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Pharmacology > Drugs of Abuse > Flashcards

Drugs of Abuse Flashcards

1
Q

what percent of the population admits to using ilicit substances during their lifetime?

A

50%

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2
Q

what is the most common abused drug

A

alcohol

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3
Q

what is most common illicit abused drug

A

marajuana

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4
Q

what is the pathway that is known as the “reward pathway”

A

mesolimbic pathway

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5
Q

what kind of feeling does the mesolimbic pathway make

A

produce feeling of pleasure as a response to enjoyable stimuli (sex, food, social interaction)

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6
Q

the mesolimbic pathway is connected to brain regions responsible for ____ and ____

A

memory and behavior

why important? - causes desire to repeat whatever caused feeling of pleasure

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7
Q

dopamine rich area =

A

ventral tegmental area

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8
Q

mediates feelings of reward

A

ventral striatum

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9
Q

memory consolidation for emotionally arousing events

A

amyglada

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10
Q

emotion, self-control, problem-solving, performance monitoring

A

pre-frontal cortex

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11
Q

substances of abuse affect

A

neurotransmitters

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12
Q

substances are

A

artificial stimulants

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13
Q

artifical stimulants are able to

A

act directly on the ventral tegmental area

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14
Q

when acting directally on the ventral tegmental area this causes

A

a more intense release of dopamine than natural stimuli

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15
Q

the more intense release of dopamine causes

A
  1. downregulation of dopamine
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16
Q

downregulation of dopamine =

A

increased cravings

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17
Q

clinical picture

A

toxidromes

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18
Q

toxicology screen includes

A

urine drug screen
serum screen

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19
Q

mix alcohol + oxy

A

no bad idea

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20
Q

drug examples of stimulants (6)

A
  1. amphetamines
  2. meth
  3. cocaine
  4. diet aids
  5. bath salts
  6. pseudophedrine
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21
Q

Symptoms of stimulants (6)

A
  1. restlessness
  2. agitation
  3. tremors
  4. insomnia
  5. anorexia
  6. diarrhea
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22
Q

signs of stimulants (5)

A
  1. hyperthermia/tachy
  2. HTN
  3. DILATED pupils
  4. seizures
  5. cardiac arrest
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23
Q

opioid drug examples (6)

A
  1. heroin
  2. fentanyl
  3. opium
  4. morphine
  5. oxycodone
  6. hydromorphone
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24
Q

symptoms of opioids (3)

A
  1. AMS
  2. drowsiness
  3. stupor
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25
Q

signs of opioids (3)

A
  1. PINPOINT pupils
  2. respiratory depression
  3. coma
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26
Q

examples of sedatives (4)

A
  1. phenobarbital
  2. benzos
  3. zolpidem
  4. ethanol
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27
Q

symptoms of sedatives (5)

A
  1. drowsiness
  2. disinhibition
  3. ataxia
  4. slurred speech
  5. confusion
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28
Q

signs of sedatives (2)

A
  1. Hypotension
  2. Resp depression
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29
Q

cholinergic examples (3)

A
  1. neostigmine
  2. donepezil
  3. oranophosphates
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30
Q

symptoms of cholinergic

A
  1. increased salivation
  2. lacrimation
  3. diaphoresis
    “wet”
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31
Q

signs cholinergic

A
  1. bradycardia
  2. PINPOINT
  3. wheezing, resp insufficency
  4. coma
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32
Q

anticholinergic examples (5)

A
  1. atropine
  2. scopolamine
  3. antihistamine
  4. antipsychotics
  5. tricylic antidepressant
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33
Q

symptoms anticholinergic

A
  1. blurry vision
  2. contipation
  3. urinary retention
  4. confusion & hallucinations
    “dry”
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34
Q

signs anticholinergic

A
  1. hyperthermia
  2. DILATED pupils
  3. flushed dry skin
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35
Q

what does a urine drug screen test for? (7)

A
  1. amphetamines
  2. barbituates
  3. benzos
  4. cannabinoids
  5. cocaine
  6. opioids
  7. phencyclidine
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36
Q

when are opioids detectable in urine

A

1-3 days

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37
Q

when is cocaine detectable in urine?

A

2-3 days

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38
Q

when are amphetamines detected in urine?

A

2-3 days

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39
Q

when are benzodiazepines detected in urine?

A

3-30 days (dependent on half life)

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40
Q

when is phencyclidine detected in urine?

A

7-14 days

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41
Q

when is marajuana detected in urine

A

1-7 days if light use
30 days if regular

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42
Q

serum drug screens test for (3)

A
  1. acetaminophen
  2. salicylates
  3. alcohol
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43
Q

who is responsible for categorizing certain drugs into schedules?

A

US DEA

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44
Q

what is the DEA categorization of drugs based on (2)

A
  1. potential for abuse
  2. potential for dependency
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45
Q

what do you need to prescribe scheduled drugs?

A

DEA license

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46
Q

highest potential for abuse, no medically accepted usage in the US

A

schedule 1 drugs

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47
Q

examples of schedule 1 drugs (4)

A
  1. heroin
  2. marajuana
  3. lysergic acid diethylamide (LSD)
  4. 3,4-methylenedioxymethamphetamine (ecstasty)
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48
Q

high potential for abuse and potential lead to severe physical or psychological dependence

A

Schedule 2 drugs

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49
Q

are schedule 2 drugs accepted for medical use in the US?

A

yes - with restrictions

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50
Q

examples of schedule 2 drugs

A
  1. hydrocodone/oxycodone/morphine/hydromorphone
  2. methadone
  3. fentanyl
  4. cocaine
  5. amphetamine/methamphetamine/methylphenidate (ADHD meds)
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51
Q

less abuse potential than schedule 2, more potential than schedule 4. low to moderate dependence.

A

schedule 3 drugs

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52
Q

examples of schedule 3 drugs

A
  1. acetaminophen with codeine (tylenol #3)
  2. anabolic steroids
  3. testosterone
  4. ketamine
  5. butalbital (fiorinal)
  6. dronabinol (marinol)
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53
Q

low potential for abuse, low risk for dependence

A

schedule 4

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54
Q

examples of schedule 4 drugs

A
  1. benzodiazepines, lorazepam (ativan), alprazolam (xanax)
  2. phenobarbitol
  3. zolpidem (ambien)
  4. tramadol (ultram)
  5. carisoprodol (soma)
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55
Q

lower potential risk than schedule 4, lower risk of dependency. contains limited quantities of certain narcotic and stimulant drugs

A

schedule 5

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56
Q

examples of schedule 5 drugs

A
  1. promethazine with codeine
  2. guaifensen with codeine
  3. diphenoxylate and atropine (lomotil)
  4. pregabalin
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57
Q

the most widely used drug in the US is

A

alcohol

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58
Q

how does alcohol work?

A

alters balance of many neurotransmitters

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59
Q

what are the four ways alcohol adjusts neurotransmitters

A
  1. increase inhibitory NT effect
  2. decrease excitatory NT effect
  3. release of endogenous opioids
  4. increase level of dopamine & serotonin
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60
Q

to metabolize alcohol what do you need? (2)

A
  1. alcohol dehydrogenase
  2. aldehyde dehydrogenase
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61
Q

alcohol dehydrogenase (ADH) converts alcohol to _____

A

acetylaldehyde

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62
Q

what metabolizes acetylaldehyde and where is it metabolized

A

aldehyde dehydrogenase, liver

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63
Q

women have (more/less) ADH

A

less

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64
Q

what is the effect of having less ADH in your body (AKA being a woman)

A

alcohol not easily metabolized and inactivated as easily

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65
Q

deficiency of aldehyde dehydrogenase (ALDH-2) is called

A

alcohol flush syndrome

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66
Q

alcohol flush syndrome causes a build up of _______ and leads to _____ which causes (signs and symptoms)

A

build up of acetylaldeyhde, leads to catecholamine release, vasodilation + severe flushing

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67
Q

three medications to treat alcohol abuse

A
  1. naltexone (reVia, vivitrol)
  2. Acamprosate (campral)
  3. disulfiram (antabuse)
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68
Q

naltrexone is an opioid _____

A

antagonist

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69
Q

naltrexone works by decreasing the activity of the ____ ____ _____

A

ventral tegmental system (mesolimbic area)

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70
Q

can you give naltrexone if the patient is taking opioids?

A

NO

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71
Q

acamprosate decreases the ______ receptor, which in turn decreases excessive ______ seen in alcohol withdrawl.

A

NMDA receptor
glutamate

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72
Q

acamprosate decreases _____ _____ of alcohol intake

A

positive reinforcement

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73
Q

disulfiram inhibits _________, which increases _____ buildup which leads to (signs and symptoms)

A
  1. acetylaldehyde dehydrogenase
  2. aldehyde buildup
  3. flushing, tachycardia, hyperventilation, N/V
74
Q

disulfram is known as a _____ _____ drug

A

conditioned avoidance

75
Q

which alcohol treatment med makes you feel like shit so hopefully youll stop drinking

A

disulfiram

76
Q

when can a reaction occur after taking disulfiram?

A

up to 14 days after

77
Q

mild alcohol withdrawl symptoms

A
  1. tremor
  2. palpatations
  3. anxiety
  4. headache
  5. diaphoresis
  6. tachy/HTN
78
Q

when does mild alcohol withdrawal occur

A

3-36 hours after last drink (dependent on dependency)

79
Q

when does alcohol induced hallucinations occur?

A

12-24 hours after, lasts 24-48 hours

80
Q

what type of hallucinations occur in alcohol WD?

81
Q

what type of seizures occur with alcohol WD? and when?

A

tonic clonic, 6-48 hours after last drink

82
Q

delirium tremens is known as

A

the most serious type of alcohol withdrawal

83
Q

when does delirium tremens occur?

A

72-96 hours

84
Q

S/S delirium tremens (3)

A
  1. confusion, agitation, hallucinations
  2. fever, tachy, HTN
  3. more severe = seizures/death
85
Q

Tx delirium tremens (5)

A

benzodiazepines (lorazepam, diazepam), supportive care, IV fluids, thiamine supplement, vitamins

86
Q

nicotine is a (antagonist/agonist) at _____ receptors

A

agonist, cholinergic

87
Q

what is released / stimulated when taking nicotine? (2)

A
  1. CNS stimulated
  2. dopamine released in ventral tegmental area
88
Q

agonist at cholinetgic receptors =

A

sympathetic activation

89
Q

how is nicotine absorbed?

A

oral mucosa, nasal mucosa, skin, lower resp tract

90
Q

CNS effects of nicotine (crap ton)

A
  1. euphora/arousal/relaxation
  2. irritability, tremors
  3. improved attention/reaction time
  4. appetite suppression
91
Q

high doses of nicotine can lead to ____ ____ ____ and ____ ____

A

central resp depression and severe hypotension

92
Q

lethal dose of nicotine

A

60 mg, one cig =1-2mg

93
Q

peripheral effects of nicotine (2, but more)

A
  1. stimulates sympathetic ganglia (tachy/HTN)
  2. causes vasoconstriction, endothelial dysfunction, hypercoaguability (tissue hypoxia)
94
Q

virchows triad =

A
  1. hypercoaguability
  2. endothelial damage
  3. venous stasis
95
Q

symptoms of nicotine withdrawal (5)

A
  1. irritable
  2. trouble concentrating
  3. anxiety
  4. HA
  5. insomnia
96
Q

treatment of nicotine withdrawl (3)

A
  1. nicotine replacement therapy
  2. buproprion (wellbutrin/zyban)
  3. Varenicline
97
Q

what is included in nicotine replacement therapy (4)

A
  1. gums
  2. lozenges
  3. sprays
  4. transdermal patch
98
Q

how does bupropion (wellbutrin) work?

A
  1. ehance dopamine and NE release
99
Q

what can burpropion help with?

A

depression part of nic WD

100
Q

what is one side effect to burpropion that puts pts with known seizure disorders/eating disorders at risk

A

lowers seizure threshold

101
Q

varenicline is a partial ______ for _____ receptors in the CNS

A

agonist for nicotinic acetylcholine receptors

102
Q

how does varenicline work?

A

decreases rewarding effect of nicotine

103
Q

S/S of varenicline (hint: behavioral)

A
  1. bizarre dreams/nightmares
  2. suicidal ideation
  3. mood disturbances
104
Q

what nicotine WD tx has a high long term quit success rate

A

varenicline

105
Q

examples of sympathomimetics/stimulants (SO MANY UGH)

A
  1. cocaine
  2. amphetamines (dextroamphetmine, methamphetamine, mixed dextroamohetamine-amphetamine, methyleneioxymethamphetmine, synthetic cathinones (BASICALLY, meth, dexedrine, desoxyn, adderal, ecstasy, bath salts)
  3. amphetamine-like meds (methyl-phenidate =ritalin)
106
Q

cocaine is a CNS (depressant/stimulant

107
Q

2 method of actions for cocaine

A
  1. inhibits reuptake of NE
  2. inhibitis reuptake of dopamine and serotonin
108
Q

what is inhibiting reuptake important (when taking cocaine)

A

stimulates the pleasure center, flood of dopamine creates a high followed by a dysphoria/crash

109
Q

cocaine + heroin =

110
Q

powder formulation of cocaine

A

water soluble hydrochloride salt

111
Q

freebase cocaine (crack) formulation

A

cocaine that has been processed to remove the hydrochloride (heated, then smoked)

112
Q

ROA cocaine

A

oral, intranasal, dissolved/injected, smoked

113
Q

intensity of high (cocaine) depends on

114
Q

injecting or smoking leads to

A

quicker and stronger high, does not last long

115
Q

intranasal cocaine lasts

116
Q

smoking cocaine lasts

A

5-10 minutes

117
Q

physiological effects of cocaine (4)

A
  1. increased temp (due to vasoconstriction)
  2. tachy/HTN
  3. DIALATED pupils
  4. restless/irritable/anxiety
118
Q

consequences of cocaine use (4)

A

cardiovascular & neurological
1. arrhythmias
2. MI
3. seizures
4. stroke

119
Q

how do people die from a cocaine OD?

A

seizures or cardiac arrest

120
Q

Tx of cocaine toxicity?

A

supportive care
benzodiazepines (calm decreases body temp & also decreases seizure likelihood)

121
Q

what type of drugs have a similar effect to cocaine?

A

amphetamines, amphetamine like drugs

122
Q

is the high for amphetamines more or less intense than cocaine?

A

less, but may last longer

123
Q

how do you manage your pt if they took amphetamines or amphetamine-like drugs?

A

same as cocaine management

124
Q

method of action methamphetamine

A

works on dopamine pathway similar to cocaine

125
Q

formulation of meth

A

white, odorless, bitter tasting, made in makeshift labs by mixing cold meds with hazardous chemicals

126
Q

ROA meth

A
  1. oral
  2. smoke
  3. intranasal
  4. dissolved in H2O/EtOH and injected
127
Q

physiological effects of meth

A

similar high/crash to cocaine but high lasts longer

128
Q

long term use of meth will lead to

A
  1. extreme weight loss
  2. minimizes saliva production (meth mouth)
129
Q

methylenedioxymethamphetamine (MDMA, Ecstasy, Molly) MOA

A

both stimulant and hallucinogen.

releases catecholamines and blocks reuptake

130
Q

what makes ectasy different from other amphetamines

A

significantly increases the release and blocks reuptake of serotonin

131
Q

is molly/ectasy/MDMA a synthetic or naturally found drug?

132
Q

ROA molly

A

oral, tablet, liquic, intrnasal (party drug)

133
Q

other physiological effects of molly

A
  1. love drug
  2. increased energy
  3. distorted time perception
  4. bruxism (teeth grind/jaw clench)
  5. hyper-everything
  6. serotonin syndrome
134
Q

Tx of methylenedioxymethamphetamine toxicity

A

benzos & serotonin antagonists

135
Q

name a serotonin antagonist

A

cyproheptadine (periactin)

136
Q

synthetic cathinones are known as

A

bath salts (street names: bliss, cloud nine, vanilla sky)

137
Q

method of action of bath salts

A

similar to cocaine, inhibits reuptake of NE, dopamine, serotonin BUT 10X STRONGER

138
Q

are bath salts found on drug screens

139
Q

formulation of synthetic cathinones (bath salts)

A

white/pink foul smelling cystallized powder

140
Q

ROA synthetic cathinones

A

oral, intranasal, inhale/smoke, inject

141
Q

physiological effects synthetic cathinones bath salts

A
  1. excited delirium (aggression)
  2. tachy/HTN
  3. chest pain
142
Q

treatment for bath salt toxicity

A

similar to cocaine

143
Q

hallucinogens are drugs that can

A

cause distortion of sense perception

144
Q

do hallucinogens cause physical dependence or withdrawal?

145
Q

examples of hallucinogens

A
  1. lysergic acid diethylamide (LSD)
  2. psilocybin (shrooms)
  3. phencyclidine (PCP, angel dust)
  4. MDMA (ecstasy)
146
Q

MOA hallucinogens

A

lots of NT involved: dopamine, glutamate, serotonin - especially LSD (serotonin syndrome)

147
Q

physiological effects of hallucinogens (7)

A
  1. heightened perception of time and senses
  2. distorted time
  3. hallucinations
  4. euphoria/sense of happiness
  5. passive observer of ones life
  6. synesthesia
  7. loss of judgement / impaired reasoning
148
Q

what is the real danger with hallucinogens?

A

loss of judgment = “bad trip” = suicide (aka jumping out of a window because you think you can fly or drowning because you are convinced youre a mermaid)

149
Q

hallucinogen toxicitiy tx

A
  1. generally stable
  2. emotional support (aw, poor baby)
150
Q

cannabis =

A

2 species of hemp plants (cannabis sativa, cannabis indica, cannabis ruderalis)

151
Q

cannabinoids

A

chemicals found in cannabis plants

152
Q

what are the two cannabindoids

A

THC & CBD
(tetrahydrocannabinol & cannabidiol)

153
Q

marajuana =

A

dried leves, flowers, stems, seeds from cannabis sativa plant

154
Q

how much THC does marajuana have in it

155
Q

hemp contains

A

very little THC, lots of CBD

156
Q

what receptors do cannabinoids ineract with?

A

CB1 - CNS
CB2 - peripheral tissues & immune cells

157
Q

CB1 receptor is located in and responsible for

A

located: frontal lobe, basal ganglia, hippocampus, cerebellum
responsible for: pleasure, though, concentration, appetite, memory, time perception, movement perception

158
Q

CB2 receptor is located in and responsible for

A

located: peripheral tissues and immune cells
responsible: anti-inflammatory and immunosuppressive effects

159
Q

three types of cannabinoids

A
  1. endogenous
  2. plant
  3. synthetic
160
Q

endocannabinoids include neurotransmitters

A

N-arachidonoylethanolamine (anadamide)
2-arachidonoglycerol (2-AG)

161
Q

what does N-arachidonoylethanolamine bind with

A

CB1 receptors

162
Q

what does 2-arachidonoglycerol bind with?

A

CB1 and CB2 receptors

163
Q

endocannabinoids affect

A

appetite, learning, memory, mood, addiction, pain, reproductive function, GI motility, inflammation, etc

164
Q

two most commonly studied phytocannabinoids include

A

THC and CBD

165
Q

THC is a CB1 and CB2 _______

166
Q

what effects come from THC

A

psychoactive

167
Q

CBD has (low/high) affinity for Cb1 receptors and bind well to CB2

168
Q

what effects come from CBD

A

anti-anxiety, anti-inflammatory, potentially anticonvulsant

169
Q

what are three synthetic cannabinoids

A
  1. dronabinol
  2. nabilone
  3. cannabidol
170
Q

dronabidol (marinol)
1. schedule?
2. MOA
3. treatment for?

A
  1. schedule 3
  2. synthetic THC, bind to CB1 > CB2
  3. Tx for chemo induced N/V, appeptite stimulant for AIDs patients
171
Q

Nabilone (cesamet)
1. schedule?
2. MOA
3. treatment for?

A
  1. 2
  2. binds CB1 receptor, similar to THC chemically
  3. chemo induced N/V
172
Q

Cannabidol(epidiolex)
1. schedule?
2. MOA
3. treatment for?

A
  1. 5
  2. CBD liquid, affects CB2 receptors
  3. tx dravet syndrome and lennox-gastaut syndrome (seizures in kids)
173
Q

adverse effects of short term use of cannabinoids

A
  1. impaired memory
  2. impaired motor
  3. altered judgement
  4. paranoid/psychosis (high doses)
174
Q

adverse long effects of cannabinoids

A
  1. cannabinoid hyperemesis syndrome
  2. addiction, lower IQ, altered brain development
  3. vaping = significant lung injury
175
Q

medical marajuana

A

schedule 1, not approved as “medicine” by FDA

176
Q

how many states have legalized med marajuana

177
Q

how many states legalized recreational marajuana?

178
Q

in PA, what do you need to get a medical MJ card (what are the conditions)

A

“serious medical condition”
1. anxiety/autism/brain damage
2. cancer
3. spastic movement disorders
4. epilepsy
5. HIV/AIDs
6. huntingtons
7. IBS
8. amyotrophic lateral sclerosis

179
Q

do you need a specific license to prescribe med MJ in PA?

A

yup, through DOH, take 4hour course

180
Q

forms of medical MJ allowed in PA

A
  1. pill
  2. oil
  3. topical
  4. vapor
  5. tincture
  6. liquid

Pharmacology (7 decks)

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