Drugs of Abuse Flashcards
1
Q
what percent of the population admits to using ilicit substances during their lifetime?
A
50%
2
Q
what is the most common abused drug
A
alcohol
3
Q
what is most common illicit abused drug
A
marajuana
4
Q
what is the pathway that is known as the “reward pathway”
A
mesolimbic pathway
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)
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
7
Q
dopamine rich area =
A
ventral tegmental area
8
Q
mediates feelings of reward
A
ventral striatum
9
Q
memory consolidation for emotionally arousing events
A
amyglada
10
Q
emotion, self-control, problem-solving, performance monitoring
A
pre-frontal cortex
11
Q
substances of abuse affect
A
neurotransmitters
12
Q
substances are
A
artificial stimulants
13
Q
artifical stimulants are able to
A
act directly on the ventral tegmental area
14
Q
when acting directally on the ventral tegmental area this causes
A
a more intense release of dopamine than natural stimuli
15
Q
the more intense release of dopamine causes
A
- downregulation of dopamine
16
Q
downregulation of dopamine =
A
increased cravings
17
Q
clinical picture
A
toxidromes
18
Q
toxicology screen includes
A
urine drug screen
serum screen
19
Q
mix alcohol + oxy
A
no bad idea
20
Q
drug examples of stimulants (6)
A
- amphetamines
- meth
- cocaine
- diet aids
- bath salts
- pseudophedrine
21
Q
Symptoms of stimulants (6)
A
- restlessness
- agitation
- tremors
- insomnia
- anorexia
- diarrhea
22
Q
signs of stimulants (5)
A
- hyperthermia/tachy
- HTN
- DILATED pupils
- seizures
- cardiac arrest
23
Q
opioid drug examples (6)
A
- heroin
- fentanyl
- opium
- morphine
- oxycodone
- hydromorphone
24
Q
symptoms of opioids (3)
A
- AMS
- drowsiness
- stupor
25
signs of opioids (3)
1. PINPOINT pupils
2. respiratory depression
3. coma
26
examples of sedatives (4)
1. phenobarbital
2. benzos
3. zolpidem
4. ethanol
27
symptoms of sedatives (5)
1. drowsiness
2. disinhibition
3. ataxia
4. slurred speech
5. confusion
28
signs of sedatives (2)
1. Hypotension
2. Resp depression
29
cholinergic examples (3)
1. neostigmine
2. donepezil
3. oranophosphates
30
symptoms of cholinergic
1. increased salivation
2. lacrimation
3. diaphoresis
"wet"
31
signs cholinergic
1. bradycardia
2. PINPOINT
3. wheezing, resp insufficency
4. coma
32
anticholinergic examples (5)
1. atropine
2. scopolamine
3. antihistamine
4. antipsychotics
5. tricylic antidepressant
33
symptoms anticholinergic
1. blurry vision
2. contipation
3. urinary retention
4. confusion & hallucinations
"dry"
34
signs anticholinergic
1. hyperthermia
2. DILATED pupils
3. flushed dry skin
35
what does a urine drug screen test for? (7)
1. amphetamines
2. barbituates
3. benzos
4. cannabinoids
5. cocaine
6. opioids
7. phencyclidine
36
when are opioids detectable in urine
1-3 days
37
when is cocaine detectable in urine?
2-3 days
38
when are amphetamines detected in urine?
2-3 days
39
when are benzodiazepines detected in urine?
3-30 days (dependent on half life)
40
when is phencyclidine detected in urine?
7-14 days
41
when is marajuana detected in urine
1-7 days if light use
30 days if regular
42
serum drug screens test for (3)
1. acetaminophen
2. salicylates
3. alcohol
43
who is responsible for categorizing certain drugs into schedules?
US DEA
44
what is the DEA categorization of drugs based on (2)
1. potential for abuse
2. potential for dependency
45
what do you need to prescribe scheduled drugs?
DEA license
46
highest potential for abuse, no medically accepted usage in the US
schedule 1 drugs
47
examples of schedule 1 drugs (4)
1. heroin
2. marajuana
3. lysergic acid diethylamide (LSD)
4. 3,4-methylenedioxymethamphetamine (ecstasty)
48
high potential for abuse and potential lead to severe physical or psychological dependence
Schedule 2 drugs
49
are schedule 2 drugs accepted for medical use in the US?
yes - with restrictions
50
examples of schedule 2 drugs
1. hydrocodone/oxycodone/morphine/hydromorphone
2. methadone
3. fentanyl
4. cocaine
5. amphetamine/methamphetamine/methylphenidate (ADHD meds)
51
less abuse potential than schedule 2, more potential than schedule 4. low to moderate dependence.
schedule 3 drugs
52
examples of schedule 3 drugs
1. acetaminophen with codeine (tylenol #3)
2. anabolic steroids
3. testosterone
4. ketamine
5. butalbital (fiorinal)
6. dronabinol (marinol)
53
low potential for abuse, low risk for dependence
schedule 4
54
examples of schedule 4 drugs
1. benzodiazepines, lorazepam (ativan), alprazolam (xanax)
2. phenobarbitol
3. zolpidem (ambien)
4. tramadol (ultram)
5. carisoprodol (soma)
55
lower potential risk than schedule 4, lower risk of dependency. contains limited quantities of certain narcotic and stimulant drugs
schedule 5
56
examples of schedule 5 drugs
1. promethazine with codeine
2. guaifensen with codeine
3. diphenoxylate and atropine (lomotil)
4. pregabalin
57
the most widely used drug in the US is
alcohol
58
how does alcohol work?
alters balance of many neurotransmitters
59
what are the four ways alcohol adjusts neurotransmitters
1. increase inhibitory NT effect
2. decrease excitatory NT effect
3. release of endogenous opioids
4. increase level of dopamine & serotonin
60
to metabolize alcohol what do you need? (2)
1. alcohol dehydrogenase
2. aldehyde dehydrogenase
61
alcohol dehydrogenase (ADH) converts alcohol to _____
acetylaldehyde
62
what metabolizes acetylaldehyde and where is it metabolized
aldehyde dehydrogenase, liver
63
women have (more/less) ADH
less
64
what is the effect of having less ADH in your body (AKA being a woman)
alcohol not easily metabolized and inactivated as easily
65
deficiency of aldehyde dehydrogenase (ALDH-2) is called
alcohol flush syndrome
66
alcohol flush syndrome causes a build up of _______ and leads to _____ which causes (signs and symptoms)
build up of acetylaldeyhde, leads to catecholamine release, vasodilation + severe flushing
67
three medications to treat alcohol abuse
1. naltexone (reVia, vivitrol)
2. Acamprosate (campral)
3. disulfiram (antabuse)
68
naltrexone is an opioid _____
antagonist
69
naltrexone works by decreasing the activity of the ____ ____ _____
ventral tegmental system (mesolimbic area)
70
can you give naltrexone if the patient is taking opioids?
NO
71
acamprosate decreases the ______ receptor, which in turn decreases excessive ______ seen in alcohol withdrawl.
NMDA receptor
glutamate
72
acamprosate decreases _____ _____ of alcohol intake
positive reinforcement
73
disulfiram inhibits _________, which increases _____ buildup which leads to (signs and symptoms)
1. acetylaldehyde dehydrogenase
2. aldehyde buildup
3. flushing, tachycardia, hyperventilation, N/V
74
disulfram is known as a _____ _____ drug
conditioned avoidance
75
which alcohol treatment med makes you feel like shit so hopefully youll stop drinking
disulfiram
76
when can a reaction occur after taking disulfiram?
up to 14 days after
77
mild alcohol withdrawl symptoms
1. tremor
2. palpatations
3. anxiety
4. headache
5. diaphoresis
6. tachy/HTN
78
when does mild alcohol withdrawal occur
3-36 hours after last drink (dependent on dependency)
79
when does alcohol induced hallucinations occur?
12-24 hours after, lasts 24-48 hours
80
what type of hallucinations occur in alcohol WD?
visual
81
what type of seizures occur with alcohol WD? and when?
tonic clonic, 6-48 hours after last drink
82
delirium tremens is known as
the most serious type of alcohol withdrawal
83
when does delirium tremens occur?
72-96 hours
84
S/S delirium tremens (3)
1. confusion, agitation, hallucinations
2. fever, tachy, HTN
3. more severe = seizures/death
85
Tx delirium tremens (5)
benzodiazepines (lorazepam, diazepam), supportive care, IV fluids, thiamine supplement, vitamins
86
nicotine is a (antagonist/agonist) at _____ receptors
agonist, cholinergic
87
what is released / stimulated when taking nicotine? (2)
1. CNS stimulated
2. dopamine released in ventral tegmental area
88
agonist at cholinetgic receptors =
sympathetic activation
89
how is nicotine absorbed?
oral mucosa, nasal mucosa, skin, lower resp tract
90
CNS effects of nicotine (crap ton)
1. euphora/arousal/relaxation
2. irritability, tremors
3. improved attention/reaction time
4. appetite suppression
91
high doses of nicotine can lead to ____ ____ ____ and ____ ____
central resp depression and severe hypotension
92
lethal dose of nicotine
60 mg, one cig =1-2mg
93
peripheral effects of nicotine (2, but more)
1. stimulates sympathetic ganglia (tachy/HTN)
2. causes vasoconstriction, endothelial dysfunction, hypercoaguability (tissue hypoxia)
94
virchows triad =
1. hypercoaguability
2. endothelial damage
3. venous stasis
95
symptoms of nicotine withdrawal (5)
1. irritable
2. trouble concentrating
3. anxiety
4. HA
5. insomnia
96
treatment of nicotine withdrawl (3)
1. nicotine replacement therapy
2. buproprion (wellbutrin/zyban)
3. Varenicline
97
what is included in nicotine replacement therapy (4)
1. gums
2. lozenges
3. sprays
4. transdermal patch
98
how does bupropion (wellbutrin) work?
1. ehance dopamine and NE release
99
what can burpropion help with?
depression part of nic WD
100
what is one side effect to burpropion that puts pts with known seizure disorders/eating disorders at risk
lowers seizure threshold
101
varenicline is a partial ______ for _____ receptors in the CNS
agonist for nicotinic acetylcholine receptors
102
how does varenicline work?
decreases rewarding effect of nicotine
103
S/S of varenicline (hint: behavioral)
1. bizarre dreams/nightmares
2. suicidal ideation
3. mood disturbances
104
what nicotine WD tx has a high long term quit success rate
varenicline
105
examples of sympathomimetics/stimulants (SO MANY UGH)
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
cocaine is a CNS (depressant/stimulant
stimulant
107
2 method of actions for cocaine
1. inhibits reuptake of NE
2. inhibitis reuptake of dopamine and serotonin
108
what is inhibiting reuptake important (when taking cocaine)
stimulates the pleasure center, flood of dopamine creates a high followed by a dysphoria/crash
109
cocaine + heroin =
speedball
110
powder formulation of cocaine
water soluble hydrochloride salt
111
freebase cocaine (crack) formulation
cocaine that has been processed to remove the hydrochloride (heated, then smoked)
112
ROA cocaine
oral, intranasal, dissolved/injected, smoked
113
intensity of high (cocaine) depends on
route
114
injecting or smoking leads to
quicker and stronger high, does not last long
115
intranasal cocaine lasts
15-30 min
116
smoking cocaine lasts
5-10 minutes
117
physiological effects of cocaine (4)
1. increased temp (due to vasoconstriction)
2. tachy/HTN
3. DIALATED pupils
4. restless/irritable/anxiety
118
consequences of cocaine use (4)
cardiovascular & neurological
1. arrhythmias
2. MI
3. seizures
4. stroke
119
how do people die from a cocaine OD?
seizures or cardiac arrest
120
Tx of cocaine toxicity?
supportive care
benzodiazepines (calm decreases body temp & also decreases seizure likelihood)
121
what type of drugs have a similar effect to cocaine?
amphetamines, amphetamine like drugs
122
is the high for amphetamines more or less intense than cocaine?
less, but may last longer
123
how do you manage your pt if they took amphetamines or amphetamine-like drugs?
same as cocaine management
124
method of action methamphetamine
works on dopamine pathway similar to cocaine
125
formulation of meth
white, odorless, bitter tasting, made in makeshift labs by mixing cold meds with hazardous chemicals
126
ROA meth
1. oral
2. smoke
3. intranasal
4. dissolved in H2O/EtOH and injected
127
physiological effects of meth
similar high/crash to cocaine but high lasts longer
128
long term use of meth will lead to
1. extreme weight loss
2. minimizes saliva production (meth mouth)
129
methylenedioxymethamphetamine (MDMA, Ecstasy, Molly) MOA
both stimulant and hallucinogen.
releases catecholamines and blocks reuptake
130
what makes ectasy different from other amphetamines
significantly increases the release and blocks reuptake of serotonin
131
is molly/ectasy/MDMA a synthetic or naturally found drug?
synthetic
132
ROA molly
oral, tablet, liquic, intrnasal (party drug)
133
other physiological effects of molly
1. love drug
2. increased energy
3. distorted time perception
4. bruxism (teeth grind/jaw clench)
5. hyper-everything
6. serotonin syndrome
134
Tx of methylenedioxymethamphetamine toxicity
benzos & serotonin antagonists
135
name a serotonin antagonist
cyproheptadine (periactin)
136
synthetic cathinones are known as
bath salts (street names: bliss, cloud nine, vanilla sky)
137
method of action of bath salts
similar to cocaine, inhibits reuptake of NE, dopamine, serotonin BUT 10X STRONGER
138
are bath salts found on drug screens
no
139
formulation of synthetic cathinones (bath salts)
white/pink foul smelling cystallized powder
140
ROA synthetic cathinones
oral, intranasal, inhale/smoke, inject
141
physiological effects synthetic cathinones bath salts
1. excited delirium (aggression)
2. tachy/HTN
3. chest pain
142
treatment for bath salt toxicity
similar to cocaine
143
hallucinogens are drugs that can
cause distortion of sense perception
144
do hallucinogens cause physical dependence or withdrawal?
nope
145
examples of hallucinogens
1. lysergic acid diethylamide (LSD)
2. psilocybin (shrooms)
3. phencyclidine (PCP, angel dust)
4. MDMA (ecstasy)
146
MOA hallucinogens
lots of NT involved: dopamine, glutamate, serotonin - especially LSD (serotonin syndrome)
147
physiological effects of hallucinogens (7)
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
what is the real danger with hallucinogens?
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
hallucinogen toxicitiy tx
1. generally stable
2. emotional support (aw, poor baby)
150
cannabis =
2 species of hemp plants (cannabis sativa, cannabis indica, cannabis ruderalis)
151
cannabinoids
chemicals found in cannabis plants
152
what are the two cannabindoids
THC & CBD
(tetrahydrocannabinol & cannabidiol)
153
marajuana =
dried leves, flowers, stems, seeds from cannabis sativa plant
154
how much THC does marajuana have in it
1-20%
155
hemp contains
very little THC, lots of CBD
156
what receptors do cannabinoids ineract with?
CB1 - CNS
CB2 - peripheral tissues & immune cells
157
CB1 receptor is located in and responsible for
located: frontal lobe, basal ganglia, hippocampus, cerebellum
responsible for: pleasure, though, concentration, appetite, memory, time perception, movement perception
158
CB2 receptor is located in and responsible for
located: peripheral tissues and immune cells
responsible: anti-inflammatory and immunosuppressive effects
159
three types of cannabinoids
1. endogenous
2. plant
3. synthetic
160
endocannabinoids include neurotransmitters
N-arachidonoylethanolamine (anadamide)
2-arachidonoglycerol (2-AG)
161
what does N-arachidonoylethanolamine bind with
CB1 receptors
162
what does 2-arachidonoglycerol bind with?
CB1 and CB2 receptors
163
endocannabinoids affect
appetite, learning, memory, mood, addiction, pain, reproductive function, GI motility, inflammation, etc
164
two most commonly studied phytocannabinoids include
THC and CBD
165
THC is a CB1 and CB2 _______
agonist
166
what effects come from THC
psychoactive
167
CBD has (low/high) affinity for Cb1 receptors and bind well to CB2
low
168
what effects come from CBD
anti-anxiety, anti-inflammatory, potentially anticonvulsant
169
what are three synthetic cannabinoids
1. dronabinol
2. nabilone
3. cannabidol
170
dronabidol (marinol)
1. schedule?
2. MOA
3. treatment for?
1. schedule 3
2. synthetic THC, bind to CB1 > CB2
3. Tx for chemo induced N/V, appeptite stimulant for AIDs patients
171
Nabilone (cesamet)
1. schedule?
2. MOA
3. treatment for?
1. 2
2. binds CB1 receptor, similar to THC chemically
3. chemo induced N/V
172
Cannabidol(epidiolex)
1. schedule?
2. MOA
3. treatment for?
1. 5
2. CBD liquid, affects CB2 receptors
3. tx dravet syndrome and lennox-gastaut syndrome (seizures in kids)
173
adverse effects of short term use of cannabinoids
1. impaired memory
2. impaired motor
3. altered judgement
4. paranoid/psychosis (high doses)
174
adverse long effects of cannabinoids
1. cannabinoid hyperemesis syndrome
2. addiction, lower IQ, altered brain development
3. vaping = significant lung injury
175
medical marajuana
schedule 1, not approved as "medicine" by FDA
176
how many states have legalized med marajuana
39
177
how many states legalized recreational marajuana?
24
178
in PA, what do you need to get a medical MJ card (what are the conditions)
"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
do you need a specific license to prescribe med MJ in PA?
yup, through DOH, take 4hour course
180
forms of medical MJ allowed in PA
1. pill
2. oil
3. topical
4. vapor
5. tincture
6. liquid
