Drugs of Abuse

Question 1

What is abstinence syndrome?

Answer 1

The signs and symptoms that occur on withdrawal of a drug in a dependent person.

Question 2

What is a designer drug?

Answer 2

A synthetic derivative of a drug with a slightly modified structure, but no major change in pharmaceutical action. It allows for circumvention of Schedules of Controlled Drugs.

Question 3

What is tolerance vs. sensitization?

Answer 3

Tolerance - a decreased response to a drug, necessitating larger doses to achieve the same effect (rightward shift).

Sensitization - an increase in response with repetition of the same dose of a drug (leftward shift).

Question 4

What are Schedules I, II, III and IV?

Answer 4

I - high addiction potential (heroin, LSD, PCP, MDMA).

II - high addiction potential (amphetamines, cocaine, barbituates, strong opioids).

III - moderate abuse potential (anabolic steroids, barbituates, dronabinol, ketamine).

IV - low abuse potential (benzodiazepines, chloral hydrate, mild stimulants, mild hypnotics, weak opioids).

Question 5

What happens to the pupils in use of marijuana, stimulants and hallucinogens vs. narcotics?

Answer 5

Marijuana, stimulants and hallucinogens - dilated pupils

Narcotics - constricted pupils

Question 6

Barbituates of abuse (3)

Answer 6

Phenobarbital
Pentobarbital
Thiopental

Question 7

Benzodiazepines of abuse (6)

Answer 7

Midazolam
Alprazolam
Lorazepam
Clonazepam
Oxazepam
Chlordiazepam

Question 8

BZP antagonist of abuse (1)

Answer 8

Flumazenil

Question 9

Benzodiazepine partial agonists of abuse (3)

Answer 9

Zaleplon
Zolpidem
Eszopiclone

Question 10

Other anxiety meds of abuse (4)

Answer 10

Buspirone
Hydroxyzine/diphenylhydramine
SSRIs
SNRIs/TCAs

Question 11

Other insomnia drugs of abuse (2)

Answer 11

Ramelteon

Doxepin

Question 12

Amphetamines, methylphenidate, cocaine

Overdose effects:

Withdrawal signs:

Answer 12

Overdose effects: agitation, HTN, tachy, hallucinations, seizures, death.

Withdrawal signs: apathy, irritability, increased sleep time, depression.

Question 13

Barbituates, benzodiazepines, EtOH

Overdose effects:

Withdrawal signs:

Answer 13

Overdose effects: slurred speech, drunken behavior, weak/rapid pulse, clammy skin, coma, death.

Withdrawal signs: anxiety, insomnia, delirium, tremors, seizures, death.

Question 14

Heroin, other strong opioids

Overdose effects:

Withdrawal signs:

Answer 14

Overdose effects: constricted pupils, clammy skin, nausea, respiratory depression, coma, death.

Withdrawal signs: nausea, chills, lacrimation, rhinorrhea, yawning, tremor.

Question 15

Drugs to treat dependence and addiction: Opioid Receptor Antagonist (2)

Answer 15

Naloxone

Naltrexone

Question 16

Drugs to treat dependence and addiction: Synthetic Opioids (1)

Answer 16

Methadone

Question 17

Drugs to treat dependence and addiction: Partial Mu-Opioid Receptor Agonist (1)

Answer 17

Buprenorphine

Question 18

Drugs to treat dependence and addiction: Nicotinic Receptor Partial Agonist (1)

Answer 18

Varencline

Question 19

Drugs to treat dependence and addiction: Benzodiazepines (2)

Answer 19

Oxazepam

Lorazepam

Question 20

Drugs to treat dependence and addiction: NMDA Receptor Antagonist (1)

Answer 20

Acamprosate

Question 21

In the long run, what can PCP and LSD cause?

Answer 21

PCP - irreversible schizophrenia-like psychosis.

LSD - may cause flashbacks of altered perception years after consumption.

Question 22

What are some indications for Caffeine? (5)

Answer 22

Migraine HA
HA after epidural anesthesia
Asthma
ADHD
Memory disorders

Question 23

What are the kinetics of Alcohol Metabolism?

How does it effect the half-life?

Answer 23

0-order kinetics: rate is constant and independent of conc. or amount of chemical.

Half-life increases with dose.

Question 24

Which 3 enzymes are involved in methanol and ethanol biotransformation?

Answer 24

ADH
Aldehyde dehydrogenase
MFOs (CYP450s)

Question 25

What should be done in acute alcohol intoxication? (4)

Answer 25

Acute

• monitor respiratory depression and aspiration of vomit.
• glucose to treat hypoglycemia and ketosis.
• thiamine to protect against W-K syndrome.
• benzodiazepines**

Question 26

Drugs to treat acute alcohol withdrawal syndrome (4)

Answer 26

Diazepam
Lorazepam
Oxazepam
Thiamine (vit. B1)

Question 27

Drugs to prevent alcohol abuse (3)

Answer 27

Acamprostate
Disulfiram
Naltrexone

Question 28

Drugs to treat acute methanol or ethylene glycol poisoning (2)

Answer 28

EtOH

Fomepizole

Question 29

Naltrexone is approved for:

MOA:

What is the effect of using it?

What is the caveat to its use?

Answer 29

Treatment of alcohol and opiate dependence.

Mu-opioid receptor antagonist (long-acting).

Reduces the craving for alcohol and rate of relapse to drinking EtOH or EtOH dependence for the short-term (12 wks.).

Patients that are physically dependent on EtOH and opioids must be opioid-free before intiating therapy due to its ability to cause an acute withdrawal syndrome.

Question 30

Acamprostate is used for…

MOA:

Answer 30

Reduces short-term and long-term relapse rates for EtOH abuse.

It is a weak NMDA-receptor antagonist and GABAA receptor agonist.

Question 31

Disulfiram MOA:

It should not be administered with…

Which types of patients are well-suited for this drug?

Answer 31

Irreversibly inhibits aldehyde dehydrogenase and causes extreme discomfort to patients who drink EtOH.

Should not be given with any meds that contain EtOH.

Highly motivated patients!!