Drugs of Abuse

Question 1

Stimulants

Answer 1

inc wakefulness, attention, physical performance. used for weight loss

Question 2

caffeine

Answer 2

adenosine antagonist

stimulant

Question 3

nicotine

Answer 3

nicotinic agonist
relaxation and increased alertness
stimulant
people eat less

bupropion (antidepressant blocks dopamine reuptake) and varenicline (nicotinic partial agonist) for smoking cessation

Question 4

sympathomimetics/psychostimulants

Answer 4

stimulate SNS 
inc wakefulness and attention 
causes pupillary dilation 
high doses cause stereotypy 
stimulation of mesolimbic dopamine system contributes to significant reinforcing euphoric effects and addictive potential

caffeine, nicotine, cocaine, amphetamine, mdma

Question 5

cocaine

Answer 5

sympathomimetics/ psychostimulants
inhibits dopamine, NE, serotonin reuptake
inc risk of intracranial hemorrhage, ischemic stroke, seizures

short duration of action, usually doesn’t cause a lot of tolerance but can lead to strong cravings

used as topical local anesthetic for mucous membranes

Question 6

d-amphetamine/ methamphetamine

Answer 6

releases and blocks reuptake of dopamine and norepinephrine (serotonin to lesser extent)
methamphetamine is longer acting with more pronounced central effects
used for ADHD and nacrolepsy (meth also used for obesity, not recommended

long term use- amphetamine psychosis
withdrawal consists of dysphoria, drowsiness/insomnia, general irritability

Question 7

MDMA

Answer 7

amphetamine derivative with greater serotonergic activity
-fosters feelings of positive mood, intimacy, empathy, sharpened sensory awareness
psychedelic effects
tolerance with repeated use

Question 8

adverse effects of MDMA

Answer 8

dose dependent jaw clenching, tachycardia, muscle aches
serotonin syndrome
hyperthermia
depletion of serotonin can be permanent with repeated use
withdrawal includes depression and increased aggression

Question 9

psychedelic hallucinogens

Answer 9

alters cognition and perception
visual hallicinations
perceptual disturbances (time distortions)
pupillary dilation, nausea

mechanism- effects on serotonergic system- altered reuptake, agonist/antagonist, inc glutamate release in cortex

rapid tolerance occurs, does not cause dependence or addiction

lsd- synthetic, effects last 6-12 hrs
mescaline- ritual purposes
psilocybin- from mushrooms

Question 10

dissociative hallucinogens

Answer 10

disconnecting from body and external reality, emotional withdrawal, apathy, impaired memory
duration 1 hr, hostile behavior

noncompetitive NMDA antagonists
does not cause dependence

phencyclidine
ketamine- anesthetic

Question 11

cannabinoids

Answer 11

causes euphoria, relaxation, giddiness 
inc appetite 
antiemetic 
modulation of endogenous cannabinoid system, CNS effects via sitmulation of cannabinoid receptors
immune modulation

Question 12

phencyclidine

Answer 12

dissociative hallucinogen
phencyclidine- pcp, angel dust- high dose produces coma, muscle rigidity, hyperthermia, seizures, long lasting psychosis with chronic exposure

Question 13

thc

Answer 13

accumulates in adipose–> detectable in urine for 3 weeks after cessation
interacts with CB1 receptors in CNS and causes giddiness, euphoria, relaxation

Question 14

cannabidiol (CBD)

Answer 14

nonpsychoactive, anticonvulsant

CB2 agonist, CB1 antagonist

Question 15

ethanol

Answer 15

cns depressant
use- recreational
clinical use- methanol and propylene glycol poisoning

affects variety of receptors and ion channels including GABAa

CNS- dec anxiety, removes inhibitions, lengthens reaction times

resp- decreased at anesthetic doses

GI- irritating to mucosa

CV- vasodilation- sensation of warmth (however, vasodilation causes loss of heat so…not good in freezing temps)

hepatic/renal- cirrhosis, inc microsomal enzyme activity, inc urine flow and volume because inhibiting ADH and increasing fluid intake

Question 16

Pharmacokinetics of ethanol

Answer 16

crosses BBB and placenta
hepatic metabolism
rapidly absorbed from GI

ethanol metabolized by alcohol dehydrogenous makes into acetaldehyde (makes you sick) which is then metabolized by aldehyde dehydrogenous into acetate

Question 17

acamprosate

Answer 17

analog of homataurine and GABA
maintenance of abstinence from alcohol
se: diarrhea, nausea, flatulence, pruritis

Question 18

disulfiram

Answer 18

inhibits acetaldehyde dehydrogenous and conversion of acetaldehyde to acetate
inc acetaldehyde causes toxicity- inc in hr, dizziness, vomiting, unconsciousness, can be fatal

warn pts about other alcohol containing products- cough syrup, mouth wash

Question 19

ethanol contraindications

Answer 19

hepatic and renal diseases
ulcers
epilepsy
other CNS depressants- additive or synergistic effects

Question 20

ethanol toxicity- acute

Answer 20

acute- coma, hypothermia, decreased respiration due to medullary suppression

Question 21

ethanol toxicity- chronic

Answer 21

alcoholic hallucinosis- paranoid psychosis without tremulousness, confusion, and other withdrawal

withdrawal- seizures hand tremors, headaches, loss of appetite, nausea, vomiting, (slowly reduce dose over time, benzos for acute symptoms)

wenicke-korsakoff syndrome- due to thiamine deficiency

cirrhosis of liver

Question 22

naltrexone

Answer 22

opioid antagonist

thought to decrease craving for ethanol, and prevent relapse