Drugs Flashcards
How does dopamine activity look in patients recovering from cocaine addiction?
- drop in neuronal activity and decreased dopamine activity which can persist for up to a year and half after stopping the drug
What pathway of dopaminergic neurons is thought be be highly involved in the sense of reward one gets from cocaine use ?
the mesolimbic pathway of dopaminergic neurons starting at the ventral tegmental area and projecting to the nucleus accumbens
What part of the brainstem contains high number of adrenergic neurons and mediates the effects of opiates?
Locus ceruleus
How long does PCP, cannabis, cocaine, and heroin stay in urine?
PCP-8 days
Cannabis-4 weeks
Cocaine-8 hours
Heroin-72 hours
Are depressed reflexes seen in inhalant intoxication
yes
signs of inhalant intoxication
assaultiveness, impaired judgement, dizziness, slurred speech, ataxia, tremor, blurred vision, stupor , coma
can cause persistent irreversible dementia
How does LSD affect serotonin receptors?
Partial agonist at post synaptic serotonin receptors
- alters postsynaptic serotonin binding
Physical effects MDMA (methylenedioxyamphetamine)
-fever, headache, cyanosis, vomiting (leading to dehydration), SOB, ataxia, tremor
MI, severe hypertension, ischemic colitis
Physical signs of ketamine
nystagmus, hypertension, ataxia, dysarthria, muscle rigidity
What is diacetylmorphine
heroin
What do pupils look like on heroin?
Pinpoint
What is the most common neurologic manifestation of chronic alcoholism?
alcoholic neuropathy
How does alcoholic dementia differ from Alzheimers?
Predominance of fine motor control and verbal deficits
Marchiafava-bignami
rare demyelinating disease affecting corpus callosum in chronic alcoholics
alcoholic nutritional cerebellar degeneration
more in men than women, unsteadiness in walking evolving over weeks to months
- trucal ataxia, with wide based gait and difficulty with tandem walking
PCP
NMDA receptor antagonist (subtype of the glutamate receptor)
- has calcium channel binding properties and prevents influx of calcium into neurons
Pinpoint pupils are a feature of what?
opioid intoxication
What is the most widely abused recreational drug among US high school students?
marijuana
- demonstarted to lead to future cocaine abuse in adolescents
cocaine causes what effect on dopamine
cocaine causes dop and norepinephrine reuptake inhibition
- increases dopamine in the mesolimbic and mesocortical pathways as well as the corpus striatum
what are sequelae of cocaine use?
hallucinations, paranoia, euphoria, increased energy, hypersexuality, and irritability
- with heavy use pts can experience a shower of lights in their central vision, as well as vivual hallucinations of black dots on their skin and in the environment
cocaine overdose treatment
- cold blankets and ice for hyeprtermia
- IV diazepam for seizures
- IV phentolamine for malignant hypertension
- haldol and lorazepam for agitation
sniffling glue, benzene, gasoline, paint thinner, lighter fluid, and aerosols
slurred speech, ataxia, hallucinations, tachy, ventricular fibrillation, liver damage, permanent brain damage, kidney damage, myocardial damage
inhalants
neuropathy
- distal motor weakness
cocaine
lowers seizure threshold
strokes
opioid intoxication does what to the pupils
pupillary constriction
have some studies shown that the efficacy of using carbamazepine in the treatment of alcohol withdrawal to be equal to benzos?
yes
PCP activates ventral tegmental dopamine what does this result in?
the reinforcing qualities of the drug
wernicke’s encephalopathy
acute neurological disorder characterized by ataxia, confusion, vestibular dysfunction and eye movement impairment
- reversible w/ treatment but if progresses to Korsakoff’s may be irreversible
korsakoff’s
impaired recent memory and anterograde amnesia
ecstacy
designer amphetamine that acts through both the dopaminergic and serotonergic systems
chronic alcoholism brain changes
cerebellar atrophy- truncal ataxia- preferential involvment in vermis
Do women have less alcohol dehydrogenase in their gut?
yes
how does MDMA work
blocking the repuptake of serotonin and inducing the massive release of serotonin contents of serotonergic neurons
How long should IV thiamine and dextrose be given for alcohol withdrawal symptoms
3 days then switch to oral thiamine
What drugs can cause nystagmus
pcp
inhalants
sedative hypnotics
alcohol
what should you avoid in cocaine induced hypertension
b- blockers (metroprolol)and combined alpha beta blocks (labetolol)
matrix therapy
for substance abuse
- relapse prevention groups, education groups, social support groups, indivisual counseling, and urine and breath testing delieverd in a structed mannor over 16 week period
methylenedioxymethamphetamine (ecstacy)
hyperthermic syndrome that can progress to disseminated intravascular coagulation, rhabdomyolysis, liver and kidney failure and death
-not dose related
how long after narcotic and the first dose of naltrexone
5 days from short acting narcotic and 10 days if long acting narcotic
how long after stopping alcohol can you take disulfiram
12 hours
at what dose is methadone thought to be most effective for opioid relapse prevention
at or above 60mg
how do you dose disulfiram
500mg daily for first 1-2 weeks then lowered to 250mg daily
how does buprenorphine work at the mew opiate receptor
agonist and antagonist
what can abrupt discontinuation of cannabis look like
insomnia, irritability, drug craving, restlessness, depressed mood, nervousness anxiety, nause, tremors, muscle twitches, sweating, myalgia, malaise
begins 24 hours after last use
peaks 2-4 days
diminishes after about 2 weeks
fetal alcohol syndrome
- perinatal growth deficiency
- mental retardation
- microcephaly
- wide set eyes
- flattened philtrum
- thin upper lip
- small palpebral fissures
fetal alcohol syndrome
- perinatal growth deficiency
- mental retardation
- microcephaly
- wide set eyes
- flattened philtrum
- thin upper lip
- small palpebral fissures
stimulant medical issues
cerbrovascular incidents, hemorrhagic stroke, cardiac dysrythmia, pneumonitis, pulmonary hemorrhage, pulmonary edema, right heart failure, pancreatic hemorrhage, mesenteric ischemia,a and acute renal failure and myoglobinuria
skin picking and missing teeth
meth
how does meth work?
cause monoamines to be released from storage vesicles into the cytoplasm
disruption of glutamate and serotonin
how does cocaine work
block re-uptake of monamine transporters and causes inverse agonism of the dopamine transporter which leads to an increase in dopamine activity
-imbalance in glutamate system
