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Neuro Pharm > Drugs of Abuse > Flashcards

Drugs of Abuse Flashcards

1
Q

what pathway do all drugs of abuse affect? what are its components?

A
  • mesolimbic pathway

- ventral tegmental area + nucleus accumbens

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2
Q

how do opioids work?

A
  • inhibit the inhibitor
  • GABA interneurons normally inhibit neurons going to the NA; opioids inhibit this inhibition = increased DA release to neurons in the end
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3
Q

deaths related to opioids are a result of …

A

respiratory depression/arrest

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4
Q

do benzos or barbiturates have a narrower therapeutic window? which has worse withdrawal symptoms?

A
  • barbiturates = narrower therapeutic window

- barbiturates also have worse withdrawal

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5
Q

where do barbiturates and benzos act? what’s the difference b/w the 2 drug classes/

A
  • barbiturates have more widespread effects and less specificity; they act on both GABA A & GABA B
  • benzos only work on GABA A
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6
Q

alcohol is the liquid version of ???

what receptors does alcohol work on?

A
  • benzos

- GABA A, NMDA glutamate, & cannabinoid receptors

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7
Q

tx for alcohol withdrawal?

A

benzos

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8
Q

what things combined explain the high addiction potential of cigarettes?

A

strong direct mesolimbic effects + inhalation route + nicotine’s short half-life

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9
Q

how does cocaine & amphetamine work?

A
  • block reuptake of NTs = DA, norepi, & 5HT

- specific targets = locus ceruleus (pons) and nucleus accumbens

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10
Q

5 approaches to addiction therapy

A
  1. administer agent that causes AE if drug abused again
  2. block effect of drug of abuse
  3. use long-acting agonists for med maintenance
  4. use meds to prevent long-term dysphoria & dysfunctional reward mechanisms
  5. tx co-occurring psych symptoms
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11
Q

what do you tx w/ disulfiram? how does it work? aversive symptoms when drug abused again?

A
  • tx alcoholism
  • inhibits aldehyde dehydrogenase
  • AS = facial flushing, headache, N/V, weakness, orthostatic hypotension, resp. difficulty
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12
Q

what does naltrexone tx? how does it work?

A
  • tx for opioid abuse
  • opioid antagonist = competitively blocks binding of opioids
  • can also be used for alcohol abuse b/c EtOH causes release of endogenous opioids
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13
Q

why is naltrexone more prone to non-adherence?

A
  • prevents the “high” from opioids but DOES NOT prevent the cravings or withdrawal symptoms
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14
Q

what does methadone tx? how does it work?

A
  • tx for heroine addiction

- long-acting opioid agonist

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15
Q

risks associated w/ methadone?

A
  • cross-tolerance to other opioids = very dangerous when combined w/ multiple opioids
  • high risk of abuse and overdose when combined w/ another opioid or CNS depressant
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16
Q

nicotine replacement: what forms, how it works

A
  • gum, lozenge, transdermal patch, inhaler
  • curbs cravings & w/drawal
  • all forms more effective than placebo w/ added benefit = avoiding toxicity assoc w/ tobacco
17
Q

buprenorphine: what receptors does it act on

A
  • mu-opioid receptor PARTIAL agonist
18
Q

benefits to buprenorphine

A
  • not a full agonist & long half-life = low risk of overdose
  • only mild w/drawal upon cessation
  • antagonizes full agonist & subsequent reinforcing effect responsible for relapse
19
Q

suboxone components?

A
  • combo of buprenorphine & naloxone (Narcan)
20
Q

why can’t you inject suboxone?

A
  • the antagonist (naloxone) will antagonize everything including the partial agonist (buprenorphine) if you inject it = pt will feel awful
  • when you take it orally as directed the antagonist is destroyed by first pass so the partial agonist can still work
21
Q

varenicline

A
  • nicotinic receptor partial agonist = outcompetes nicotine

- s/e = neuropsych symptoms (emotional lability, acute psychosis) = FDA warning for use in pts w/ psych disorders

22
Q

acamprosate

A
  • modulates glutamate hyperactivity
  • tx for alcohol dependence
  • only NALTREXONE has been proven significantly better than placebo
23
Q

topiramate

A
  • anti-epileptic drug = inhibits AMPA glutamate receptors

- being studied as tx for alcoholism but NOT YET approved

24
Q

bupropion

A
  • anti-depressant = inhibits reuptake of DA and norepi
  • can help in smoking cessation
  • buffers nicotine w/drawal induced cravings
  • s/e = lowers seizure threshold = don’t use for pts w/ seizure disorders
25
Q

anti-depressants in clinical trials for …

A
  • not many tx options for cocaine & amphetamine abuse –> NONE approved by FDA
  • both desipramine & fluoxetine have been shown to reduce cravings BUT NOT prevent use

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