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Neuro-Psych Exam II > Drug Abuse/ Drugs of Abuse > Flashcards

Drug Abuse/ Drugs of Abuse Flashcards

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1
Q

What is a drug related leading cause of death in WV?

A

Methadone OD– possible assn. with genetic polymorphisms

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2
Q

Which state has # 1 rate of drug OD deaths?

A

WV

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3
Q

Which dopaminergic pathway mediates the pleasure response to drug use?

A

Mesolimbic pathway– increases DA when take drug, decreases baseline DA over time

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4
Q

Which parts of the brain mediate the “craving” element of drug addiction?

A
  1. PFC
  2. Hippocampus
  3. Hypothalamus* –withdrawal/ negative effects of abuse
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5
Q

Why have prescription drugs become so popular in contrast to street drugs?

A

Drugs abusers have false perception that they are safer

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6
Q

Which drugs of abuse are important to keep in the differential when diagnosing psychotic patients?

A
  • LSD
  • amphetamines also cause psychosis! think meth mites
  • cocaine
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7
Q 
Opioids: 
MOA 
Therapeutic use/ Effects of abuse 
Presentation of OD
4 factors that complicate OD
A

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

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8
Q

Emergent treatment of opioid OD:

3 things to do

A
  1. Ventilation
  2. IV/ IM naloxone
  3. Naloxone bolus if pt does not begin breathing
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9
Q

Three drugs to maintain patients after acute Opioid OD

A
  1. Methadone (gold standard)
    - Long t 1/2
    - No K effect
  2. Buprenorphine (24 HRS OFF OPIOIDS)
    - Better binding u and K without activation–will displace and cause acute withdrawal in patient not actively withdrawing
  3. Naltrexone
    - PO agonist; prevents relapse
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10
Q

Physical signs of opioid withdrawal (3)

Patient complaints + Drugs to treat them (3)

A 
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)
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11
Q

Oxycodone:
Drug class
Metabolism
ROA (Abuse)

A

Opioid
Longest t1/2 (12 hrs, longest pain reliever on market)

ROA: Swallow, snort, IV

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12
Q

What are two massive complications associated with oxycocone abuse?

A
  1. Hepatotoxicity due to combination with acetaminophen

2. Hep C

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13
Q

Heroine:
Drug class
Bioavailability
Largest danger asstd with use*

A

Opioid

  • Best opioid at crossing BBB (>morphine!)
  • Often cut with dangerous materials like tylenol PM “cheese”–> hepatotoxic
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14
Q

2 MOAs for all sedatives:

A

^ GABA signaling

^ endogenous opioid signaling

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15
Q

When are BDZ dangerous in overdose

A

Combination with other sedatives like ETOH–> respiratory depression

*DO NOT cause resp depression without adjunct sedative

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16
Q

Antidote for BDZ OD?

A

FLUMAZENIL–use in severe OD cases only, otherwise supportive care

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17
Q

How do we treat abrupt BDZ withdrawal?

What are 5 sx?

A

IV Diazepam

  1. Tremor/ anxiety
  2. perceptual disturbance
  3. dysphoria
  4. psychosis
  5. Seizures
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18
Q

Which BDZ is a date rape drug? Why is it used for this purpose?

A

FLUNITRAZEPAM–causes amnesia

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19
Q

Why are barbiturates exceptionally dangerous

A

Independently cause resp depression and death in OD

NO ANTIDOTE

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20
Q

Propopfol:
Therapeutic use
Primary means of abuse
Addictive potential?

A
  • Standard clinical anesthesia for surgery
  • Abused by anesthesiologists to take power naps (use not monitored)
  • addictive if used long term
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21
Q

Gamma-Hydroxybuterate (GHB, GBH)

  • MOA
  • Use
A

Date rape drug

  • Causes increase then decrease in DA + ^ release endogenous opioids
  • Depresses CNS + Causes amnesia in toxic doses
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22
Q

ETOH:

MOA

A

^ GABA, ^ Opioid transmission

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23
Q

Two drugs used to treat Alcoholism

A
  1. Naltrexone– inhibits opioid stimulation

2. Disulfiram–Increase acetylaldehyde; ^ hangover

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24
Q

Amphetamines:
MOA (3)
How do MOAs differ with dose?

A 
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!)
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25
Q

Which Amphetamine is most effective at crossing BBB?

A

Methamphetamine–highly effective for this reason

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26
Q

Acute effects of amphetamine use and therapeutic application

A

^ attention, concentration, focus, talkativeness (school)
^ vigilance, wakefulness (truckers)
^ mood, elation, euphoria, self confidence (recreation)
Decrease appetite*

Tx: ADHD

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27
Q

Most abused drug on college campuses?

A

Amphetamines– specifically methylphenidate (ritalin)

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28
Q

With which psychological disorder might amphetamine abuse be confused and why?

A

Schizophrenia: chronic use causes paranoia, delusions, hallucinations

29
Q

(Severe) Adverse effects of amphetamine use on cardio and GI? (2)

A
  1. circulatory collapse

2. Anorexia (n/v/d + abdominal cramps)

30
Q

Two important signs that a patient is on meth and what causes them

A
  1. meth mites (phantom itch)

2. meth mouth (low blood flow to gums + neglect hygiene)

31
Q

Describe to which effects patients develop tolerance with amphetamine use and why this is dangerous

A

Tolerance develops to mood elevation + euphoria effects faster than toxic CNS effects (convulsions)–> patients take more drug to get pleasure effects,

32
Q
  • Three symptoms of amphetamine withdrawal
A
  1. mental depression
  2. fatigue
  3. ravenous hunger
33
Q

How does an amphetamine OD present?

What are three important signs?

A

Sympathomimetic (CNS stim.)

  1. Dilated Pupils*
  2. Tachy–DO NOT GIVE B-BLOCKER!
  3. HTN
34
Q

With which drugs can we treat amphetamine OD? (2)

A
  1. BDZ = first line

2. Admin antipsychotic if pt does not respond

35
Q

4 important actions to take in treating amphetamine OD

A
  1. ABC’s
  2. Admin activated charcoal (absorb leftovers)
  3. Control for seizure
  4. Modify urine pH (^ excretion)
36
Q

MDMA:
MOA
Effects
Biggest danger when taking this drug?

A

^ 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

37
Q

Cocaine:
MOA
Therapeutic Use
Effects (abuse)

A

-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

38
Q

Describe the prolonged effects of cocaine use on the limbic system

A

Euphoria–> chronic drug intake–> DA depletion–> Cravings

–*Drug decreases endogenous DA production and causes Anhedonia; abusers have HIGHER threshold for pleasure

39
Q

2 Most common drugs that cause psychosis?

A 
#1: Meth 
#2: Cocaine
40
Q

How does Cocaine effect sympathetic NS?

A

Potentiates NE: fight or flight syndrome

41
Q

Cocaethylene: what is it?

A
  • -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
42
Q

Describe presentation of cocaine intoxication
Psych?
Cardio?
CNS? (3)

A
  1. Delirium, violent bx
  2. Cardiac failure
  3. ~Tonic clonic seizures + malignant encephalopathy + stroke due to rapid ^ BP
    - * Presents as possible MI but think cocaine in younger pts
43
Q

How do we treat Cocaine intoxication
Psych?
HTN?
MI?

A
  1. BDZ
  2. NOT BETA BLOCKERS! Give Phentolamine
    (a-antagonist)
  3. ASA, Nitroglycerine, Phentolamine for cardiac failure
44
Q

How do we treat cocaine withdrawal?

A

Bromocriptine to reduce cravings (DA agonist)

45
Q

Levamisole:
MOA
Therapeutic use
Why is it important to drug abusers?

A
  • MAOi, COMTi

- Mexican antihelminth; used by cocaine producers to cut product; causes seizures in cocaine abusers

46
Q

What is Crack?

A

Free base cocaine; smoke from crack pipe

called crack because causes nasty cracked lips

47
Q
  • **Fun ways to remember that cocaine is rarely abused independent of other drugs!
  • ***Definitely on test.
A

“Baller”–cocaine in your vajayjay
“Five Way”–cocaine+ heroine + meth+ Flutrasepam + ETOH!
“Cocaine + PCP” –Beam me up, Scotty

48
Q

What three drugs are used to make “bath salts”?
MOA?
Presentation of OD?
How do we treat OD?

A
  • 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
49
Q

Khat:
How does intoxication present?
Geographically where is it used?

A
  • Similar effects to amphetamines; withdrawal= similar to amphetamine
  • Seen in California; from African plant
50
Q

Nicotine:
MOA
Therapeutic Use
Recreational Use (effects)

A

Stimulates then blocks nicotinic cholinergic receptors
MAOi –> ^ DA transmission–> Addiction*
^NE, ^DA
-Tx: tobacco addiction
-Recreational use: euphoria, arousal , concentration, ^ memory, decrease appetite

51
Q

Where (2) is nicotine metabolized? What is its primary metabolite? How is it excreted?

Why is nicotine dangerous for babies?

A

Lung, liver
*Cotinine = major metabolite, excreted in urine
Crosses placental barrier; secreted in breast milk

52
Q

Describe nicotine toxicity

A

Brain stem depression–> hypotension, resp collapse

53
Q

Caffeine:
MOA (3)
Therapeutic Use
Recreational Use

A
  • 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
54
Q

Which population will appear in ED for caffeine intoxication?
How do they present?

A

Teenagers who drink sports drinks with caffeine: anxiety, tremors

55
Q

2 Effects of caffeine on the GI system–which patients do we have to council about caffeine intake?

A
  1. Diuretic

2. ^ Gastric HCL ***Council patients with gastric ulcers

56
Q 
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?

A
  • 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
57
Q

Ketamine:
MOA
Intoxication

A
  • Glutamate antagonist

- Dissociative anesthesia; patient’s don’t feel pain but are still conscious; may see muscle rigidity or ^ BP/HR

58
Q

Psilobycin, Psilocin
Effects of toxicity (4)
How to treat (2)

A

Magic Mushrooms
Dilated pupils, Exhilaration, laughter, hallucination , n/v
-Give DIAZEPAM + activated charcoal

59
Q

Peyote:
MOA
*Unique feature

A

Mescaline = active agent; effects similar to LSD but not as potent
*Legally used in Native American Church ceremonies

60
Q 
Marijuana: 
Active metabolite? 
Effects of use? (3)
Tolerance and withdrawal possible? 
Metabolic features?
A

*THC
-Euphoria–> drowsiness + relaxation, munchies
Short term memory impairment
Visual hallucination + delusion
Tolerance and withdrawal = possible
*Highly lipophilic–> cross BBB

61
Q

Dronabinol
Active metabolite?
Therapeutic use

A

*THC
-Treats nausea and pain in AIDS and cancer pts
Common adjunct to treatment of MS attack in Europe

62
Q

how can you tell someone is abusing inhalants?

A

*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

63
Q

Bromocriptine use?

A

Cocaine withdraw, DA agonist

64
Q

Teenage patient presents with MI symptoms. What should you consider as a cause?

A

cocaine intoxication

65
Q

MDVP + methylene + mephedrone=

A

bath salts

66
Q

Haloperidol is first line for reversal of what recreational drug?

A

LSD

67
Q

What drug of abuse may present with tonic-clonic seizures and encephalopathy?

A

cocaine

68
Q

What common drug can be used to treat circulatory collapse?

A

caffeine

Neuro-Psych Exam II (11 decks)

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