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PPP Winter FINAL > Drugs Of Abuse > Flashcards

Drugs Of Abuse Flashcards

1
Q

Briefly define substance use disorder according to DSM-V

A

Tolerance
(Need more or diminished effect)

Withdrawal
(Substance used to relieve or avoid withdrawal symptoms)

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2
Q

Define the common neural pathway of drugs of abuse.

A

Increase dopamine

Reward pathway

Major effects:
+euphoria
+omnipotence
+relaxation

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3
Q

Define the part in the brain where all drugs of abuse causes increased dopaminergic transmission

A

Mesolithic pathway

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4
Q

List MOA of psychostimulants

Amphetamines
Methylphenidate
Cocaine

A

Inc. NE, DA, serotonin

Cocaine + Methylphenidate:
no effect on 5HT!!

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5
Q

List desired and toxic effects of psychostimulants

A 
Effects:
\+euphoria
\+hallucination
\+strength
\+dec. appetite
\+long-term performance
\+dec. need for sleep

Toxicity:

  • cardiac arrhythmias
  • psychosis
  • seizures
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6
Q

List clinical use of psychostimulants

A

Amphetamines:
Anorexiant (obesity)
ADHD

Methylphenidate: ADHD

Cocaine: local anesthetic

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7
Q

Describe withdrawal syndrome and treatment of intoxication for

Psychostimulants

A

Withdrawal:

  • dec. pleasure
  • psychomotor retardation
  • fatigue
  • inc. appetite

Tx:
+control agitation = BNZ
+hyperthermia = ice
+HTN = nitroprusside or phentolamine

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8
Q

List MOA of marijuana

A

Stimulation of cannabinoid receptors

Dec. GABA = inc. DA release

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9
Q

List desired and toxic effects of marijuana

A

Stimulant phase
Depressive + munchies

Toxicity:

  • Anticholinergic = tachycardia, dry mouth
  • Bloodshot eyes
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10
Q

Describe clinical use for marijuana

A

Antiemetic effects
= dronabinol

Appetite promoting in AIDS and cancer patients = dronabinol + Nabilone

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11
Q

Describe withdrawal syndrome and treatment of intoxication for

Marijuana

A

None well characterized

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12
Q

List MOA of opioids

A

Agonist at mu receptors in Mesolimbic pathway

Dec. GABA = inc. DA

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13
Q

List desired and toxic effects of opioids

A

Effects:
Depressed mental status
Respiratory depression
Pinpoint pupils (miosis)

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14
Q

Describe clinical use of opioids

A

Moderate to severe pain

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15
Q

Describe withdrawal syndrome and treatment of intoxication for

Opioids
(Heroine, morphine, codeine, oxycodone)

A

Withdrawal:

  • muscle aches
  • autonomic hyperactivity
  • GI: N/V/D
  • neuro: restlessness

Tx of intoxication:
Respiratory support
Naloxone

Tx of withdrawal:
Methadone (substitution therapy)
Buprenorphine
Clonidine

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16
Q

List MOA for CNS depressants (ethanol)

A

Inc. endogenous opioids?

17
Q

List desired and toxic effects of ethanol

A

Chronic effects:
Alcoholic fatty liver can eventually turn into cirrhosis and failure

Neurotoxicity: peripheral neuropathy, Wernicke-Korsakoff syndrome

18
Q

Describe withdrawal syndrome and treatment of intoxication for

Ethanol

A

Withdrawal:

  • Stage 1: tachycardia, epileptic seizures, tremor, N, sweating
  • Stage 2: predelirium
  • Stage 3: delirium

Tx: of intoxication:
Thiamine
Dextrose (IV)
Electrolytes

Tx of withdrawal:
Correct electrolytes
Thiamine
Sedatives

19
Q

List the three major enzymes involved in ethanol metabolism and describe the reaction catalyze by them

Including cofactors and products

A

Alcohol-dehydrogenase

  • takes ethanol into acetaldehyde
  • cofactors: NAD+ into NADH

MEOS

  • ethanol into acetalaldehyde
  • cofactors: NADPH + O2 => NADP+ and water

Aldehyde-dehydrogenase

  • takes acetalaldehyde into acetate
  • cofactors: NAD+ => NADH
20
Q

Describe elimination of ethanol including the 3 major routes

A

Liver

Lungs

Urine

21
Q

Briefly explain why women are more susceptible to alcohol intoxication

A

Smaller amounts of alcohol-dehydrogenase in the liver

22
Q

Briefly explain the reason for the zero order kinetics in ethanol metabolism

A

RLS is provision of NAD+

Cofactors in conversion of acetalaldehyde

23
Q

Briefly describe the acute effects of alcohol in the CNS

A

Lower [] =
Euphoria, sedation, anxiolytic

Higher [] =
Slurred speech, ataxia, impaired judgment

24
Q

List the major target organs of chronic ethanol use and briefly describe the underlying pathomechanism

A

Accumulation of fat int he liver

Inhibits TCA cycle and inhibits oxidation of fat because of excess NADH

25
Q

List the therapeutic strategies to treat acute alcohol intoxication, alcohol withdrawal and alcoholism

A

Alcoholism:
Naltrexone
Disulfiram
Acamprosate

26
Q

For the following drugs to treat alcoholism, list their MOA, major side effects and CIs:

Naltrexone

A

Long acting opioid antagonist

AEs: N, hepatotoxicity

CI:
-liver failure or acute hepatitis

27
Q

For the following drugs to treat alcoholism, list their MOA, major side effects and CIs:

Disulfiram

A

Suicide inhibitor of aldehyde dehydrogenase = buildup of acetaldehyde

AEs (from accumulation): severe flushing, headache, N/V, hypotension with ethanol

***careful with “hidden” alcohol - vinegar, cough syrups

28
Q

For the following drugs to treat alcoholism, list their MOA, major side effects and CIs:

Acomprosate

A

GABA(A) activator
Weak NMda antagonist

AEs:
CNS = anxiety, depression, insomnia, dizziness
Diarrhea

PPP Winter FINAL (8 decks)

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