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Neuro IV > Drugs of abuse > Flashcards

Drugs of abuse Flashcards

1
Q

opiate reinforcing effects

A

euphoria, analgesia, sedation with anxiety reduction

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2
Q

opiate CNS action

A

interferes with endogenous mu opioid recepors

histamine release –> “rush” feelings

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3
Q

CNS depressants reinforcing effects

A

euphoria, sedation, anxiolytic, body building effects (GHB)

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4
Q

CNS depressant action

A

enhanced GABA activity
barbiturates and ETOH at high doses –> decreased glutamate
GHB –> complex effects at brain DA systems

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5
Q

CNS stimulant action

A

block catecholamine (esp DA) reuptake, increased catecholamine release

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6
Q

CNS stimulant reinforcing effects

A

elevation of mood, feeling of exhilaration, sense of increased energy and alertness, decreased fatigue and need for sleep, decreased appetite

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7
Q

Nicotine CNS action

A

nicotinic neuronal receptor agonist

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8
Q

Nicotine reinforcing effect

A

mild alerting effect

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9
Q

Hallucinogens CNS action

A

agonist at 5HT2 postsynaptic serotonin receptors

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10
Q

Hallucinogens reinforcing effects

A

altered perception, mood elevation, dissociation from self

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11
Q

Marijuana CNS action

A

cannabinoid receptor agonist (CB1) –> increased dopamine release in nucleus accumbens

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12
Q

Marijuana reinforcing effects

A

euphoria; changes in mood, perception and motivation

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13
Q

anticholinergic CNS action

A

block muscarinic cholinergic receptors

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14
Q

anticholinergic reinforcing effects

A

mood elevation, hallucinations, delirium

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15
Q

inhalants CNS action

A

general CNS depression via altered membrane permeability –> altered GABA/DA neurotransmission

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16
Q

inhalants reinforcing effects

A

euphoria, giddiness, dizziness, lightheadedness, disinhibition, floating sensation, misperception, clouding of thoughts

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17
Q

dissociative anesthetics CNS action

A

NMDA receptor antagonist. blocks reuptake of DA and serotonin. increased DA release in limbic and cortical structures

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18
Q

dissociative anesthetics reinforcing effects

A

lower dose: floating feeling of euphoria and heightened emotionality
Intermediate dose: increased talkativeness, misperceptions of sensory input, feelings of unreality, changes in body image
higher doses: hostile/bizarre behavior

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19
Q

opioid toxicity and treatment

A

toxic symptoms: coma, respiratory distress, pinpoint pupils, arrhythmias, parkinson-like effects (MPTP)

Treatment: establish airway, stabilize cardiopulmonary status. Naloxone (can lead to withdrawal in dependent addicts)

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20
Q

CNS depressant toxicity and treatment

A

Toxicity: confusion, emotional lability, ataxia, hyporeflexia, miosis.
severe = respiratory depression and hypotension –> coma and death

Treatment: supportive measures. Flumazenil (benzo OD). Respiratory support, IV glucose, thiamine, multivitamins, K, MG (ETOH OD)

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21
Q

CNS stimulant toxicity and treatment

A

Toxicity: peripheral sympathetic overactivity.
Severe = chest pain –> MI, fatal arrhythmias, stroke-like CNS vasculature

Treatment: Cardiopulmonary support, gastric lavage, acidify urine (increase excretion)
seizures –> diazepam
BP elevation –> phentolamine (never ever ever use beta blockers)
positive psych sx –> haldol

22
Q

Nicotine toxicity and treatment

A

Toxicity: Due to accidental ingestion of insecticides, children ingesting tobacco
Rapid –> nausea vomiting, abdominal pain, salivation, diarrhea, headache/dizziness
Later –> hypotension, dyspnea, weak and irregular pulse –> terminal convulsions, respiratory failure

Treatment: gastric lavage or induced vomiting, then activated charcoal. respiratory assistance and shock tx

23
Q

Hallucinogens toxicity and treatment

A

Toxicity: exaggerated panic reaction (vital signs); hallucinations –> anxiety. loss of contact with reality; schizophrenia-like sx; severe –> fever, CV collapse, convulsions, rhabdomyolysis

Treatment: stabilize cardiopulmonary function and treat convulsions and hyperthermia. Talk down, supplement with benzos

24
Q

Marijuana toxicity and treatment

A

Toxicity: decreased muscle strength, balance, motor coordination; increased reaction time; increased heart rate; seizures in epileptics; risk for ketoacidosis in diabetics

Treatment: general support and reassurance in low stimuli room

25
Q

Dissociative anesthetics toxicity and treatment

A

Toxicity: most difficult to manage (2-6wk recovery due to ion trapping of weak base PCP in stomach)
Initial: delirium, tachypnea, hypertension, tachycardia, hyperpyrexia, muscle rigidity, increased DTRs, blank stare
Later: stupor –> coma, seizures –> death from resp/cardiac complications

Treatment: manage symptoms. Benzos for agitation, antipsychotics for PROLONGED psychotic behavior

26
Q

Inhalants toxicity and treatment

A

Toxicity: similar to ETOH
Treatment: general supportive care, control arrythmias, respiratory assistance

27
Q

Anticholinergic toxicity and treatment

A

Toxicity: disorientation and delirium, dry skin and mouth, flushed face, fever, unreactive pupils, blurry vision, memory impairment

Treatment: physostigmine, benzos for behavioral excitation

28
Q

Opiate tolerance/dependence

A

rapid tolerance with frequent use.

rapid physical dependence

29
Q

opiate withdrawal

A

not medically dangerous. after 1-2wk of multidose days.

Early: restlessness, sleeplessness, yawning, nasal discharge, sweating
Late: agitation, chilling, anorexia, fever, muscle/joint pain, vomiting, diarrhea, abdominal cramps/muscle spasms, tachycardia, hypertension

30
Q

Opiate withdrawal treatment

A

clonidine –> alleviated sympathetic overactivity
methadone/codeine –> substitution to alleviate sx
Buprenorphine (subutex) = partial mu agonist –> minimal withdrawal sx
Naltrexone (Revia) = opioid antagonist –> blocked reinforcing actions of heroin, no effect on craving or protracted withdrawal syndrome

31
Q

CNS depressant tolerance/dependence

A

rapid tolerance to barbiturates, moderately rapid to ETOH, less with benzodiazepines

physical tolerance develops. EEG changes and insomnia after 1 week of ordinary usage

32
Q

CNS depressant withdrawal

A

induced seizures –> significant risk of morbidity and mortality

Symptoms: rebound hyperexcitability. Severe = grand mal seizures, fever, delirium

33
Q

CNS depressant withdrawal treatment

A

tapered reduction/substitution (with barbiturate or benzo)
Buspar for anxiety
Carbemazepine/watchful waiting for seizures

34
Q

CNS stimulant tolerance/dependence

A

Tolerance to anorexia, euphoria, hyperthermia. Supersensitivity to effects on movement and psychomimetic/paranoia effects

Dependence: strong PSYCHOLOGICAL dependence

35
Q

CNS stimulant withdrawal

A

No obvious physiological sx. Only intense craving and drug seeking initially, with eventual normalized sleep and mood

36
Q

CNS stimulant withdrawal treatment

A

behavioral.

TCADs and bupropion –> relieve depression and reduce craving
Topiramate –> reduced relapse rate
Modafinil –> reduced cocaine-induced euphoria, relieved cocaine withdrawal sx

37
Q

Nicotine tolerance/dependence

A

tolerance: yes for subjective effects (better feeling after a period of abstinence) and nausea

Physical dependence: moderate

38
Q

Nicotine withdrawal

A

irritability/impatience/hostility, anxiety, depressed mood, difficulty concentrating, restlessness, increased appetite. Depression –> often relapse

39
Q

Nicotine withdrawal treatment

A

nicotine replacement –> suppressed withdrawal without same magnitude of subjective effects

sustained release bupropion (Zyban) –> improved anstinence in combination with nicotine replacement

varenicline (Chantix) –> ease withdrawal, blocks nicotine effects from cigarettes

Nicotine vaccine –> binds nicotine in periphery and prevents CNS effects

40
Q

Hallucinogen tolerance/dependence

A

tolerance: uncommon due to infrequent repeated use. larger doses increase tolerance to behavioral effects

Physical dependence: None

41
Q

Hallucinogen withdrawal

A

None

42
Q

Marijuana tolerance/dependence

A

Tolerance: rapid appearance, rapid disappearance

Physical dependence: high potential –> preoccupation, compulsion, reinforcement and withdrawal after chronic use

43
Q

Marijuana withdrawal

A

high lipid solubility –> long half life –> uncommon withdrawal appearance

Sx: mild withdrawal syndrome

44
Q

Marijuana withdrawal treatment

A

usually unnecessary. Heavy users –> depression –> require antidepressants

45
Q

Common inhalants

A

Glues/adhesives, aerosol propellants, cleaning solutions, paints, paint thinners, correction fluids, nail polish remover, fuels

46
Q

Common dissociative anesthetics

A

Phencyclidine (PCP), ketamine, very high dose dextromethorphan

47
Q

Common hallucinogens

A

Indoleamines: LSD, DMT, psilocybin, bufotenine (toad skin)

Phenylethylamines: mescaline, MDMA

48
Q

Common CNS stimulants

A

methamphetamine, cocaine

49
Q

Common CNS depressants

A

barbiturates (pentobarbital, secobarbital, amobarbital), benzodiazepines, ETOH, GHB, kava (herb)

50
Q

Common opiates

A

heroin, morphine, oxycodone, meperidine, fentanyl, hydrocodone, codeine

Neuro IV (21 decks)

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