Drugs of Abuse

Question 1

Opioids

Answer 1

agonists at μ-opioid receptors [Gi]

Question 2

CNS Depressants

Answer 2

enhance GABA and/or inhibit glutamate fxn

Question 3

CNS Stimulants

Answer 3

block DA reuptake or enhance DA release

Question 4

Nicotine:

Answer 4

agonist at nicotinic neuronal receptors

Question 5

Hallucinogens

Answer 5

partial agonist at 5HT2 receptors (DA releaser)

Question 6

Dissociative Anesthetics:

Answer 6

antagonist at NMDA-Glu receptors

Question 7

Cannabinoids

Answer 7

agonist at cannabinoid (CB1-CB2) receptors

Question 8

Reinforcing Effects of Drugs of Abuse

Opioids

Answer 8

Euphoria, sedation, anxiolytic

Question 9

Reinforcing Effects of Drugs of Abuse

CNS Depressants

Answer 9

Euphoria, sedation, loss of inhibition

Question 10

Reinforcing Effects of Drugs of Abuse

CNS Stimulants

Answer 10

Euphoria, decreased fatigue, increased arousal

Question 11

Reinforcing Effects of Drugs of Abuse

Nicotine

Answer 11

Increased alertness

Question 12

Reinforcing Effects of Drugs of Abuse

Hallucinogens

Answer 12

Altered sensory perception, enhanced insight

Question 13

Reinforcing Effects of Drugs of Abuse

Dissociative Anesthetics

Answer 13

Euphoria, heightened emotionality

Question 14

Reinforcing Effects of Drugs of Abuse

MJ

Answer 14

Euphoria, “mellowness”, changes in perception

Question 15

Opioids - via mu-opioid receptor activation

Respiratory depression-pinpoint pupils-coma

Treatment: ________________

Answer 15

naloxone

Question 16

CNS Depressants - via GABA activation +/- GLU inhibition

Respiratory depression, coma (extremely rare with BDZs)

Benzodiazepines Rx: ____________

Answer 16

flumazenil

Question 17

CNS Depressants - via GABA activation +/- GLU inhibition

Respiratory depression, coma (extremely rare with BDZs)

ETOH

Answer 17

Treatment

Ethanol: supportive plus fluids-electrolytes-thiamine

Question 18

CNS Stimulants - via activation of NE and DA receptors

SNS overactivity, increased HR-BP-temp, chest pain-MI, psychosis

Treatment: CVS support, ____________________

Answer 18

vasodilators for BP

BDZs for agitation-seizures
-reduce sym overactivity

Question 19

Nicotine: rare (insecticide-cigarettes ingestion by children) - via activation of nicotinic-cholinergic receptors

Treatment: CVS support, _____________

Answer 19

emetics-gastric lavage-charcoal

Question 20

Tox MDMA: Agitation, hyperthermia, _____________

Answer 20

ADH release–> hyponatremia

Question 21

Tox Cannabinoids via activation of CB1 receptors

Answer 21

Minimal –>possible anxiety, impaired coordination-tracking, acute psychosis

Question 22

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

Answer 22

Ethanol- rd
Heroin  rd
Morphine  rd
Oxycodone  rd
Phenobarbital  rd
Diazepam- generally safe w/o resp comorbid

Question 23

Tolerance to Drugs of Abuse

Cross Tolerance means?

Answer 23

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

Question 24

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

Answer 24

Diazepam (Valium)

ETOH and Bdz–> Facilitates GABA fxn

Question 25

Dependence on Drugs of Abuse | Opioids

Answer 25

Develops rapidly

Question 26

Dependence on Drugs of Abuse | CNS Depressants

Answer 26

Appears within weeks

Question 27

Dependence on Drugs of Abuse | Cannabinoids

Answer 27

Accumulating evidence for dependence syndrome

Question 28

Tolerance to Drugs of Abuse | Rapid

Answer 28

Opioids: Develops rapidly CNS Depressants--> Rapid to barbiturates

Question 29

Cross Dependence | + side

Answer 29

Ability of one drug to suppress the withdrawal associated with physical dependence on another drug

Question 30

Tolerance and dependence do not necessarily coexist - nor do addiction and physical dependence

Answer 30

Tolerance and dependence do not necessarily coexist - nor do addiction and physical dependence

Question 31

The exaggerated expression of drug effects experienced immediately after cessation of treatment

Answer 31

withdrawal

Question 32

A state of neuroadaptation produced by repeated drug administration that necessitates continued drug administration to prevent the withdrawal syndrome from occurring.

Answer 32

drug dependence

Question 33

A reduced effect of the drug generated by repeated administration of the drug in a particular environment.-

Answer 33

tolerance

Question 34

The ability of one drug to suppress the manifestations of another drug’s actions

Answer 34

cross dependence

Question 35

Withdrawal SZ

Answer 35

↑↑↑ Cl--> wd ↓ Gaba ETOH ↓ Glu--> wd ↑ Glu Benz

Question 36

Opoid wd rx

Answer 36

clonide ↓ SNS methadone cross tol Rarely life-threatening  insomnia, diarrhea, irritability, cramps, muscle aches, increased BP

Question 37

CNS ↓ wd

Answer 37

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

Question 38

Withdrawal from Drugs of Abuse | Nicotine

Answer 38

Treatment: relapse--> nicotine replacement, bupropion, varenicline

Question 39

``` 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 ```

Answer 39

```   Alcohol- cns Barbiturates- cns Benzodiazepines- cns Opioid analgesics- u- least likely ```