Drugs of abuse Flashcards
opiate reinforcing effects
euphoria, analgesia, sedation with anxiety reduction
opiate CNS action
interferes with endogenous mu opioid recepors
histamine release –> “rush” feelings
CNS depressants reinforcing effects
euphoria, sedation, anxiolytic, body building effects (GHB)
CNS depressant action
enhanced GABA activity
barbiturates and ETOH at high doses –> decreased glutamate
GHB –> complex effects at brain DA systems
CNS stimulant action
block catecholamine (esp DA) reuptake, increased catecholamine release
CNS stimulant reinforcing effects
elevation of mood, feeling of exhilaration, sense of increased energy and alertness, decreased fatigue and need for sleep, decreased appetite
Nicotine CNS action
nicotinic neuronal receptor agonist
Nicotine reinforcing effect
mild alerting effect
Hallucinogens CNS action
agonist at 5HT2 postsynaptic serotonin receptors
Hallucinogens reinforcing effects
altered perception, mood elevation, dissociation from self
Marijuana CNS action
cannabinoid receptor agonist (CB1) –> increased dopamine release in nucleus accumbens
Marijuana reinforcing effects
euphoria; changes in mood, perception and motivation
anticholinergic CNS action
block muscarinic cholinergic receptors
anticholinergic reinforcing effects
mood elevation, hallucinations, delirium
inhalants CNS action
general CNS depression via altered membrane permeability –> altered GABA/DA neurotransmission
inhalants reinforcing effects
euphoria, giddiness, dizziness, lightheadedness, disinhibition, floating sensation, misperception, clouding of thoughts
dissociative anesthetics CNS action
NMDA receptor antagonist. blocks reuptake of DA and serotonin. increased DA release in limbic and cortical structures
dissociative anesthetics reinforcing effects
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
opioid toxicity and treatment
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)
CNS depressant toxicity and treatment
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)
CNS stimulant toxicity and treatment
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
Nicotine toxicity and treatment
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
Hallucinogens toxicity and treatment
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
Marijuana toxicity and treatment
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
Dissociative anesthetics toxicity and treatment
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
Inhalants toxicity and treatment
Toxicity: similar to ETOH
Treatment: general supportive care, control arrythmias, respiratory assistance
Anticholinergic toxicity and treatment
Toxicity: disorientation and delirium, dry skin and mouth, flushed face, fever, unreactive pupils, blurry vision, memory impairment
Treatment: physostigmine, benzos for behavioral excitation
Opiate tolerance/dependence
rapid tolerance with frequent use.
rapid physical dependence
opiate withdrawal
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
Opiate withdrawal treatment
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
CNS depressant tolerance/dependence
rapid tolerance to barbiturates, moderately rapid to ETOH, less with benzodiazepines
physical tolerance develops. EEG changes and insomnia after 1 week of ordinary usage
CNS depressant withdrawal
induced seizures –> significant risk of morbidity and mortality
Symptoms: rebound hyperexcitability. Severe = grand mal seizures, fever, delirium
CNS depressant withdrawal treatment
tapered reduction/substitution (with barbiturate or benzo)
Buspar for anxiety
Carbemazepine/watchful waiting for seizures
CNS stimulant tolerance/dependence
Tolerance to anorexia, euphoria, hyperthermia. Supersensitivity to effects on movement and psychomimetic/paranoia effects
Dependence: strong PSYCHOLOGICAL dependence
CNS stimulant withdrawal
No obvious physiological sx. Only intense craving and drug seeking initially, with eventual normalized sleep and mood
CNS stimulant withdrawal treatment
behavioral.
TCADs and bupropion –> relieve depression and reduce craving
Topiramate –> reduced relapse rate
Modafinil –> reduced cocaine-induced euphoria, relieved cocaine withdrawal sx
Nicotine tolerance/dependence
tolerance: yes for subjective effects (better feeling after a period of abstinence) and nausea
Physical dependence: moderate
Nicotine withdrawal
irritability/impatience/hostility, anxiety, depressed mood, difficulty concentrating, restlessness, increased appetite. Depression –> often relapse
Nicotine withdrawal treatment
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
Hallucinogen tolerance/dependence
tolerance: uncommon due to infrequent repeated use. larger doses increase tolerance to behavioral effects
Physical dependence: None
Hallucinogen withdrawal
None
Marijuana tolerance/dependence
Tolerance: rapid appearance, rapid disappearance
Physical dependence: high potential –> preoccupation, compulsion, reinforcement and withdrawal after chronic use
Marijuana withdrawal
high lipid solubility –> long half life –> uncommon withdrawal appearance
Sx: mild withdrawal syndrome
Marijuana withdrawal treatment
usually unnecessary. Heavy users –> depression –> require antidepressants
Common inhalants
Glues/adhesives, aerosol propellants, cleaning solutions, paints, paint thinners, correction fluids, nail polish remover, fuels
Common dissociative anesthetics
Phencyclidine (PCP), ketamine, very high dose dextromethorphan
Common hallucinogens
Indoleamines: LSD, DMT, psilocybin, bufotenine (toad skin)
Phenylethylamines: mescaline, MDMA
Common CNS stimulants
methamphetamine, cocaine
Common CNS depressants
barbiturates (pentobarbital, secobarbital, amobarbital), benzodiazepines, ETOH, GHB, kava (herb)
Common opiates
heroin, morphine, oxycodone, meperidine, fentanyl, hydrocodone, codeine
