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Drugs of Abuse Flashcards

1
Q

When someone first uses a drug, it activates

A

the brain’s central reward system, called the mesocorticolimbic dopamine pathway

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2
Q

how can drug use lead to addiction?

A

a drug activates the ventral tegmental area (VTA) and sends dopamine to the nucleus accumbens and prefrontal cortex, creating feelings of pleasure and reward that reinforces the behavior, making the drug seem important, motivating the person to use it again to trigger euphoria, motivation, and the desire to repeat the experience

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3
Q

what is a schedule I drug?

A

drug that cannot have prescriptions written due to high abuse potential

Examples: Heroin, LSD, marijuana, mescaline, MDMA, psilocybin, dimethyltryptamine (DMT), cathinone, ibogaine, methaqualone

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4
Q

What are common CNS stimulants and how do they work?

A

cocaine, amphetamines, MDMA, methylphenidate, nicotine, caffeine, and bath salts
- increase activity in the central and cardiovascular systems by enhancing neurotransmission of DA, NE, and 5-HT

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5
Q

What is the primary mechanism of action of cocaine in the brain?

A

binds to dopamine transporter (DAT) and blocks the reuptake of dopamine, serotonin, and norepinephrine, increasing their levels in the synapse

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6
Q

How does cocaine act as a local anesthetic?

A

blocks voltage-gated sodium (Na⁺) channels, which prevents nerve signal transmission and numbs tissue

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7
Q

how is cocaine used?

A

Intranasal, intravenous, or smoked as the free-base with an onset of less than 1 min (IV/smoked) and lasting 20-60 minutes often used with alcohol, benz or opioids

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8
Q

what are the positive and negative effects of cocaine use?

A

POS: Euphoria, Arousal, Elation, Alertness
NEG: Anxiety, Restlessness, Paranoia

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9
Q

What are key clinical features of cocaine addiction and dependence?

A

Binge use pattern, irritability, restlessness, paranoia, psychological and physical dependence, with some tolerance and sensitization

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10
Q

What are the phases and symptoms of cocaine withdrawal?

A

Crash phase (1–4 days): anxiety, anhedonia, hyperphagia, hypersomnolence

Protracted withdrawal (2–12 weeks): muscle pain, tremor, anhedonia, drug craving

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11
Q

What are the central nervous system (CNS) toxic effects of cocaine?

A

Psychosis, depression, long-term personality changes, intracerebral hemorrhage, cerebral infarction, seizures, and headaches

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12
Q

What are the cardiovascular (CV) toxic effects of cocaine?

A

Tachycardia, vasoconstriction, arrhythmias, cardiomyopathy, myocardial infarction (MI), and fatal cardiac arrest

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13
Q

What causes death in cocaine overdose (OD)?

A

Death is due to cardiac arrhythmias, convulsions, or cardiac arrest

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14
Q

what are the treatments for cocaine dependance ?

A

behavioral therapy

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15
Q

What are some FDA-approved amphetamine and related compounds?

A
  • Adderall (amphetamine/dextroamphetamine)
  • Desoxyn (methamphetamine)
  • Ritalin/Concerta (methylphenidate)
  • Focalin (dexmethylphenidate)
  • Adipex-P (phentermine)
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16
Q

What are examples of street or recreational amphetamine-related drugs?

A

Methamphetamine (also known as speed, crank, meth, chalk, ice) and MDMA (Ecstasy, X)

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17
Q

what is the MOA for Amphetamines?

A

Enters the presynaptic neuron via DAT and interferes with vesicular monoamine transporter (VMAT) releasing DA and NE from stores and also reverses the function of DAT and NET forcing DA and NE into the synaptic cleft

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18
Q

what effect does Amphetamine have on the CNS?

A

Alertness
Euphoria
Exhilaration
Enhanced well-being

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19
Q

what effect does Amphetamine have on sympathetic nervous system?

A

Increased blood pressure
Increased respiration
Tachycardia
Mydriasis
Sweating
Constipation

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20
Q

What are the routes, duration and dependancies of amphetamine?

A
  • Routes of use: Oral, intravenous (IV), or smoked as free-base
  • Duration of action: 4–6 hours (some prescription forms are sustained-release)
  • Dependence: Causes both psychological and physical dependence with chronic use
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21
Q

what can chronic use of Amphetamines cause?

A
  • Anxiety
  • Fatigue
  • Akathesia
  • Headaches
  • Compulsive behaviors
  • Psychosis
  • Volatile mood & violence
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22
Q

what does withdraw from chronic use of Amphetamines cause?

A
  • Ravenous appetite
  • Exhaustion
  • Dysphoria
  • Depression
  • Confusion/delusions
  • Memory loss
  • Weeks to months
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23
Q

What are the signs and symptoms of amphetamine overdose?

A
  • CNS and cardiovascular (CV) overstimulation
  • Coma and convulsions, which can progress to status epilepticus
  • Hypertension, hyperthermia, mydriasis (dilated pupils), subarachnoid hemorrhage, and arrhythmias
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24
Q

What are key features of methamphetamine compared to amphetamine?

A

Methamphetamine is an amphetamine derivative that is more potent, longer acting, and more neurotoxic than amphetamine

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25
How does methamphetamine use affect oral and dental health?
Linked to poor oral hygiene, nutrition and causes a distinctive pattern of tooth decay ("meth mouth") due to dry mouth, teeth grinding, and sugar cravings along with corrosive substances used in production (e.g., ammonia, HCl) also damage teeth
26
what is METHYLENE-DIOXY- METHAMPHETAMINE and what is it used for?
MDMA - FDA recently approved phase 3 clinical trial for MDMA in PTSD patients
27
what is the MOA for MDMA?
Promotes serotonin release, inhibits serotonin reuptake and also blocks dopamine reuptake for about 3/4 hours
28
what are the positive effects of MDMA use?
* Emotional openness * Euphoria * Stimulation * Reduction of critical and cynical thoughts * Decreased inhibitions
29
what are the negative effects of MDMA?
* Visual distortion * Nystagmus * Shivering * Hyperthermia * Teeth clenching * Nausea & vomiting
30
what can MDMA toxicity cause?
- hyperthermia - convulsions - tachycardia - death
31
what is the MOA for Nicotine?
Acts as an agonist at nicotinic acetylcholine receptors, especially the α4β2 subtype in the brain which stimulates release of key neurotransmitters: - Epinephrine (adrenaline) - Norepinephrine (increases alertness) - Dopamine (creates rewarding feelings, reinforcing addiction) - Indirectly enhances glutamate transmission - inhibits monoamine oxidase (MAO)
32
what are the stimulant and relaxant effects of Nicotine?
Stim: Epinephrine release, Alertness/Arousal, Euphoria, mild, Increases blood glucose, Hypertension Relax: Acetylcholine activation, Increased concentration, Calmness
33
what are the treatments for Nicotine addiction?
1. Nicotine Replacement Therapy (NRT) 2. Varenicline (Chantix®): partial agonist at the nicotinic acetylcholine receptor 3. Bupropion (Zyban®): norepinephrine-dopamine reuptake inhibitor and nicotine receptor antagonist 4. Behavioral Therapy
34
what is the MOA for Caffeine?
adenosine receptor antagonist and phosphodiesterase inhibitor
35
what are the pharmacological classes of hallucinogens and examples?
- Psychedelics: LSD - Dissociatives: PCP and Ketamine - Deliriants: scopolamine, atropine - Miscellaneous: Salvinorin (Salvia)
36
what is the MOA for Psychedelics?
activate 5HT₂A receptors found on neurons in the cortex responsible for processing sensory input, emotions, and thoughts which excites neurons and leads to the release of excessive glutamate and enhances dopamine transmission
37
what are the early effects of Lysergic Acid Diethylamine (LSD)?
* Nauseated * Mydriasis * Increased blood pressure * Tachycardia * Tremor * Diaphoresis
38
what are the delayed effects of Lysergic Acid Diethylamine (LSD)?
* Perceptual effects * Euphoria & Elation * Hilarity OR * Anxiety * Panic * Rage
39
what are the characteristics of LSD abuse?
very potent drug taken orally or give IV/intranasally with a short-term tolerance and little to no withdraw signs or physical dependence
40
What are the key features of LSD toxicity?
panic reactions, acute depression, psychosis, overdose is rare, may cause errors in judgment and risk of Hallucinogen Persisting Perception Disorder (HPPD)
41
what are the types of LSD-like Hallucinogens?
Mescaline: peyote cactus Psilocybin: magic mushrooms 25i-NBOMe: synthetic hallucinogen DMT (N,N-dimethyltryptamine)" Dimitri
42
what is the MOA for the dissociative hallucinogens (anesthetics)?
NMDA receptor antagonists that indirectly stimulates dopamine and serotonin release and has many other cellular targets
43
how is Ketamine abused?
commercially available as a liquid, converted into a powder and taken intramuscularly (IM) or intranasally (snorted) for quick onset (5-10 min) and lasts about 1 hour
44
What are the effects of low doses of ketamine during acute intoxication?
* mild inebriation & vertigo * dreamy thinking * stumbling, clumsy, robotic movements * reduced sensations
45
What are the effects of high doses of ketamine during acute intoxication?
* extreme difficulty moving * complete dissociation * classic ‘Near Death Experiences’ * compelling visions * blackouts
46
What are the key signs and risks of ketamine toxicity?
- Vomiting and respiratory depression - Catatonia: flat facial expression, fixed staring, rigid posture - High doses may lead to social withdrawal, autistic-like behavior, impaired thinking, and paranoia - Has a high therapeutic index - Can be physically and psychologically addictive
47
What are the common names, routes of administration, and onset/duration of Phencyclidine?
also called PCP or Angel Dust usually smoked (with tobacco or marijuana), intranasal, orally taken with an initial onset of 15-30 min and lasts several hours
48
what can low and high doses of PCP cause?
low doses: euphoria, agitiation, bizarre behavior high doses: anger, violence, psychosis, nystagmus
49
what does an overdose on PCP cause?
seizures, coma, rhabdomyolysis, death
50
What is Salvia divinorum and how is it used?
Salvia divinorum is a plant from the mint family, traditionally used in spiritual rituals by the Mazatec people and is typically ingested by smoking the leaves
51
What is Salvinorin A and how does it work?
main active compound in Salvia divinorum is a highly potent and selective agonist of the kappa opioid receptor, which is responsible for its hallucinogenic effects
52
What are the effects of Salvinorin A?
causes vivid imagery and psychedelic-like experiences with rapid onset (under 1 minute) and short duration (under 30 minutes). Users often feel detached, with changes in mood, perception, and body sensations
53
What are the risks and toxicities of Salvinorin A?
can lead to cognitive and memory issues, catalepsy (muscle rigidity), catatonia, and emotional problems like anxiety and depression and also been linked to suicides
54
what are opioid use characteristics?
* Euphoria – rush * Warm flushing of the skin * Tranquility * Dry mouth * Heaviness of the extremities * Following this initial euphoria, the user goes “on the nod,” an alternately wakeful and drowsy state
55
what is Methadone?
orally administered, long-acting, opioid receptor agonist that has cross-tolerance with other opioids thereby prevents withdrawal symptoms
56
what is Buprenorphine?
Partial agonist at the mu opioid receptor & kappa receptor antagonist which relieves drug cravings and withdrawal symptoms
57
what is Naltrexone?
Oral or injectable long-acting formulation (Vivitrol®) that is an opioid receptor antagonist ** Not addictive or sedating; does not result in physical dependence
58
what is the MOA for Marijuana?
primary psychoactive component in marijuana is delta-9-tetrahydrocannabinol (Δ⁹-THC) that act as an agonist at CB1 and CB2 receptors, psychoactive effects and suppress immune function respectively
59
what are the effects of marijuana?
* anti-emetic * appetite stimulation * lowered intraocular pressure * reduced spasticity * euphoria * drowsiness * impairs cognition and memory * immunomodulation - inhibitory
60
What is Dronabinol (Marinol®, Syndros®) used for, and is it FDA-approved?
FDA-approved (Schedule CIII) for treating nausea and vomiting from chemotherapy, and for appetite and weight loss associated with AIDS.
61
What is Nabilone (Cesamet®) approved for?
FDA-approved (Schedule CII) for nausea and vomiting. It's also used as an adjunct for neuropathic pain treatment.
62
What is Nabiximols (Sativex®), and where is it approved?
THC and cannabidiol mouth spray approved in Canada and parts of Europe for cancer-related pain, spasticity, and neuropathic pain in multiple sclerosis
63
What is Cannabidiol (Epidiolex®) used for?
FDA-approved for epilepsy treatment and is being studied for relieving neuropathic pain.
64
what are the acute and chronic effects of marijuana?
- acute: Lethargy, sedation, slurred speech, decreased reaction time, xerostomia, increased heart rate, arrhythmia - chronic: Respiratory disease, Coronary artery disease, Oligospermia, abnormal menstruation, Growth hormone and thyroid hormone suppression
65
What are the main toxic effects of heavy or chronic marijuana use?
- Poor school performance and increased dropout (especially in teens) - Memory loss, lower IQ, and cognitive problems - Linked to anxiety, depression, and schizophrenia - Increased heart rate and irregular heartbeat - Lung problems - Risk of drug dependence
66
what are withdraw symptoms for marijuana?
irritability, anxiety, decreased appetite, weight loss, restlessness, disrupted sleep, cannabis craving * Starts 24 hrs after last use, peaks in 2-3 days, last about 2-3 weeks
67
What is "Spice" or synthetic cannabinoids made of and how is it used?
Inert plant material sprayed with synthetic cannabinoids (e.g., JWH-018, CP-47,497) and usually smoked using pipes or rolled cigarettes
68
How do synthetic cannabinoids compare to THC, and what is their legal status?
They are over 10 times more potent than THC, act as CB1 and CB2 receptor agonists and now classified as Schedule I drugs by the DEA
69
what are the synthetic cannabinoids adverse effects?
Anxiety & agitation Confusion & hallucinations Paranoia & psychosis Headache Seizures Increased HR/BP; MI Vomiting Death
70
what are Benzodiazepines classified as?
sedative hypnotics (Alprozolam (Xanax®), Clonazepam (Klonopin®), Diazepam (Valium®), Flunitrazepam (Rohypnol®))
71
how do benzodiazepines work and what are the effects?
GABA receptor agonist causing drowsiness, impaired motor coordination, ataxia, slurred speech and some amnesia
72
what are the abuse characteristics for benzodiazepines?
Psychological dependence and Physical dependence if high doses taken for long periods of time
73
What are the key features of benzodiazepine toxicity and its treatment?
Abrupt withdrawal in dependent individuals can cause seizures and be life-threatening and overdose (OD) may lead to respiratory failure and death from cerebral anoxia Treatment includes: - Flumazenil (antidote) - Gastric lavage - Respiratory support
74
What is nitrous oxide and how is it used recreationally?
Also known as Whippets, Hippie Crack, Galaxy Gas usually an inhaled gas, often from whipped cream chargers or balloons that has a rapid onset within seconds and lasts about 5–30 minutes
75
What are the desired and negative effects of nitrous oxide?
- Desired Effects: Euphoria and giddiness, Perceptual distortions and dreamy feelings, Ataxia (loss of coordination), slurred speech - Negative Effects: Coughing, sneezing, rhinitis (nasal inflammation), Nausea, vomiting, Eye irritation and tinnitus (ringing in the ears)
76
What are the toxic effects of nitrous oxide?
High doses: Risk of asphyxia, respiratory depression, or cardiac arrest and may cause: - Arrhythmias (especially in those with CV conditions) - Vitamin B12 deficiency - Psychological dependence (low physical dependence)

NSP Final (11 decks)

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