Drug of Abuse Flashcards
Opioids (name some)
Heroin Morphine Fentanyl Oxycodone Hydrocodone
Opioids (mechanism)
u-opioid agonists
Opioids (reinforcing effects)
euphoria
sedation
Opioids (acute toxicity symptoms and treatment)
RESPIRATORY DEPRESSION
Miosis
COMA
Death, arrhythmias, convulsions are possible
Treatment: Naloxone (IV/SC)
Opioids (tolerance)
Develops rapidly
Does NOT develop to constipation or miosis
Opioids (Dependence)
Develops rapidly (3-4 doses/day x 1-2 weeks)
Opioids (Withdrawl)
Rarely life-threatening
Irritability, insomnia, increased BP, increased HR, cramps, diarrhea,
Treatment: clonidine (decrease SNS signs), methadone
Relapse: buprenorphine +/- naloxone, naltrexone
Ethanol (Mechanism)
CNS depressant
Facilitate GABA function
Inhibit GLU-NMDA fxn
Ethanol (reinforcing effects)
Anxiolysis, sedation, loss of inhibition
Ethanol (acute toxicity symptoms and treatment)
RESPIRATORY depression
COMA
Death
Treatment: Supportive plus fluids, thiamine, electrolytes
Ethanol (tolerance)
Moderately rapid
Tolerance to sedation-intoxication, less to lethal dose
Ethanol (Dependence)
YES
Within weeks
Ethanol (Withdrawl- treatment and relapse treatment)
Significant risk of mortality due to seizures
Visual hallucination
Delirium tremens
Treatment: BDZ (flumazenil)
Relapse: acamprosate, naltrexone, disulfiram
Benzodiazepines (mechanism)
CNS depressant
Facilitate GABA fxn
Benzodiazepines (reinforcing effects)
anxiolysis
sedation
loss of inhibition
Benzodiazepines (acute toxicity symptoms and treatment)
Lethality rare, unless combined with other CNS depressants
Treatment: Flumazenil
Benzodiazepines (tolerance)
Less than with ethanol
Benzodiazepines (dependence)
Harder to become dependent than with ethanol but still possible
Benzodiazepines (Withdrawl- treatment and relapse treatment)
Yes, can have seizures
Dose taper may require months
Treatment:
Busiprone is used for anxiety
Carbamazepine, phenobarbital are used as anticonvulsants
Barbiturates (mechanism of action)
CNS Depressant
Facilitate GABA fxn
Inhibit GLU-AMPA fxn
Barbiturates (Reinforcing effects)
anxiolysis
Sedation
Loss of inhibition
Barbiturates (acute toxicity signs and treatment)
Respiratory depression
Coma
Death
Treatment: supportive
Barbiturates (tolerance)
Very rapid
Significant tolerance to sedation-intoxication but less to lethal dose
Barbiturates (dependence)
YES
within weeks
Barbiturates (withdrawl)
Risk of mortality due to seizures
Treatment:
Busiprone is used for anxiety
Carbamazepine, phenobarbital are used as anticonvulsants
Cocaine (machanism)
CNS stimulant
Inhibits monoamine reuptake transporters
Cocaine (reinforcing effects)
euphoria
Decreased fatigue
increased arousal and confidence
appetite suppression
Cocaine (acute toxicity- signs and treatment)
SNS overactivity Increased HR, BP, body temp Chest pain Arrhythmias MI Paranoid psychosis
Treatment:
CV support
Vaodilators for BP
BDZs for agitation/seizures
Cocaine (tolerance)
Tolerance to euphoria, anorexia, hyperthermia
Supersensitivity to paranoia
Cocaine (dependence)
Arguable
Lack of physiological symptoms
Cocaine (withdrawl- symptoms and treatment)
Generally mild
sleepiness, fatigue, depression, hyperphagia, craving
Treatment: largely behavioral
Amphetamine, methylphenidate, methamphetamine (mechanism)
CNS stimulants
Stimulate monoamine release
Amphetamine, methylphenidate, methamphetamine (reinforcing effects)
euphoria
Decreased fatigue
increased arousal and confidence
appetite suppression
Amphetamine, methylphenidate, methamphetamine (acute toxicity- signs and treatment)
SNS overactivity Increased HR, BP, body temp Chest pain Arrhythmias MI Paranoid psychosis
Treatment:
CV support
Vaodilators for BP
BDZs for agitation/seizures
Amphetamine, methylphenidate, methamphetamine (Tolerance)
Tolerance to euphoria, anorexia, hyperthermia
Supersensitivity to paranoia
Amphetamine, methylphenidate, methamphetamine (Dependence)
Arguable
Lack of physiological symptoms
Amphetamine, methylphenidate, methamphetamine (Withdrawl- symptoms and treatment)
Generally mild
sleepiness, fatigue, depression, hyperphagia, craving
Treatment: largely behavioral
Nicotine (mechanism)
CNS stimulant
Nicotinic cholinergic receptor agonist
Nicotine (reinforcing effects)
Milder stimulant than amphetamines
increased alertness
Nicotine (acute toxicity- signs and treatment)
rare, unless ingestion of insecticide or tobacco products by children
n/v, diarrhea, weakness, CVP collapse, convulsions
Treatment: CVP support, emetics, gastric lavage, charcoal
Nicotine (tolerance)
Tolerance to subjective effects and nausea
Nicotine (dependence)
moderate development
Nicotine (withdrawl- symptoms and treatment)
irritability, hostility, anxiety, increased appetite, weight gain
Relapse: nicotine replacement, bupropion, varenicline
Indoleamines (name some!)
LSD
Psilocybin
Bufotenine
Indoleamines (mechanism)
Hallucinogen
Partial agonist at 5HT-2 serotonin receptors
Indoleamines (reinforcing effects)
altered sensory perception, hallucinations, intense arousal, mood elevation
Indoleamines (acute toxicity- symptoms and treatment)
“bad trip”
severe anxiety
intense depression
visual disturbances
treatment:
“talking down”, BDZ for severe agitation
Indoleamines (tolerance)
not common since repeated use unusual
Indoleamines (dependence)
NO
no abstinence syndrome
Indoleamines (withdrawl)
not known but “flashbacks” seen in some former users (hallucinogenic persisting perception disorder)
Phenylethylamines (name some!)
MDMA
Mescaline
Phenylethylamines (mechanism)
Hallucinogen
Partial agonist at 5HT-2 plus DA releasing actions
Phenylethylamines (reinforcing effects)
pleasant sensory experience with enhanced perception, enhanced insight and self-knowledge
Phenylethylamines (acute toxicity)
visual hallucinations, agitation, hyperthermia, increased ADH can lead to hyponatremia
Phenylethylamines (tolerance)
not common since repeated use unusual
Phenylethylamines (dependence)
NO
no abstinence syndrome
Phenylethylamines (withdrawl)
not known but “flashbacks” seen in some former users (hallucinogenic persisting perception disorder)
Dissociative anesthetics (name some!)
Phencyclidine
Ketamine
Nitrous oxide
Dextromethorphan
Dissociative anesthetics (mechanism)
antagonist at GLU-NMDA receptors
Dissociative anesthetics (reinforcing effects)
euphoria and heightened emotionality (low dose)
misperceptions, unreality (intermediate dose)
Dissociative anesthetics (acute toxicity- signs and treatment)
delirium, increased RR, HR, BP, and body temp
Muscle rigidity
agitation
violent behavior
Treatment: supportive via control of BP, hyperthermia, agitation (with BDZ or antipsychotics)
Dissociative anesthetics (tolerance)
not well studied
Dissociative anesthetics (dependence)
probably not
Dissociative anesthetics (withdrawl)
not observed
Marijuana (mechanism)
Cannabinoid
agonist at cannabinoid receptors
Marijuana (reinforcing effects)
euphoria, “mellowness”, changes in perception, mood, motivation
Marijuana (acute toxicity)
minimal, possible anxiety, impaired coordination and tracking behavior
acute psychosis
Marijuana (tolerance)
Develops rapidly to most effects
Disappears rapidly too
Marijuana (dependence)
abuse potential is moderate
10% of chronic users become addicted
Marijuana (withdrawl)
not clinically significant due to long t1/2
Mild symptoms following chronic high doses (malaise, headache, anxiety, nausea)
