of cocaine formed without ETOH are inactive
Describe presentation of cocaine intoxication
Psych?
Cardio?
CNS? (3)
- Delirium, violent bx
- Cardiac failure
- ~Tonic clonic seizures + malignant encephalopathy + stroke due to rapid ^ BP
- * Presents as possible MI but think cocaine in younger pts
How do we treat Cocaine intoxication
Psych?
HTN?
MI?
- BDZ
- NOT BETA BLOCKERS! Give Phentolamine
(a-antagonist) - ASA, Nitroglycerine, Phentolamine for cardiac failure
How do we treat cocaine withdrawal?
Bromocriptine to reduce cravings (DA agonist)
Levamisole:
MOA
Therapeutic use
Why is it important to drug abusers?
- MAOi, COMTi
- Mexican antihelminth; used by cocaine producers to cut product; causes seizures in cocaine abusers
What is Crack?
Free base cocaine; smoke from crack pipe
called crack because causes nasty cracked lips
- **Fun ways to remember that cocaine is rarely abused independent of other drugs!
- ***Definitely on test.
“Baller”–cocaine in your vajayjay
“Five Way”–cocaine+ heroine + meth+ Flutrasepam + ETOH!
“Cocaine + PCP” –Beam me up, Scotty
What three drugs are used to make “bath salts”?
MOA?
Presentation of OD?
How do we treat OD?
- Mephedrone + MDVP + Methylene
- MOA: Similar to amphetamine but not as potent; effects are similar to amphetamine
- M for Make bath salts; all three drugs= M
- OD: presents similar to amphetamine and treated like amphetamine
Khat:
How does intoxication present?
Geographically where is it used?
- Similar effects to amphetamines; withdrawal= similar to amphetamine
- Seen in California; from African plant
Nicotine:
MOA
Therapeutic Use
Recreational Use (effects)
Stimulates then blocks nicotinic cholinergic receptors
MAOi –> ^ DA transmission–> Addiction*
^NE, ^DA
-Tx: tobacco addiction
-Recreational use: euphoria, arousal , concentration, ^ memory, decrease appetite
Where (2) is nicotine metabolized? What is its primary metabolite? How is it excreted?
Why is nicotine dangerous for babies?
Lung, liver
*Cotinine = major metabolite, excreted in urine
Crosses placental barrier; secreted in breast milk
Describe nicotine toxicity
Brain stem depression–> hypotension, resp collapse
Caffeine:
MOA (3)
Therapeutic Use
Recreational Use
- Methylxanthane
1. Translocates extracellular Ca
2. ^ cAMP, ^cGMP (inhibits PDE)
3. Blocks adenosine receptors - Tx: Acute circularity failure, adjuvant analgesic
- Rec: Decreases fatigue and increases mental alertness, causes anxiety and tremor in higher doses
Which population will appear in ED for caffeine intoxication?
How do they present?
Teenagers who drink sports drinks with caffeine: anxiety, tremors
2 Effects of caffeine on the GI system–which patients do we have to council about caffeine intake?
- Diuretic
2. ^ Gastric HCL ***Council patients with gastric ulcers
LSD: MOA Good Trip/ Bad Trip How to treat in ER? How to differentiate a trip from schizophrenia?
Is this considered a drug of abuse?
- 5HT1/2 receptor agonist
- Good Trip = vibrant visual hallucinations + altered mood
- Bad Trip: Hyperreflexia, n/v, muscle weakness, ^BP, ^HR, mydriasis (sympathomimetic)
- Give HALOPERIDOL to reverse*
- Schizophrenia = auditory NOT a drug of abuse
- Get flashbacks after trip
Ketamine:
MOA
Intoxication
- Glutamate antagonist
- Dissociative anesthesia; patient’s don’t feel pain but are still conscious; may see muscle rigidity or ^ BP/HR
Psilobycin, Psilocin
Effects of toxicity (4)
How to treat (2)
Magic Mushrooms
Dilated pupils, Exhilaration, laughter, hallucination , n/v
-Give DIAZEPAM + activated charcoal
Peyote:
MOA
*Unique feature
Mescaline = active agent; effects similar to LSD but not as potent
*Legally used in Native American Church ceremonies
Marijuana: Active metabolite? Effects of use? (3) Tolerance and withdrawal possible? Metabolic features?
*THC
-Euphoria–> drowsiness + relaxation, munchies
Short term memory impairment
Visual hallucination + delusion
Tolerance and withdrawal = possible
*Highly lipophilic–> cross BBB
Dronabinol
Active metabolite?
Therapeutic use
*THC
-Treats nausea and pain in AIDS and cancer pts
Common adjunct to treatment of MS attack in Europe
how can you tell someone is abusing inhalants?
*Look for BURN MARKS on patient’s face because the drugs work like anesthetics and will cause patients who smoke + abuse inhalants to accidentally burn face
Bromocriptine use?
Cocaine withdraw, DA agonist
Teenage patient presents with MI symptoms. What should you consider as a cause?
cocaine intoxication
MDVP + methylene + mephedrone=
bath salts
Haloperidol is first line for reversal of what recreational drug?
LSD
What drug of abuse may present with tonic-clonic seizures and encephalopathy?
cocaine
What common drug can be used to treat circulatory collapse?
caffeine
