Drugs of Abuse Flashcards
Order of abuse
tolerance, dependence, addiction
What is tolerance
drug effect is progressively reduced
secondary to repeated exposure
is reversible
-often seen in opioid, nitrates, etc
What is dependence
body requires the drug to function normally
occurs with chronic exposure
desensitization
risk of some degree of misuse
-often in opioids, barbiturates, benzos, etc
What is addiction
compulsive, uncontrolled drug seeking behavior
negative behavior/consequences
learning and memory systems affected
What neurotransmitter is involved in reinforcing “constructive” behavioral adaptation
Dopamine
areas of brain affected
ventral tegmental area
nucleus accumbens
Schedule 1 drugs include
heroin, MDMA, LSD, Marijuana, Gamma hydroxybutyrate, morpheridine, etc, etc
Schedule 2 opiates include
morphine, narcotics, oxycodone, fentanyl….
Schedule 2 stimulants include
dextroamphetamine, methylphenidate (ritalin)
Schedule 2 depressants include
secobarbital, pentobarbital, glutethimide
Schedule 3 categories include
Stimulants
Depressants
Opioid Combinations
+anabolic steroids, and marijuana derivatives
Schedule 4 categories include
Depressants: Benzos
Stimulants: Modafinil, phentermine
Analgesics: butorphanos, pentazocine
Schedule 5 categories include
Opiates: codeine-containing cough “syrup”
Antiseizure meds: pregabalin, ezogabine, lacosamide
~herbal- ephedrine products
Do opioids have a ceiling dose?
No, toxic doses vary too
Presentation: Lethargy “pinpoint” pupils Blood pressure/pulse rate depressed Bowel sounds diminished Flaccid muscles
Opioid OD (mild to moderate)
severe= coma, respiratory depression
Benzodiazepines frequently abused include
Xanax- alprazolam Librium- cloridiazepoxide klonopin- clonazepam tranxene-T- clorazepate valium- diazepam Ativan- lorazepma oxazepam
How to treat opioid OD
Airway management O2
Naloxone 200-400mcg IV/IM q2-3m
(larger doses have been used)
Are benzodiazepines lethal by themselves?
No, but in combination can be
Dependence withdrawals can be horrible though
Reversal agent for benzodiazepine
Flumazenil (aka Romazicon)
0.2mg IV q1min titrated to response or 3mg
When is Flumazenil contraindicated
coingestion of seizure inducing agents or known seizure disorder
cocaine would increase what NT
dopamine, norepinephrine, and serotonin
tx of OD pscychostimulant
monitor VS
sedation- benzos
for Chest pain: no BB, normal meds
for seizures: benzos
Active ingredient of bath salts
MDPV- 4-methylene-dioxypyrovalerone
Treatment for GHB
supportive and benzos for withdrawal
