Drugs of Abuse

Question 1

Acute withdrawal cocaine

Answer 1

Bromocriptine-dopamine agonist-helps with dopamine deficiency state of cocaine withdrawal
Benzos-sedation

Question 2

How do opioids work?

Answer 2

1. agonist M receptor
2. inhibit GABA interneurons
3. disinhibition of mesolimbic DA system

Question 3

What are withdrawal symptoms of opioid?

Answer 3

lacrimation, rhinorrhea, yawning, goosebumps, involuntary movement, dilation of pupils

Question 4

Nalaxone

Answer 4

treatment of overdose
ANTAGONIST
-short hl

Question 5

Naltrexone

Answer 5

treatment of opioid dependence
ANTAGONIST
-heroin self administration no longer rewarding
-avoid in patients with liver failure

Question 6

Methadone

Answer 6

treatment of withdrawal and maintenance

AGONIST

Question 7

Buprenorphine

Answer 7

treatment of withdrawal and maintenance
PARTIAL AGONIST
-hard to overdose
-high affinity for receptors and dissociates slowly
-can be given in combination with naloxone so if IV withdrawal

Question 8

cannabinoids mechanism

Answer 8

agonist CB1

disinhibition of mesolimbic DA system

Question 9

How does alcohol affect the dopamine and opioid systems?

Answer 9

1. indirect increase dopamine –associated with positive reinforcing effects of alcohol
2. indirect interaction with opioid receptors resulting in activation of opioid system

Question 10

What does chronic exposure of alcohol do to GABA and NMDA?

Answer 10

1. GABA receptors reduced (because increases effect of GABA)
2. upregulation of NMDA
   - -sudden reduction—overactivation of NDMA

(side note: alcohol inhibits the effects of glutamate)

Question 11

What do you give for immediate symptoms of withdrawal from alcohol?

Answer 11

benzodiazepine such as diazepam or lorazepam(for liver cirrhotic patients)

Question 12

Alcohol withdrawal

Answer 12

1. minor withdrawal (6-36 hours)-CNS hyperactivity
2. seizures (6048 hours)
3. alcoholic hallucinations (12-48 hours)
4. delirium tremens (48-5 days)-life threatening

Question 13

Disulfiram

Answer 13

Alcohol aversion
-inhibits ALDH-which converts acetaldehyde to acetate–nausea vomiting

-Asians slow ALDH

Question 14

Naltrexone

Answer 14

Long acting opioid antagonist

• reduces alcohol cravings
• dont give disulfiram and naltrexone together–hepatotoxins

Question 15

Acamprosate

Answer 15

Restores balance between neuronal excitation and inhibition

• dose adjustment in patients with renal moderate renal disease
• contraindicated in severe renal disease

Question 16

Benzos

Answer 16

indirect agonists of GABA receptor

Question 17

Nicotine

Answer 17

agonist nAChR

-stimulates dopaminergic neurons in VTA

Question 18

varenicline

Answer 18

partial agonist of nAChR that binds to subunits of nicotinic acetylcholine receptors

• relieves cravings
• binds with greater affinity than nicotine-nicotine less rewarding

Question 19

LSD

Answer 19

serotonin receptor 5HZT2A in cortex