Drugs of abuse [3]

Question 1

Drugs of abuse share which final common pathway?

Answer 1

VTA activation releases DA onto NA neurons

- pleasure is received

Question 2

MOA of
CNS stimulants
Dissociative anesthetics
Hallucinogens

Answer 2

CNS stim: block DA reuptake or enhance DA release

Dissociative anesthetics: antagonist at NMDA-Glu

Halluc: partial agonist at 5HT2 receptor (DA releaser)

Question 3

Drug that blocks reuptake of DA and NE into presynatptic catecholamine (DA, NE, E) neurons and also block Na channels in neuronal membrane:

Answer 3

Cocaine

• caines: block Na channels in neuronal membrane
  ie: lidocaine - amide - longer duration of action

Question 4

opioid (mu opioid rcptr activ)

acute toxicity and tx

Answer 4

respiratory depression
pinpoint pupils
coma

tx: naloxone

Question 5

CNS depression (GABA activ, GLU inhib) 
acute toxicity and tx for:
ethanol
BDZ
barbs

Answer 5

resp depression
coma (with BDZs)

Tx:
Ethanol: thiamine
BDZ: Flumazenil
Barbs: supportive

Question 6

CNS stimulants (activ of NE and DA receptors) 
acute toxicity and tx

Answer 6

SNS overactivity
Increase HR-BP=Temp
Chest pain-MI, payxhoaia

Tx: vasodilators, BDZs

Question 7

Nicotine acute toxicity (insecticides) and tx for:

Nicotine

Answer 7

nausea-vomit
diarrhea
convulsions

tx: emetics-gastric lavage charcoal
(nicotine replacement
bupropion
verenicline)

Question 8

Tx for Hallucinogens and dissociative anesthetics

Answer 8

BDZs for agitation

Dissociative anesthetics: antagonist at NMDA-Glu

Halluc: partial agonist at 5HT2 receptor (DA releaser)

Question 9

very little chance of resulting in fatality if ingested orally in excessive amts as single agents

Answer 9

Diazepam (BDZ)

Question 10

Cross tolerance

• what is it
• give 2 ex

Answer 10

tolerance develops to one drug
- then will be seen to other drugs of the same class-same target

ie:
heroin→cross tolerance to hydrocodone
- both act at u-opioid receptors)

alcoholic patient tolerant to ethanol → cross tolerance to BDZ
- both act at GABA receptors

Question 11

Pt who is alcoholic, would display cross tolerance to which of the followig drugs

Answer 11

OH: enhance GABA + decrease Glu

BDZ: ie diazepam (Valium)

Question 12

CNS depressants:
which one is more rapid
ethanol, barbs, BDZ

Answer 12

Barbs > ethanol, BDZ

Question 13

Cross dependence

Answer 13

ability of one drug to suppress the w/drawal associated with physical dependence on another drug

ie: suppressing w/drawal symp of ethanol with BDZ
- w/drawal symp can be fata and may require emergent intervention for drugs of abuse

Question 14

Withdrawal effects from drug of abuse

Answer 14

characterized by rebound effects

effects generally opposite of the acute effects of the drug

Can be fatal and may require emergent intvn

Question 15

Opioids w/drawal

- tx

Answer 15

you feel miserable - rarely life threatening

Tx: clonidine, methadone

clonidine: short term
- shut down SNS, muscarinic saliva formation - dry mouth side effect

methadone: long term sub

Question 16

CNS depressant w/drawal

- tx

Answer 16

Significant risk of mortality due to seizures

Tx: sub w/ BDZ

Question 17

Nicotine tx:

Answer 17

irritability, hostility, anxiety, increase appetite

nicotine replacement
bupropion
verenicline

Question 18

Which drug of abuse is least likely to be associated with seizures?

Answer 18

Opioid analgesics

typically CNS depressant w/drawal will have risk of mortality due to seizures