Drugs of Abuse Flashcards
What are the sedatives (aka CNS depressants)?
Alcohol, benzodiazepines, barbiturates, opioids
Alochol, benzodiazepines, barbiturates: MOA
Potentiate GABA recpetor.
Opioids: MOA
Exert effects at
opioid receptors,
such as the μ
receptor.
Alcohol Intoxication: Symptoms/Complications
Ataxia and incoordination, loquacity and
slurred speech, euphoria, impaired attention,
irritability, mood changes, sedation. Can get
Wernicke-Korsakoff syndrome and alcoholic
nephropathy; depletion of NAD+ and
accumulation of TCA metabolites causes liver
degeneration (cirrhosis).
Fetal alcohol syndrome: Low birth weight,
microcephaly, upturned nose, smooth philtrum,
intellectual disability, heart defects.
Alcohol: Withdrawal Sx
Altered perceptions, delirium tremens (usually 48-96h after last drink), insomnia, irritability, seizures, tremor, HTN, tachycardia, nausea, sweating. Withdrawal is potentially FATAL.
Delerium tremens is a medical emergency that involves sudden and severe mental nervous system changes.
Alcohol, benzodiazepines, barbiturates: Treatment of overdose
TAPERED
benzodiazepine
withdrawal.
Alcohol: Metabolism
ETOH metabolism: conv. To acetaldehyde by Alcohol DH. Acetaldehyde then conv to acetate by Acetaldehyde DH. EtOH at higher or chronic doses also undergoes oxidation by P450 (CYP2E1). Accumulation of acetaldehyde -> hangover. BAC is amount EtOH in blood (0.08 = legal limit)
Benzodiazepines and barbiturates intoxication: Sx
Similar to alcohol, with hypotension and
respiratory depression.
Reminder of alcohol withdrawal sx: Ataxia and incoordination, loquacity and
slurred speech, euphoria, impaired attention,
irritability, mood changes, sedation.
Benzodiazepines and barbiturates: withdrawal sx
As for alcohol, but no
tremor, nausea or
sweating.
W/ muscle
cramps + twitching.
Withdrawal from alcohol OR benzodiazepines is
potentially FATAL.
Barbiturate withdrawal=Not fatal.
Opioid Intoxication: Sx
Motor slowness, slurred speech, apathy,
euphoria or dysphoria, impaired attention,
sedation, miosis.
Opioids: Withdrawal Sx
As for EtOH, but no tremor.
W/ muscle
aches, PLUS fever,
mydriasis, diarrhea,
yawning + piloerection.
What are the stimulants?
Cocain, amphetamines, caffeine, nicotine
Cocaine: MOA
Inhibits neuronal
reuptake of NE
and dopamine
Amphetamines: MOA
Increases synaptic
concentrations of
NE and dopamine
Caffeine: MOA
Indirectly enhances DA neurotransmission by blocking adenosine R’s
Nicotine: MOA
Activates
cholinergic
nicotinic R’s in
CNS and PNS
Cocaine Intoxication: Sx
Tactile hallucinations of bugs crawling on skin,
mydriasis
Amphetamines Intoxication: Sx
BEHAVIORAL: grandiosity, euphoria,
hypervigilance, paranoia, agitation.
AUTONOMIC: HTN, tachycardia, chills, mydriasis, nausea, vomiting, nystagmus,
sweating
Cocaine and amphetamines: Withdrawal sx
Increased appetite,
bradycardia,
depression/dysphoria, drowsiness/fatigue
Cocaine and amphetamines: Overdose treatment
Supportive care. Lorazepam for agitation, cardiac monitoring and support, haloperidol for psychosis
Caffeine: Withdrawal Sx
Anxiety, depression,
impaired
concentration, HA,
malaise
Nicotine: Withdrawal Sx
Increased appetite, bradycardia,
dysphoria, anxiety,
irritability, restless
What are the hallucinogens?
PCP, LSD, marijuana
PCP: MOA
Blocks NMDA
receptor.
LSD: MOA
Acts via serotonin
R’s in neocortex,
limbic system and
brain stem.
PCP: Intoxication Sx
PSYCHOTIC Sx: Hallucinations and delusions with associated euphoria and violent behavior. NEUROLOGICAL Sx: Rigidity and nystagmus. AUTONOMIC: Miosis and tachycardia and sweating.
LSD: Intoxication Sx
PSYCHOTIC Sx: Hallucinations and delusions.
NEUROLOGICAL Sx: Ataxia and tremor.
AUTONOMIC: Mydriasis, tachycardia, sweating.
PCP and LSD: Overdose Treatment
Supportive care. Lorazepam for agitation, haloperidol for psychosis, minimize sensory input.
Marijuana: MOA
Active agent is tetrahydrocanna binol (THC), inhibits adenyl cyclase + cAMP
Marijuana: Intoxication Sx
Rapid speech, conjunctivitis, hallucinations
(at high doses), jocularity, HTN, tachycardia,
increased appetite, tightness in chest,
euphoria and sensory intensification, dry
mouth. Can cause fetal malformations.
Maijuana: Withdrawal Sx
Irritability, mild agitation, mild agitation, sleep disturbances, nausea, stomach cramps.
Marijuana: Overdose Treatment
Can potentially treat agitation with lorazepam. Treatment of other withdrawal Sx are unnecessary.
Naloxone is used for?
Tx: Opioid dependence
Naltrexone is used for?
Tx: Opioid and alcohol dependence
MOA:Opioid antagonist (blocks μ receptors)
Naltrexone affects endogenous opioid system pathways that cause reinforcement of alcohol addiction.
Disulfiram is used for?
Tx: Alcohol abuse
Inhibits aldehyde dehydrogenase
Accumulation of acetaldehyde causes sweating, palpitations, dizziness, nausea. This is prescribed to help people abstain from alcohol use.
Buprenorphine is used for?
Tx: Opioid dependence
