Drugs of Abuse Flashcards
Opioids
agonists at μ-opioid receptors [Gi]
CNS Depressants
enhance GABA and/or inhibit glutamate fxn
CNS Stimulants
block DA reuptake or enhance DA release
Nicotine:
agonist at nicotinic neuronal receptors
Hallucinogens
partial agonist at 5HT2 receptors (DA releaser)
Dissociative Anesthetics:
antagonist at NMDA-Glu receptors
Cannabinoids
agonist at cannabinoid (CB1-CB2) receptors
Reinforcing Effects of Drugs of Abuse
Opioids
Euphoria, sedation, anxiolytic
Reinforcing Effects of Drugs of Abuse
CNS Depressants
Euphoria, sedation, loss of inhibition
Reinforcing Effects of Drugs of Abuse
CNS Stimulants
Euphoria, decreased fatigue, increased arousal
Reinforcing Effects of Drugs of Abuse
Nicotine
Increased alertness
Reinforcing Effects of Drugs of Abuse
Hallucinogens
Altered sensory perception, enhanced insight
Reinforcing Effects of Drugs of Abuse
Dissociative Anesthetics
Euphoria, heightened emotionality
Reinforcing Effects of Drugs of Abuse
MJ
Euphoria, “mellowness”, changes in perception
Opioids - via mu-opioid receptor activation
Respiratory depression-pinpoint pupils-coma
Treatment: ________________
naloxone
CNS Depressants - via GABA activation +/- GLU inhibition
Respiratory depression, coma (extremely rare with BDZs)
Benzodiazepines Rx: ____________
flumazenil
CNS Depressants - via GABA activation +/- GLU inhibition
Respiratory depression, coma (extremely rare with BDZs)
ETOH
Treatment
Ethanol: supportive plus fluids-electrolytes-thiamine
CNS Stimulants - via activation of NE and DA receptors
SNS overactivity, increased HR-BP-temp, chest pain-MI, psychosis
Treatment: CVS support, ____________________
vasodilators for BP
BDZs for agitation-seizures
-reduce sym overactivity
Nicotine: rare (insecticide-cigarettes ingestion by children) - via activation of nicotinic-cholinergic receptors
Treatment: CVS support, _____________
emetics-gastric lavage-charcoal
Tox MDMA: Agitation, hyperthermia, _____________
ADH release–> hyponatremia
Tox Cannabinoids via activation of CB1 receptors
Minimal –>possible anxiety, impaired coordination-tracking, acute psychosis
Which of the following drugs of abuse is least likely to result in a fatality if orally ingested in excessive amounts as a single agent? Ethanol Heroin Morphine Oxycodone Phenobarbital Diazepam
Ethanol- rd Heroin rd Morphine rd Oxycodone rd Phenobarbital rd Diazepam- generally safe w/o resp comorbid
Tolerance to Drugs of Abuse
Cross Tolerance means?
Tolerance develops to one drug – then will be seen to other drugs of the same class - same target
Examples
Drug of abuse (heroin)–> cross-tol to medically used drug (hydrocodone) –>both drugs act at u-opioid receptors
Alcoholic patient tolerant to ethanol–> cross-tolerance to benzodiazepines - both drugs act at GABA receptors
A patient who is an alcoholic would be most likely to display cross-tolerance to which of the following drugs? Lidocaine (Xylocaine) Hydrocodone (in Vicodin) Ibuprofen (Motrin) Diazepam (Valium ) Acetaminophen
Diazepam (Valium)
ETOH and Bdz–> Facilitates GABA fxn
Dependence on Drugs of Abuse
Opioids
Develops rapidly
Dependence on Drugs of Abuse
CNS Depressants
Appears within weeks
Dependence on Drugs of Abuse
Cannabinoids
Accumulating evidence for dependence syndrome
Tolerance to Drugs of Abuse
Rapid
Opioids: Develops rapidly
CNS Depressants–> Rapid to barbiturates
Cross Dependence
+ side
Ability of one drug to suppress the withdrawal associated with physical dependence on another drug
Tolerance and dependence do not necessarily coexist - nor do addiction and physical dependence
Tolerance and dependence do not necessarily coexist - nor do addiction and physical dependence
The exaggerated expression of drug effects experienced immediately after cessation of treatment
withdrawal
A state of neuroadaptation produced by repeated drug administration that necessitates continued drug administration to prevent the withdrawal syndrome from occurring.
drug dependence
A reduced effect of the drug generated by repeated administration of the drug in a particular environment.-
tolerance
The ability of one drug to suppress the manifestations of another drug’s actions
cross dependence
Withdrawal SZ
↑↑↑ Cl–> wd ↓ Gaba ETOH
↓ Glu–> wd ↑ Glu Benz
Opoid wd rx
clonide ↓ SNS
methadone cross tol
Rarely life-threatening insomnia, diarrhea, irritability, cramps, muscle aches, increased BP
CNS ↓ wd
Significant risk of mortality due to seizures (monitor)
Treatment: substitution with BDZs –> loading dose - then taper to prevent seizures
use benzos for cross, most often wd is from etoh
Withdrawal from Drugs of Abuse
Nicotine
Treatment: relapse–> nicotine replacement, bupropion, varenicline
Untreated withdrawal from drugs of abuse can produce symptoms that include potentially life-threatening seizures. Seizures are LEAST likely to occur following withdrawal from which of the following classes of abused drugs? Alcohol Barbiturates Benzodiazepines Opioid analgesics
Alcohol- cns Barbiturates- cns Benzodiazepines- cns Opioid analgesics- u- least likely
